2019-07-03T16:01:31-05:00 2018-12-31 562382653 Northwest CPA Group PLLC 1333 Columbia Park Trail Ste 210 Richland WA 99352 990 2018-01-01 911952283 SIGN Fracture Care International SIGN 5093711107 451 Hills Street Suite B Richland WA 99354 Jeanne Dillner Chief Executive Officer 5093711107 2019-06-28 1 Alison C Gebers P00423745 5097351300 64.146.129.8 2019-06-28 13:14:55 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A91EF04F74A0564A03B0D327BD4BB47988B7FAD5 2018 2019-02-21 02:37:17Z SIGN 451 Hills Street Suite B Richland WA 99354 7406602 0 X www.signfracturecare.org X 1999 WA Build orthopaedic capacity in developing countries by providing orthopaedic training and implants. 10 10 55 94 0 0 2895228 3573413 1514890 831528 336536 591242 -33691 -24986 4712963 4971197 0 143435 0 0 2131589 2338900 0 0 404417 3529629 3851630 5661218 6333965 -948255 -1362768 11692188 9652006 238375 283605 11453813 9368401 X See Schedule O 0 0 769164 143435 26427 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 orthopaedic surgeons on the SIGN Board.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 2018 SIGN Conference held at headquarters in Richland, Washington included 6 BioSkills Labs for pelvic fractures, hip fractures, elbow fractures, ankle fusions, and soft tissue wound coverage. This elevated the surgical training experience for all SIGN Surgeons in attendance. We continue to partner with IGOT which provides additional cadaver training in flaps and pelvic fractures after the SIGN Conference. IGOT also provides regional training in other surgical techniques to SIGN Surgeons in East Africa and Nepal.The annual SIGN Conference is a tremendous experience for the SIGN Surgeons. However, the conference is limited to 150 participants. We have a long-term goal to establish regional trauma courses. In 2018, regional SIGN Conferences were held in Eldoret, Kenya, Dar es Salaam, Tanzania, and Yangon, Myanmar. In addition, we are partnering with Black Lion Hospital, in Addis Ababa, Ethiopia to create the first East African pelvic fellowship.Board member, Richard Gellman, MD, is now traveling to provide regional workshops on deformity correction. In 2018, he held a training session in Cameroon, and in 2019, he plans to hold three more workshops. Each trip includes donation of appropriate implants.In an effort to expand our educational opportunities to those who lack the ability to travel away from their hospital, we have launched a new website, called The Hub. The Hub allows SIGN Surgeons to collaborate with colleagues around the world via forum posts and provides easy access to our most up to date educational resources.We also offer educational opportunities for volunteers planning to travel to hospitals overseas. In 2018, we traveled to North Carolina to participate in a workshop hosted by World Medical Mission, which is a part of Samaritan's Purse. We also participated in a workshop hosted by the Canadian Orthopaedic Trauma Association. 4796458 805101 Distribute appropriate orthopaedic implants:The SIGN IM Nail and Interlocking 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 2018, we distributed several new products including drill covers and a new plating system that can reach more areas of the bone. SIGN Engineers also made progress on a linear clamp for use with femur and pelvic fractures.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 2018, we distributed 24,145 SIGN Nails to 50 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 12 new SIGN Programs in 2018. The breakdown was as follows: Africa: 8 programs Asia: 3 programs South America: 1 programAs of December 31, 2018, the World Bank income classifications by GNI for the countries with new SIGN Programs were as follows: Low Income 50%, Lower Middle Income 42%, and 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 2018, SIGN partnered with US-based NGO, ANERA, to begin the process of getting government approval to send a SIGN IM Nail System to Gaza. We also started a SIGN Program at Jigjiga University Meles Referral Hospital in Ethiopia, which treats a high number of refugees from Somaliland, as well as soldiers who work at the border. 5565622 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 1 11 0 1 55 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 10 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 Sandy Brown 5093711107 451 Hills Street Suite B Richland WA 99354 Carla Smith MD PhD Board Member 3.00 X 0 0 0 David Whitney MD Board Member 3.00 X 0 0 0 John Staeheli MD Board Member 3.00 X 0 0 0 Lewis G Zirkle MD President/Founder 72.00 X X 0 0 0 Randall Huebner Board Member 15.00 X 0 0 0 Stephen Schwartz Board Member 2.00 X 0 0 0 Richard Gellman MD Board Member 2.00 X 0 0 0 Thomas Vasileff MD Board Member 2.00 X 0 0 0 Patrick Yoon MD Board Member 2.00 X 0 0 0 David Shearer MD Board Member 2.00 X 0 0 0 Jeanne Dillner Secretary /Treasurer 75.00 X 141285 0 12567 