2023-08-15T16:43:04-05:00 2022-12-31 562382653 NORTHWEST CPA GROUP PLLC 1333 COLUMBIA PARK TRAIL STE 210 RICHLAND WA 99352 990 2022-01-01 911952283 SIGN FRACTURE CARE INTERNATIONAL SIGN 5093711107 451 HILLS STREET SUITE B RICHLAND WA 99354 JEANNE DILLNER CHIEF EXECUTIVE OFFICER 5093711107 2023-08-14 1 JEANNE DILLNER 999009999 1 ALISON C GEBERS P00423745 5097351300 2023-08-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SIGN 451 HILLS STREET SUITE B RICHLAND WA 99354 9183879 0 X WWW.SIGNFRACTURECARE.ORG X 1999 WA BUILD ORTHOPAEDIC CAPACITY IN DEVELOPING COUNTRIES BY PROVIDING ORTHOPAEDIC TRAINING AND IMPLANTS. 11 11 48 47 0 0 7982956 6595978 1084354 795028 468009 136409 39317 45922 9574636 7573337 104823 147621 0 0 2666222 2695301 0 0 535399 3492405 4314549 6263450 7157471 3311186 415866 16004301 15343472 347896 383197 15656405 14960275 X SEE SCHEDULE O 0 0 1172780 147621 14051 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; 3) PROVIDE TRAINING IN ORTHOPAEDIC AND TRAUMA PROCEDURES FOR INJURIES SUCH AS OPEN WOUNDS, LIMB DEFORMITY, PEDIATRIC, AND PELVIC AND 4) BEGIN THE PLANNING PROCESS TO START SIGN SPINE.EXPAND TRAINING AND EDUCATIONAL OPPORTUNITIES:THE ANNUAL SIGN CONFERENCE WAS HELD IN OCTOBER 2022 AT SIGN HEADQUARTERS IN RICHLAND, WASHINGTON AFTER A TWO-YEAR HIATUS. THIS CONFERENCE PROVIDED A COMBINATION OF DIDACTIC LECTURES ON FRACTURE MANAGEMENT, CASE STUDIES, AND SIX CADAVER LAB SESSIONS. WITH AN EYE ON THE DWINDLING GLOBAL PANDEMIC AND UNCERTAINTY AROUND INTERNATIONAL TRAVEL, WE DECIDED TO PROVIDE SPECIALIZED TRAINING TO A LIMITED NUMBER OF THE SENIOR SIGN SURGEONS, WITH THE HOPE THAT THEY WOULD IMPART THIS KNOWLEDGE ON THEIR FELLOW SIGN SURGEONS WHEN THEY RETURN TO THEIR HOME COUNTRIES. AS A RESULT, 27 SIGN SURGEONS FROM 16 DIFFERENT COUNTRIES ATTENDED THE 2022 SIGN CONFERENCE.IN ADDITION, THE 2022 SIGN CONFERENCE FEATURED THE INAUGURAL USE OF THE NEW BIOSKILLS LAB AND PROCEDURAL LEARNING CENTER, WHICH WAS COMPLETED IN EARLY 2022. THESE NEW FACILITIES, COUPLED WITH A SMALLER GROUP OF CONFERENCE ATTENDEES, ALLOWED US TO HOST MORE CADAVER LAB SESSIONS. THE LAB SESSIONS COVERED CRITICAL TOPICS SUCH AS PELVIC FRACTURES, PROXIMAL FEMUR FRACTURES, ELBOW FRACTURES, ANKLE FUSIONS, AND SOFT TISSUE WOUND COVERAGE. THIS CONFERENCE ALSO MARKED THE FIRST CADAVER LAB SESSION ON CERVIAL SPINE. WE CONTINUE TO PARTNER WITH THE INSTITUTE FOR GLOBAL ORTHOPAEDICS AND TRAUMATOLOGY (IGOT) WHO PROVIDES ADDITIONAL CADAVER TRAINING IN FLAPS AND DEFORMITY CORRECTION IN THEIR TWO-DAY SMART COURSE AFTER THE SIGN CONFERENCE. IGOT ALSO PROVIDES REGIONAL TRAINING IN OTHER SURGICAL TECHNIQUES TO SIGN SURGEONS IN EAST AFRICA AND NEPAL.IN 2020, IN PARTNERSHIP WITH IGOT, WE LAUNCHED THE SUCCESSFUL SIGN TRAUMA SESSIONS WEBINAR SERIES. THESE WEBINARS ARE HELD MONTHLY VIA ZOOM AND RECORDED FOR THOSE SURGEONS WHO CANNOT ATTEND LIVE. NEARLY EVERY SESSION INCLUDES FACULTY WHO ARE SIGN SURGEONS. THE SIGN TRAUMA SESSIONS GIVE SIGN SURGEONS A CHANCE TO SHARE THEIR KNOWLEDGE AND EXPERTISE WITH THEIR COLLEAGUES AND DISCUSS RELEVANT TOPICS IN TRAUMA CARE SUCH AS HUMERUS FRACTURES, PEDIATRIC FRACTURES, SOFT TISSUE WOUND COVERAGE, AND PELVIC FRACTURES. IN 2022, WE HAD 10 WEBINARS WHICH REACHED MORE THAN 1,100 SIGN SURGEONS. 