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        <ReturnReference>PART V, LINE 4:</ReturnReference>
        <Explanation>THE PURPOSE OF THE ENDOWMENT FUND IS TO FINANCE ORTHOPAEDIC MEDICAL EDUCATION.</Explanation>
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      <Form990ScheduleDPartXIV>
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      <Form990ScheduleDPartXIV>
        <Identifier>PART XII, LINE 4B - OTHER ADJUSTMENTS:</Identifier>
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        <NamePerson>RICHARD PETERSON JD</NamePerson>
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        <NamePerson>WILLIAM R MARTIN MD</NamePerson>
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        <NamePerson>MARILYN L FOX</NamePerson>
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        <NamePerson>LEWIS W JENKINS</NamePerson>
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        <NamePerson>DAVID A LOVETT JD</NamePerson>
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        <NamePerson>JAMES A OGLE</NamePerson>
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        <NamePerson>CHARLES TURKELSON</NamePerson>
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        <NamePerson>LYNNE DOWLING</NamePerson>
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        <NamePerson>MARITA POWELL</NamePerson>
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        <NamePerson>SUSAN MCSORLEY</NamePerson>
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        <NamePerson>JEFFREY KRAMER</NamePerson>
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        <NamePerson>E ANTHONY RANKIN MD</NamePerson>
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      <Form990ScheduleJPartIII>
        <ReturnReference>PART I, LINE 1A</ReturnReference>
        <Explanation>AIRFARE ONE CLASS UP FROM COACH IS AVAILABLE TO THE PRESIDENTIAL LINE FOR ALL AAOS ACTIVITIES AND ONE PERSON RECEIVED THIS BENEFIT. AIRFARE ONE CLASS UP FROM COACH IS AVAILABLE TO THE BOARD OF DIRECTORS FOR ALL BOARD-RELATED ACTIVITIES AND 16 PEOPLE RECEIVED THIS BENEFIT. TRAVEL FOR COMPANIONS IS AVAILABLE TO THE BOARD OF DIRECTORS AND EXECUTIVE TEAM MEMBERS (CEO, CFO, CHIEF EDUCATION OFFICER, MEDICAL DIRECTOR, AND GENERAL COUNSEL) AND THE AMOUNT OF COMPANION TRAVEL WAS TREATED AS TAXABLE COMPENSATION TO ALL WHO RECEIVED THIS BENEFIT. (21 PEOPLE) THE BOARD OF DIRECTORS RECEIVES GROSS-UP PAYMENTS FOR THIS COMPENSATION AND THAT IS ALSO TREATED AS TAXABLE COMPENSATION. (18 PEOPLE)</Explanation>
      </Form990ScheduleJPartIII>
      <Form990ScheduleJPartIII>
        <ReturnReference>PART I, LINES 4A-B</ReturnReference>
        <Explanation>KAREN HACKETT, CHIEF EXECUTIVE OFFICER ACCRUED A 457F SUPPLEMENTAL RETIREMENT BENEFIT OF $16,500 WHICH IS INCLUDED IN SCHEDULE J, PART II, DEFERRED COMPENSATION. DAVID LOVETT, DIRECTOR OF GOVERNMENT AFFAIRS, RECEIVED A SEVERANCE PAYMENT OF $123,480 WHICH IS INCLUDED IN SCHEDULE J, PART II, OTHER REPORTABLE COMPENSATION.</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <GeneralExplanation>
        <Identifier>FORM 990, PART VI, SECTION A, LINE 6</Identifier>
        <Explanation>AS A MEMBERSHIP ASSOCIATION, THE ORGANIZATION CURRENTLY HAS 36,000 MEMBERS. ALL FELLOWS AND MEMBERS OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS (ACADEMY), SHALL ALSO BE CONSIDERED FELLOWS AND MEMBERS OF THE SAME CLASSIFICATION OF THE AMERICAN ASSOCIATION OF ORTHOPAEDIC SURGEONS (ASSOCIATION), A RELATED ORGANIZATION. THERE ARE TWO CATEGORIES OF MEMBERSHIP IN THE ACADEMY AND THE ASSOCIATION: FELLOWS AND MEMBERS. ONLY FELLOWS SHALL HAVE THE RIGHT TO VOTE AND HOLD OFFICE.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>FORM 990, PART VI, SECTION A, LINE 7A</Identifier>
        <Explanation>ELECTIONS OF THE OFFICERS AND THE AT-LARGE MEMBERS OF THE ASSOCIATION AND ACADEMY BOARD OF DIRECTORS SHALL BE DETERMINED BY THE ADOPTION OF THE REPORT OF THE NOMINATING COMMITTEE OR BY THE VOICE, WRITTEN, OR ELECTRONIC BALLOT OF THOSE FELLOWS PRESENT AT THE BUSINESS MEETING OF THE ANNUAL MEETING. EACH FELLOW WHO IS PRESENT AT THE BUSINESS MEETING OF THE ANNUAL MEETING SHALL BE ENTITLED TO ONE (1) VOTE FOR EACH OFFICER OF THE ASSOCIATION AND ACADEMY, MEMBER OF THE BOARD OF DIRECTORS, MEMBER OF THE MEMBERSHIP COMMITTEE, AND NOMINEES TO THE AMERICAN BOARD OF ORTHOPAEDIC SURGERY TO BE ELECTED. THOSE INDIVIDUALS RECEIVING THE GREATEST NUMBER OF VOTES SHALL BE CONSIDERED ELECTED, EVEN IF THEY DO NOT RECEIVE A MAJORITY OF THE VOTES CAST.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>FORM 990, PART VI, SECTION B, LINE 11</Identifier>
