Jai Vakeel, a nonprofit organization in India, serves individuals with Intellectual Disability (IQ below 70). The organization was founded by the parents of a child with Down Syndrome, and they (and their next generation) steadily built the organization over 60 years to the become the largest such organization in India. Yet the organization served only some 1000 children annually when there were millions more needing the healthcare, education and skills to lead a decent life with ID. This case describes the evolution of the organization from the founder's family (six decades) to the first CEO from outside. As Archana Chandra appointed in 2013 brings about several changes to the organization she wonders how to scale the organization from the current 1,000 people it serves annually to at least 10,000 and then to the many millions who are in need.