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In partnership with communities in
resource-poor areas, PIVOTs mission is
to combine accessible and comprehensive
health care services with rigorous scientific
research to save lives and break cycles
of poverty and disease.

3 Letter from the Co-CEOs

4 Madagascar

6 Major Impacts

8 Our Approach

10 Clinical Programs

14 Strengthened Systems

18 Data and Research

22 Partners

27 Financials
Letter from the Co-Chief Executive Officers

Five years ago, we first encountered a health crisis in Madagascar that was being
neglected by the global community. In Ifanadiana District, where PIVOT now works,
1 in 14 women died in childbirth, and 1 in 6 children died before their 5th birthday,
typically from diseases like malaria, pneumonia, and diarrhea. Why do such death
rates persist in the 21st century when the apparent causes are both known and
simple to treat? There is a "Know-Do" gap because seemingly simple solutions require
complex delivery systems that must align at the point of care and work for all patients.

Three years ago, we founded PIVOT with the premise that failed health systems are
not inevitable. We set forth to partner with Madagascar's government and local
communities to create a model district rooted in strengthening delivery systems,
guided by strong existing policies, and to produce evidence to fill the "Know-Do" gap.
We believed that, if done right, this could scale across the country while launching a
new era of science aligned with the needs of the poor.

This year, we are humbled and proud to report that, thanks to our staff, partners, and
supporters, the foundation for this model system has been laid and the first set of
population-based results are in: utilization rates of health facilities have quadrupled,
while deliveries in health facilities have doubled. In two years, neonatal and under-five
mortality declined by 36% and 19%, respectively. Our data systems are informing
national policies (such as Universal Health Coverage), tracking costs to assess
affordability at scale, and attracting some of the greatest scientists in the world. The
government of Madagascar has recognized PIVOT as a top nongovernmental partner
in the country.

While there remains so much more work to do, we hope that you see from these
pages the improbable progress that has already been made.

Thank you for your support,


Co-Founder and Co-Chief Executive Officer
Co-Chief Executive Officer

Urgent Need
24 million $420
Extraordinary Opportunity Country Annual household
population income (USD)

Madagascar is among of the poorest countries in the world, with one

of the weakest health systems. Despite the availability of medicines 203,474 $14
and technologies for treatment of common diseases at the national Ifanadiana District Per capita spending
population on healthcare (USD)
level, too many people are dying unecessarily due to lack of integrated
healthcare delivery systems at the point of care.

Through partnerships with academic institutions and the recently-

elected Madagascar government, PIVOT is becoming the leading
non-governmental partner for establishing an evidence-based model 78% 50% 90%
health system. This new model is transforming health conditions in a
way that is both equitable and scalable throughout the country.

Population living in Chronic Deforestation
extreme poverty Malnutrition

Before PIVOT arrived in Ifanadiana District:

1 in 6 1 in 14
Under-5 Maternal
mortality mortality

4 5
Major Impacts
During our first two years, the likelihood that a mother will deliver

at a health facility and that a sick child will be treated has doubled.
This increased health access has contributed to a 36% decrease in
neonatal mortality and a 19% decrease in under-five mortality.
>patients treated
Infant Mortality Neonatal Mortality

90 50


Deaths per 1000

Deaths per 1000




50 0
2014 2016 2014 2016

Access to Delivery Care Access to Treatment for Fever

40 60

30 45

20 30

10 15

0 0
2014 2016 2014 2016

PIVOT Catchment Area

Outside PIVOT

6 7
Our Approach
We are creating an evidence-based model health district
in partnership with the Ministry of Health that can be scaled
throughout Madagascar.

Guided by existing policies, the model

includes the integration of clinical programs,
strengthened systems, and data and research... ...which are implemented across
all levels of the health system:



As of the end of 2016, PIVOT had begun the transformation

of the District Hospital, established four model health
centers, and constructed twenty community health posts.

CLINICA Malnutrition
Malnutrition is one of the biggest underlying causes of death in childhood,
and Madagascar has one of the highest rates of childhood malnutrition in the
world. We are spearheading the implementation of a national program
in the district to combat malnutrition through screening, treatment, and
prevention of severe acute and moderate acute malnutrition across all levels
of the health system.