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. THE UPGRADES ALLOWED OUR TEAM TO ASK QUESTIONS ONLY OF CERTAIN PROGRAMS, GIVING US THE ABILITY TO CREATE LIMITED ENROLLMENT STUDIES, AND IMPROVED SITE SECURITY.WE CONTINUE TO PARTNER WITH BLACK LION HOSPITAL, IN ADDIS ABABA, ETHIOPIA ON THE FIRST EAST AFRICAN PELVIC FELLOWSHIP PROGRAM. IN 2022, THEY TRAINED 3 ETHIOPIAN FELLOWS WHO WERE THEN ABLE TO RETURN HOME AND PUT THEIR NEW SKILLS INTO PRACTICE IN THEIR LOCAL COMMUNITY.OUR TRAVELING SET PROGRAM MODEL WAS A CONTINUED SUCCESS IN ETHIOPIA AND TANZANIA. 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 10 CASES WITHIN THE THREE-MONTH PERIOD, THEY ARE ELIGIBLE TO APPLY TO START THEIR OWN SIGN PROGRAM. IN 2022, WE ADDDED TWO ADDITIONAL TRAVELING SETS, ONE IN TANZANIA AND ONE IN ETHIOPIA. DUE TO A LIMITATION ON SOME OF OUR INSTRUMENTS THERE WERE ONLY TWO NEW SIGN PROGRAMS STARTED USING THE TEACHING SET MODEL. HOWEVER, WE ARE LOOKING FORWARD TO MAKE UP THE DIFFERENCE IN 2023. 5091196 780977 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 2021, SIGN ENGINEERS DEVELOPED ONE NEW PRODUCT AND MADE DESIGN IMPROVEMENTS TO ONE INSTRUMENT TO ASSIST IN A VARIETY OF ORTHOPAEDIC SURGERIES. THE NEW PRODUCT WAS AN L-HANDLE SCREW EXTRACTOR, DESIGNED TO REMOVE SHOULDER CAP SCREWS FROM THE L-HANDLE WHEN BROKEN OFF INSIDE. AND THE SHOULDER CAP SCREW WAS RE-DESIGNED TO INCREASE USAGE AND MINIMIZE THE ABILITY FOR OPERATING STAFF TO OVER TORQUE THE SCREW, WHICH CAN LEAD TO BREAKAGE.WE SUPPLY NEW 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 2022, WE DISTRIBUTED 28,278 SIGN NAILS TO 57 COUNTRIES. OUR AIM IS TO ENABLE THE POOR TO GAIN ACCESS TO AFFORDABLE ORTHOPAEDIC SURGERY, WHICH MEANS THAT THE MAJORITY OF OUR IMPLANTS ARE DONATED FREE OF CHARGE TO THE PATIENT.WE STARTED 29 NEW SIGN PROGRAMS IN 2022. THE BREAKDOWN WAS AS FOLLOWS: AFRICA: 11 PROGRAMS ASIA: 2 PROGRAMS EUROPE: 16 (UKRAINE CONFLICT)AS OF DECEMBER 31, 2022, THE WORLD BANK INCOME CLASSIFICATIONS BY GNI FOR THE COUNTRIES WITH NEW SIGN PROGRAMS WERE AS FOLLOWS: LOW INCOME 40% AND LOWER MIDDLE INCOME 60%. DISASTER AND CONFLICT RESPONSE:WE BELIEVE IN EQUALITY OF FRACTURE CARE FOR ALL, REGARDLESS OF GENDER, RELIGION, POLITICAL AFFILIATION, OR ANY OTHER IDENTITY. SINCE THE BEGINNING OF THE WAR IN UKRAINE, WE PARTNERED WITH UKRAINIAN SURGEONS AND LIKE-MINDED ORGANIZATIONS TO GET THE SIGN NAILS AND INSTRUMENTS INTO THE HANDS OF THE DOCTORS ON THE GROUND. WE HAVE SENT SIGN SETS TO 15 HOSPITALS THROUGHOUT UKRAINE, ALONG WITH OVER 900 SIGN NAILS (INCLUDING SIGN