ANNUAL REPORT 2020 Dear Friends,

Welcome to Americares Fiscal Year 2020 Annual Report, which presents our accomplishments in an exceptional year, when a global pandemic “ threatened the world. I became Americares president and CEO halfway through the year, just as the pandemic hit. I am proud of Americares achievements during this challenging time, and grateful for the collaborations with our donors and partners that have saved lives and eased the burden of the pandemic for so many. “Many patients are

Americares mission focuses on communities affected by poverty or defenseless and do disaster — those that suffer the greatest impact from every health threat, not have another health including the coronavirus. To save lives and improve health during this pandemic, Americares launched a multi-pronged global emergency provider. Those who response, expanded our partner network and adapted every program to meet the added demands of COVID-19. This includes providing personal take care of them are protective equipment and technical assistance to keep our partners, their us — Americares.” patients and our colleagues safe. We added staff and expertise, acting on our mission every day. —Bradys Taboada, Americares clinic staff, This year also brought a strong call for social change. The pandemic laid bare the inequities that prevent people from accessing the care they need, and shattered any notion that health, a human right, can be provided to all without addressing the centuries of racial discrimination often at the root of poor health outcomes.

Access to medicine, community health, clinic services — our programs have never been more relevant and needed. But we have an additional challenge that is imperative: To never forget the losses the world suffered during this pandemic and the inequities 2020 revealed that, unless addressed, will blunt every effort to improve health far beyond this pandemic.

The world is forever changed, and Americares is changed with it. We pledge to incorporate every lesson learned into our goal to improve the health of more people, in more places, so they can truly thrive and live the full, productive lives they choose.

Thank you for all you have done to further Americares mission. Together, we are making a difference.

Sincerely,

Christine Squires President and CEO

1 Colombia Emergency Programs In Fiscal Year 2020* 41 disasters 29 countries 8.7 million supplies 383,000 prescriptions 72 health projects for disaster survivors $42 million total emergency aid

“It gave me peace of mind to count on Americares during my pregnancy. If these services did not exist, we Venezuelans would not have the means to pay for medical consultations, medications or, in my case, a referral for a cesarean section.” * July 1, 2019 to June 30, 2020 —Roxeli C., patient, Americares clinic in Colombia 2 Colombia Emergency Programs

Americares responds to disasters and humanitarian crises, establishes long-term recovery projects and brings disaster preparedness programs to vulnerable communities. The COVID-19 pandemic struck mid-Fiscal Year 2020, requiring a global response and introducing increased complexity to ongoing and new emergencies, including hurricanes, typhoons and floods. The team added infection prevent and control supplies, training and education to every emergency program to lower the risk of disaster survivors and responders becoming infected with COVID-19.