2016 IM PACT
18,767 9,331
Children screened at Children screened
the community level at health centers

205 498
Children treated for Children treated for moderate
severe acute malnutrition acute malnutrition

Across all four health centers, we observed increased cure rates and
decreased drop-out rates in our severe acute malnutrition treatment program.

Program Drop-Out Rates Program Cure Rates

100 100

80 80

60 60

40 40

20 20

0 0

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Ranomafana Ifanadiana Kelilalina Tsaratanana

Health Center Health Center Health Center Health Center

10 11
Community Health Integrated Management
We train and equip Community Health Workers (CHWs) who work on the of Childhood Illness
front lines of care. They are responsible for diagnosis and treatment of
We implement national protocols for Integrated Management of Childhood Illness
illnesses among pregnant mothers and children under 5 (e.g., diarrhea,
(IMCI) at the community and health center levels. IMCI is a systematic approach
pneumonia, and malaria) and refer patients to higher levels of care when
developed by UNICEF and WHO that guides health care providers in low resource
needed. CHW supervisors provide critical oversight and mentoring through
settings to diagnose and treat illnesses and assess nutrition and vaccine status in
monthly visits to ensure the highest standards of care.
children under 5, the age group that bears the highest burden of deaths from

2 0 1 6 IM PA C T common childhood diseases.

CHWs fully Children

40 trained and
5,902 treated
by CHWs
2 0 1 6 I M PA C T
Total Consultations of Children
Under 5 at Health Centers


Children under 5 in our community health program

are now being seen at a rate of nearly ten times that of children in 12,802 12,000

communities outside of that area. 11,000

Children under
5 seen in health
center outpatient 10,000

42 8,000

CHWs trained
in IMCI protocol 7,000


covered the 5,000
triage system,
Heads of health
antibiotic use,
centers trained 4,000
and dietary
in IMCI protocol


Prior to PIVOTs
intervention, the IMCI
protocol was not
standard practice, 0

whereas in 2016, an Oct 2015 Jan 2016 May 2016 Aug 2016 Dec 2016
average of 86% of
We inaugurated 20 community health sites in 2016. Each site is a dignified and equipped work-
children were treated
place, improving the conditions for patient care. PIVOT provides roofing, nails, hinges, and furni- under the protocol.
ture, the mayors office provides cement, and members of the community carry out construction.

12 13
SYSTEM Essential Medicines
We remove financial barriers to care by covering the costs of all
essential medicines and supplies at no cost to the patient.

2 0 1 6 IMPACT


$0.83* $20*
per patient at per patient at
the health center level the district hospital

Average Outpatient Utilization at Health Centers


PIVOT Health Centers

Outside PIVOT


Average Utilization


14 15 15 15 15 16 16 16
20 20 20 20 20 20 20 20
t Jan Ap
r Jul Oc
Jan Ap
r Jul

4X Since this program was initiated, patient utilization

has quadrupled at model health centers.

*Cost per patient calculated with data from January-December of 2016.

14 15
Infrastructure and Equipment
We ensure that health facilities are safe, accessible,
and dignified places for receiving care.

Recruitment and Training

2016 I MPACT
Renovated and equipped hospital laboratory
and malnutrition ward
Through joint recruitment with the Ministry of Health and training programs,
Constructed new maternity facility in Kelilalina
PIVOT ensures all 20 health centers and the district hospital are fully staffed Constructed and equipped 20 community health

at or above government norms. posts


42 50 85 Ambulance Network
PIVOT-MoH PIVOT PIVOT We manage Ifanadiana Districts 24-hour
Joint Staff Clinical Staff Support Staff ambulance referral network, which we
launched in 2014.
Jointly recruited staff represent 58% of total MoH medical staff in
Ifanadiana District. 92% of PIVOT staff are Malagasy. 201 6 I M PA C T
Provided 3 ambulances for countrys only
district-level ambulance system

CHWs trained in diagnosing and 2,177 patients transported to care
treating malnutrition district-wide

Over 800 individual trainings by national

and international experts in:
Patient Accompaniment
Integrated Management Epidemiological
of Child Illness (IMCI) research Our social team accompanies patients and families,
Malnutrition Emergency medicine who often travel long distances to health facilities,
and follows up with them after discharge.
Leadership Ultrasound
2016 I MPACT
707 social kits containing sheets, blankets, bed
nets, and soap distributed to vulnerable patients
2,039 patients and family members oriented
to health facilities, taught disease prevention and

