Digital health · Global surgery
Watsi
A nonprofit that lets anyone put $5 toward a named patient’s operation in a low income country. Y Combinator’s first nonprofit, with thirteen years of IRS returns showing what the model costs and what it delivers.
The red folder
On December 3, 2010, a Peace Corps volunteer named Chase Adam was on a bus in Costa Rica when a woman boarded and asked passengers for money for her son’s medical care. That happened often. What did not happen often was that she got it.
“And then I found out she had her son’s medical record with her,” Adam told Voice of America. “It was in a red folder and she was passing it around the bus, and that really resulted in the trust of all these local passengers.”
He gave her money, then sat there thinking about the folder. The bus was passing through a town called Watsi. That became the name.
The gap it is aimed at
Watsi funds a narrow thing: surgical care under $1,500, with a high probability of success, out of reach for the patient. Cataract surgery. Clubfoot repair. A hysterectomy for a Kenyan widow who had lived with fibroids for twelve years.
Watsi does not pick patients. Vetted local medical partners do. Each must be legally registered where it works, have three years of history, and be tied to a US 501(c)(3), which pulls it into the same disclosure regime.
The counterargument to case by case giving is old and serious: it rewards photogenic stories over medical need, and treats symptoms of a broken financing system rather than the system. Watsi’s answer is that it guarantees funding for every case it accepts, so patients never compete.
Three founders and a Tuesday night call
Adam came home in 2011 and started building. Grace Garey, then at Kiva, heard about it from his younger brother and talked her way into running marketing. Jesse Cooke built the first version. The early team spanned six continents and eight time zones, everyone holding down day jobs.
Hospitals were harder to win than donors. “To most of the partners we initially reached out to, Watsi sounded like a fraud,” Garey told HuffPost. After dozens of cold emails they landed three: Nepal, Guatemala, Ethiopia.
Watsi launched in August 2012, hit the top of Hacker News, and caught Paul Graham’s eye. In January 2013 Y Combinator admitted it as the accelerator’s first nonprofit. Graham set out the arrangement: donations fund treatment, the organization is funded separately. That is the whole financial architecture, and the thing the tax filings can and cannot verify.
The Coverage detour
By 2016 the founders had decided that funding one operation at a time was treating the wrong layer. A boy in Haiti needed $1,500 of open heart surgery because untreated strep throat had gone septic. So Watsi started building health insurance software.
YC Research funded it. Engineers moved to Rwibaale, Uganda, and lived beside a clinic run by the Banyatereza Sisters for three months, building alongside the staff. Enrollment opened in March 2017; the FY2017 Form 990 records 5,880 people enrolled. A Harvard Center for Primary Care study found enrollment time fell from 15 days to under 90 seconds. In June 2018 an East African government agreed to replicate it.
Then it stopped. The announcement post now carries one line: “Meso is now being operated as an open-source project.” That was February 2020. Watsi kept the crowdfunding platform and gave the software away.
What the ledger did next
FY2017 expenses hit $5,612,012 against $3,071,857 of revenue. Calendar 2019 ran another $1,401,364 deficit. Fifteen people were on the payroll in 2019, five of them engineers over $100,000. In 2020 the headcount was three and other salaries fell from $1,035,522 to $97,178.
Both founders left operations. The 2020 return lists Chase Adam as “DIRECTOR (FORMER CEO)” and Grace Garey as “DIRECTOR (FORMER COO).” Mackinnon Engen, who had spent nearly fifteen years running international surgical programs at the UN and at NGOs, took over. Grants paid have since climbed from $997,285 in 2020 to $1,590,627 in 2024.
