Direct Relief, which is funded entirely by private charitable contributions and does not accept government support, prioritizes operational efficiency through strategic partnerships with businesses and organizations. The vast majority of the donations it receives and distributes consist of in-kind donations of medicine and medical supplies. These contributions, valued at their wholesale cost, comprise the predominant share of the organization’s annual revenue.

Forbes awarded Direct Relief a score of 99% for charitable commitment (how much of a charity’s total expenses go directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Forbes also ranked California-based Direct Relief as the largest of the six California charities included in its 2023 list.

Direct Relief, one of the world’s largest channels for humanitarian medical assistance to underserved communities and survivors of disasters, also ranks as the second largest charity in the “International Needs” category, according to Forbes.

Direct Relief in 2023

Doctors, midwives, community health workers, and other health professionals working in public-benefit health organizations around the world rely on Direct Relief to equip them with the medical resources they need to care for any patient, without regard to politics, religion, or ability to pay.

In its 2023 fiscal year, Direct Relief provided assistance in the form of essential medications, a broad range of medical supplies, and financial support in response to requests from healthcare providers and other local organizations across 88 countries and 55 US states and territories. The 2,900 tons of medical essentials provided by Direct Relief included 534 million defined daily doses of specifically requested medications, vaccines, insulin, and biologic therapies. The organization also provided $77 million in financial assistance through grants for a variety of emergency response and public-health related purposes.

In 2023, Direct Relief once again sustained and expanded existing programs while also responding to humanitarian emergencies globally. The organization’s continuing response to the war in Ukraine – now exceeding $1.5 billion in humanitarian assistance – remains the largest mobilization of medical resources in Direct Relief’s history.

Direct Relief’s longstanding approach of supporting locally run facilities providing essential health services to underserved communities has enabled the organization to distribute more medicine and supplies and strengthen fragile health systems in more places than ever before in its 75-year history. 

Since January 1, 2023, Direct Relief has:

• Donated insulin to 40,332 children with Type 1 diabetes in 32 countries.
• Provided more than 460,000 doses of lifesaving naloxone to health centers, free clinics, community organizations and harm reduction groups in the U.S.
• Delivered critical rare disease therapies to treat more than 600 patients in 17 countries.
• Launched projects to provide resilient energy solutions to 41 healthcare facilities in California, Florida, Louisiana, and North Carolina, projected to yield an estimated $4.3 million in cost savings annually.

2023 Charity Ratings

In addition to its top ranking from Forbes, Direct Relief earned a four-star rating from Charity Navigator, America’s largest independent charity evaluator.

This recognition marks Direct Relief’s 13th consecutive four-star rating and the first time it has been evaluated in Charity Navigator’s Impact & Results beacon, where its 100% rating contributed to an overall perfect score across the key nonprofit performance indicators Charity Navigator assesses.

Direct Relief also retains an A+ rating from Charity Watch, the highest score given by the independent charity watchdog.

Direct Relief, which receives no government funding and is supported entirely from charitable contributions, has a longstanding commitment to efficiency and frugality in all its organizational activities, including fundraising activities.

Direct Relief’s revenue includes both gifts of medications and other medical commodities and cash. Direct Relief believes it important to note that revenue associated with medical product contributions obviously may not be used for fundraising purposes, and that its modest fundraising expenses average about 2 percent of its total cash revenue. The organization pays all such fundraising expenses with earnings from a generous bequest, which means that zero percent of donated funds are used for the organization’s fundraising activities.

To learn more, please read the Direct Relief 2023 Impact Report.

This recognition marks Direct Relief’s 13th consecutive four-star rating and the first time it has been evaluated in Charity Navigator’s Impact & Results beacon, where its 100% rating contributed to an overall perfect score across the key nonprofit performance indicators Charity Navigator assesses.

Charity Navigator introduced the Impact & Results beacon to gauge the “actual impact a charity has on the lives of those it serves and determine whether it is making good use of donor resources to achieve that impact.”

At the date of publication, only 2,202 or 1% of the 209,155 charities scored by Charity Navigator have earned an Impact & Results rating.

Direct Relief also earned a 100% score in Charity Navigator’s newly updated Accountability & Finance beacon, which assesses “a charity’s financial health (financial efficiency, sustainability, and trustworthiness) and its commitment to governance practices and policies.”

“We are delighted to provide Direct Relief with third-party accreditation that validates their operational excellence,” said Michael Thatcher, President and CEO of Charity Navigator. “The Four-Star Rating is the highest possible rating an organization can achieve. We are eager to see the good work that Direct Relief is able to accomplish in the years ahead.”

Reflecting Direct Relief’s key role in delivering humanitarian medical aid in response to disasters, Charity Navigator in 2023 named Direct Relief to its list of the best Humanitarian Relief Charities and among the charities it recommended donating to after disasters, including the Maui Wildfire, Flooding in Libya, Hurricane Idalia, Tropical Storm Hilary, and the earthquakes in Morocco, Turkey and Syria.

In addition to its responses to the specific disasters noted above, Direct Relief in 2023 has:

• Delivered 458 million defined daily doses of medicine to more than 2,300 healthcare facilities in 87 countries, including all 50 U.S. states.
• Donated insulin to 40,332 children with Type 1 diabetes in 32 countries.
• Provided more than 460,000 doses of lifesaving naloxone to health centers, free clinics, community organizations and harm reduction groups.
• Delivered critical rare disease therapies to treat more than 600 patients in 17 countries.
• Launched projects to provide resilient energy solutions to 41 healthcare facilities in California, Florida, Louisiana, and North Carolina, projected to yield an estimated $4.3 million in cost savings annually.

Operational Efficiency & Transparency

Direct Relief, which is funded entirely by private charitable contributions and does not accept government support, prioritizes operational efficiency through strategic partnerships with businesses and organizations. The vast majority of the donations it receives and distributes consist of in-kind donations of medicine and medical supplies. These contributions, valued at their wholesale cost, comprise the predominant share of the organization’s annual revenue, with approximately 99.5 cents out of every donated dollar going to program expenses, 0.3 cents to administration and 0.1 cents to fundraising expenses.

Direct Relief seeks to be efficient and frugal in all organizational activities, including fundraising activities.

While Direct Relief’s modest fundraising expenses average about 2 percent of its total cash revenue, its fundraising expenses are paid by the earnings from a generous bequest, meaning zero percent of donated funds support the organization’s fundraising activities.

Forbes awarded Direct Relief a score of 100% for both charitable commitment (how much of a charity’s total expenses go directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Top 5 Charities 2022 – Forbes

Top 5 California Charities 2022 – Forbes

Headquartered in California, Direct Relief is the largest of the five California charities included in the 2022 Forbes ranking.

Top 5 International Charities – Forbes

Direct Relief, one of the world’s largest channels for humanitarian medical assistance to underserved communities and victims of disasters, also ranks as the largest charity in the “International Needs” category, according to Forbes.

Direct Relief Activities – 2022

In its fiscal year 2022, Direct Relief provided more than $2 billion in medical aid and $58.2 million in financial assistance to healthcare providers and other local organizations in 98 countries and 52 US states and territories.

