Sign Fracture Care International
Public records show a registered, tax-exempt organization in good standing.
What it says it does
SIGN PARTNERS WITH OVERSEAS SURGEONS TO BUILD SUSTAINABLE ORTHOPAEDIC CAPACITY BY DONATING EDUCATION, INSTRUMENTS, AND IMPLANTS. BY WORKING WITH TEACHING HOSPITALS AND HOSTING EDUCATIONAL CONFERENCES WORLDWIDE, SIGN EQUIPS SURGEONS TO HEAL PATIENTS WITHIN THEIR OWN COMMUNITIES.
- Income
- $51.4 million
- Spending
- $14.1 million
- Spent on programs
- 92%
- Reserves
- 40.5 months of spending
- Largest source of income
- donations and private grants, 98%
- Employees
- 41
- Volunteers
- 54
- Highest pay
- $196,232, secretary/ceo
Source: Form 990 for the year ending December 31, 2025, filed with the Internal Revenue Service. Rating method 2026.2. How we rate
Financial health
Strong: 100 out of 100. Higher than 93% of charities in its peer group (health care, $10m to $100m).
Reserves
35 of 35Spendable reserves would cover 40.5 months of spending.
Debt
20 of 20It owes 0% of what it owns.
Living within its means
15 of 15Income exceeded spending by 73% of income.
Income trend
15 of 15Income rose 633% on the year before.
Spending floor
15 of 1592% of spending went to programs and raising each dollar of donations cost 1 cents.
Source: Form 990 for the year ending December 31, 2025, filed with the Internal Revenue Service. Rating method 2026.2. How we rate
Governance
Strong: 100 out of 100. Higher than 52% of charities in its peer group (health care, $10m to $100m).
Independent board
25 of 259 of 9 voting board members are independent.
Conflict of interest policy
15 of 15Has a written conflict of interest policy.
Whistleblower policy
8 of 8Has a written whistleblower policy.
Record keeping policy
7 of 7Has a written policy on keeping and destroying records.
Board minutes
5 of 5Keeps minutes of board meetings.
Board sees the tax return
10 of 10Gave the board a copy of this return before filing it.
Pay set independently
5 of 5Sets its chief executive's pay through independent review and comparison.
Independent check of accounts
15 of 15Its accounts were audited by an independent accountant.
No reported misuse
10 of 10Reports no diversion of assets, excess benefits or loans to insiders.
Source: Form 990 for the year ending December 31, 2025, filed with the Internal Revenue Service. Rating method 2026.2. How we rate
Impact evidence
Describes programs. Its tax return describes what it does but we have found no measurable results in it.
Programs described in its return (3)
- $11.3 million spent. 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.
- $1.4 million spent. WE BUILD SUSTAINABLE ORTHOPAEDIC CAPACITY IN LMIC BY EDUCATING LOCAL SURGEONS TO CARE FOR PATIENTS IN THEIR HOME COMMUNITIES. FOR 26 YEARS, SIGN HAS BEEN WORKING ALONGSIDE SURGEONS IN LMIC, RAISING ORTHOPAEDIC KNOWLEDGE AND SKILL. WE NOW RELY ON SIGN SURGEON MENTORS TO PROVIDE EDUCATION TO NEW SURGEONS. ONCE NEW SURGEONS ARE TRAINED, THEY RECEIVE THEIR OWN STARTER SET OF THE SIGN IM NAIL SYSTEM WITH TRAINING MATERIALS INCLUDED. THE TRAINING MANUALS ARE AUGMENTED BY ONLINE MENTORSHIP VIA THE SIGN SURGICAL DATABASE (SSDB). SURGEONS ARE REQUIRED TO ENTER CASES INTO THE SSDB IN EXCHANGE FOR A FREE RESUPPLY OF SIGN NAILS. EACH CASE IS REVIEWED BY AN ORTHOPAEDIC SURGEON FROM OUR BOARD OR EXPERIENCED SIGN SURGEON MENTORS. THEIR FEEDBACK ON EACH CASE IS SENT TO ALL ORTHOPAEDIC SURGEONS AT THAT HOSPITAL VIA EMAIL.WE PROVIDE ACCESS TO ORTHOPAEDIC TRAINING AND EDUCATION TO SURGEONS IN DEVELOPING COUNTRIES VIA FIVE PRIMARY CHANNELS:1. ONSITE VISITS BY LOCAL SURGEONS AND NORTH AMERICAN AND EUROPEAN SURGEONS. 