HIP NAILS AND PEDIATRIC NAILS), 19 LARGE EXTERNAL FIXATOR SETS, SMALL AND LARGE FRAGMENT SETS, AND MANY OTHER GENERAL SURGERY CONSUMABLES. TO PROVIDE ADDITIONAL RESOURCES FOR THE UKRAINIAN SURGEONS, WE TRANSLATED AN INTRODUCTION TO SIGN PRESENTATION INTO UKRAINIAN AND ADDED UKRAINIAN SUBTITLES TO OUR ANIMATED TECHNIQUE VIDEO. WE CONTINUE TO COMMUNICATE WITH THESE SURGEONS IN UKRAINE, AND WE ARE PREPARING SHIPMENTS TO RESUPPLY THEIR HOSPITALS WITH SIGN IMPLANTS AS NEEDED.THERE WAS A PEACE TREATY SIGNED BETWEEN THE ETHIOPIAN GOVERNMENT AND TIGRAY PEOPLE'S LIBERATION FRONT. WE'VE RECEIVED REQUESTS FROM SEVERAL AFFECTED SIGN PROGRAMS AT FRONTLINE HOSPITALS WHO SAW AN INCREASE IN CASUALTIES RELATED TO THIS CONFLICT. AT THE TIME OF WRITING THIS REPORT, WE HAVE SENT 6 SETS OF LARGE EXTERNAL FIXATORS, 1 SIGN INSTRUMENT SET, AND 90 EXTRA NAILS TO ETHIOPIAN SIGN PROGRAMS WHO ARE TREATING THE WOUNDED. WE CONTINUE TO COORDINATE WITH OUR ETHIOPIAN SIGN PROGRAMS TO ENSURE THESE PROGRAMS HAVE THE SIGN INSTRUMENTS AND SIGN NAILS THEY NEED TO TREAT THEIR PATIENTS.IN AUGUST, TORRENTIAL MONSOON RAINS CAUSED THE MOST SEVERE FLOODING IN PAKISTAN'S RECENT HISTORY. UNICEF REPORTED THAT 33 MILLION PEOPLE WERE AFFECTED BY THE HEAVY MONSOON RAINS. IN RESPONSE, WE SENT A SIGN SET AND 50 NAILS TO A SIGN SURGEON IN LARKANA, PAKISTAN, TO ASSIST WITH THE INJURED PATIENTS HE WAS RECEIVING AT HIS HOSPITAL.SINCE THE TRANSFER OF POWER TO THE TALIBAN IN AFGHANISTAN, TRAVEL IN AND OUT OF THE COUNTRY HAS YET TO NORMALIZE. THIS HAS GREATLY AFFECTED OUR ABILITY TO SEND NAILS TO THE LOCAL SIGN PROGRAMS. IN LATE NOVEMBER 2021, WE WERE ABLE TO SEND A SHIPMENT VIA AN AIR FREIGHT COMPANY. NOW THAT WE HAVE FOUND A RELIABLE SHIPPING ROUTE INTO AFGHANISTAN, WE CONTINUE TO SUPPLY OUR SIGN SURGEONS WITH THE IMPLANTS THEY NEED TO TREAT THE INJURED POOR.SIGN SPINE: A TEAM OF SPINE SURGEONS FROM THE US AND CANADA ARE IMPLEMENTING A MULTI-SITE PROJECT TO ESTABLISH A SIGN SPINE PROGRAM. BY THE END OF 2022, THE SIGN SPINE PROGRAM HAD RAISED THE FUNDS TO PURCHASE INITIAL SPINE IMPLANTS AND INSTRUMENTATION FOR TWO HOSPITALS; ONE IN KENYA AND THE OTHER IN TANZANIA. THEY HAVE ALSO IDENTIFIED TWO SURGEONS WHO WILL ATTEND A ONE-YEAR ORTHOPAEDIC/NEUROSURGERY SPINAL FELLOWSHIP AT MCMASTER UNIVERSITY IN CANADA. THE TANZANIA PROGRAM IS EXPECTED TO BEGIN BY THE END OF 2023 AND THE KENYA PROGRAM WILL BEGIN IN JULY 2024. 6263976 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 6 0 1 48 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 AL AK AR CA CO DC FL GA HI IL KS KY MA MD MI MN MS NH NJ NM NV NY NC OH OK OR PA SC TN UT VA WA WI CT ME RI ND WV MO X ANGELA HOYER 5093711107 451 HILLS STREET SUITE B RICHLAND WA 99354 CARLA SMITH MD PHD BOARD MEMBER 1.00 X 0 0 0 JOHN STAEHELI MD BOARD MEMBER 1.50 X 0 0 0 LEWIS G ZIRKLE MD PRESIDENT/FOUNDER 60.00 X X 0 0 0 RANDALL HUEBNER BOARD MEMBER 22.00 X 0 0 0 STEPHEN SCHWARTZ BOARD MEMBER 1.00 X 0 0 0 RICHARD GELLMAN MD BOARD MEMBER 1.00 X 0 0 0 PATRICK YOON MD BOARD MEMBER 1.00 X 0 0 0 DAVID SHEARER MD VICE PRESIDENT 2.00 X X 0 0 0 ANN PENNER BOARD MEMBER 5.00 X 0 0 0 MICHAEL COSCIA MD BOARD MEMBER 10.00 X 0 0 0 BEN RIVERA BOARD MEMBER 10.00 X 0 0 0 JEANNE DILLNER SECRETARY/TREASURER/CEO 75.00 X 171248 0 13679 ROBERT SCHMITT REGULATORY AFFAIRS MANAGER 40.00 X 124489 0 13116 TERRY SMITH ENGINEERING MANAGER 40.00 X 145412 0 6198 BRIAN BARNES IT MANAGER 40.00 X 118423 0 12437 559572 0 45430 4 0 1 0 DASSAULT SYSTEMS AMERICAS CORP 175 WYMAN ST WALTHAM MA 02451 PROVIDE AND IMPLEMENT NEW ERP SYSTEM 371686 1 6595978 1435538 6595978 IMPLANT REVENUE 339110 780977 780977 OTHER REVENUE 541900 9216 9216 TRAINING CONFERENCE 611430 4835 4835 795028 92266 92266 63600 17678 45922 45922 45922 1637007 1592864 44143 44143 44143 7573337 795028 0 182331 147621 147621 172815 129611 43204 2522486 1882890 260386 379210 21875 21875 83216 31507 22093 29616 9772 8935 369 468 11914 10675 318 921 108769 108769 149446 132561 7178 9707 14993 11669 1465 1859 SUPPLIES 1910024 1857050 12195 40779 COST OF PRODUCT DISTRIB 1666441 1666441 SHIPPING 136586 136586 DUES, FEES AND TAXES 68530 32659 19460 16411 132983 107002 12757 13224 7157471 6263976 358096 535399 869678 1896701 3978029 3394837 172500 237742 171966 761094 956431 103829 125319 7782159 3038265 4488863 4743894 5380030 4044170 12536 10154 16004301 15343472 347896 383197 347896 383197 X 14402246 13254042 1254159 1706233 15656405 14960275 16004301 15343472 415866 -1111996 0 X X 0 1 X 1 0 X 3629218 8420434 5247095 7982956 6595978 31875681 831528 943761 878615 1084354 795028 4533286 4460746 9364195 6125710 9067310 7391006 36408967 792373 1557089 669090 1558238 1034783 5611573 370893 517401 552226 560894 408616 2410030 1163266 2074490 1221316 2119132 1443399 8021603 28387364 163467 143468 151940 156555 155866 771296 163467 143468 151940 156555 155866 771296 4624213 9507663 6277650 9223865 7546872 37180263 0.76350 0.73090 0.02070 0.02280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 880000 880000 1631388 163836 1467552 2000411 771731 1228680 2460217 1872331 587886 810143 230367 579776 4743894 X 7860119 -1111996 1381100 17678 286782 7573337 0 7573337 8556249 1381100 17678 1398778 7157471 0 7157471 PART X, LINE 2: MANAGEMENT HAS EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 17,678. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 17,678. 0 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 91561 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 65307 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 83531 MIDDLE EAST AND NORTH AFRICA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 28922 SOUTH AMERICA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 3671 SOUTH ASIA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 1403275 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 