Form 990 for tax year 2025

Totals

Total revenue

$51,354,803

Total expenses

$14,057,217

Contributions and grants received

$50,406,422

Grants paid

$246,866

Program service revenue

$494,689

Investment income

$413,565

Other revenue

$40,127

Total assets, end of year

$53,272,231

Total liabilities, end of year

$250,824

Net assets or fund balances, end of year

$53,021,407

Program services expenses (Part IX)

$12,930,669

Management and general expenses

$441,302

Fundraising expenses

$685,246

Program service expenses (Part III)

$12,930,669

Program services were 92.0% 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 · 2025

• 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. 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 2025, WE DISTRIBUTED 28,356 SIGN NAILS TO 52 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 2025. THE BREAKDOWN WAS AS FOLLOWS: AFRICA: 16 PROGRAMS ASIA: 6 PROGRAMS AS OF DECEMBER 31, 2025, 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. IN LATE JANUARY, ARMED REBELS SEIZED GOMA, THE LARGEST CITY IN EASTERN DEMOCRATIC REPUBLIC OF THE CONGO. WE HAVE BEEN IN COMMUNICATION-IN BETWEEN INTERNET ROLLING BLACKOUTS-WITH THE TWO PROGRAM MANAGERS IN GOMA. TO ASSIST WITH THE INCREASED NUMBER OF TRAUMA PATIENTS, WE SENT AN ADDITIONAL SIGN SET AND 100 SIGN NAILS TO DRS. JOHN MUSUBAO AND ALFRED CHASUMBA.A SERIES OF TWO INTENSE EARTHQUAKES STRUCK THE MANDALAY REGION IN MYANMAR ON MARCH 28TH. TWO DAYS AFTER THE EARTHQUAKES, THE MYANMAR GOVERNMENT REPORTED 1644 DEATHS AND 3408 INJURIES. WE WERE FORTUNATE THAT THE TWO HOSPITALS NEAR THE EPICENTERS WERE NOT ADVERSELY AFFECTED BY THE EARTHQUAKES AND WERE ABLE TO START TREATING INJURED PATIENTS WITH SIGN NAILS IMMEDIATELY. TO HELP SUPPORT THE SIGN PROGRAMS' EFFORTS IN TREATING INJURED PATIENTS, WE SENT 2 SIGN SETS, 200 SIGN NAILS, AND 3 LARGE EXTERNAL FIXATOR KITS. ON AUGUST 31ST, AFGHANISTAN EXPERIENCED A 6.0 EARTHQUAKE IN NURGAL DISTRICT, A REGION 102 MILES OUTSIDE OF KABUL. THE INITIAL EARTHQUAKE AND SUBSEQUENT AFTERSHOCKS INJURED 4,000 PEOPLE AND DAMAGED MULTIPLE HEALTH CENTERS IN THE AREA. TO ASSIST WITH THE PATIENT LOAD, WE SENT TWO NEW SIGN SETS, 373 SIGN NAILS, 8 LARGE EXTERNAL FIXATOR KITS, AND A LARGE FRAGMENT INSTRUMENT SET.

  Expenses $11,297,605 · Revenue $473,674

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

  Expenses $1,394,593 · Grants $246,866 · Revenue $21,015

• PEOPLE LIVING IN LMICS CANNOT ACCESS SPINE CARE WHEN IT IS NOT AVAILABLE IN THEIR COMMUNITY. THE INCIDENCE OF TRAUMATIC SPINAL INJURIES IN LMICS 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.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. AS OF 2025, WE HAVE ACTIVE SPINE PROGRAMS IN KENYA, TANZANIA, MALAWI, ETHIOPIA, AND PAKISTAN.

  Expenses $238,471

As filed on the 2025 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

2025

Filed

22 July 2026

IRS schema version

2025v4.2

Source object

202602159349300630

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