2. EMAIL COMMUNICATIONS WITH SIGN HEADQUARTERS.3. DISCUSSION TOPICS AND EDUCATIONAL RESOURCES POSTED ON OUR WEBSITE, THE HUB.4. REVIEW OF CASES SUBMITTED TO THE SIGN SURGICAL DATABASE BY SENIOR ORTHOPAEDIC SURGEONS AND SIGN BOARD MEMBERS. 5. REGIONAL SIGN AND TRAUMA CONFERENCES, AS WELL AS THE ANNUAL INTERNATIONAL ORTHOPAEDIC CONFERENCE HELD AT SIGN HEADQUARTERS.THE OBJECTIVES FOR ALL MODES OF TRAINING ARE: 1) ENSURE SIGN SURGEONS UNDERSTAND THE SURGICAL TECHNIQUE FOR THE SIGN PRODUCTS IN THEIR HOSPITAL; 2) PROVIDE TRAINING ON CURRENT AND RELEVANT ORTHOPAEDIC PRINCIPLES; AND 3) PROVIDE TRAINING IN ORTHOPAEDIC AND TRAUMA PROCEDURES FOR INJURIES SUCH AS OPEN WOUNDS, LIMB DEFORMITY, PEDIATRIC, AND PELVIC.EXPAND TRAINING AND EDUCATIONAL OPPORTUNITIES:THE ANNUAL SIGN CONFERENCE WAS HELD IN SEPTEMBER 2025 AT SIGN HEADQUARTERS IN RICHLAND, WASHINGTON. THIS CONFERENCE PROVIDED A COMBINATION OF DIDACTIC LECTURES ON FRACTURE MANAGEMENT, CASE STUDIES, SEVEN CADAVER LAB SESSIONS, AND A SPECIAL FULL-DAY SESSION ON THORACOLUMBAR SPINE.THE 2025 SIGN CONFERENCE FEATURED 96 SURGEONS FROM 21 COUNTRIES. THE FIRST TIME ATTENDEE ORIENTATION WAS ATTENDED BY 13 SURGEONS AND INCLUDED A TOUR OF THE SIGN HQ AND BREAKOUT SESSIONS TO FAMILIARIZE NEW ATTENDEES WITH OUR INSTRUMENTS AND IMPLANTS.THE BIOSKILLS LAB AND PROCEDURAL LEARNING CENTER, WHICH WAS COMPLETED IN EARLY 2022, CONTINUES TO BE A FOCAL POINT DURING THE SIGN CONFERENCE. THESE FACILITIES ALLOW CONFERENCE ATTENDEES TO EXPERIENCE HANDS-ON TRAINING FROM EXPERT CLINICAL EDUCATORS. THE LAB SESSIONS TEACH CRITICAL TECHNIQUES SUCH AS PELVIC FRACTURES, PROXIMAL FEMUR FRACTURES, ELBOW FRACTURES, ANKLE FRACTURES/FUSIONS, THORACIC/LUMBAR SPINE, AND TIBIAL PLATEAU FRACTURES. WE CONTINUE TO DEVELOP OUR RELATIONSHIP WITH THE INSTITUTE FOR GLOBAL ORTHOPAEDICS AND TRAUMATOLOGY (IGOT). IN 2025, IGOT HOSTED THEIR THREE-DAY SURGICAL MANAGEMENT AND RECONSTRUCTIVE TRAINING COURSE (SMART) COURSE IN SAN FRANCISCO AFTER THE CONCLUSION OF THE SIGN CONFERENCE. THIS ALLOWED NEARLY ALL CONFERENCE ATTENDEES TO ATTEND AND RECEIVE ADDITIONAL CADAVER TRAINING IN FLAPS FOR SOFT TISSUE RECONSTRUCTION AND DEFORMITY CORRECTION. THE SMART COURSE INCLUDED A "REAL-LIFE" SURGICAL CASE SIMULATION, PROVIDING ATTENDEES WITH THE OPPORTUNITY TO APPLY THE SKILLS THEY LEARNED OVER THE WEEK INTO PRACTICE. IGOT ALSO HELD A CLINICAL RESEARCH SYMPOSIUM FOCUSED ON CONDUCTING STUDIES TO ADDRESS CRITICAL TREATMENT QUESTIONS FACED BY THE ATTENDEES' SPECIFIC PATIENT POPULATIONS.IGOT ALSO PROVIDES REGIONAL TRAINING IN OTHER SURGICAL TECHNIQUES TO SIGN SURGEONS IN EAST AFRICA AND NEPAL.THE 2ND INTERNATIONAL SIGN CONFERENCE WAS HELD AT SHAHAB ORTHOPAEDIC HOSPITAL IN PESHAWAR, PAKISTAN IN MAY 2025. 54 AFGHANI AND PAKISTANI SURGEONS ATTENDED IN PERSON AND DOZENS MORE PARTICIPATED VIA TELECONFERENCE. MODELING THE FORMAT AFTER THE ANNUAL SIGN CONFERENCE IN RICHLAND, WA, DR. FASEEH SHAHAB ORGANIZED LOCAL SURGEONS TO BE THE PRIMARY FACULTY, PROVIDING LECTURES THAT HIGHLIGHTED THEIR EXPERTISE, RESEARCH, AND EXPERIENCE.DR. DAVID SHEARER, VICE PRESIDENT OF THE SIGN BOARD, TRAVELED AND PRESENTED AT THE CONFERENCE IN PERSON. IN ADDITION, EXPERT SURGEONS FROM AROUND THE WORLD PRESENTED VIA ZOOM, INCLUDING DR. LEWIS