Ukraine was the largest recipient country of Direct Relief’s assistance in 2022, receiving 1,099 tons of medicine and medical supplies from Direct Relief, valued at $640 million, at the request of the Ukrainian Ministry of Health and other healthcare providers after Russia invaded the country in February. This includes extensive supplies for treating traumatic injuries and a broad range of medications ranging from cancer therapies, insulin, and antidotes for chemical attacks to those needed for chronic health conditions.

In addition, through the generosity of donors worldwide, Direct Relief provided $29.4 million in cash assistance for programs benefiting Ukrainians and Ukrainian refugees.

Direct Relief’s other recent activities include:

• Awarded $22.7 Million to 71 US healthcare and other nonprofit organizations through Direct Relief’s Fund for Health Equity
• Delivered 12.5 tons of emergency medical essentials to fight a cholera outbreak in Haiti, including IV fluids, oral rehydration salts, antibiotics and water purification tablets. Direct Relief also is actively responding to cholera outbreaks across the globe in Lebanon, Syria, and Malawi.
• Donated 273,312 doses of the lifesaving drug naloxone, which counteracts opioid overdoses, to public and private healthcare providers in 45 US states
• Distributed medicines to treat Type 1 and Type 2 diabetes to 536 healthcare facilities in 438 US cities in 2022
• Responded to Hurricanes Fiona and Ian with more than $4.5 million in medical aid to 127 healthcare providers throughout the US and Caribbean

2022 Charity Ratings

In addition to its top ranking from Forbes, Direct Relief earned a four-star rating for the 12th consecutive year from Charity Navigator, America’s largest independent charity evaluator.

Direct Relief received a 100% rating in Charity Navigator’s Accountability & Finance category, which “provides an assessment of a charity’s financial health (financial efficiency, sustainability, and trustworthiness) and its commitment to governance practices and policies,” Charity Navigator says.

Direct Relief also received an A+ rating from Charity Watch, the highest score given by the independent charity watchdog.

Direct Relief is supported only by private, charitable contributions, accepting no government funding. The vast majority of the value of donations received and aid distributed is in the form of medicine and medical supplies donated by their manufacturers (in-kind contributions). Direct Relief values donated medicine and supplies at wholesale value; see https://www.directrelief.org/about/finance/cash-and-in-kind-contributions/ for more information.

To learn more, please read the Direct Relief 2022 Impact Report.

Direct Relief has received a 100% rating in Charity Navigator’s Accountability & Finance category, which “provides an assessment of a charity’s financial health (financial efficiency, sustainability, and trustworthiness) and its commitment to governance practices and policies,” Charity Navigator says. Direct Relief has also earned 100% scores in the Leadership & Adaptability and Culture & Community categories.

In a report issued in October, the non-profit watchdog CharityWatch gave Direct Relief an A+ grade, its highest rating, based on its independent analysis of how Direct Relief uses donated funds. CharityWatch also named Direct Relief to its list of “Top-Rated Charities Providing Aid in Ukraine.”

From January through mid-November 2022, Direct Relief distributed more than $1.5 billion (wholesale value) of medicines and supplies to more health workers providing services to more people in more communities around the world than ever before in its 74-year history. Direct Relief distributed more than 507 million defined daily doses of medicine to people in 92 countries and all 50 U.S. states.

Responding to the Ukraine Crisis

Since Russia invaded Ukraine in February 2022, Direct Relief has been the largest private donor of medicine and medical supplies to help the people of Ukraine. Direct Relief has delivered over 1,030 tons of medical assistance, including trauma kits, cancer drugs, insulin, antidotes for chemical attacks, and other critical medical products, to the Ukrainian Ministry of Health and other healthcare providers.

Direct Relief has also supplied the Ministry of Health with hundreds of emergency medical backpacks for first responders working in the field who are dealing with injuries, trauma, infections, and other acute medical needs.

Through the generosity of donors from around the world, Direct Relief has provided $20 million in cash assistance for programs benefiting the Ukrainian people. Working with Pelion, Poland’s largest healthcare company, Direct Relief has connected more than 270,000 Ukrainian refugees in Poland with medications they need to maintain their health, free of charge.

Other highlights of Direct Relief’s actions in 2022 include:

• Hurricane response: Direct Relief has provided more than $6.2 million in medical aid and disbursed more than $1 million in grants in response to hurricanes in Puerto Rico and Florida this year.
• Cholera response: Direct Relief has delivered 12.5 tons of emergency medical essentials to fight a cholera epidemic in Haiti, including IV fluids, oral rehydration salts, antibiotics and water purification tablets. Direct Relief also is actively responding to three other cholera outbreaks across the globe in Lebanon, Syria, and Malawi.
• Diabetes and cardiovascular health: Direct Relief distributed medicines to treat Type 1 and Type 2 diabetes to 536 healthcare facilities in 438 U.S. cities. It also distributed medicines to treat cardiovascular diseases to 546 healthcare facilities in 450 U.S. cities.
• Bolstering oxygen supply: Since January 2020, Direct Relief has shipped or provided funding to procure 35,541 oxygen concentrators to healthcare facilities in 55 countries
• Expanding cold storage for medicine: To enable access to vaccines, insulin, and other medications that require refrigeration, Direct Relief funded the construction of Nepal’s first modern cold chain facility with a $275,000 grant, and has delivered 243 pharmaceutical-grade refrigerators and freezers to health care providers in eight countries in 2022.

More on Charity Ratings

Charity Navigator’s Financial score reflects measures of stability, efficiency, and sustainability. At Direct Relief, 99.4 cents out of every donated dollar goes to program expenses, with 0.3 cents going to administration and 0.1 cents covering fundraising expenses.

Direct Relief does not spend donor contributions to cover its traditionally modest fundraising expenses, which are paid by earnings on bequests held in a separate foundation, the Direct Relief Foundation.

“Charitable givers should feel confident that these national institutions put their donations to good use.” – Charity Navigator.

Charity Navigator’s 2022 Best Charities List

• Forbes ranks Direct Relief the fifth largest charity in the United States in 2021, and Charity Navigator rates the organization a “Perfect 100.”
• In response to devastating tornadoes in multiple U.S. states, Direct Relief has provided medications, wound care products, Tdap vaccines, and solar power generators. 
• Super Typhoon Rai has killed hundreds in the Philippines. Direct Relief is sending emergency supplies and funding.
• Many Americans live in “pharmacy deserts,” where access to pharmaceutical care and resources are scarce.

Top Stories

Direct Relief Ranked Fifth Largest Charity in the U.S., Rated “Perfect 100”

The situation: Forbes releases an annual list of the 100 largest U.S. charities, ranked by private donations. The independent evaluator Charity Navigator examined 160,000 nonprofits this year.

The response: Direct Relief, which received $1.9 billion in private donations in 2021, is fifth on the Forbes list. The organization is also one of 92 earning a “Perfect 100” from Charity Navigator for accountability and transparency.