COVID-19 PANDEMIC the , Americares shelters, the Philippines team shook southern , RESPONSE: To save lives disaster risk reduction provided 1,226 hygiene kits families moved to safety, and stop the spread of the included technical reviews of and, to protect families from often sleeping in the streets coronavirus, Americares individual health center plans. airborne ash, 2,000 masks. outside their homes, creating focused on three key areas: The mobile medical team a physical and mental health access to critical supplies, In all, in Fiscal Year 2020, conducted over 1,000 patient emergency. Americares teams continuity of ongoing health Americares delivered consultations to meet physical provided local health centers services and access to preparedness programming to and mental health needs. with medicine, supplies and credible safety information, health centers in , training for mental health including skills training for the Philippines and 15 U.S. After wildfires forced tens of support. A 2019 earthquake Bahamas, health workers. Globally, by states and Puerto Rico. thousands of people from also displaced families in June 30, 2020, Americares their homes in the western Pakistan, where Americares had provided technical Americares also continued to , Americares provided survivors with assistance and emergency grow its roster of emergency provided relief supplies to supplies to combat harsh supplies to 13 countries, responders, with 628 roster shelters and clinics and winter weather. including shipments members representing 51 made mental health training from Americares global countries. Roster members available to health care Americares medicine and distribution center and local deployed to 50 percent workers, for themselves and emergency relief supplies procurements. In , for of all Americares disaster their patients. More than 70 this year reached insecure example, Americares provided responses, including the health care workers received environments, including 15 6.2 million supplies, which dengue fever outbreak disaster-specific COVID-19 shipments to Somalia, Syria included lifesaving equipment in the Marshall Islands. training as part of Americares and Yemen. In Lebanon, such as ventilators. In the ongoing preparedness and Americares is supporting United States, by June 30, RESPONSE: Americares mental health resilience an innovative pilot program 2020, Americares emergency operates 10 clinics in project targeting communities that allows vulnerable Syrian shipments reached more Colombia for Venezuelan affected by wildfires. refugees to access cash for than 100 hospitals and migrants and refugees health services. Americares community clinics in 36 states, who have fled the crisis in After Hurricane Dorian and its local partner will providing more than 2 million Venezuela or crossed the battered the Bahamas with 40 continue to monitor health Pakistan, earthquake safety supplies, including border to seek care. In Fiscal hours of wind, rain and storm outcomes, with the goal of masks, gloves, gowns and Year 2020, Americares clinics surge, Americares emergency expanding the program. disinfectants. Technical conducted 145,845 patient response teams supported Puerto Rico, earthquakes assistance included health consultations, including 21,256 displaced survivors in Nassau RECOVERY: Americares worker training, community for pregnant women seeking with medicine and supplies, continues to expand education and outreach. prenatal care and 24,220 then deployed mobile medical knowledge of how to mental health consultations, teams to hard-hit Hope Town, protect the health of chronic PREPAREDNESS: In early critical for migrants who have providing more than 4,500 disease patients during and 2020, Americares modified lost everything. With the onset medical and 3,200 mental after disasters, as stress its preparedness programs of the pandemic, staff adopted health consultations. exacerbates physical and to include pandemic additional infection-prevention mental illnesses. In Houston, preparedness, including how safety protocols, installed In response to flooding after Americares collaborated to shift to telehealth, operate handwashing stations and heavy rains in Kerala, India, with five partner clinics to with less staff and adopt offered COVID-19 education Americares medical teams lower the risk of diabetes in practices to reduce risk of to patients, with the goal of set up 35 health camps patients who are Hurricane infection while maintaining reducing community spread. in 2019, providing 2,845 Harvey survivors. Americares services for patients. In patient consultations as well also provided direct mental one survey, 88 percent of In the Philippines, when as critical relief supplies, health and psychosocial attendees reported using 150,000 people fled the including water purification services to more than 2,800 information from the training erupting Taal volcano, tablets to 5,000 families. Harvey survivors in Texas and when making decisions. In Americares emergency convened a behavioral health teams deployed to meet the In December 2019 and summit for Texas health 4 immediate health needs of January 2020, when a workers. families and communities. In swarm of earthquakes United States, COVID-19 United States, wildfires Access to Medicine 10.3 million prescriptions

25.7 “The people of northern million supplies Kentucky don’t have to fear chronic diseases anymore and 1.8* fight the battle between medication million people reached and other basic things to live, by medicine alone because we get our medications through Americares, at no cost to us. It would just be absolutely 83 impossible to do what we do countries reached without you, on a regular basis by any program and during this crisis.” —Aaron Broomall, Executive Director, Faith Community Pharmacy, Florence, KY 6,600* health centers supported

* estimated

6 Philippines AccessAccess toto Medicine Medicine

To improve health outcomes for patients and communities, Americares increases access to quality medicine and supplies to health centers and volunteer medical teams.

