Form 990 for tax year 2024

Totals

Total revenue

$7,005,562

Total expenses

$6,624,843

Contributions and grants received

$6,175,920

Grants paid

$189,825

Program service revenue

$440,249

Investment income

$345,163

Other revenue

$44,230

Total assets, end of year

$15,598,095

Total liabilities, end of year

$407,801

Net assets or fund balances, end of year

$15,190,294

Program services expenses (Part IX)

$5,644,852

Management and general expenses

$362,446

Fundraising expenses

$617,545

Program service expenses (Part III)

$5,644,852

Program services were 85.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Mission and programs · 2024

• NEARLY HALF OF THE WORLD LIVES ON LESS THAN $8.30 PER DAY. PATIENTS ARE TOO POOR TO BUY THE IMPLANTS NEEDED, AND MOST HOSPITALS DO NOT HAVE THE RESOURCES TO PURCHASE THE IMPLANTS. WHEN A PERSON LIVING IN A LOW- OR MIDDLE-INCOME COUNTRY (LMIC) BREAKS AN ARM OR LEG AND CANNOT AFFORD APPROPRIATE CARE, IT CAN EASILY SEND THEIR WHOLE FAMILY SPIRALING INTO POVERTY. WE DEVELOPED AN INNOVATIVE IMPLANT SYSTEM FOR TREATING PATIENTS IN LOW-RESOURCE HOSPITALS. THIS SYSTEM CAN BE USED WITHOUT EXPENSIVE X-RAY IMAGING OR ELECTRICITY. SIGN SURGERY TYPICALLY ENABLES A PATIENT WITH A FRACTURED BONE TO WALK IN 1 DAY, LEAVE THE HOSPITAL IN 1 WEEK, AND BE BACK AT WORK IN 1 MONTH. THE PATIENT AVOIDS POSSIBLE PERMANENT DISABILITY AND IS RETURNED TO MOBILITY. SEE SCHEDULE O ON HOW WE DISTRIBUTE APPROPRIATE ORTHOPAEDIC TECHNOLOGY.DISTRIBUTE APPROPRIATE ORTHOPAEDIC TECHNOLOGY:THE SIGN IM NAIL AND INTERLOCKING SCREW SYSTEM IS DESIGNED FOR USE IN HOSPITALS IN DEVELOPING COUNTRIES WHERE C-ARMS AND RELIABLE POWER ARE NOT AVAILABLE. SIGN ENGINEERS CONTINUALLY DEVELOP NEW ORTHOPAEDIC INSTRUMENTS AND IMPLANTS IN RESPONSE TO THE NEEDS DESCRIBED BY THE LOCAL SURGEONS. IN 2024, THE ELBOW PLATE BENDING TEMPLATE WAS RELEASED. THE ELBOW PLATE BENDING TEMPLATE IS USED TO CONTOUR SMALL BONE FRAGMENTARY PLATES, SUCH AS THE SIGN FX PLATES, TO MATCH THE ANATOMY OF THE DISTAL HUMERUS AND OLECRANON WHEN STABILIZING ELBOW FRACTURES. THE TEMPLATE CAN BE USED WITH NON-SIGN PRODUCTS (LIKE THE 3.5MM RECONSTRUCTION PLATES) AND BOTH BEFORE AND DURING SURGERY.WE SUPPLY NEW SIGN PROGRAMS WITH THE SIGN IM NAIL SYSTEM, WHICH SURGEONS USE TO REPAIR SEVERE FRACTURES IN THE FEMUR, TIBIA, AND HUMERUS. ONCE A PROGRAM HAS DEMONSTRATED ITS ABILITY TO REPORT THEIR CASES, INCLUDING ADEQUATE FOLLOW-UP THAT CONFIRMS THEIR RESULTS COMPLY WITH OUR EXPECTATIONS, THEY BECOME ELIGIBLE TO RECEIVE ADDITIONAL SIGN PRODUCTS, AS WELL AS IN-KIND DONATIONS RECEIVED FROM FOR-PROFIT ORTHOPAEDIC IMPLANT COMPANIES.IN 2024, WE DISTRIBUTED 27,107 SIGN NAILS TO 48 COUNTRIES. OUR AIM IS TO ENABLE THE POOR TO GAIN ACCESS TO AFFORDABLE ORTHOPAEDIC SURGERY, WHICH MEANS THE MAJORITY OF OUR IMPLANTS ARE DONATED FREE OF CHARGE TO THE PATIENT.WE STARTED 22 NEW SIGN PROGRAMS IN 2024. THE BREAKDOWN WAS AS FOLLOWS: AFRICA: 15 PROGRAMS ASIA: 6 PROGRAMS NORTH AMERICA: 1 (HAITI)WE HAVE ALSO BEGUN DEVELOPING A NEW KIND OF PROGRAM, FOCUSED ON PROVIDING EDUCATION AND IMPLANTS RELATING TO TREATING SPINE FRACTURES. THIS NEW PROGRAM IS REFERRED TO AS SIGN SPINE. WE STARTED SIGN SPINE PROGRAMS IN KENYA AND TANZANIA IN 2024 AND ARE PROJECTED TO START FIVE ADDITIONAL SIGN SPINE PROGRAMS IN THE COMING YEAR. AS OF DECEMBER 31, 2024, THE WORLD BANK INCOME CLASSIFICATIONS BY GNI FOR THE COUNTRIES WITH NEW SIGN PROGRAMS WERE AS FOLLOWS: LOW INCOME: 48% LOWER MIDDLE INCOME: 44% UPPER MIDDLE INCOME: 8%DISASTER AND CONFLICT RESPONSE:WE BELIEVE IN EQUALITY OF FRACTURE CARE FOR ALL, REGARDLESS OF GENDER, RELIGION, POLITICAL AFFILIATION, OR ANY OTHER IDENTITY. WE CONTINUE TO SUPPORT THE 17 SIGN PROGRAMS IN HAITI AS BEST AS WE ARE ABLE. THE ONGOING GANG VIOLENCE IN THE COUNTRY LIMITS OUR ABILITY TO PROVIDE REPLACEMENT SIGN IMPLANTS AND INSTRUMENTS AS AIRLINES ROUTINELY CANCEL FLIGHTS. WE CONTINUE TO COMMUNICATE WITH THE SURGEONS IN-COUNTRY AND SEND REPLACEMENT SIGN IMPLANTS AND INSTRUMENTS THROUGH AVAILABLE AVENUES AS THEY APPEAR.IN LATE 2024, A STUDENT-LED MOVEMENT OUSTED THE CURRENT PRIME MINISTER OF BANGLADESH. THE FALLOUT OF THE MOVEMENT RESULTED IN AN INCREASE IN VIOLENCE FROM VARIOUS INTERNAL GROUPS. A LOCAL SIGN SURGEON ALERTED US TO THE INCREASE IN FRACTURE PATIENTS IN THE WEEKS FOLLOWING THE OUSTING OF THE FORMER PRIME MINISTER AND REQUESTED ADDITIONAL SIGN NAILS AND INSTRUMENT SETS TO TREAT THE INFLUX OF PATIENTS. IN RESPONSE TO THEIR REQUEST, WE PROVIDE TWO ADDITIONAL SIGN SETS AND 130 SIGN NAILS TO ASSIST WITH THE INCREASED PATIENT LOAD.IN MYANMAR, THE EFFECTS OF THE MILITARY COUP ARE STILL FELT BY THE POOR POPULATION, AND ACCESS TO FRACTURE CARE IS CRUCIAL. WE CONTINUE TO SUPPORT THE SIGN PROGRAMS THERE WITH IMPLANTS AND INSTRUMENTS WHEN WE'RE ABLE TO SHIP TO THEM.WE ARE ALSO SUPPORTING MANY HOSPITALS IN AFGHANISTAN AS THEY NAVIGATE THROUGH THEIR TUMULTUOUS LANDSCAPE, AND WORK WITH LOCAL SURGEONS TO ENSURE THE AVAILABILITY OF FRACTURE CARE IS WIDESPREAD FOR THE POOR POPULATION. IN EARLY 2024, WE WERE ABLE TO START 2 NEW SIGN PROGRAMS IN AFGHANISTAN AND ARE LOOKING FORWARD TO WORKING WITH THEM IN THE FUTURE.