The impact: “The acute new health challenges that Covid brought on for everyone made all the existing challenges that much worse—particularly for people and places most vulnerable and least fortunate,” said Thomas Tighe, Direct Relief President and CEO. “Direct Relief has and will continue to stretch every dollar to help in the most efficient, productive way possible.”

After Deadly Tornadoes Rip through South, Midwest, Direct Relief Launches Response Efforts

The situation: Tornadoes have ripped through parts of Kentucky, Arkansas, Illinois, Missouri, Mississippi, and Tennesee, and the death toll currently stands above 90.

The response:  Direct Relief is equipping on-the-ground groups with Tdap vaccines, solar generators, insulin, wound care products, baby formula, and more.

The impact: The supplies are designated to help shelter residents and power a donation distribution point.

The Death Toll of Super Typhoon Rai Continues to Rise. Direct Relief is Responding.

The situation: As the fifteenth and strongest storm to affect the Philippines this year, Super Typhoon Rai has killed at least 375 people and injured 500.

The response: Direct Relief is coordinating with agencies on the ground, including ASEAN’s AHA Centre and the Philippines Department of Health, to send emergency supplies and provide financial support. Direct Relief-funded emergency supplies are already staged at the AHA Centre’s disaster response depot.

The impact: The organization will continue to support on-the-ground agencies and groups caring for those affected by the storm.

Across the U.S., Many Live Without Access to a Pharmacy

The situation: Millions of people in the U.S. don’t have access to a pharmacy, meaning they can’t pick up prescriptions, meet face-to-face with a pharmacist, or access other health care services.

The response: Nonprofit charitable pharmacies are working to bridge the gap, sending people their medications, often for free. And despite the distance, they still manage to keep close tabs on patients.

The impact: For many patients, these pharmacies are their only reliable link to medication they can afford. But they’re not a substitute for in-person care, an expert says.

In Brief

The United States

• Over the past two weeks, Direct Relief has made 780 shipments to 516 partners in 45 states and territories, totaling $10.5 million in value and more than 17,425 pounds.
• During the same period, $1.2 million in grants was distributed.
• Direct Relief has begun receiving donations of Narcan, a nasally-administered form of naloxone that is frequently requested by health facilities and organizations, for groups fighting the opioid crisis.

Around the World

• In the past two weeks, Direct Relief has made 43 shipments to 34 partners in 22 countries, totaling $34.4 million in value and more than 91,480 pounds.
• A total of $100,000 was granted during the same period of time.

Among the ten largest charities in the Forbes 2021 ranking, Direct Relief is the only one to receive a score of 100% for both charitable commitment (how much of a charity’s total expense go directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Direct Relief is one of the world’s largest channels for humanitarian medical assistance to underserved communities and victims of disasters.

In Calendar Year 2021, Direct Relief has:

• Mobilized $1.9 billion worth of medicines, cancer therapies, vaccines, PPE, and other health-related supplies, all provided at no charge to thousands of healthcare providers across the globe.
• Supported local healthcare facilities, public health authorities, and logistical partners in 101 countries, including 55 U.S. states and U.S. territories.
• Launched the Fund for Health Equity with an initial $75 million in funding to improve access to health care in communities in which the effects of historic racism and socioeconomic disparities persist. Since then, Direct Relief has granted more than $10 million to 50 organizations advancing health equity across the U.S..
• Donated and distributed over 800 midwife birthing kits to facilitate 40,000 safe births across 10 countries; more than 9 million doses of insulin for children with Type 1 diabetes across 24 countries; and more than 687,000 doses of naloxone, a drug that reverses opioid overdoses, to organizations throughout the U.S.
• Nearly tripled its capacity to distribute cold chain medicine requiring refrigeration, including Covid-19 antibody treatments, insulin for children with Type 1 diabetes, and advanced chemotherapy medicine to treat pediatric cancer patients.
• Provided extensive, ongoing charitable support to over 2,000 community health centers and free & charitable clinics across the U.S. with donations of essential medications for patients without insurance or means to pay.
• Provided medicines to healthcare facilities in disaster zones, including to those affected by the earthquake in Haiti, hurricanes in Central America and the Gulf Coast, wildfires throughout the Western U.S. and Mediterranean, and ongoing refugee crises.
• Delivered 262.6 million Defined Daily Doses of medicine and 8.4 million pounds of medicine and supplies and supported 2,379 healthcare providers.

Among the 160,000 non-profits rated by Charity Navigator in 2021, Direct Relief is one of the 92 on the current “Perfect 100” list of charities earning scores of 100 in both the Financial and Accountability & Transparency categories.

“The acute new health challenges that Covid brought on for everyone made all the existing challenges that much worse—particularly for people and places most vulnerable and least fortunate,” said Thomas Tighe, Direct Relief President and CEO. “Direct Relief has and will continue to stretch every dollar to help in the most efficient, productive way possible.”

Direct Relief is supported only by private, charitable contributions, accepting no government funding. The vast majority of the value of donations received and aid distributed is in the form of medicine and medical supplies donated by their manufacturers (in-kind contributions). Direct Relief values donated medicine and supplies at wholesale value; see https://www.directrelief.org/about/finance/cash-and-in-kind-contributions/ for more information.

The complete list of Forbes’s ratings and its methodology for America’s Top Charities 2021 is available at https://www.forbes.com/lists/top-charities/?sh=72ca225f5f50.

To learn more, please read the Direct Relief 2021 Impact Report.

Among the 160,000 non-profits rated by Charity Navigator in 2021, Direct Relief is one of the 92 on the current “Perfect 100” list of charities earning scores of 100 in both the Financial and Accountability & Transparency categories.

Direct Relief also received 100 out of 100 in two new evaluation categories introduced this year, Leadership & Adaptability and Culture & Community.

“Because Direct Relief receives no government funding, it’s gratifying to share the Charity Navigator recognition with every person, organization, and business that pitches in and is part of the work because it’s about their money and how it was used,” said Thomas Tighe, Direct Relief CEO.

Since the beginning of the pandemic, the organization engaged in intensive Covid response efforts while maintaining critical humanitarian assistance to people and areas in severe need even before the pandemic hit them disproportionately hard.

The organization has been the largest charitable supplier of PPE to the US, Africa, and globally since the onset of the pandemic, providing over 132 million units of PPE in its fiscal year 2021 while delivering 237.9 million defined daily doses of medication. Direct Relief also disbursed $56 million in grants in its 2021 fiscal year.

Other highlights include:

• Since January 1, 2021, Direct Relief has donated and distributed over 800 midwife birthing kits to facilitate 40,000 safe births across 10 countries; more than 9 million doses of insulin for children with Type 1 diabetes across 24 countries; and more than 687,000 doses of naloxone, a drug that reverses opioid overdoses, to organizations throughout the US; and delivered baby formula and other staples for pregnant women, new mothers, and infants to newly arrived refugees from Afghanistan at Marine Corps Base Quantico in Virginia.
• In March 2021, Direct Relief announced the formation of its Fund for Health Equity with an initial $75 million in funding to improve access to health care in communities in which the effects of historic racism and socioeconomic disparities persist. Since then, Direct Relief has granted more than $10 million to 50 organizations advancing health equity across the US.
• Direct Relief in 2021 nearly tripled its capacity to distribute cold chain medicine requiring refrigeration, including Covid-19 antibody treatments, insulin for children with Type 1 diabetes, and advanced chemotherapy medicine to treat pediatric cancer patients.
• Expansive emergency responses to natural disasters including the Haiti earthquake, California wildfires and Hurricane Ida, among others.
• Extensive, ongoing charitable support to over 2,000 community health centers and free & charitable clinics across the US with donations of essential medications for patients without insurance or means to pay. 