16 17
DATA&RESEARC Monitoring and Evaluation
The M&E system tracks 848 indicators to measure all health system
We collect data to inform health programs and produce interventions, which are represented in 9 distinct dashboards to improve
lessons for replicating and scaling up the model. Our data real-time programmatic decisions. Some of the results are featured within
platform supports routine monitoring and evaluation each section of this report.
(M&E) on the health system intervention, implementation
research to evaluate impacts and improve performance,
and scientific innovation to make fundamental advances
for diagnosing and treating disease. Research
Governments and policy-makers often know what to do but not how to
do it. Our implementation research program aims to fill this Know-Do gap,
while providing a platform for scientific innovation. Our signature intitiave
is a longitudinal cohort study that provides unprecedented insights into
the process of transforming health conditions for a district population.




Left: Bioengineer and 2016 MacArthur Genius Dr. Manu Prakash, who joined the
PIVOT board in 2016, demonstrates his new ultra low-cost paperfuge, which can
provide the same functions as commercial centrifuges.(1,2) Right: PIVOT-trained MoH
community health worker tests the paperfuge in Ranomafana.

18 19
Longitudinal Cohort Study Study on Universal Health Coverage
The second round of our longitudinal cohort study of a representative sample of Research on universal coverage4 showed that removing financial barriers to care in
1,520 households (~8,000 individuals) was completed in 2016. The population-level the PIVOT catchment area costs $0.68* per patient at health centers and $26* per
impacts include some of the most statistically rigorous and independently verified patient at the hospital with the following results:
evidence of changes in health care access and mortality rates within a
government district.3

Proportion of Febrile Children that Received Treatment

increase in outpatient consultations for all patients

G 52%
G increase in outpatient consultations for children under 5

increase in maternal consultations (prenatal, delivery, postnatal)
*Analysis of cost includes data from February 2014 to December 2015.
uF "G

1. Bhamia, MS. et al. Hand-powered ultralow-cost paper centrifuge. Nature
2014 2016
Biomedical Engineering 1 (2017): 0009.

Villages Sampled 0-4%

2. This 20-cent paper pinwheel could transform medicine in the developing world.

5-9% Science Magazine, January 10, 2017.

Household acces

Commune Limit
to health care

3. Garchitorena, A. et al. 2017. Removing financial barriers for universal health
PIVOT Catchment Area

coverage in a rural district of Madagascar, Health Affairs (in press).
H District Hospital 25-29%

30-39% 4. Miller, AC. et al. 2017. Baseline population health conditions ahead of a health
Health Center
40-49% system strengthening program in rural Madagascar. Global Health Action Vol. 10,
Model Health Center 50-100%
Iss. 1,2017. DOI: 10.1080/16549716.2017.1329961.

20 21


Benjamin Andriamihaja Bob Hower

Matt Bonds Tara Loyd
Stephen Della Pietra Ed Norton
Vincent Della Pietra Manu Prakash Ministry of Health Centre ValBio
Partners In Health
Paul Farmer Michael Rich
Tom Gillespie Cassia van der Hoof Holstein ADIDAS RunBase Johns Hopkins University
Jim Herrnstein, Chairman Patricia Wright Bureau du Dveloppement de Operation Smile
Robin Herrnstein lEcar de Mananjary Programme dAppui dUrgence aux
Doctors of the World Education, Nutrition et Sant
VOLUNTEERS Energy Fitness Stanford University Center for
Harvard Medical School Innovation in Global Health
Jane Allen Elizabeth Marshall Division of Global Health Equity at Stanford University Department of
Jason Frangos Charles Mead Brigham and Womens Hospital Emergency Medicine
Ole-Petter Hamnvik Jeffrey Mendel Institute for the Conservation of Stony Brook University
Louise Ivers Archana Patel Tropical Environments UNICEF
Gene Kwan Beth Rivielo Institut National de la Statistique University of South Carolina
Jennifer Lyons Tim Walker Institut Pasteur de Madagascar USAID Mikolo

PIVOT Country Director Dr. Mohammed Ali Ouenzar (left)

and PIVOT Co-Founder and Board Chair Jim Herrnstein (right) Partners In Health doctor and PIVOT clinical advisor Dr. Alishya
celebrate the inauguration of newly-constructed maternity ward Mayfield accompanies a patient during her rounds at the Ifana-
at Kelilalina Health Center. diana District Hospital.

