Sign Fracture Care International

What it reported doing in 2025

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

Financial Efficiency

• Mission deployment rate: 25.6%; rating input score 26
• Program expense ratio: 92%; rating input score 92
• Fundraising efficiency: $73.56 raised per $1 spent on fundraising; rating input score 73; 73rd percentile among comparable filings

Transparency & Controls

• Consistency checks: 88.2%; rating input score 88; 2nd percentile among comparable filings
• Pay-setting controls: 2 of 6 controls in place; rating input score 33
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Pass
  • Board or committee approval: Pass
• Foreign activity oversight: 2 of 8 controls in place; rating input score 25
  • Claims monitoring procedures: Pass
  • Requires narrative reports: Limited
  • Conducts field audits: Limited
  • May suspend future funding: Limited
  • Requires financial reports: Pass
  • Conducts site visits: Limited
  • Requires grant agreements: Limited
  • May require repayment: Limited
• Grant itemization coverage: 97%; rating input score 97; 37th percentile among comparable filings
• Major donor itemization: Yes; rating input score 100
• Related-party transparency: Limited

Accountability

• Independent voting board: 100%; rating input score 100; 65th percentile among comparable filings
• Governance controls: 9 of 9 controls in place; rating input score 100
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Pass
  • Other executive compensation review process: Pass
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 72.6%; rating input score 96; 96th percentile among comparable filings
• Total-asset coverage ratio: 3.79; rating input score 75; 75th percentile among comparable filings
• Liabilities to assets ratio: 0; rating input score 93; 93rd percentile among comparable filings
• Officer compensation ratio: 7.6%; rating input score 8; 8th percentile among comparable filings

Growth

• Program expense growth: 3.5% per year; rating input score 100; 25th percentile among comparable filings
• Revenue growth: 12.9% per year; rating input score 100; 82nd percentile among comparable filings
• Asset growth: 12.1% per year; rating input score 100; 77th percentile among comparable filings