Since sending its first medical aid shipment in response to the Covid-19 pandemic in January 2020, Direct Relief has supported healthcare organizations in 56 US states and territories and 106 countries with $3 billion in medicine and medical supplies totaling 13,700,000 lbs., more than 8 million Covid-19 vaccine doses, and $107.5 million in cash funding.

Charity Navigator’s Financial score reflects measures of stability, efficiency, and sustainability. At Direct Relief, 99.4 cents out of every donated dollar goes to program expenses, with 0.3 cents going to administration and 0.1 cents covering fundraising expenses.

The organization does not spend donor contributions to cover its traditionally modest fundraising expenses, which are paid by earnings on bequests and held in a separate foundation. 

In fiscal year 2021, the organization incurred fundraising expenses of $3.4 million and received $174 million in public cash support and $1.7 billion in contributed goods (primarily prescription medications and medical supplies) and services, such as donated transportation from FedEx.

Direct Relief’s Charity Navigator rating is available at https://www.charitynavigator.org/ein/951831116.

Of the more than 9,000 charities rated by Charity Navigator, Direct Relief is also one of only 69 to receive a perfect 100 score. These charities have earned scores of 100 in Charity Navigator’s evaluations of both Financial Health and Accountability & Transparency.

“The exceptional charities on this list execute their missions in a fiscally responsible way while adhering to good governance and other best practices that minimize the chance of unethical activities,” Charity Navigator says about its Perfect 100 list. “Less than one percent of the thousands of charities rated by Charity Navigator have earned perfect scores.”

Charity Navigator has also included Direct Relief in several of its “top ten” recommendation lists:

10 Highly Rated Charities Relying on Private Contributions – Charity Navigator

10 of the Best Charities Everyone’s Heard Of – Charity Navigator

“Direct Relief receives no government funding and is deeply committed to honoring the generosity and intent of every person, organization, and business that pitches in and is part of the work,” said Thomas Tighe, Direct Relief CEO. “It’s nice to share the Charity Navigator recognition with each of them because it’s about their money and also because it reflects the organization’s longstanding effort to use every charitable resource it receives in the most productive, efficient way possible for the public benefit.”

The new rating, which is based on the 2019 fiscal year, comes as Direct Relief responds to the concurrent crises of Covid-19, a record-setting hurricane season, and historic wildfires, as well as chronic and widening gaps in health care access globally.

Direct Relief was the first U.S. charity to earn national accreditation as a pharmaceutical wholesale distributor, and provides donations of prescription medications, vaccines, and medical supplies provided by healthcare companies to address chronic gaps and in response to emergency situations in all U.S. states and territories and approximately 100 countries each year. The organization’s humanitarian activities also include grantmaking and applied research involving GIS data to inform and direct public health and emergency response efforts.

Since January 1, 2020, Direct Relief has donated and distributed more than 6.8 million lbs. of requested medical aid, including more than 131 million doses of medicine to more than 90 countries; more than 40 million masks and other supplies to protect health workers on the frontlines of the Covid-19 pandemic; over 600 midwife birthing kits to facilitate 30,000 safe births across three continents; insulin for 14,000 children with Type 1 diabetes across 20 countries; and more than 500,000 doses of naloxone, a drug that reverses opioid overdoses, to organizations throughout the U.S.

Additionally, Direct Relief has issued more than $40 million in grants to community health centers, free & charitable clinics, and other non-profit health providers serving people across the U.S. and world at disproportionate risk from Covid-19 and other emergencies. It is also working with infectious disease epidemiologists and technology companies to analyze and derive insights from aggregated mobility data to inform decision-makers at the state and local levels on social distancing policies.

Direct Relief’s Charity Navigator rating is available at https://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=3626

For an explanation of Charity Navigator’s ratings methodologies, see https://www.charitynavigator.org/index.cfm?bay=content.view&cpid=33

The $1.17 billion in aid is more than a seven-fold increase from the $149 million Direct Relief provided in 2009.

Since Jan 1, 2019, Direct Relief has shipped 19,726 deliveries – 62% more than the 12,161 shipments provided in 2018 – to 1,808 locally run health care providers in 97 countries, including $167 million in aid to communities in 50 U.S. states, Puerto Rico, and the U.S. Virgin Islands.

Direct Relief’s crucial role in supplying humanitarian medical aid worldwide in 2019 has earned broad recognition by charity watchdogs and rating agencies.

In February, Fast Company magazine named Direct Relief to its list of the World’s Most Innovative Companies for 2019, a recognition Direct Relief also received in 2015. Fast Company cited Direct Relief in part for its work transitioning Puerto Rico’s health centers to solar-powered smart grids designed to be resilient in future natural disasters; and its pioneering work with Facebook using anonymized location information to determine the movement of people fleeing California wildfires, guiding how Direct Relief distributed breathing masks.

Charity Navigator, America’s largest independent charity evaluator, reaffirmed Direct Relief’s four-star rating for 2019, the ninth consecutive time that Direct Relief has earned this top distinction, and awarded it a 100% score for Accountability & Transparency. Charity Navigator also included Direct Relief in its 2019 recommendation lists of “10 of the Best Charities Everyone’s Heard Of,” “Highly-rated organizations providing aid and relief” for victims of Hurricane Dorian, charities still working on “Ongoing Recovery in Puerto Rico” two years after 2017’s Hurricane Maria, providers of “Relief after Tornadoes in the Midwest” and “California Wildfires,” and more.

Others recognizing Direct Relief in 2019 include CharityWatch (Top-Rated Charities) and the Center for High Impact Philanthropy at University of Pennsylvania (2019 High Impact Giving Guide.)

According to Forbes, Direct Relief last year ranked as the seventh largest U.S. charity, scoring 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and 99 percent for its charitable commitment (charitable services as a percent of total expenses.)

Hurricane Dorian

When one of the most powerful hurricanes ever recorded in the Atlantic devastated entire islands in the Bahamas, Direct Relief sprang into action. Since Sept. 1, the organization has distributed $5.9 million worth of medical aid weighing more than 113,000 lbs. to the Bahamas, making it the largest post-disaster provider of donated medicines and medical supplies to the island nation.

The scale of the destruction of public and private infrastructure is immense. Direct Relief will remain deeply involved in helping the Bahamas recover, as it has in Puerto Rico since 2017’s Hurricane Maria. Among its projects, Direct Relief is working closely with the University of Miami and the Bahamian Ministry of Health as part of a medium to long-term health recovery plan on the Abaco Islands.

