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        <InvestmentEarningsOrLossesAmt>-2143996</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>542628</OtherExpendituresAmt>
        <EndYearBalanceAmt>10561394</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>10199908</BeginningYearBalanceAmt>
        <ContributionsAmt>7026</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>3592759</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>558254</OtherExpendituresAmt>
        <EndYearBalanceAmt>13241439</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>7961755</BeginningYearBalanceAmt>
        <ContributionsAmt>13785</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>-82175</InvestmentEarningsOrLossesAmt>
        <OtherExpendituresAmt>19900</OtherExpendituresAmt>
        <EndYearBalanceAmt>7873465</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>50447</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>48925</DepreciationAmt>
        <BookValueAmt>1522</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>131307</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>128669</DepreciationAmt>
        <BookValueAmt>2638</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>4160</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Charitable Remainder Trust Receivable</Desc>
        <BookValueAmt>2742892</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Cash Surrender Value of Life Insurance</Desc>
        <BookValueAmt>1906949</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Other receivables</Desc>
        <BookValueAmt>12584</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Right Of Use - Lease Assets</Desc>
        <BookValueAmt>67251</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>4729676</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Due to Orthopaedic Partners</Desc>
        <Amt>580380</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Lease Liability ST</Desc>
        <Amt>68020</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>648400</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>4923109</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>671694</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>32128</OtherRevenueAmt>
      <RevenueNotReportedAmt>703822</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>4219287</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>36479</InvestmentExpensesNotIncldAmt>
      <RevenueNotReportedFinclStmtAmt>36479</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>4255766</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>5217594</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>15888</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>15888</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>5201706</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>36479</InvestmentExpensesNotIncld2Amt>
      <ExpensesNotRptFinclStmtAmt>36479</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>5238185</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV, Line 2b:</FormAndLineReferenceDesc>
        <ExplanationTxt>On behalf of other orthopaedic organizations, the Foundation accepts contributions for which it performs recordkeeping and provides grants requested by those organizations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>FIN 48 Note from Audited Financial Statements: The Foundation, an Illinois nonprofit corporation, is exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code and applicable state law, except for taxes pertaining to unrelated business income, if any. The Foundation's annual information and income tax returns filed with the federal and state governments are subject to examination generally for three years after they are filed. The Foundation has adopted the requirements for accounting for uncertain tax positions and management has determined that the Foundation was not required to record a liability related to uncertain tax positions as of June 30, 2024.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in cash surrender value of life insurance policies 44,641. Change in charitable remainder trust receivable -12,513.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Orthopaedic partner endowment distribution 15,888.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Boston Children's Hospital</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>300 Longwood Avenue</AddressLine1Txt>
          <CityNm>Boston</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>02115</ZIPCd>
        </USAddress>
        <RecipientEIN>042774441</RecipientEIN>
        <CashGrantAmt>20000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Effect of vitamin D in prevention and treatment of pediatric fractures</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Columbia University Irving Medical Center</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>Sponsored Projects Administration</AddressLine1Txt>
          <AddressLine2Txt>Columbia University 630 West 168th</AddressLine2Txt>
          <CityNm>New York</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10032</ZIPCd>
        </USAddress>
        <RecipientEIN>135598093</RecipientEIN>
        <CashGrantAmt>20000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Enhanced Enthesis Regeneration via Gli1+ Enthesis Stem Cell Treatment</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>MAYO CLINIC ROCHESTER MN</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>200 First St SW</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>MN</StateAbbreviationCd>
          <ZIPCd>559050001</ZIPCd>
        </USAddress>
        <RecipientEIN>416011702</RecipientEIN>
        <CashGrantAmt>20000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Osteoarthritis Gene Therapy: A 30-Year Journey from Concept to Clinical Trials</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Medical Technology Enterprise Consortium - The Geneva Foundation</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>315 Sigma Drive</AddressLine1Txt>
          <CityNm>Summerville</CityNm>
          <StateAbbreviationCd>SC</StateAbbreviationCd>
          <ZIPCd>29486</ZIPCd>
        </USAddress>
        <RecipientEIN>474960128</RecipientEIN>
        <CashGrantAmt>50000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Objective Dynamic and 3D Knee Assessment Medical Device to Improve Recovery and Accelerate Return to Readiness of Members with Knee Pain</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
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        <USAddress>
          <AddressLine1Txt>315 Sigma Drive</AddressLine1Txt>
          <CityNm>Summerville</CityNm>
          <StateAbbreviationCd>SC</StateAbbreviationCd>
          <ZIPCd>29486</ZIPCd>
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        <RecipientEIN>474960128</RecipientEIN>
        <CashGrantAmt>50000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Dynamic Gait-Synchronous Neuromuscular Electrical Stimulation Following Anterior Cruciate Ligament Reconstruction</PurposeOfGrantTxt>
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        <RecipientBusinessName>
          <BusinessNameLine1Txt>MedStar Health Research Institute</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>6525 Belcrest Road Suite 700</AddressLine1Txt>