Joel Gillard Senior R&D Engineer 40.00 X 115759 0 13703 Robert Schmitt Regulatory Affairs / Quali 40.00 X 108296 0 11908 Terry Smith Engineering Manager 40.00 X 129279 0 5459 Sandra Brown Business Admin Manager 40.00 X 101778 0 19464 596397 0 63101 5 0 1 0 0 252653 3320760 1416789 3573413 Implant Revenue 339110 805101 805101 Other Revenue 541900 16442 16442 Training Conference 611430 9985 9985 831528 163467 163467 2782389 2341539 13075 440850 -13075 427775 427775 55805 252653 80791 -24986 -24986 4971197 831528 0 566256 143435 143435 143000 112750 30250 2195900 1650787 280615 264498 25500 25500 74277 33503 17895 22879 73083 55021 8402 9660 64793 59399 916 4478 165723 165723 72431 65229 2265 4937 13021 9670 1618 1733 Cost of Product Distrib 1694150 1694150 Supplies 1412432 1360095 7907 44430 Shipping 99236 99236 Dues, Fees and Taxes 45863 9067 27085 9711 111121 82057 17223 11841 6333965 5565622 363926 404417 64967 150413 2162573 3118877 1412950 855490 505911 80496 946598 1116328 32426 65225 3275351 2331031 1109467 944320 5440301 3305392 16995 15465 11692188 9652006 238375 283605 238375 283605 X 9534262 8111450 1919551 1256951 11453813 9368401 11692188 9652006 -1362768 -722644 0 X X 0 1 X 1 0 X 3620639 10945635 2449418 2952158 3629218 23597068 1407710 1362502 1098905 1514890 831528 6215535 5028349 12308137 3548323 4467048 4460746 29812603 1095335 1185897 707896 811252 792373 4592753 656126 537418 692199 1051967 370893 3308603 1751461 1723315 1400095 1863219 1163266 7901356 21911247 140236 179527 200177 165317 163467 848724 140236 179527 200177 165317 163467 848724 5168585 12487664 3748500 4632365 4624213 30661327 0.71460 0.70760 0.02770 0.02640 X 1021524 448159 573365 1951141 1598174 352967 302686 284698 17988 944320 5106292 -722644 790650 80791 148797 4957495 13702 13702 4971197 7191704 790650 93866 884516 6307188 26777 26777 6333965 Part XI, Line 2d - Other Adjustments: Direct fundraising expenses 80,791. Part XI, Line 4b - Other Adjustments: Loss on equipment disposal -13,075. Donated auction items 26,777. Part XII, Line 2d - Other Adjustments: Direct fundraising expenses 80,791. Loss on equipment disposal 13,075. Part XII, Line 4b - Other Adjustments: Donated auction items 26,777. 1 Central America and the Caribbean 0 0 Program Services Orthopaedic Implants 70219 East Asia and the Pacific 0 0 Program Services Orthopaedic Implants 496943 Europe (Including Iceland & Greenland) 0 0 Program Services Orthopaedic Implants 46709 Middle East and North Africa 0 0 Program Services Orthopaedic Implants 6130 South America 0 0 Program Services Orthopaedic Implants 12891 South Asia 0 0 Program Services Orthopaedic Implants 267247 Sub-Saharan Africa 0 0 Program Services Orthopaedic Implants 729095 Sub-Saharan Africa 0 0 Grants Training, implants, stipend 143135 South Asia 0 0 Grants Training 300 0 0 0 0 0 0 1772369 300 1772669 Sub-Sarharan Africa Trauma center 100000 Cash payment 1 Travel, training, living stipend Sub-Saharan Africa 1 9728 Cash payment Implants and instruments, fellowship stipends Sub-Saharan Africa 1 24000 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. Tri-Cities Benefit 198851 168511 30340 16350 4230 13990 200 8240 Portland Benefit 109607 84142 25465 10427 7592 15038 4724 308458 252653 55805 26777 11822 29028 200 12964 80791 -24986 X X 0 0 0 0 0 0 0 0 0 Jeanne Dillner Secretary /Treasurer 141285 0 0 0 0 0 5060 0 7507 0 153852 0 0 0 Richard Gellman Board Member 2200 Cash payment Training X 4 6527 Fair value X 607 Fair value X 8501 Fair value X 9 55504 Fair value X 8 6216 Fair value X 22 1256261 Fair value X Travel Expenses for Training 10 36398 Fair value X Office Supplies 41 11485 Fair value X Other 10 10118 Fair value 0 0 0 Form 990, Part III, Line 1 SIGN's mission is to build orthopaedic capacity in developing countries by providing ongoing training and education to the local orthopaedic surgeons, which is augmented by providing a sustainable supply of orthopaedic implants designed for use in primitive local hospital conditions. The majority of the implants and instruments provided to programs have been designed and manufactured by SIGN personnel. In-kind donations of products not manufactured by SIGN are distributed to some of the busier programs. According to the World Health Organization, 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 developing countries where access to adequate care is limited. SIGN's mission to build the orthopaedic capacity within these countries will support the local surgeons in providing appropriate and timely care to the injured poor. There are approximately 5,000 surgeons in nearly 300 hospitals in 50 developing nations which have benefited from SIGN training and the provision of implants and instruments. SIGN also responds to disasters in locations where SIGN has existing programs or where SIGN programs need to be developed. 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.