ZIRKLE, SIGN PRESIDENT AND FOUNDER, AND DR. AUNG THEIN HTAY FROM MYANMAR, DR. ISMAIL WARDAK FROM AFGHANISTAN, AND DR. EMEKA IZUAGBA FROM NIGERIA.SIGN AND IGOT PARTNERED WITH THE MUHIMBILI ORTHOPAEDIC INSTITUTE TO HOLD THE 10TH ANNUAL TANZANIA SMART COURSE IN JUNE 2025. OVER 140 SURGEONS ATTENDED THE COURSE FOCUSING ON A MIX OF DIDACTIC LECTURES AND DEMONSTRATIONS FOR ORTHOPAEDIC SURGEONS AND RESIDENTS. THIS YEAR'S COURSE FEATURED SEVERAL MEMBERS OF THE SIGN CLINICAL ADVISORY COMMITTEE AS FACULTY: DR. BILLY HAONGA (TANZANIA), DR. FASEEH SHAHAB (PAKISTAN), DR. EMEKA IZUAGBA (NIGERIA), AND DR. DAVID SHEARER (USA).THE HUB, SIGN'S WEBSITE FOR EDUCATIONAL RESOURCES FOR SURGEONS, CONTAINS VIDEOS, ARTICLES, DISCUSSIONS, AND MORE TO PROVIDE ONGOING LEARNING OPPORTUNITIES FOR SURGEONS ACROSS THE GLOBE.THE SIGN IT DEPARTMENT CONTINUES TO MAKE IMPROVEMENTS TO THE SIGN SURGICAL DATABASE WEBSITE, WHICH IS THE BACKBONE OF REPORTING AND RESEARCHING SURGICAL CASES. OUR IT DEPARTMENT HAS IMPROVED THE STUDIES AND RESEARCH TOOLS ON THE DATABASE TO ACCOMMODATE USER NEEDS AND UPDATED THE BACK-END FRAMEWORK OF THE DATABASE TO IMPROVE OVERALL EFFICIENCY.OUR TRAVELING SET PROGRAM MODEL WAS A CONTINUED SUCCESS IN ETHIOPIA, TANZANIA, AND GHANA. IN THIS MODEL, THE MENTOR SURGEON MANAGING THE SET IDENTIFIES A HOSPITAL THEY BELIEVE HAS THE POTENTIAL TO SERVE MANY PATIENTS. THE MENTOR SURGEON THEN TRAVELS TO THE HOSPITAL AND TRAINS THE SURGEONS IN THE SIGN TECHNIQUE AND DATABASE REPORTING. AFTER THE TRAINING IS COMPLETED, THE SET IS STATIONED AT THE HOSPITAL FOR THREE MONTHS. IF THE HOSPITAL REPORTS AT LEAST 25 CASES WITHIN THE THREE-MONTH PERIOD, THEY ARE ELIGIBLE TO APPLY TO START THEIR OWN SIGN PROGRAM. WE STARTED 4 NEW PROGRAMS IN TANZANIA VIA THE
- $238,471 spent. 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.
Source: Form 990 for the year ending December 31, 2025, filed with the Internal Revenue Service. Rating method 2026.2. How we rate
Legitimacy checks
Is it registered with the IRS? Passed.
Listed in the IRS master file of tax-exempt organizations as a 501(c)(3) charitable organization.
Source: Exempt Organizations Business Master File, Internal Revenue Service, file dated October 13, 2026.
Has the IRS revoked its tax-exempt status? Passed.
Not on the IRS automatic revocation list.
Source: Automatic revocation of exemption list, Internal Revenue Service, file dated October 13, 2026.
Are donations tax-deductible? Passed.
On the IRS list of organizations eligible to receive tax-deductible contributions.
Source: Publication 78 data: organizations eligible for tax-deductible contributions, Internal Revenue Service, file dated October 13, 2026.
Is it keeping up with its IRS filings? Passed.
Most recent return on file covers the year ending December 2025.
Source: Exempt Organizations Business Master File, Internal Revenue Service, file dated October 13, 2026.
How long has it been tax-exempt? Passed.
Recognized by the IRS since December 1999.
Source: Exempt Organizations Business Master File, Internal Revenue Service, file dated October 13, 2026.
Is it in good standing with state regulators? Passed.
Not on California's list of charities barred from soliciting. Other states are not yet checked.
Source: May Not Operate or Solicit for Charitable Purposes list, California Attorney General, Registry of Charities and Fundraisers, file dated October 21, 2026.
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