22 23
David and Barbara Duryea Donna Barry Samyra and Brett Cox Jennifer Furin Jim Kurz
Peter Fairley Daniel and Joanne Bartone Tim Creed James Gallop Cheryl Lampitelli
Jill and Gerry Finkelstein Cynthia Bearer Harry Crowther Bill Gallucci Bill LaPoint
We extend our sincere Michael and Stacey Gargiulo Anthony Beasley Deirdre Cunnane Susan Galvani Emilio Lastella
thanks to those who made Tom Gillespie George Beisel Andrew Cunningham Gina Gamez Angie Lavrenchik
gifts from July 1, 2015 Google, Inc. Nancy Berg Patricia and Robert Cunningham Timothy Gates Elliott and Dean Leake
through December 31, 2016. Gary Gottlieb Sarah Berg Helene D'Orazio Andrew Geison Gay and Christopher Legg
Bart Harvey Eric Berger Ophelia Dahl Billy Genovese Wan Wan Li
$100,000+ Rick Hauser Theresa Bernhardt Danielle Daly Linda and Allan Gersten Rachel Liciaga
Anonymous (2) Susan Herrnstein Matt Bingham Sally Daly Porter Gifford Carl-Johan Lindgren
Stephen Della Pietra and Chris and Martha Higgins Alan and Eve Blachman Ashley Damewood Natalie Gill-Mensah and Michelle Lindgren
Pamela Hurst-Della Pietra In. Site: Architecture, LLP Elizabeth Blachman David and Cailin DeBiase Kwame Sarfo-Mensah Sara Lofink
Vincent Della Pietra and Jacky Jennings Sarah Bodary Joseph Della Pietra Bill and Meredith Gisness Christine Loughlin
Barbara Amonson Salmaan Keshavjee Tiffany Bogich Timothy Deren Larry Giunta Danielle Lowe
Herrnstein Family Foundation Marko Kleine Berkenbusch Jean Bonawandt Mark Desrochers Phyllis and Alvin Glazerman Kristine Lowe
Walter and Judy Rich Josh and Ariya Lapan Beth Boonin Denise Devlin Steve Goodman Charles Loyd
Jim and Jennifer Loyd Lauren Boretti Enrico DiChiappari Kenneth Gosselin Herb Loyd and Renata Kinney
$25,000-99,999 Tara Loyd and James Keck Kari Bosch Anthony Distafano Deborah Grondin Andrew Lynn
Mitchell Adams Kevin Magill and Margaret Bourdeaux and Frederick and Carolyn Distler Jane Groneman Dianne MacIlwinen
Peter Barrer and Judy Nichols Merywen Wigley David Charbonneau Jeffrey Dobrinsky Jeb Gutelius and Faith Madzar
Kevin and Deborah Bartz David Matthews Mary Lynne Bowman Amy Donahue Margaret Butler Cynthia Maguire
The Burke Family Pat Melampy Greg Bradford Elaine and Steve Donahue Anne and Robert Hall The Mak Family Trust
Miriam and David Donoho Patricia Mukherjee Martha Bradley Barbara Doucette Ken Hanly Bern Makris
Bob and Kira Hower John Mullman Nicole Breazeale Robert Downing Lulie Harry Laura Manville and Brian Valle
Carmella Kletjian FW Nugent and Allis Kim Jessica Brewer Melinda Downs Hodan Hassan Denisse Maribel Marin Bedoya
Dan Koranyi Phil and Betsy Palmedo Jay Bride Peter Drobac Jack and Carlene Haughey Gina Marino
Robert Lourie Myles Perkins and Heather Brown Nancy and Michael Dunn John Haymes Elizabeth and Sean Martin
Erik and Meredith Nachbahr Christina Lindgren Amy Bruch Kelli and Rick Dupuis Keith Henderson Lisa and Michael Maxwell
Tom Simonet Kathryn and Steve Puopolo Charlie Brummitt Kevin Ebbecke Jeff Hess Alishya Mayfield
David Shedd Michael Burke Charles and Christine Eccles Jonathan Hoch Andrea Mcalonen
$5,000-24,999 Jimmy Rouse Jessie Cabrera Timothy Egan Daniel Holmgren and Mary McBride and
Anonymous Brendan Swords Jim Cafarelli John Eleazarraraz Erik Haaland Maggie FitzPatrick
Stanko and Nicole Barle Jack and Barbra Thomas Lauren Capers Jason and Casey Ellin Arthur Horan Meg McCarty