        <Explanation>THE BOARD RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO PREPARE THE ORGANIZATION'S FORM 990. MANAGEMENT REVIEWS THE COMPLETED FORM 990 AND PROVIDES A FULL COPY TO ALL VOTING MEMBERS OF THE GOVERNING BODY VIA A SECURE SECTION OF ITS WEBSITE PRIOR TO FILING. A CONFERENCE CALL IS SCHEDULED FOR THE CPA FIRM AND ORGANIZATION MANAGEMENT TO DISCUSS THE FORM 990 WITH THE FINANCE COMMITTEE AND TO ANSWER ANY QUESTIONS PRIOR TO FILING FORM 990 WITH THE IRS. THE FINANCE COMMITTEE HAS BEEN DELEGATED THE AUTHORITY TO REVIEW AND APPROVE THE FORM 990 BY THE VOTING MEMBERS OF THE GOVERNING BODY.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 12C</ReturnReference>
        <Explanation>BOARD MEMBERS, KEY VOLUNTEERS, AND KEY STAFF ARE NOTIFIED IN WRITING TWICE A YEAR TO UPDATE THEIR WRITTEN DISCLOSURES. THE DISCLOSURE DATABASE IS MAINTAINED ELECTRONICALLY AND ANYONE WHO HAS NOT UPDATED THEIR RECORD IS NOTIFIED UNTIL THEY HAVE DONE SO. ADDITIONALLY, BEFORE EVERY BOARD AND COMMITTEE MEETING PARTICIPANTS ARE ASKED IF THEY HAVE ANYTHING NEW TO DISCLOSE.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 15</ReturnReference>
        <Explanation>A COMPENSATION COMMITTEE IS DESIGNATED BY THE VOTING MEMBERS OF THE GOVERNING BODY AND IS CHARGED WITH DEVELOPING AND NEGOTIATING THE TERMS OF EMPLOYMENT AND ESTABLISHING THE TOTAL COMPENSATION PACKAGE FOR DESIGNATED POSITIONS. AN EVALUATION PROCESS IS COMPLETED ANNUALLY AND A RECOMMENDATION IS MADE REGARDING COMPENSATION THAT IS THEN SENT TO THE BOARD FOR APPROVAL. THIS PROCESS INCLUDES THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF EDUCATION OFFICER, MEDICAL DIRECTOR, AND GENERAL COUNSEL.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 19</ReturnReference>
        <Explanation>GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE ON THE ORGANIZATION'S WEBSITE WHICH IS OPEN TO THE PUBLIC. FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE APPLICABLE GOVERNMENTAL AGENCIES.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>CHANGES IN NET ASSETS OR FUND BALANCES:</Identifier>
        <ReturnReference>FORM 990, PART XI, LINE 5:</ReturnReference>
        <Explanation>NET UNREALIZED GAINS ON INVESTMENTS: 5,058,520.</Explanation>
      </GeneralExplanation>
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          <AddressLine1>6300 N RIVER ROAD</AddressLine1>
          <City>ROSEMONT</City>
          <State>IL</State>
          <ZIPCode>60018</ZIPCode>
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          <City>ROSEMONT</City>
          <State>IL</State>
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          <City>ROSEMONT</City>
          <State>IL</State>
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        <PrimaryActivities>FOSTER A NATIONAL CENTER FOR DATA COLLECTION ON JOINT REPLACEMENTS</PrimaryActivities>
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      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>1</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>0</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>1</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>0</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>1</SharingOfFacilities>
      <SharingOfPaidEmployees>1</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>0</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>1</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>0</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>0</OtherTransferFromOtherOrg>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AMERICAN ASSOCIATION OF ORTHOPAEDIC SURGEONS</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>P</TransactionType>
        <AmountInvolved>4806387</AmountInvolved>
        <MethodOfAmtDetermination>COST</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AMERICAN ASSOCIATION OF ORTHOPAEDIC SURGEONS</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>C</TransactionType>
        <AmountInvolved>4250000</AmountInvolved>
        <MethodOfAmtDetermination>COST</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AMERICAN JOINT REPLACEMENT REGISTRY NFP (AJRR)</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>A</TransactionType>
        <AmountInvolved>9796</AmountInvolved>
        <MethodOfAmtDetermination>COST</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AMERICAN JOINT REPLACEMENT REGISTRY NFP (AJRR)</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>B</TransactionType>
        <AmountInvolved>325981</AmountInvolved>
        <MethodOfAmtDetermination>COST</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>AMERICAN JOINT REPLACEMENT REGISTRY NFP (AJRR)</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>P</TransactionType>
        <AmountInvolved>103152</AmountInvolved>
        <MethodOfAmtDetermination>COST</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
    </IRS990ScheduleR>
  </ReturnData>
</Return>