California Wildfires

As the Kincade Fire torched more than 120 square miles in Northern California, the Getty Fire and other wildfires impacted communities across the state. The blazes dangerously compromised air quality for many residents, and Direct Relief distributed more than 140,000 N95 masks, which filter out 95% of very small (0.3 micron) particles, along with respiratory medications, oxygen concentrators, back-up power systems and hygiene kits.

Hours after Direct Relief delivered 50 Emergency Medical Packs to Ventura County’s Medical Reserve Corps, the Maria Fire broke out, forcing about 8,000 people to evacuate. The Medical Reserve Corps, which provides medical aid during large-scale local emergencies, was activated that night and sent to a nearby shelter to provide aid, immediately putting to use their new packs, which include the medical supplies most commonly needed in emergency response.

Yemen and Syria

Direct Relief sent a 40-ft. container of specifically requested medical supplies worth $200,000 to be distributed to the Ministry of Health and two major public hospitals in Taizz, Yemen. The shipment contained emergency health kits, diabetes medications, antibiotics, water purification tablets, and oral rehydration salts to prevent and treat cholera.

In Syria, Direct Relief since 2015 has provided nearly $150 million worth of critically needed medicine and medical supplies to dozens of charitable NGOs and medical facilities throughout Syria and in neighboring countries where Syrian refugees reside.

Ebola Outbreak in Democratic Republic of the Congo

In August, Direct Relief shipped a 13-pallet donation, weighing almost 5,000 pounds, to the DRC, filled with critical personal protection equipment, including coveralls, masks, tents, bandages, reflective vests and first aid tape. Direct Relief has also purchased 26 additional pallets of emergency Ebola personal protective equipment including gloves and gowns, in anticipation of future requests from NGOs and government agencies in the DRC, Rwanda, South Sudan and Uganda.

Logistics

Last year, Direct Relief opened its new headquarters and warehouse, along with a new cold chain facility. The refrigerated room, funded by BD, has been a portal to a new world of capability for Direct Relief, greatly expanding the organization’s ability to deliver medicines that require constant refrigeration. This, in turn, has already given tens of thousands of people around the world access to lifesaving insulin for controlling diabetes, vaccines for fighting a myriad of diseases, and advanced treatments for rare genetic disorders.

In the not-for-profit category, the top three spots went to Girls Who Code, DonorsChoose.Org, and Direct Relief.

Direct Relief, which also received this recognition in 2015, delivers lifesaving medical resources throughout the world to communities in need—without regard to politics, religion, or ability to pay.

Recent innovations achieved by the organization  include:

• With support from AbbVie, transitioning Puerto Rico’s health centers to resilient smart grids using solar power with battery storage, to prevent interruptions in care caused by future natural disasters.
• Constructing a technology-infused 155,000-square-foot headquarters and distribution center to ensure that its humanitarian relief activities meet stringent new federal requirements related to secure storage and distribution of prescription medications and are conducted in the most efficient manner possible to meet the increased demand stemming from emergencies and in areas of chronic need.
• Engaging Tesla to build a microgrid to ensure uninterrupted operations and maintenance of critical cold-chain capacity for vaccines, insulin, and medications requiring cold storage in the event of extended loss of grid power for many months.
• Working with Facebook to use anonymized location information to determine the movement and location of people fleeing California forest fires, guiding how Direct Relief distributed N-95 breathing masks to protect the public from smoke inhalation.

The recognition came after a year defined by humanitarian crises and natural disasters of unprecedented scale during which Direct Relief responded more expansively than ever before in its 70-year history—delivering more than $1.1 billion in humanitarian assistance to locally-run healthcare providers in 100 countries, including $231 million in aid to communities in 50 U.S. states, Puerto Rico, and the U.S. Virgin Islands.

“Direct Relief receives no government funding and its work is fueled by the generosity, passion, and participation of people from all backgrounds and companies of all types and industries just wanting to help people who need it,” said Direct Relief President and CEO Thomas Tighe. “This wonderful recognition is a testament to their involvement, which provides the energy and the ideas and for which we are deeply grateful.”

Direct Relief earned a four-star rating for 2018 from Charity Navigator, America’s largest independent charity evaluator, the eighth consecutive time that Direct Relief has earned this top distinction. Of the more than 8,000 charities rated by Charity Navigator, Direct Relief is one of only 66 to receive a perfect 100 score.

Others recognizing Direct Relief recently include the Center for High Impact Philanthropy at University of Pennsylvania (2019 High Impact Giving Guide), Wallet Hub (2018’s Best Charities for Holiday Giving), Okta (2018 Oktane Award Finalist) and TheStreet (30 Charities That Won’t Waste Your Money).

This year, Fast Company’s editors and writers sought out groundbreaking businesses across 35 industries and every region. The World’s Most Innovative Companies provides both a snapshot and a road map for the future of innovation across the most dynamic sectors of the economy.

Fast Company’s Most Innovative Companies issue (March-April 2019) is now available online at https://www.fastcompany.com/MIC, as well as in app form via iTunes and on newsstands beginning February 27th.

Direct Relief earned a four-star rating for 2018 from Charity Navigator, America’s largest independent charity evaluator, the eighth consecutive time that Direct Relief has earned this top distinction. Of the more than 8,000 charities rated by Charity Navigator, Direct Relief is one of only 66 to receive a perfect 100 score. These charities have earned perfect scores in Charity Navigator’s evaluation of Financial Health and Accountability & Transparency.

Charity Navigator also included Direct Relief in its 2018 lists of “10 of the Best Charities Everyone’s Heard Of,” the “10 Best Humanitarian Relief Organizations,” and “10 Highly Rated Charities Relying on Private Contributions.”

Others recognizing Direct Relief in 2018 include the Center for High Impact Philanthropy at University of Pennsylvania (2019 High Impact Giving Guide), Wallet Hub (2018’s Best Charities for Holiday Giving), Okta (2018 Oktane Award Finalist) and TheStreet (30 Charities That Won’t Waste Your Money).

According to Forbes, Direct Relief ranks as the seventh largest U.S. charity in 2018, scoring 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and 99 percent for its charitable commitment (charitable services as a percent of total expenses).

A Year of Disaster and Response

The ratings came in a year defined by humanitarian crises and natural disasters of unprecedented scale, and Direct Relief has responded more expansively than ever before in its 70-year history—delivering $923 million in humanitarian assistance to locally-run healthcare providers in 101 countries, including $212 million in aid to communities in 50 U.S. states, Puerto Rico and the U.S. Virgin Islands.

Examples of Direct Relief’s work in 2018 include:

Disaster Response: Within the first two weeks after Hurricane Florence struck the Carolinas in September, leading to at least 47 deaths, Direct Relief had delivered more than 14,000 lbs. of medicine and medical supplies, including more than 300,000 defined daily doses of medicine, to local health centers and free clinics in the affected areas.

Over Thanksgiving week, Direct Relief staff rushed deliveries to California’s Butte County, where local shelters housing thousands of people displaced by the Camp Fire were hit by outbreaks of highly contagious norovirus. The team delivered prescription anti-nausea medications, anti-infectives, oral rehydration salts, and personal protective gear and disinfectants for clinical staff and clean-up teams.