2242968 SUB-SAHARAN AFRICA 0 0 GRANTS TRAINING, IMPLANTS, STIPEND 79250 RUSSIA & THE NEWLY INDEPENDENT STATES 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 379002 EAST ASIA AND THE PACIFIC 0 0 GRANTS TRAINING, IMPANTS, STIPEND 6250 SOUTH ASIA 0 0 GRANTS TRAINING, IMPANTS, STIPEND 2201 0 0 0 0 0 0 3998485 387453 4385938 FELLOWSHIP STIPEND SUB-SAHARAN AFRICA 6 79250 CASH PAYMENT FELLOWSHIP STIPEND EAST ASIA AND THE PACIFIC 1 6250 CASH PAYMENT FELLOWSHIP STIPEND SOUTH ASIA 1 2201 CASH PAYMENT 0 0 0 0 0 0 PART I, LINE 2: GRANT REQUESTS ARE REVIEWED BY THE GRANT REVIEW COMMITTEE AS ESTABLISHED BY THE SIGN COMPLIANCE PROGRAM. MONITORING AWARDS IS A TWO PRONG APPROACH: A) FINANCIAL REPORTS OR RECEIPTS ARE SUBMITTED; AND, B) STATUS UPDATES ARE PROVIDED BY RECIPIENTS. PART III ACCOUNTING METHOD: X X 0 0 0 0 0 0 0 0 0 JEANNE DILLNER SECRETARY/TREASURER/CEO 171248 0 0 0 0 0 6913 0 6766 0 184927 0 0 0 TERRY SMITH ENGINEERING MANAGER 145412 0 0 0 0 0 5829 0 369 0 151610 0 0 0 X 42000 FAIR VALUE X 7183 FAIR VALUE X 7 85070 FAIR VALUE X 1 1320 FAIR VALUE X 34 1245998 FAIR VALUE X OTHER 2 35520 FAIR VALUE X TRAVEL EXPENSES FOR TRAINING 2 18446 FAIR VALUE 0 0 0 FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: SIGN'S VISON IS TO CREATE EQUALITY OF FRACTURE CARE THROUGHOUT THE WORLD. IN IMPLEMENTING ITS VISION, SIGN EMPOWERS SURGEONS, IMPLANTS HOPE AND RESTORES THE LIVES OF THE INJURED POOR AROUND THE WORLD. SIGN SURGERY ENABLES PEOPLE WITH SEVERELY BROKEN BONES TO WALK AND RETURN HOME WITHIN ONE WEEK OF SURGERY AND RETURN TO NORMAL FUNCTION WITHIN A FEW WEEKS. SIGN'S MISSION IS TO GIVE THE INJURED POOR ACCESS TO FRACTURE SURGERY BY DONATING ORTHOPAEDIC EDUCATION AND IMPLANT SYSTEMS TO SURGEONS IN DEVELOPING COUNTRIES. SIGN BUILDS SUSTAINABLE ORTHOPAEDIC CAPACITY IN LOW- AND MIDDLE-INCOME COUNTRIES (LMIC) BY EDUCATING LOCAL SURGEONS TO CARE FOR AND TREAT PATIENTS IN THEIR HOME COMMUNITIES. SIGN EQUIPS THE SURGEONS WITH THE SKILLS AND TOOLS THEY NEED, ENABLING THEM TO PROVIDE ONGOING CARE AND SUPPORT TO THEIR PATIENTS. THIS EDUCATION IS AUGMENTED THROUGH THE PROVISION OF A SUSTAINABLE SUPPLY OF ORTHOPAEDIC IMPLANTS AND INSTRUMENTS DESIGNED FOR USE IN LOW-RESOURCE HOSPITAL CONDITIONS. BY EMPOWERING SURGEONS IN LMIC, THESE SURGEONS ARE ABLE TO ACHIEVE EQUITABLE RESULTS IN THE TREATMENT THEY PROVIDE TO PATIENTS IN THEIR COMMUNITIES. SIGN DESIGNS AND MANUFACTURES THE SIGN IM NAIL SYSTEM WHICH IS DESIGNED FOR USE IN AUSTERE OPERATING ROOM CONDITIONS. SIGN FRACTURE CARE INTERNATIONAL IS REGISTERED WITH THE UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA). SIGN MANUFACTURES FINISHED MEDICAL DEVICES IN COMPLIANCE WITH THE CODE OF FEDERAL REGULATIONS, FDA QUALITY SYSTEM REGULATION. SIGN MAINTAINS A QUALITY MANAGEMENT SYSTEM THAT IS CERTIFIED TO BE COMPLIANT WITH ISO 13485:2016. ADDITIONALLY, SIGN DISTRIBUTES IN-KIND DONATIONS OF PRODUCTS NOT