Paul and Didi Farmer Bill and Patricia Thomas Josh Carlin Energy Fitness Judy Horan Charlie and Marylou McDowell
Catherine Marchiano Bill Wiberg and Lynda Sperry Merida Carmona Fort Salonga Staff John and Paula Hornbostel Joe McGann
Robert Mercer Margaret Williams Andy Carmone Kaylee Engellenner James Houghton Wayne and Toi McGary
Edward Norton and Young Presidents Organization John and Patricia Carr Caroline Fair Nancy Hower Douglas McGilvray
Shauna Robertson Mr. and Mrs. Carr Doris Fair Michael and Beverly Huckman Gary McGrath
Ed and Ann Norton Up to $1,000 Mary Carroll Jim Fair Robert Huckman Elvara and Donald McIver
Philip Perkins and Harry Adamo Martha Castano Jonathan and Susan Fair Goddard Mathilde and Matthew Hutchings Jordan McKinley
Margaret Allen Margaret and Stuart Adams Israel and Stephanie Catz Diane Fair Sibley Donna Hutton Nancy Mears
Brian Rich Christian Allen and Lorraine Chamblin Kyle Fardelmann Robert and Jacqueline Hutton Adam Meister
Michael Rich Melissa Gillooly Eva Chang Eileen and David Feikens Sabrina Hymel Anthony Mercogliano
Jonathan and Linda Rich AnneMarie Amatulli Qui Chau Sarah Feinberg Anthony Imbriaco Gregg Messina
Jim and Patty Rouse Norma Andreadis Richard Chenell Mark Fetting and Susan Immelt Melinda Mestres
Charitable Foundation Irina Angel Joseph and Kelly Choi Georgie Smith Joel Ingram Lisette Metauten
Teddy Rouse Anonymous (10) Sanjiv Chopra Karen Finnegan and Darby Jack JP and Liz Midgley
Traquina Family Charitable Fund Benjamin Andriamihaja Blanche and Francis Ciccarelli James Mbabazi Darius Jazayeri Melissa Mikami
Cassia van der Hoof Holstein Michelle and Jeff Arsenault City Life Historic Properties Richard Finnegan Denise Jobin Welch Ann Miller
and Peter Albers Pamela Austin Pamela Ciula Susan Fitzharris Lauren Johnson Katherine Miller
Keshia Bacchus Vicky Ciulla Margaret Fitzpatrick Christina Jones Robin Miller
$1,000-4,999 Ryan Bader and Michael Coakley Emily Fleming Sandra and Theodore Joseph Arsh Mirmiran
Margaret Archer-Batten Margaret Austin Bader John Cody Lindsay Pyke Fleming Nir Kaissar Carole Mitnick
Gerald and Gloria Barrett Shaeleen Bader Vanessa Coe Maria Flexer Margaret Kang Tisha Mitsunaga
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Matt Bonds and Molly Norton Dexter and Angela Bailey Bernadette Commisa Ming Chie Fong Matthew Kaufman Suerie Moon
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Barbara Clark Ellen Ball JoAnn Cortopassi Michael Fox Alice and Danny Kim Frank Morency
Anthony Compagnone Ann Banchoff Gregory Costa Molly Franke Chris King Nataliya Morozova
Bob and Liz Cunningham Fatima Bangura Sean Costa Jeff Freeman Denise King Daniel Motz
Chris and Jennifer D'Antonio Daisy Barquist Alysse Cottle Suzanne Friend Travis Knowles Hallam Movius
Mary and George Donovan Elizabeth Barrera Coulter 2006 Management Trust Friends School of Baltimore Katherine Krum Joia Mukherjee
24 25
Burt and Margaret Mullen Tom Ritter Edward Thomas
Lisbee Mumford Benjamin Robinson Jeffrey Thomas
Michael Munzer Sanam Roder-DeWan Will and Jeannie Thorndike
Kees Nachbahr Pejman Rohani Doug Thorstensen
Kristina Napoli Anne Rooney Blair and Sandy Thrush
Edward Nardell Aurora Rosales Kent Thrush
Ruvandhi Nathavitharana and Larry Rosenberg Anthony and Dolores Torti
Werner Neuhausser