MORE MEDICINE medicine is matched with TO MORE PEOPLE: behavioral programs that This year, Americares aim to reduce the need added 80 new partners for medication. In an worldwide, expanding our Americares program to global network to include boost regular visits in El more than 6,000 local Salvador, 83 percent of health centers providing patients with hypertension, health care to people diabetes or who, because of poverty attended critical health United States United States or disaster, could not checks, with 68 percent otherwise access health showing reduced blood services. Local partners pressure. PARTNER TO INCREASE CAPACITY: Americares supported VACCINATION FOR CONTINUING CARE target unique health medical teams making short-term volunteer trips to 700 health FLU: In partnership with DURING THE PANDEMIC: conditions in their own In a program to improve facilities in 68 countries with enough medicine to fill 1.1 million U.S. PROGRAMS Walgreens, Americares In one weekend in March communities: In Zambia, the health of mothers and prescriptions, valued at nearly $48 million. partner clinics held 174 2020, Americares Free a new partnership with babies in a drought-affected As COVID-19 spread across the United States, flu vaccination events that Clinics pivoted from in- Prison Fellowship will region of Guatemala, protected approximately person service to 100 Americares responded with critical safety supplies, 7,000 uninsured, low- percent telehealth, not improve the health of Americares paired health technical assistance, training and other support for marginalized communities worker training and a income patients from the missing one day of patient without access to health supply of prenatal vitamins nearly 1,000 safety net clinics that together serve flu. In a related flu vaccine care, even as state care in the prison system. to support more than 7,700 more than 7 million low-income people. Clinics campaign, Americares four regulations changed. Staff In the Central African women with vitamins and faced immense pressure, including funding gaps, free clinics in Connecticut also filled prescriptions for Republic, Americares now information about health vaccinated 10 percent more curbside pickup, so chronic fewer volunteer staff, an increase in newly people than last year. disease patients could supports the country’s only during pregnancy. unemployed and uninsured patients and the pediatric hospital. control their conditions. SUPPLY CHAIN need for a constant supply of personal protective IMPROVING QUALITY The clinic made referrals MEETING THE DEMANDS EXCELLENCE: Americares equipment. Americares support for clinics and AND EQUITY OF CARE: for COVID-19 tests, OF COVID-19: The continues to refine and their low-income patients in the U.S. included The highest standard for provided isolation kits for demand for medicine and improve every step of our quality health care in the patients with symptoms enough medicine to fill 4 million prescriptions U.S is patient-centered and raised community safety supplies, including supply chain to streamline and 11 million medical supplies — 5.4 million masks and disinfectants, ordering and inventory medical home (PCMH) support for grocery gift hit in March. In response, management. This includes more supplies than last year. recognition. Americares is cards, critical during a Americares expanded custom technology at certified to coach health time of food insecurity. EXPANDING REDUCING DIABETES our partner network and the Stamford distribution centers to reach this Before the pandemic, BEHAVIORAL HEALTH RISK: Americares provided increased shipments, center as well as software standard, and is supporting Americares Free Clinics CARE: Two pilot programs seven types of insulin to providing more than 9 and training for local five free and charitable was expanding services explored how technology partner clinics, critical so million more supplies partners, with the goal of clinics in reaching that to include well-women can bridge gaps between patients have the no-cost than the previous year. adequate supply and less standard, with four care, diabetes prevention free and charitable option that works best for waste. In alone, clinics having achieved and management and clinics’ patients and their them. Nearly a quarter of Americares trained health recognition. Americares legal and other services to MEDICINE FOR THE caregivers, and caregivers patients with prediabetes in workers at 16 sites in skills is also co-leading a help patients with social GREATEST NEEDS: and experts. Health workers an Americares healthy diet To improve the health ranging from logistics and collaborative project that determinants of health. In received telementoring and app-based program of people with chronic information and storeroom will allow hundreds of free all, Americares free clinics through the ECHO achieved a 5 percent weight disease, Americares management to forecasting and charitable clinics to provided care valued at program to better integrate loss, cutting their risk for provided enough medicine and ordering. In Tanzania track and showcase their more than $10 million, behavioral health care into chronic disease in half. to fill 4 million monthlong and Malawi, improvements quality and impact. A key at no cost, to more than patient care. After receiving The results will inform prescriptions that helped an also included pharmacy element is the creation of a 2,500 low-income, training via a virtual patient future programs. estimated 400,000 people repairs to keep medicine new data repository that will uninsured patients. simulation, caregivers made control their conditions. secure and ensure last-mile allow free and charitable measurable increases in In India and El Salvador, safety for patients. clinics to demonstrate and addressing and screening improve equitable care for 8 Philippines and referrals for substance all patients. 9 abuse. Clinics to Communities

10,129 health workers trained “When we do outreach in the 339,188 community around COVID-19, consultations in Americares-run if we do not have the actual fixed and mobile health clinics* tools to promote the message, it is almost as if we are doing nothing. The handwashing 27,357 stations help so much.” surgeries supported with —Dr. Waly Turin, Americares Project Officer in medicine and medical supplies**

*includes emergency response

** conducted and reported by volunteer medical teams

10 Malawi Clinics to Communities

Americares improves and expands quality clinical services at Americares-run clinics and those of our partners. To prevent disease and promote good health in vulnerable communities, Americares supports, designs and implements disease prevention and health education efforts that connect local clinics and hospitals with the communities they serve.