Puerto Rico Post-Maria: Direct Relief was the first organization to bring medicine into Puerto Rico when the commercial supply chain completely broke down after Hurricane Maria made landfall in September 2017. More than a year later, Direct Relief has provided $70.2 million in medical aid, invested $12 million in initiatives to bolster health services and local infrastructure, and installed 791 kilowatts of solar energy and 2 megawatts of battery backup at 14 health centers and remote communities across the island.

Opioid Epidemic: Direct Relief last year began shipping the life-saving drug naloxone, which can revive people who have overdosed on opioid medications, to health partners around the country. Through November 30, 2018, Direct Relief has shipped 173,460 doses of naloxone to healthcare providers in 45 states, Washington, DC, and Puerto Rico as part of a four-year commitment from Pfizer to supply up to 1 million total doses.

Humanitarian Crises: While responding to fast-onset disasters, Direct Relief continued aiding local healthcare providers in parts of the world enduring “slow-burn” humanitarian disasters—from Syria, Yemen and the Democratic Republic of Congo to Bangladesh.

In Bangladesh, where over 700,000 Rohingya have sought refuge from mass violence in Myanmar, Direct Relief is working with its longstanding partner HOPE Foundation in Cox’s Bazar to establish a field hospital for women and children, and provided durable medical tents, diagnostic and testing supplies, medical protective gear, oral rehydration salts, prenatal vitamins and personal hygiene items.

“Only 3% of the charities we evaluate have received at least eight consecutive 4-star evaluations, indicating that Direct Relief outperforms most other charities in America,” said Michael Thatcher, President & CEO of Charity Navigator. “This exceptional designation from Charity Navigator sets Direct Relief apart from its peers and demonstrates to the public its trustworthiness.”

Of the more than 8,000 charities rated by Charity Navigator, Direct Relief is one of only 69 to receive a perfect 100 score. These charities have earned perfect scores in Charity Navigator’s evaluation of Financial Health and Accountability & Transparency.

“Direct Relief receives no government funding, so private generosity fuels all the organization’s humanitarian work,” said Thomas Tighe, Direct Relief CEO. “This inspires a deep commitment to using all the resources that are contributed in the most productive, efficient way possible.”

For an explanation of Charity Navigator’s rating methodologies, see https://www.charitynavigator.org/index.cfm?bay=content.view&cpid=5593

Direct Relief’s rating is available at and other information about charitable giving are available free of charge on www.charitynavigator.org.

The growing support from donors came in a year when Direct Relief extended help to more people in need than ever before in its 69-year history, furnishing essential medications, vaccines, instruments and supplies through 13,554 deliveries to all 50 U.S. states and 86 countries. Direct Relief is supported only by private, charitable contributions, and accepts no government funding.

In the Forbes ranking, Direct Relief earned a perfect score of 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and a 99 percent rating for its charitable commitment (charitable services as a percent of total expenses).

Direct Relief has also earned a place on the Perfect 100 list published by Charity Navigator, one of only 65 charities to achieve 100 percent scores out of the nearly 8,000 organizations rated by the charity watchdog for accountability, transparency and financial health.

From July 2016 through June 2017, Direct Relief’s activities included the following:

• Provided $129 million in lifesaving medicines and other medical aid to more than 1,300 health centers and clinics throughout the United States, helping patients face challenges including chronic diabetes and opioid addiction.
• Responded to Hurricane Matthew in Haiti and prepositioned emergency medical supplies along the Gulf Coast of the U.S. and the Caribbean in advance of the devastating 2017 hurricane season.
• Supported doctors in Syria with urgently needed medical items, including a chemical weapons antidote, after a deadly series of attacks on Syrian medical facilities.
• Bolstered Yemeni hospitals with medications and supplies to combat a rapidly expanding outbreak of cholera.Since 2009, Direct Relief has provided more than $4.4 billion in lifesaving medicines and medical resources to help low-income people in 115 countries and all 50 U.S. states. The only organization to obtain VAWD accreditation to distribute pharmaceuticals in all 50 U.S. states, Direct Relief operates the country’s largest charitable medicines program.

The full list of Forbes’s ratings and methodology for The 100 Largest U.S. Charities of 2017 is available here.

Direct Relief earned a perfect score of 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and a 99 percent rating for its charitable commitment (charitable services as a percent of total expenses).

The Forbes ranking is the most recent of several accolades received in 2016 by the humanitarian medical aid group:

• CNBC last month named Direct Relief #1 on its list of “Top 10 Charities Changing the World in 2016.”
• Of the more than 8,000 charities rated by independent evaluator Charity Navigator, Direct Relief was one of only 49 to achieve a perfect score of 100 under Charity Navigator’s new rating system, CN 2.1. To be named to the Perfect 100 list, Direct Relief achieved perfect scores in Charity Navigator’s two main ratings categories, Financial Health and Accountability & Transparency.
• Charity Navigator last month named Direct Relief its highest ranked charity in the Humanitarian Relief Supplies category.

Supported only by private, charitable contributions, Direct Relief this year (FY2016) extended more help to more people in need than ever before in its 68-year history, furnishing $760 million in essential medications, vaccines, instruments and supplies through 11,146 deliveries to all 50 states and 81 countries.

Over the past 12 months, Direct Relief’s activities have included the following:

• In response to Hurricane Matthew, Direct Relief delivered $10 million in medicines and medical supplies to Haiti – nearly 20 tons, including more than half a million daily doses of medication. Direct Relief also shipped more than $1.3 million worth of supplies to storm-affected communities in the U.S.
• When a 7.8 magnitude earthquake on April 16 caused devastation in Ecuador, Direct Relief chartered a 767 cargo aircraft that delivered 47 tons of medicines and supplies worth $2.1 million – the largest single shipment of emergency medical assistance sent in response.
• Direct Relief this year has provided more than $4 million in critically-needed medical items to support health services for refugees of Syria’s civil war.
• In Liberia and Sierra Leone, where maternal mortality has gone up since the Ebola crisis, Direct Relief provided prenatal vitamins to more than 100,000 expectant or recent mothers.

Since 2000, Direct Relief has provided more than $2.2 billion in medical resources to support health services for low-income people in 88 developing countries and all 50 U.S. states.

“A strong network of community health centers is critical to improve access to our health system, and this year’s winners represent what’s possible for community health in the U.S.,” said Vincent A. Forlenza, Chairman, CEO and President of BD. “The wellness, prevention and care community health centers provide help avoid unnecessary hospital visits and sometimes represent the only care for some of our country’s most vulnerable populations.”

Part of the BD Helping Build Healthy Communities initiative — a collaboration between BD, Direct Relief, and NACHC — the $100,000 awards acknowledge innovative approaches to the prevention and treatment of diseases that disproportionately affect vulnerable populations. The initiative includes a commitment by BD of approximately $5 million in cash and product for community health centers and clinics nationwide.