  Expenses $4,341,608 · Revenue $301,247

• Withheld by Nonprofiteer: this text may name a private individual.

  Expenses $1,261,573 · Grants $189,825 · Revenue $52,177

• PEOPLE LIVING IN LMIC CANNOT ACCESS SPINE CARE WHEN IT IS NOT AVAILABLE IN THEIR COMMUNITY. THE INCIDENCE OF TRAUMATIC SPINAL INJURIES IN LMIC IS ESTIMATED TO BE 13.7 CASES PER 100,000 PERSONS. SIGN HAS IMPLEMENTED A SIGN SPINE PROGRAM AT TWO HOSPITALS IN TWO COUNTIES. WE HAVE PLANS TO EXPAND INTO THREE MORE COUNTRIES WITH A TOTAL OF 10 SITES. WE HAVE THREE GOALS: 1. IMPROVE ACCESS TO SAFE SPINE SURGERY WORLDWIDE. 2. IMPROVE ACCESS TO SPINE SURGICAL EDUCATION AND TRAINING. 3. IMPROVE ACCESS TO AFFORDABLE SPINE IMPLANTS. SIGN IS PARTNERING WITH TEACHING HOSPITALS IN CANADA TO PROVIDE YEAR-LONG FELLOWSHIPS FOR SURGEONS FROM LMIC HOSPITALS. THE GRADUATES WILL RETURN TO THEIR HOSPITALS TO PROVIDE SAFE, EFFECTIVE CARE FOR PATIENTS WITH SPINE INJURIES, AS WELL AS PROVIDE TRAINING TO OTHER SURGEONS.

  Expenses $41,671 · Revenue $86,825

As filed on the 2024 return. The filer continues this part on Schedule O, which is not shown here. A text marked withheld matched a screen for wording that may name a private individual, such as an honorific or "in memory of". Most of what it withholds names no one; it is withheld so that what does is never shown.

Listed in Part VII

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Provenance

Return type

form_990

Tax year

2024

Filed

24 July 2025

IRS schema version

2024v5.2

Source object

202512109349300136

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