COVID-19 OUTREACH RESPECTFUL CARE FOR COMMUNITY-BASED CARE Americares health center AND EDUCATION: WOMEN: For ten years, FOR THE URBAN POOR: in El Salvador, trained Americares webinars and Americares program to repair Americares seven mobile volunteers promote online education, free to birth injuries in mothers in health centers manage healthy behaviors and do health workers, includes Tanzania and, more recently, over 100,000 patient basic monitoring of their checklists for safety, Liberia, has included radio visits in 211 Mumbai slum neighbors’ health. In Fiscal pandemic preparedness, messages and funds for communities each year and Year 2020, Americares led infection prevention and transportation as well as reach more than 54,000 97 educational sessions control, psychological first aid surgery, rehabilitation and individual patients with health reaching 2,800 people in and mental health for health education to prevent such education, which covers local communities, screened workers. Six months into injuries. In Fiscal Year 2020, hygiene, nutrition and chronic 1,700 people and sent more the pandemic, Americares Americares began a multi- disease. Already equipped than 4,000 text messages training had reached more year respectful care project with electronic medical to patients diagnosed with than 27,000 participants. in both countries to change records, the mobile health chronic disease. One result: Malawi the way women experience centers made the pivot to lower blood pressure in 67 LEADING IN BEST health care at every stage of telehealth when the pandemic percent of hypertensive PRACTICES: Last year, their reproductive lives, with hit. Americares trained health patients. The health center Americares-supported the goal of improving the friend volunteers, in person also has outreach to volunteer medical teams health of women and babies and then remotely, to continue extremely poor communities, delivered care, including and reducing birth injuries to promote Americares with help for transportation more than 27,000 surgeries, and maternal and newborn health services, even during and other costs. In all, at more than 700 health deaths. With respectful care, pandemic lockdowns. Clínica Integral de Atención facilities in 68 countries. more women will seek care Familiar managed 53,000 Americares leads the throughout their pregnancies SCHOOL-BASED HEALTH visits from more than 37 industry-wide Partnership and have attended births. PROMOTION: thousand patients; the clinic for Quality Medical More than 18,000 students in had permission from the Donations–Health Systems INCREASED SKILLS AND 72 Mumbai schools engaged government to stay open Strengthening Medical KNOWLEDGE: Americares in a variety of health- during COVID-19 restrictions Missions initiative that training invests in local focused activities, including and adopted strict safety developed and published workers and builds stronger, screenings for vision, protocols. best-practice standards for more resilient local health anemia and oral health, partnerships and practices. centers. From July 2019 and received treatment, HANDWASHING To ensure that the teams to July 2020, Americares if needed. Americares STATIONS COMBAT understand and meet the training increased the program also includes skills COVID-19: To make hygiene Haiti needs of the host facilities, knowledge and skills of more building around hygiene and possible where water Americares partners have than 10,000 health workers. nutrition, including cooking is scarce or unreliable, direct access to those Training topics included classes and handwashing Americares installed standards and hundreds of mental health and prenatal demonstrations with the handwashing stations and other educational tools and nutrition, infection control, goal of making students into provided public education, resources on a dedicated supply chain management health ambassadors in their which included posters, town Americares website. In and disaster preparedness. families and communities. criers and radio messaging. addition, qualified surgical By December 2020, When COVID-19 restrictions More than 200 stations were partners share surgical Americares COVID-specific closed schools, the program installed In Colombia, Haiti, safety checklists and pulse training had involved nearly shifted to remote activities. Malawi and Tanzania by oximeters through our Safe 30,000 participants. June 30, and, by December Surgery Initiative. MODEL QUALITY HEALTH 2020, Americares had SERVICES: To reduce the made nearly 500 water risk of chronic disease such infrastructure improvements as diabetes and hypertension in eight countries. in the communities around 12 El Salvador Philippines Improving Health Around the World 2020

