Form 990 for tax year 2023

Totals

Total revenue

$6,205,211

Total expenses

$7,246,960

Contributions and grants received

$5,466,734

Grants paid

$90,738

Program service revenue

$496,916

Investment income

$205,918

Other revenue

$35,643

Total assets, end of year

$14,980,608

Total liabilities, end of year

$467,363

Net assets or fund balances, end of year

$14,513,245

Program services expenses (Part IX)

$6,246,646

Management and general expenses

$405,376

Fundraising expenses

$594,938

Program service expenses (Part III)

$6,246,646

Program services were 86.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Mission and programs · 2023

• 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 OCTOBER 2023 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 LUMBAR SPINE.EXPANDING ON THE SUCCESS OF THE 2022 SIGN CONFERENCE, WE INCREASED THE NUMBER OF OVERSEAS ATTENDEES TO 58. IN ADDITION, WE ADDED A SPECIAL SESSION ON THE PONSETI METHOD (A NONSURGICAL TREATMENT FOR CLUBFOOT IN YOUNG CHILDREN).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, LUMBAR SPINE, AND TIBIAL PLATEAU FRACTURES. WE CONTINUE TO DEVELOP OUR RELATIONSHIP WITH THE INSTITUTE FOR GLOBAL ORTHOPAEDICS AND TRAUMATOLOGY (IGOT). IN 2023, IGOT HOSTED THEIR TWO-DAY SMART COURSE AT SIGN HEADQUARTERS 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 PAST WEEK INTO PRACTICE. IGOT ALSO PROVIDES REGIONAL TRAINING IN OTHER SURGICAL TECHNIQUES TO SIGN SURGEONS IN EAST AFRICA AND NEPAL.SIGN AND IGOT CO-HOSTED THE 8TH ANNUAL MOI TANZANIA TRAUMA COURSE OVERSEAS IN JUNE 2023. THE COURSE INCLUDED A MIX OF DIDACTIC LECTURES AND DEMONSTRATIONS FOR ORTHOPAEDIC SURGEONS AND RESIDENTS. COURSE TOPICS INCLUDED HIP AND KNEE, UPPER EXTREMITY, PELVIS AND ACETABULUM, AND OPEN FRACTURE AND SOFT-TISSUE FLAPS.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 2023, SIGN HELD TWO WEBINARS THAT REACHED ALMOST 300 SIGN SURGEONS. WE MADE THE DECISION TO DO FEWER WEBINARS IN 2023 IN FAVOR OF OFFERING IN-PERSON CONFERENCES, LIKE THE SIGN & IGOT TANZANIA COURSE AND THE 2023 SIGN CONFERENCE. 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.WE CONTINUE TO PARTNER WITH BLACK LION HOSPITAL, IN ADDIS ABABA, ETHIOPIA ON THE FIRST EAST AFRICAN PELVIC FELLOWSHIP PROGRAM. IN 2023, THEY TRAINED 2 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. BUILDING ON GROUNDWORK THAT WAS SET IN 2022, WE STARTED 5 NEW PROGRAMS IN ETHIOPIA AND 1 NEW PROGRAM IN TANZANIA VIA THE TRAVELING SETS IN 2023. WE ALSO ADDED AN ADDITIONAL TRAVELING SET IN TANZANIA.

  Expenses $1,076,830 · Grants $90,738 · Revenue $21,171

• 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 2023, THE SIGN SKIN GRAFT SYSTEM WAS RELEASED WITH THE GOAL OF PROVIDING A SIMPLE SKIN GRAFTING SYSTEM THAT PRODUCES HIGH-QUALITY SKIN GRAFTS FROM A DONOR SITE TO COVER A DEFECT, LIKE A BURN. THE SKIN GRAFT SYSTEM IS COMPRISED OF TWO INSTRUMENTS: A DERMATOME AND A MESHER. THE DERMATOME HARVESTS SKIN FROM A HEALTHY DONOR SITE AND THE MESHER IS USED TO EXPAND THE SKIN GRAFT TO COVER A LARGER SURFACE AREA. THIRTY-SIX HOSPITALS HAVE RECEIVED THE SIGN SKIN GRAFT SYSTEM AND INITIAL FEEDBACK IS OVERWHELMINGLY POSITIVE.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 2023, WE DISTRIBUTED 26,186 SIGN NAILS TO 52 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 25 NEW SIGN PROGRAMS IN 2023. THE BREAKDOWN WAS AS FOLLOWS: AFRICA: 15 PROGRAMS ASIA: 6 PROGRAMS EUROPE: 2 (UKRAINE/BOSNIA AND HERZEGOVINA) NORTH AMERICA: 1 (HAITI) SOUTH AMERICA: 1AS OF DECEMBER 31, 2023, THE WORLD BANK INCOME CLASSIFICATIONS BY GNI FOR THE COUNTRIES WITH NEW SIGN PROGRAMS WERE AS FOLLOWS: LOW INCOME 48%, LOWER MIDDLE INCOME 44%, AND 8% UPPER MIDDLE INCOME.DISASTER AND CONFLICT RESPONSE:WE BELIEVE IN EQUALITY OF FRACTURE CARE FOR ALL, REGARDLESS OF GENDER, RELIGION, POLITICAL AFFILIATION, OR ANY OTHER IDENTITY. ON FEBRUARY 6, 2023, A 7.8 MAGNITUDE EARTHQUAKE HIT SOUTHEAST TURKEY NEAR THE SYRIAN BORDER. IN PARTNERSHIP WITH THE SYRIAN AMERICAN MEDICAL SOCIETY, WE SENT A SIGN SET ALONG WITH 70 SIGN NAILS AND EXTERNAL FIXATOR SETS. IN AUGUST 2023, ETHIOPIA'S FEDERAL GOVERNMENT DECLARED A STATE OF EMERGENCY FOLLOWING CLASHES WITH THE MILITARY AND REBEL GROUPS IN THE AMHARA REGION. THE AMHARA REGION, WHICH IS THE SECOND MOST POPULOUS REGION IN ETHIOPIA, IS HOME TO FIVE SIGN PROGRAMS THAT SAW AN IMMEDIATE INCREASE IN PATIENTS WHEN THE CONFLICT BEGAN. IN COORDINATION WITH SIGN SURGEONS, WE CONTINUED SENDING SIGN IMPLANTS TO THE AFFECTED PROGRAMS. THE ETHIOPIAN TRAVELING SETS WERE TRANSFERRED TO HOSPITALS IN THE AMHARA REGION TO HELP EASE THE PATIENT LOAD. 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 17 HOSPITALS THROUGHOUT UKRAINE, ALONG WITH 1,600 SIGN NAILS (INCLUDING SIGN HIP NAILS AND PEDIATRIC NAILS), 23 EXTERNAL FIXATOR SETS, SMALL AND LARGE FRAGMENT SETS, AND MANY OTHER GENERAL SURGERY CONSUMABLES. WE CONTINUE TO COMMUNICATE WITH THESE SURGEONS IN UKRAINE, AND WE ARE PREPARING SHIPMENTS TO RESUPPLY THEIR HOSPITALS WITH SIGN IMPLANTS AS NEEDED. ONCE THE CRISIS SUBSIDES, WE WILL PARTNER WITH THEM TO REPORT CASES ON THE SIGN SURGICAL DATABASE AND BECOME FULLY PARTICIPATING SIGN PROGRAMS.

  Expenses $5,169,816 · Revenue $475,745

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Provenance

Return type

form_990

Tax year

2023

Filed

12 September 2024

IRS schema version

2023v5.1

Source object

202422639349300817

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