“The Innovations in Care Award recognizes the critical role of clinics and community health centers as America’s healthcare safety net,” said Thomas Tighe, President and CEO of Direct Relief. “Direct Relief is delighted to work once again with BD and NACHC to highlight and elevate such deserving health centers for their amazing commitment, insight, and effectiveness in serving their patients and communities.”

The following winners were selected with guidance from a panel of experts in diabetes, its co-morbidities, and clinical and community healthcare:

Community Health and Social Services (CHASS), Detroit: For any provider with 35 percent of its patients diagnosed with uncontrolled diabetes, as have CHASS’s patients, disease management would be daunting. For the patients, it can wreak havoc on their self-esteem, undermining motivation to self-manage their disease. To address this problem, CHASS created the Behavioral Health Intervention for Diabetic Support program. Through this program, the center identifies high-risk patients with diabetes and utilizes the entire health care team – providers, a certified medical assistant, a behavioral health provider, and community health workers – to coordinate wrap-around services for care. This model of care incorporates Population Health tools and techniques to care proactively for both the physical and mental health of patients.

Cornerstone Family Healthcare, Cornwell, N.Y.: The Bridging Gaps: Improving Continuity for Patients with Diabetes program at Cornerstone Family Healthcare enhances access to comprehensive diabetes care for patients in the Hudson Valley Region of New York State. Despite the availability of a full scope of clinical and supportive services, few patients with diabetes have access to all of the services needed to manage their condition. Through this program, patients with diabetes, or with pre-diabetes, are connected to in-house programs and services including primary and specialty care, nutrition services, health and physical education, and diagnostic screening through the work of a registered nurse care manager. The nurse care manager works directly with patients to ensure needed services are utilized and results and care plans are shared among multiple providers for best outcomes.

First Choice Health, East Hartford, Conn.: As the only safety net provider to offer interdisciplinary, integrated care, First Choice Health Centers is expanding a multifaceted diabetes care program through First Choice Focus on Diabetes Initiative 2016. This initiative expands education, nutrition, and exercise classes to the health center’s entire population with diabetes, including the oversight of a diabetes care coordinator who is also a registered nurse. The program addresses the substantial comorbidity between depression and diabetes by integrating a behavioral health specialist into the care team. The value of the model’s focus on tracking, collecting, interpreting, and maintaining information in electronic form, exemplified by the Diabetes Registry and Diabetes Report Card.

The Daily Planet, Richmond, Va.: The Diabetes Impact Program at The Daily Planet integrates shared visits with the primary care provider, pharmacist, oral and behavioral health professionals, and nutritionist for high-risk patients with diabetes and who are also homeless. The pharmacist and nutritionist provide weekly educational sessions for participants through an evidence-based approach to help patients learn methods for medication adherence and better nutritional balance. Outreach workers and case managers are engaged in enrolling patients, resulting in greater access and improvements in the patients’ ability to care for themselves. The Diabetes Impact Program is a comprehensive, interprofessional approach to target the unique needs of patients served by The Daily Planet.

Henry J. Austin Health Center, Trenton, N.J.: Low literacy, difficulty with medication adherence, effective patient-provider communication, and engagement are just a few of the challenges faced by patients with diabetes in Trenton. In response to these difficulties, the Henry J. Austin Health Center developed the successful Improving Outcomes for Diabetics program, a team-based program that combines the work of clinical pharmacists with innovative technology to engage, educate, and treat more patients with diabetes. The Patient Activation Measure and SenseHealth tools increase patient knowledge, create self-management plans, and assist in appointment reminders and follow up.

The Institute for Family Health, Harlem, N.Y.: In response to high demand for nutrition education and counseling services, The Institute for Family Health created the Improve Health Outcomes and Eliminate Disparities diabetes program at their Family Health Center of Harlem (FHCH). The program combines a bilingual certified diabetes educator and health coach with primary and behavioral health care services. Through the creation of a custom registry of patients with diabetes, the FHCH care enhances the ability to provide diet, activity, and behavioral therapy targeted to 1,000 patients.

Lanai Community Health Center (LCHC), Lanai City, Hawaii: Diabetes has long loomed over the rural island community of Lanai City and the Lanai Community Health Center (LCHC). Their work focuses on diabetes treatment and preventative education to those who need it most. Developing from an already successful diabetes program, LCHC is expanding the High Tech and High Touch Diabetes and Prediabetes Management Program, an enhanced office and home-based prevention and treatment program through remote monitoring to include Bluetooth-enabled blood glucose reading along with community-based self-management support. Community health workers take on an expanded role in providing community and home diabetes management while behavioral health and dental care are fully integrated into the program.

Mary’s Center for Maternal and Child Care, Washington, D.C.: Through the nurse-led Empowerment Program, Mary’s Center for Maternal and Child Care (Mary’s Center) aims to reduce and eliminate barriers to diabetes diagnosis through prevention and successful management for its patients throughout Washington. Mary’s Center created a unique and efficient program that combines case management, social engagement, group education, and information technology, which results in documented improvements in patients’ self-management strategies.

Raphael Health Center, Indianapolis, Ind.: The Raphael Health Center took a Population Health approach in treating its newly diagnosed, high-risk patients with diabetes. Lead by a diabetes navigator, the Diabetes Medical Home Partnership program identifies and categorizes patients based on the stage of diagnosis and sets the frequency of education information, including in-person meetings, follow up text messages and phone calls. The diabetes navigator helps determine the barriers to care that a patient may face and works with a care manager and healthcare team to remove the obstacles. A diabetes “checklist” tool tracks and focuses the program’s outcome measures.

Santa Barbara Neighborhood Clinics, Santa Barbara, Calif.: The Diabetes Collaborative brings together three local Santa Barbara organizations to support the multi-dimensional needs of patients with pre-diabetes and diabetes. Santa Barbara Neighborhood Clinics, William Sansum Diabetes Center, and the Foodbank of Santa Barbara County joined to tighten the safety net for patients through the provision of comprehensive diabetes services and resources. Together, these organizations provide screening, medical care, care management, education, and food and nutrition services to support patients who are high-risk. This partnership promotes whole-person care and recognizes the importance of lifestyle changes in the treatment and prevention of diabetes.

Only 51 of the more than 8,000 charities rated annually by Charity Navigator received an overall score of 100.

As America’s largest and most widely used independent evaluator of charities, Charity Navigator works to guide donors toward more intelligent giving.

“We applaud these charities for exceeding industry standards and outperforming other organizations performing similar work,” said Sandra Miniutti, VP of Marketing at Charity Navigator.”

The ninth-largest U.S. charity, according to Forbes Magazine, Direct Relief conducts the most expansive charitable medicines program in the United States and is among the largest private providers globally of humanitarian medical material aid to people in need due to poverty or emergency situations.

To be named to the Perfect 100 list, Direct Relief achieved perfect scores in Charity Navigator’s two main ratings categories, Financial Health and Accountability & Transparency.

Direct Relief is also rated No. 1 on Charity Navigator’s “10 of the Best Charities Everyone’s Heard Of” list.

Direct Relief was among the many groups to which people contributed. While that in itself is inspiring, it’s also a poignant reminder of the special obligation that exists when people give money to Direct Relief to help those affected by a particular event.