Shelby Nessralla
Craig Rosenblatt
Patricia Roszkowski
Sheila Towers
John and Connie Towne Audited Financials
Lan Nguyen Oliver Rothschild Stephen Travieso
Tri Nguyen Amy Rouse Debbie Trelfa
Minda Nicolas Katrina Rouse Irene Trelfa
Greg Norton Lucinda Rouse Kristen Tubman
Jimbo Norton and Andrea Rubinfeld Michael Tucci
Natasha Dolezal Dan and Eileen Ryan Trevor Tucci
Doris O'Connor Turid Sabia Daria Tucker
Expenses Revenue
Jeanne O'Neil Kathryn Saloom Bill Tyree
Katarina O'Regan David Sampliner Mary Jo Urbanek Programs: Gifts & Grants $3,765,244
Amber and Jeremy Oberc Jacob Sands Brian Valle Madagascar $2,861,769 Contributed Services $7,510
Peter Olds Nimish and Niti Sanghrajka Philip vanderWilden
Research $267,347 Interest & Dividend Income $851
Ron and Eileen Olsen Alissa Scharf Victoria Vanik
Kevin Osborn Jeffrey Scherr Dave Vargus Administration & Fundraising $682,501 Total $3,773,605
Elna Osso Jennifer Schongalla Laura Vaughan Total $3,811,617
Andre and Catherine Papantonio Kevin Seims Arthur Vaught
Arturo Pavon Christine Senh Kamaria and Jason Vaught
Deborah Perkins Lewis Seton L. Villa
Rina Perrault KJ Seung Frieda Von Qualen Assets
Demerise Perricone Lynda Shannis Claire Wagner
Pauline and Mark Peters Marjorie Shedd Natalia and Andrew Wainwright
Net Assets, Beginning of Year $1,784,018
Clinton and Kathryn Pettus Rebecca Shedd Edward and Jacqueline Waldman
Stacey Pflomm Steven Sherry Kelly Walker Change in Net Assets -$8,667
Tam Pham William Shiflett Joseph Walsh Net Assets, End of Year $1,775,351
Jasmine Phan Darla Shine JJ Wang
Lilian Philiposian and Mike Sileo Jennifer Webber
Todd Hunter Harry Siler Scott Weinstein
Christine Piazza-Darrohn Peter Small and Jennie Weiss Block
Marianna Pierce Delaney Ruston Kathleen Wetherby and
Donna Pollack Dian Smith Henry Zenzie
Sandra Porter Caoimhe Smyth Hanako Williams 82%
Katherine Pretl Adrienne Socci Gabriel Wilmoth
Joel Prives Stephanie Sogg Edward Winstead and Expenses
Kristine Puopolo Kaitlyn Somers Ann-Barron Carneal
Nina Puopolo Craig Spitzer Thomas and Carol Winstead
Nancy Raposa Kristy St. Aubin Mark Winters 18%
Lisa Raschdorf Diane and William Stansbury Benjamin Wise
Mysore and Judith Ravindra Craig and Regina Stanton Brian Woods
James Reardon Cassandra Sticco Rosemary Woolfe
Karen Reddy Sara Stockwell Jessica Wright
John Renner Donald Strickland Patricia Wright
John and Linda Renner George Stubbs Aspasia Xypolia
Maureen and William Renner Sara Stulac and Paul and Maureen Yasi
Joe Rhatigan Aaron Bernstein Askar Yedilbayev and
Guy Riccardi John Sugrue Elga Dzhusupova
David Rich Kelly Swanston Susan Young Programs
Edward and Elaine Rich Christopher Sweeney David Zaltas
Jennifer Rich Jacquelin Tancredi and Virginia and Mark Zanger Administration & Fundraising
Ronald Rich and Noah Steignberg-DiStefano Ashley Zauderer
Claudine Eilberg James Taylor Jason Zimmerman
Stephen and Carol Rich Howard Temkin and
Elisa and Bill Richardson Barbara Koren
Matthew Rienzo Telly and Liz Theodoropolus
Cassidy Rist Rachelle Therrien
26 27
PIVOTs identity is defined by the delicate balance
between doing whatever we can right now for the sick

and suffering we can reach, and doing what we can for

those we have not yet reached, in space and time.

Jim Herrnstein
PIVOT Co-Founder
and Board Chair

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