Global Presence Global Health Programs Emergency Programs Impact by Region $42 million 8.7 million medical supplies 382,970 prescriptions 72 health projects Global Presence Latin America/CaribbeanLatin America/Caribbean Asia/Eurasia/EuropeAsia/Eurasia/Europe 9 countries with full-time staff$125 million $125 million $59$59 million million Complex Emergencies, Disease Outbreaks, Earthquakes, Tsunamis, Flooding, Landslides 26 countries with health projects2.2 million prescriptions2.7 million prescriptions 1 1.1million million prescriptions prescriptions Political Crises and Drought and Hunger: Wildfires Volcano: and Severe Storms: 83 countries reached 7.3 million medical supplies7.6 million medical supplies 1.41.5 million million medical medical supplies Refugee Crises: Democratic Republic Congo, Pakistan, Philippines, Bahamas, India, Dominica, 29 countries with disasters11 health projects 11 health projects 21 supplies health projects Bangladesh, Colombia, Somalia, (all the COVID United States (California) El Salvador, Malawi, 21 health projects Mexico, Syria, Yemen responses) Marshall Islands, Mozambique, , Africa/Middle East United States Philippines, Samoa Sierra Leone, Philippines, $71 million $231,521* United States and territories 1.6 million prescriptions 4 million prescriptions 2.3 million supplies 5.6 million medical supplies 4 health projects 18 health projects

*does not include $530 million patient 14 assistance program 15 CONDENSED FINANCIAL INFORMATION FINANCIAL INFORMATION FOR THE 12-MONTH PERIOD ENDING JUNE 30 2020 2019 CHANGE$ CHANGE%

Thanks to the generous support of our donors and partners, Fiscal Year 2020 was among the strongest in OPERATING REVENUE ($IN 000S) Americares 41-year history. This allowed Americares to respond to the COVID-19 pandemic and continue our CONTRIBUTIONS (CASH AND SECURITIES) $74,957 $50,504 $24,453 48% ongoing programs to improve the health of millions of people affected by poverty or disaster in the United States U.S. GOVERNMENT GRANTS & CONTRACTS 4,669 1,388 3,281 236% and around the world. Our FY2020 results bring our historical level of total aid provided to just over $19 billion. GIFTS-IN-KIND AND CONTRIBUTED SERVICES 1,375,685 934,798 440,887 47% OTHER REVENUE 2,573 3,574 (1,001) (28%) Geographically this year, Americares reached 83 countries, 49 U.S. states and three U.S. territories: the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Also of significant note were responses TOTAL OPERATING REVENUE 1,457,884 990,264 467,620 47% to 41 emergencies in 26 countries, including the U.S. (see the geographical distribution chart, “Improving Health Around the World”). Our U.S. Program remains the largest nonprofit provider of donated medical OPERATING EXPENSES AND CHANGES IN NET ASSETS aid in the country. In all, Americares delivered more than $790 million in medicine, supplies and technical TOTAL PROGRAM SERVICES assistance to low-income patients and our network of free and charitable clinics in FY2020. (WITHOUT GIK) 223,783 89,272 134,511 151% TOTAL GIK EXPENSES 1,017,333 984,619 32,714 3% Americares revenue in FY2020 totaled $1.46 billion. This was driven, in largest part, by both restricted cash FUNDRAISING 14,113 12,974 1,139 9% and medical gifts-in-kind support for our U.S. and Latin America health programs. The FY2020 overall revenue MANAGEMENT & GENERAL 6,578 5,738 840 15% represents a significant increase (47 percent) in overall revenue from FY2019, mainly due to the large level ($16 million) of restricted COVID-19 relief revenue received in the spring of 2020 and a $9 million increase TOTAL OPERATING EXPENSES 1,261,807 1,092,603 169,204 (15%) in restricted emergency response revenue. Although the majority of our revenue is driven by our medical EXCESS/(DEFICIENCY) OF OPERATING gifts-in-kind program, it is significant to note that the cash (non-GIK) revenue portion was $82.2 million. REVENUE OVER EXPENSES 196,077 (102,339) 298,416

