2026-08-03T18:40:49-05:00 2025-12-31 562382653 NORTHWEST CPA GROUP PLLC 1333 COLUMBIA PARK TRAIL STE 120 RICHLAND WA 99352 990 2025-01-01 911952283 SIGN FRACTURE CARE INTERNATIONAL SIGN 5093711107 451 HILLS STREET SUITE B RICHLAND WA 99354 DR SARIAH KHORMAEE CHIEF EXECUTIVE OFFICER 5093711107 2026-07-22 1 ALISON C GEBERS P00423745 5097351300 2026-07-22 2025 2025-03-06 01:10:19Z SIGN DR SARIAH KHORMAEE 451 HILLS STREET SUITE B RICHLAND WA 99354 51979744 0 X WWW.SIGNFRACTURECARE.ORG X 1999 WA GIVE PATIENTS ACCESS TO AFFORDABLE AND EFFECTIVE ORTHOPAEDIC CARE IN LMIC. 9 9 41 54 0 0 6175920 50406422 440249 494689 345163 413565 44230 40127 7005562 51354803 189825 246866 0 0 2780029 3044445 0 0 685246 3654989 10765906 6624843 14057217 380719 37297586 15598095 53272231 407801 250824 15190294 53021407 X 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. 0 0 11297605 473674 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. 1394593 246866 21015 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 TRAVELING SETS IN 2025. BASED ON THE SUCCESS OF THE PREVIOUS TRAVELING SETS, WE HAVE ADDED NEW TRAVELING SET PROGRAMS IN TANZANIA AND THE GAMBIA. 238471 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. 12930669 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 5 0 1 41 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 AK AL AR CA CO CT DC FL GA HI KS MA MD ME MI MN MS NC ND NH NJ NM NV NY OH OK OR PA RI SC TN VA WA WV X KIM FAIR 5093711107 451 HILLS STREET SUITE B RICHLAND WA 99354 CARLA SMITH MD PHD BOARD MEMBER 1.00 X 0 0 0 DANIELE SCIUTO MD BOARD MEMBER 9.50 X 0 0 0 LEWIS G ZIRKLE MD PRESIDENT/FOUNDER 50.00 X X 0 0 0 RANDALL HUEBNER BOARD MEMBER 20.00 X 0 0 0 STEPHEN SCHWARTZ BOARD MEMBER 1.00 X 0 0 0 RICHARD GELLMAN MD BOARD MEMBER 4.00 X 0 0 0 DAVID SHEARER MD VICE PRESIDENT/TREASURER 5.00 X X 0 0 0 ANN PENNER BOARD MEMBER 10.00 X 0 0 0 BEN RIVERA BOARD MEMBER 1.50 X 0 0 0 JEANNE DILLNER SECRETARY/CEO 60.00 X 180416 0 15816 SARIAH KHORMAEE MD PHD SECRETARY/CEO 60.00 X 71848 0 8950 ROBERT SCHMITT REGULATORY AFFAIRS MANAGER 40.00 X 149260 0 15679 TERRY SMITH ENGINEERING MANAGER 40.00 X 168359 0 7002 BRIAN BARNES IT MANAGER 40.00 X 139783 0 14357 JOEL GILLARD SENIOR R&D ENGINEER 40.00 X 125191 0 16616 FRANKLYN FAULTERSACK QUALITY ASSURANCE MANAGER 40.00 X 120104 0 31531 954961 0 109951 12 0 1 0 ADP ONE ADP BOULEVARD ROSELAND NJ 070681728 PAYROLL SERVICES 121103 1 113195 50293227 44901178 50406422 IMPLANT REVENUE 339110 473674 473674 OTHER REVENUE 541900 15692 15692 TRAINING CONFERENCE 611430 5323 5323 494689 209124 209124 66600 17678 48922 48922 48922 791409 3100 589622 446 201787 2654 204441 204441 8400 113195 17195 -8795 -8795 51354803 494689 0 453692 246866 246866 265030 212713 19877 32440 2779415 2005919 291078 482418 26914 26914 94557 27268 32838 34451 8395 7770 250 375 41589 34243 4200 3146 195004 195004 253880 205546 19226 29108 21869 16162 2287 3420 SUPPLIES 7601536 7527243 11533 62760 COST OF PRODUCT DISTRIB 2159824 2159824 SHIPPING 135249 135249 MISCELLANEOUS 65353 39996 16871 8486 161736 116866 16228 28642 14057217 12930669 441302 685246 1813294 1177925 1987581 3111785 110680 13739 1036574 38309295 137011 163362 8767790 4239911 4971812 4527879 5531828 5961059 9315 7187 15598095 53272231 407801 250824 407801 250824 X 14326232 52000013 864062 1021394 15190294 53021407 15598095 53272231 37297586 533527 0 X X 0 1 X 1 0 X 7982956 6595978 5466734 6175920 6347590 32569178 7982956 6595978 5466734 6175920 6347590 32569178 8982435 23586743 156555 155866 207407 215441 275124 1010393 33579571 3311236 0.70240 X 0.87780 0.02460 SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: MEDICAL IMPLANTS AND RELATED CASH FOR DISTRIBUTION DATE: 10/26/25 AMOUNT: 37481087. DESCRIPTION: SPINE IMPLANTS DATE: 07/16/25 AMOUNT: 3645980. DESCRIPTION: MEDICAL IMPLANTS AND INSTRUMENTS DATE: 12/04/25 AMOUNT: 2931765. PART II LINE 1 DESCRIPTION OF UNUSUAL GRANTS: EXTRAORDINARY, UNEXPECTED, AND NON-RECURRING IN-KIND DONATIONS OF MEDICAL DEVICES WAS RECEIVED IN 2025 FROM THREE DISINTERESTED CORPORATE DONORS WITH A FAIR VALUE OF $43,958,832 AND CASH OF $100,000 TO BE USED TO DISTRIBUTE THE MEDICAL DEVICES. THE MEDICAL DEVICES WILL BE DONATED TO HOSPITALS IN DEVELOPING COUNTRIES TO SUPPLEMENT THE ORGANIZATION'S CURRENT PROGRAM. DUE TO THE EXCEPTIONAL SIZE RELATIVE TO OUR TYPICAL ANNUAL CONTRIBUTIONS, INCLUSION OF THE IN-KIND DONATIONS WOULD SEVERELY DISTORT THE ORGANIZATION'S PUBLIC SUPPORT CALCULATION FOR THE 5-YEAR PERIOD. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 880000 880000 1631388 414038 1217350 2093974 1019115 1074859 3232835 2162830 1070005 929593 643928 285665 4527879 X 54078462 533527 2155259 34873 2723659 51354803 0 51354803 16247349 2155259 34873 2190132 14057217 0 14057217 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. SPECIAL EVENT EXPENSES 17,195. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 17,678. SPECIAL EVENT EXPENSES 17,195. 0 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 99266 EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 654982 SOUTH AMERICA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 9054 SOUTH ASIA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 968704 SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 3770567 SUB-SAHARAN AFRICA 0 0 GRANTS TRAINING, IMPLANTS, STIPEND 230468 RUSSIA & THE NEWLY INDEPENDENT STATES 0 0 PROGRAM SERVICES ORTHOPAEDIC IMPLANTS 20061 0 0 0 0 0 0 5753102 0 5753102 EUROPE FELLOWSHIP STIPEND 11218 WIRE 0 NORTH AMERICA FELLOWSHIP STIPEND 50000 WIRE 0 SUB-SAHARAN AFRICA - ANGOLA, BENIN, BOTSWANA, BURKINA FASO, RESEARCH/EDUCATION STIPEND 15000 WIRE 0 NORTH AMERICA FELLOWSHIP STIPEND 50000 WIRE 0 SUB-SAHARAN AFRICA - ANGOLA, BENIN, BOTSWANA, BURKINA FASO, RESEARCH/EDUCATION STIPEND 10000 WIRE 0 SUB-SAHARAN AFRICA - ANGOLA, BENIN, BOTSWANA, BURKINA FASO, RESEARCH/EDUCATION STIPEND 10000 WIRE 0 SUB-SAHARAN AFRICA - ANGOLA, BENIN, BOTSWANA, BURKINA FASO, MEDICAL INSTRUMENTS 0 13995 MEDICAL INSTRUMENTS COST FELLOWSHIP STIPEND SUB-SAHARAN AFRICA 4 79250 WIRE 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-CITY BENEFIT 121595 113195 8400 4569 8400 2015 2211 121595 113195 8400 4569 8400 2015 2211 17195 -8795 X X 0 0 0 0 0 0 0 0 0 JEANNE DILLNER SECRETARY/CEO 180416 0 0 0 0 0 6819 0 8997 0 196232 0 0 0 TERRY SMITH ENGINEERING MANAGER 168359 0 0 0 0 0 6739 0 263 0 175361 0 0 0 ROBERT SCHMITT REGULATORY AFFAIRS MANAGER 149260 0 0 0 0 0 6048 0 9631 0 164939 0 0 0 BRIAN BARNES IT MANAGER 139783 0 0 0 0 0 5798 0 8559 0 154140 0 0 0 FRANKLYN FAULTERSACK QUALITY ASSURANCE MANAGER 120104 0 0 0 0 0 5622 0 25909 0 151635 0 0 0 X 12 148221 FAIR VALUE X 30 44703585 FAIR VALUE X TRAVEL EXPENSES FOR TRAINING 5 24417 FAIR VALUE X OFFICE SUPPLIES 19 13304 FAIR VALUE X OTHER 3 11650 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.