What is proven, and what is still claimed
| Evidence | What the record shows | Source type |
|---|---|---|
| Form 990, 2024 | Revenue $2,268,111, expenses $2,482,900, deficit $214,789, net assets $2,146,863. Five employees, four independent directors. | Public record |
| Money sent for care | Line 13 totals $17,866,116 across thirteen filed periods. The 2024 figure of $1,590,627 splits on Schedule F into Africa $912,415, Asia $557,024, Americas $121,188, paid through Stripe to foreign individuals. | Public record |
| The 100 percent claim | Watsi says every donation funds the chosen patient and that it absorbs the card fee, with overhead paid separately. Form 990 does not split designated gifts from unrestricted ones, so the claim cannot be audited from the return. In 2024 grants paid equalled 70.2 percent of contributions. | Company-stated |
| Overhead as filed | 2024: program $2,055,429 or 82.8 percent, admin $227,211 or 9.2, fundraising $200,260 or 8.1. Watsi’s 2025 review, marked audit in progress, gives 84 / 8 / 8. | Public record |
| Executive pay | 2024: Engen $159,179 plus $63,812. CFO Keenyn McFarlane, 20 hours a week, $60,231 plus $49,885. All directors zero. One person cleared $100,000. | Public record |
| Cumulative total | The January 2026 post announces $20 million directed toward healthcare. The 2019 Form 990 already said Watsi had raised $20M. The two count different things, money out versus money in. | Claims differ |
| Accountability | Charity Navigator scores 100 percent on all seven published Accountability and Finance metrics. The 4-star Encompass rating and GuideStar Platinum Seal are claimed by Watsi and not readable on the fetched page. | Independent |
| Scale | The 2024 return states more than 30,000 patients across 33 countries. Medical partners fell from 11 in FY2017 to 8 by 2019 while countries rose from 22 to 25. | Public record |
| Peer review | One PubMed hit, Primary Care 2030, Annals of Global Health, February 2020, with C. Adam among the authors. No outcome study of Watsi patients found. | Not found |
Read plainly: the money trail is unusually well documented for an organization this size, and it corroborates the scale Watsi claims. What the filings cannot settle is the marketing promise. A Form 990 reports total contributions, not which dollars were earmarked. Splitting the pass-through stream from the operating stream is an accounting act that only the audited statements and the public transparency ledger can show.
What to watch
- The calendar 2025 Form 990, and where the $20 million milestone lands on line 13.
- Whether the 2024 deficit repeats. Net assets cover about ten months of spending.
- Whether the Emergency Surgery Fund gets its own program service line.
- Renewal of The Collective’s three year unrestricted commitments.
- The medical partner count, 11 in FY2017 and 8 by 2019.
In their words
“And then I found out she had her son’s medical record with her. It was in a red folder and she was passing it around the bus, and that really resulted in the trust of all these local passengers.”
Chase Adam, co-founder, Voice of America, 2016 · Independent
“In that moment I had what can only be described as an epiphany. If I could somehow connect this woman with my friends and family back home, she would have the money to pay for her son’s medical treatment within the day.”
Chase Adam, The Next Web, January 2013 · Independent
“At Watsi, 100% of your donations directly fund medical treatments. Watsi.org is separately funded. They pay all their operational costs from their own funding, and none from your donations.”
Paul Graham, Y Combinator, January 2013 · Independent
“To most of the partners we initially reached out to, Watsi sounded like a fraud.”
Grace Garey, co-founder, HuffPost, 2015 · Interview
“In practice, Watsi is operating a bit like a global social insurance system whereby you have all these providers around the world who represent patients and we connect them to the funding that they need”
Grace Garey, The Guardian, June 2014 · Independent
“I’d rather that an organisation focuses on the recipients rather than the donors, but I can see that if you give a payback to the donor you are likely to raise more money”
Bryan Vernon, healthcare ethics, Newcastle Medical School, The Guardian, 2014 · Independent
“One means of doing that may be to encourage more transparent, nonprofit platforms such as Watsi as alternatives to the dominant, for-profit players.”
Jeremy Snyder, Simon Fraser University, STAT, February 2017 · Independent
Related companies
Sources
- Public recordIRS Form 990, Watsi Inc, calendar 2024
- Public recordIRS Form 990 filings, FY2014 to 2023
- Public recordNonprofit Explorer data, EIN 45-3236734
- Public recordForm 990 Schedules F, J and O, 2024
- Public recordPrimary Care 2030, PMID 32064227
- IndependentCharity Navigator rating page
- IndependentY Combinator Admits Watsi To Its Next Class
- IndependentNonprofit Watsi tries a new way to fund do-gooding
- IndependentCrowdfunding platform funds medical operations
- IndependentWatsi Receives $3.5M Philanthropic Round
- InterviewStartup Insider: Grace Garey
- IndependentWatsi Crowd-funds Healthcare for the World
- IndependentAn experiment in crowdfunded healthcare
- IndependentEthical issues in medical crowdfunding
- IndependentScaling technology to increase access
- CompanyWatsi FAQ
- CompanyIntroducing Watsi Coverage (Meso)
- CompanyOur journey to $20 Million
- CompanyWatsi 2025 Year in Review
- CompanyMeso Health FAQ
Profile researched and written by Healthcare Discovery. Last updated September 29, 2026.