Direct Relief has a specialized focus and nearly 70 years’ experience providing ongoing and emergency humanitarian assistance (in the form of medications, medical and surgical supplies, and other health-related commodities) to local organizations. That was the lens through which we saw events in Nepal, where we had been working for years supporting committed, impressive local groups doing important work to improve the health and lives of people who face all sorts of health risks, have few resources, and little access to needed care.

The enormity of the immediate human tragedy was heartbreaking to everyone who saw the images. It was only made worse knowing that the initial earthquake, in a moment, simultaneously caused an increase in the need for care while destroying so much of the already limited capacity to provide it.

Direct Relief doesn’t receive government funding and, since our organization’s ongoing work in Nepal had never received specific patronage or dedicated financial support, it has been among the many things our organization pays for through general (or unrestricted in nonprofit-speak) contributions. Donors that make such gifts essentially permit our organization to use their funds however best, in our judgment, they will make a difference. A high degree of trust is implicit in these gifts, without which Direct Relief could not function. The immediate response to the earthquake began only because of such support and, as always, without the knowledge of whether the event would result in additional donations. We hoped it would, and immediately provided a designation on our website’s donation page to ensure that any potential donor clearly understood how to make a restricted gift for Nepal if that was the intent and, also, that Direct Relief would use any such contribution only for Nepal.

I note this because, as events unfolded, an outpouring of private philanthropic support did occur. For Nepal.

Direct Relief received $6,559,066 in financial contributions for Nepal from people and businesses and organizations. Thousands of those who made contributions also sent very personal, often emotion-laden comments as to why they were making a gift to help in Nepal, including one heartrending online gift of $20 from a Nepali citizen living on the outskirts of Kathmandu.

Direct Relief also received many other in-kind donations of medications and other health commodities and services that were requested by partners — including two humanitarian airlifts from FedEx – which allowed Direct Relief’s support to be far more extensive than would have been possible had the funds been used to purchase those essential goods and services.

As the one-year mark approached, we prepared a detailed report to explain – importantly, to people in Nepal for whose benefit we received the contributions, as well as to donors who made them — what, how much, where, why they’ve been used. We sent it to the Nepali government and partner organizations in Nepal at the same time we sent it to all those who’d made contributions and posted it, so we were pleased when Charity Navigator conducted a survey to ask many of the same questions.

As a technical, legal matter, the receipt of restricted contributions to help in Nepal didn’t make Direct Relief a trustee for people in Nepal with regard to the use of the money. But, on a personal level, the obligation feels something like that, particularly when people making gifts share their personal motivation with such emotion. I doubt very few if any of them were made with tax-optimization in mind or in consultation with a tax adviser. In Nepal, as in other events that create similar dynamics, receiving funds from one group to help others creates an obligation on both sides, which we continue to try to figure out how best to do.

Several years ago, following another emergency in which Direct Relief became the focal point for significant charitable contributions, the amount of restricted-by-donor cash contributions for that event exceeded our entire planned operating budget for the year. When I mentioned this had happened to our then board chair who was onsite handling phone calls, she said, “Well, this isn’t our money. The people calling are giving money to Direct Relief, but it’s for the people they’re seeing on TV living through hell.” Simply said, and exactly right – then, and in every similar event that inspires private giving to help the people or country that experiences a disaster. The Asian tsunami. Hurricanes Katrina and Sandy. The earthquakes in Haiti, Pakistan, and Indonesia. Typhoon Haiyan in the Philippines. The recent cyclone in Fiji, and current flooding in Houston and earthquake recovery ongoing in Ecuador. And Nepal.

For Direct Relief and all American nonprofits, honoring donor intent has long been a bedrock principle – but we recognize it’s difficult to assess adherence to, since the only standardized basis of comparison is a single, lengthy IRS form that all groups submit annually and requires groups like Charity Navigator to interpret and make the contents understandable for the public. It’s impossible to honor donor intent without giving donors the opportunity to express that intent. That’s why seemingly little things, like the specific language on website donation pages and in solicitations are so important – particularly in high-profile, deeply compelling emergencies such as occurred in Nepal after last year’s tragic earthquakes.

But, the anniversary of the Nepal tragedy also reminds us of the special obligation that Direct Relief has to the people of Nepal, having been entrusted with funds directed to our organization for their benefit. It seems an important – maybe the most important – obligation, and we hope we get it right, even though it’s different from the legal requirements and norms so obviously essential to inform those who made generous contributions that allowed Direct Relief to assist as it has and will continue to do.

In addition to ranking the top American charities by size, the magazine evaluates the financial efficiency of each nonprofit. Direct Relief received a perfect score of 100 percent in fundraising efficiency.

Top Ten U.S. Charities

Direct Relief’s Forbes ranking is based on its revenue of $892 million in the fiscal year that ended June 30, 2015, nearly twice the $455 million received by the nonprofit in the year prior. The vast majority of Direct Relief’s revenue came in the form of donated medications and medical supplies, which the organization provides, at no charge, to support humanitarian health efforts throughout the United States and internationally.

Direct Relief is being called upon more than ever before to assist people who are vulnerable – from poverty or emergency situations, and often both,” said Thomas Tighe, Direct Relief President and CEO. “The Forbes ranking reflects an expansion in private support – mainly in the form of donated essential medications – which are critically needed by people stuck in the huge gaps that remain in both the U.S. and around the world.”

Direct Relief’s cash revenue of $27 million came from private contributors, whose financial support enabled the organization to deliver of 1,837 tons, or 278 million defined daily doses, of requested medications and supplies to health centers and clinics in all 50 U.S. states and more than 70 countries worldwide, including in response to the Ebola crisis that occurred in West Africa and the earthquakes in Nepal.

Top Charity Ratings

Forbes joins other independent charity evaluators in giving Direct Relief high marks for its efficiency. This includes Charity Navigator, the country’s largest independent evaluator of charities, which assigns Direct Relief an overall score of 99.4/100 and the No. 1 spot on its list of the “Ten Best Charities Everyone’s Heard Of.”

The Ten Best Charities in The U.S. – Charity Navigator

Charity Navigator, the largest independent evaluator of U.S. charities, ranks the 10 top charities from the more than 8,000 organizations it reviews each year. Charitable givers should feel confident that these national institutions put their donations to good use. – Charity Navigator.

As America’s largest and most utilized independent evaluator of charities that exists anywhere, Charity Navigator works to guide donors toward more intelligent giving.

In addition to maintaining Charity Navigator’s 4-star accreditation, Direct Relief was rated #1 on the rating organization’s “10 of the Best Charities Everyone’s Heard Of” list.

Direct Relief consistently receives numerous awards and recognitions from some of the nation’s top independent evaluators of humanitarian relief organizations. Direct Relief was recognized last year by Forbes as “100% efficient,” and “[among the] 20 most efficient large U.S. charities.”

Direct Relief has received The Independent Charities Seal of Excellence, has been included in CharityWatch’s Top-Rated charities, and has also been recognized by the Better Business Bureau, Chronicle of Philanthropy, and Worth Magazine, among others.