Our GIK revenue was $441 million higher in FY2020, led mainly by increases in medicine and supplies EXCESS RELATED TO NON-GIK to our U.S. Program. Management & UNRESTRICTED OPERATING FUNDS 5,487 2,065 3,422 Total Expenses EXCESS/(DEFICIENCY) RELATED TO On the expense side, led by our Access to Medicine program, our programs accounted for 98.4 percent ofGeneral our GIK & RESTRICTED FUNDS 190,765 (104,462) 295,227 total expenses, including both cash and gifts-in-kind. Without gifts-in-kind expenses, our program expenses0.5% How We Use EXCESS/(DEFICIENCY)H RELATED TO were a very strong 91.5 percent of total expenses. In addition, our Forbes Private Fundraising Efficiency ratio Fundraising NON-OPERATING ACTIVITY (175) 58 (233) was 1.0 percent in FY2020, also considered best-in-class. Finally, Americares unrestricted cash operating Our Resources TOTAL INCREASE/(DECREASE) IN NET ASSETS $196,077 $(102,339) $298,416 surplus for FY2020 (a strong measure of financial health in a nonprofit’s financial statements) was $5.5 million, 1.1% which is dedicated to health programs in the upcoming fiscal year. It should also be noted that the $196. COMPOSITION OF NET ASSETS 1 million surplus of revenue-to-expenses is mainly driven by the $181.9 million increase in gifts-in-kind WITHOUT DONOR RESTRICTIONS $47,131 $65,032 $(17,901) (28%) inventory (net intake). WITH DONOR RESTRICTIONS 365,045 151,067 213,978 142% These metrics put Americares in a very strong position to roll out our five-year Strategic Plan, which will grow and diversify the organization’s funding and deepen our impact on local health centers and the TOTAL NET ASSETS $412,176 $216,099 $196,077 91% lives of people in need. Program Services

98.4% HOW WE USE OUR HOW WE USE OUR WHERE WE WORK MAJOR PROGRAMS RESOURCES (TOTAL)† CASH RESOURCES (by value of aid delivered) (without gifts-in-kind) (without gifts-in-kind) CLINICAL SERVICES & Management & ManagementExpenses w/o GIK COMMUNITY HEALTH Total Expenses GeneralMANAGEMENT & GENERAL How We Use & GeneralMANAGEMENT, Fundraising FUNDRAISING, MIDDLE EAST/ EMERGENCY Major Programs** 0.5% H & GENERAL AFRICA Clinical Services & Community 9.4% Richard K. Trowbridge, Jr. 0.5% PROGRAMSHealth 2.7% 5.8%5.8% ASIA 9.4% FundraisingFUNDRAISING Our Resources 2.7% CFO, Treasurer and SVP Operations 1.1% 11.5% Emergency10% Programs 1.1% 14.1% 10.0%

Access to Medicines 80.6% LATIN AMERICA & Program Services CARIBBEAN 98.4% UNITED PROGRAMS 25.8% STATES* ACCESS TO MEDICINE 98.4% PROGRAMS 48.6% Note: Americares Fiscal Year 2020 spanned July 1, 2019 to June 30, 2020 ManagementExpenses w/o GIK & General, Fundraising, Program 80.6% * not including FY2017, which had the anomaly of a one-time $1.3 billion 2.7% 5.8% 91.5% gifts-in-kind donation of a hepatitis C medication. Services, 91.5%

*Americares also administered patient assistance (**) not including gifts-in-kind programs by providing an additional $536.9 million **Not including gifts-in-kind Program to patients in the U.S.(not included on this chart). Services, 16 91.5% 17 Colombia

All photos by Americares staff, except as noted: Cover, page 1-2: Nicolo Filippo Rossi. Page 5, Puerto Rico: Alejandro Granadillo. COVID-19: International Medical Response. Wildfires: David Royal. Page 6: eejayV Villafranca. Page 8: Philippines: Veejay Villafranca. Page 10-11: Thoko Chikondi. Page 13: Malawi: Thoko Chikondi. Haiti: Almando Etienne. Philippines: Veejay Villafranca. Page 19: Bryan Bedder/Getty Images. Page 31: Erica Hill.

Cover photo: Colombia, health workers at Americares clinics; Emergency Programs, Venezuelan refugee crisis Our Mission

Americares saves lives and improves health for people affected by poverty or disaster so they can reach their full potential.

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