MANUFACTURED BY SIGN TO SOME OF THE BUSIER PROGRAMS. ACCORDING TO THE WORLD HEALTH ORGANIZATION (WHO), THE EPIDEMIC OF INJURIES CAUSED BY ROAD TRAFFIC ACCIDENTS, WORK INJURIES, AND CONFLICTS AFFECTS 20 TO 50 MILLION PEOPLE EVERY YEAR. NINETY PERCENT OF THE PEOPLE INJURED LIVE IN LMIC WHERE ACCESS TO ADEQUATE CARE IS LIMITED. BY EQUIPPING LOCAL SURGEONS WITH THE SKILLS AND TOOLS THEY NEED, SIGN ENABLES THEM TO PROVIDE ONGOING CARE AND SUPPORT TO THEIR PATIENTS. THIS EMPOWERMENT UPLIFTS RECIPIENTS AND THEIR FAMILIES, ENABLING THEM TO BREAK FREE FROM THE CYCLE OF POVERTY. THERE ARE APPROXIMATELY 7,000 SURGEONS IN MORE THAN 410 HOSPITALS IN 57 LMIC WHICH HAVE BENEFITED FROM SIGN EDUCATION AND THE PROVISION OF IMPLANTS AND INSTRUMENTS. WITH MORE THAN 400,000 SURGERIES TO DATE, AND WITH AN AVERAGE FAMILY SIZE OF FIVE, THIS MEANS SIGN HAS TOUCHED AND IMPROVED THE LIVES OF OVER 2 MILLION PEOPLE. SIGN ALSO RESPONDS TO DISASTERS AND CONFLICTS IN LOCATIONS WHERE SIGN HAS EXISTING PROGRAMS OR WHERE SIGN PROGRAMS NEED TO BE DEVELOPED. SINCE ELECTRICITY AND OTHER RESOURCES TYPICALLY FOUND IN OPERATING ROOMS AREN'T NEEDED TO PERFORM SIGN SURGERY, IT IS AN EFFECTIVE MEANS TO REDUCE THE NUMBER OF PERMANENT DISABILITIES FOR INJURED PEOPLE FOLLOWING A NATURAL DISASTER OR CONFLICT. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF FORM 990 IS PROVIDED TO SIGN'S CEO. THE FORM 990 IS PRESENTED FOR REVIEW TO THE BOARD OF DIRECTORS. ANY CHANGES ARE THEN DIRECTED TO THE RETURN PREPARER AND ADDRESSED BEFORE THE FINAL RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS MONITORED AND REVIEWED BY THE CHIEF COMPLIANCE OFFICER. THE CHIEF COMPLIANCE OFFICER REQUESTS ANNUAL CONFLICT OF INTEREST STATEMENTS FROM EACH BOARD MEMBER. THE STATEMENTS ARE REVIEWED WITH THE CEO/SECRETARY AND DISPOSITIONED. THE PRESIDENT IS BRIEFED ON FINDINGS ALONG WITH THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 15 AN ANNUAL PERFORMANCE REVIEW IS CONDUCTED FOR ALL EMPLOYEES INCLUDING THE CEO. THE ENTITY'S SIZE, INDUSTRY, TYPE OF ORGANIZATION, AND POSITION OF RESPONSIBILITIES ARE CONSIDERED IN DETERMINING COMPENSATION ADJUSTMENTS. ACCORDING TO THE ORGANIZATION'S BY-LAWS, THE PRESIDENT IS AUTHORIZED TO CONDUCT THE CEO'S ANNUAL REVIEW AND DETERMINE COMPENSATION. THE ORGANIZATION UTILIZES A SUBSCRIPTION TO PAYSCALE WHICH PROVIDES ACCURATE SALARY INFORMATION TO ESTABLISH PAY RANGES FOR EMPLOYEES. PAYSCALE ALSO ALLOWS THE ORGANIZATION TO INPUT PERFORMANCE RANKING DATA IN ORDER TO OBTAIN "RECOMMENDED RAISES" VIA THOSE RANKS JUXTAPOSED WITH WHERE EACH INDIVIDUAL'S CURRENT SALARY LANDS IN THE SALARY RANGE FOR THEIR POSITION. FORM 990, PART VI, SECTION C, LINE 19 THE PUBLIC MAY CONTACT THE ORGANIZATION AT IT'S PHYSICAL LOCATION TO REQUEST COPIES OF ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED THEIR OVERSIGHT PROCESS OR SELECTION PROCESS OF SELECTING AN INDEPENDENT AUDITOR DURING THE TAX YEAR.