          <CityNm>Hyattsville</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20782</ZIPCd>
        </USAddress>
        <RecipientEIN>526056274</RecipientEIN>
        <CashGrantAmt>149948</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Treating Cauda Equina Syndrome from a Health Care Disparities Perspective</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>The Hospital for Special Surgery</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>535 East 70th Street</AddressLine1Txt>
          <CityNm>New York</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10021</ZIPCd>
        </USAddress>
        <RecipientEIN>131624135</RecipientEIN>
        <CashGrantAmt>300000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Objective TKA Laxity: Correlation with Patient Perceptions of Instability?</PurposeOfGrantTxt>
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          <AddressLine1Txt>535 East 70th Street</AddressLine1Txt>
          <CityNm>New York</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10021</ZIPCd>
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        <RecipientEIN>131624135</RecipientEIN>
        <CashGrantAmt>50000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Characterizing the effects of corticosteroids in rotator cuff tendinopathy</PurposeOfGrantTxt>
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          <BusinessNameLine1Txt>The Ohio State University</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>1960 Kenny Road</AddressLine1Txt>
          <CityNm>Columbus</CityNm>
          <StateAbbreviationCd>OH</StateAbbreviationCd>
          <ZIPCd>43210</ZIPCd>
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        <RecipientEIN>316025986</RecipientEIN>
        <CashGrantAmt>20000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Transformative Solutions for Reducing Frequent 911 Fall Calls</PurposeOfGrantTxt>
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        <USAddress>
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          <AddressLine2Txt>Shields Ave</AddressLine2Txt>
          <CityNm>Davis</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>95616</ZIPCd>
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        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
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          <CityNm>Philadelphia</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
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        <PurposeOfGrantTxt>Validating the use of Next-Generation Sequencing in Open Fracture Care</PurposeOfGrantTxt>
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          <BusinessNameLine1Txt>University of Florida</BusinessNameLine1Txt>
        </RecipientBusinessName>
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          <AddressLine1Txt>207 Grinter Hall</AddressLine1Txt>
          <CityNm>Gainesville</CityNm>
          <StateAbbreviationCd>FL</StateAbbreviationCd>
          <ZIPCd>32611</ZIPCd>
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        <RecipientEIN>596002052</RecipientEIN>
        <CashGrantAmt>25000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Educational tools for injury prevention guidelines for baseball caregivers</PurposeOfGrantTxt>
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        </RecipientBusinessName>
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          <AddressLine2Txt>Brooklyn Ave NE Box 359472</AddressLine2Txt>
          <CityNm>Seattle</CityNm>
          <StateAbbreviationCd>WA</StateAbbreviationCd>
          <ZIPCd>98195</ZIPCd>
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        <RecipientEIN>916001537</RecipientEIN>
        <CashGrantAmt>100000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <PurposeOfGrantTxt>Magnetic Microgels for Composite Musculoskeletal Tissue Regeneration</PurposeOfGrantTxt>
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      <RecipientTable>
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          <BusinessNameLine1Txt>Washington University in StLouis</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>Campus Box 1054 One Brookings Drive</AddressLine1Txt>
          <CityNm>St Louis</CityNm>
          <StateAbbreviationCd>MO</StateAbbreviationCd>
          <ZIPCd>631304862</ZIPCd>
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        <RecipientEIN>430653611</RecipientEIN>
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          <CityNm>Saint Louis</CityNm>
          <StateAbbreviationCd>MO</StateAbbreviationCd>
          <ZIPCd>63110</ZIPCd>
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        <CashGrantAmt>20000</CashGrantAmt>
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          <CityNm>New Haven</CityNm>
          <StateAbbreviationCd>CT</StateAbbreviationCd>
          <ZIPCd>065208327</ZIPCd>
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        <PurposeOfGrantTxt>Mid-Substance PCL Tear: A Novel Arthroscopic Direct Repair Technique</PurposeOfGrantTxt>
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          <CityNm>Ontario</CityNm>
          <ProvinceOrStateNm>Ontario</ProvinceOrStateNm>
          <CountryCd>CA</CountryCd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Research Grants Committee is responsible for allocating research funding to advance research in the specialty of orthopaedics and is empowered to establish criteria for the allocation and distribution of philanthropic funds to advance research in the specialty of orthopaedics, implement and conduct independent peer review process to select research funding recipients, prepare and distribute necessary promotional information and application forms for research grants and awards and to accept and allocate or decline to allocate, at its sole and absolute discretion, grants and awards for research. One-year grant recipients receive 50% of the funds to start, then 40% after a six-month financial report is received. A final scientific and lay report within 60 days after the grant ends along with a final financial report is required. Once OREF has the final reports the remaining 10% of the funds are released. One-time award/educational grant/lectureship grants receive full payment after they are approved. Documentation is in the file for lectureships, educational programs and awards. Two or three-year grants are paid and spread over the term of the grant. 10% is withheld until all of the reports are received. Multi-year grant recipients submit annual scientific reports which are then reviewed by the original peer review committee member.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>Bylaws have been updated with revisions to the pages below. **** (new page 1, old page 1) Article II is now Purpose instead of Goals and Objectives with updated language. **** (new page 2, old page 2) Article VI, Section 3 The makeup of the board of trustees. **** (new page 3, old page 4) Section 10 of the old Offices and Places of Meeting is deleted. **** (new page 4, old page 5) Section 15 (old) is removed **** (new page 5, old page 6) Article V, Section 1, A, B &amp; C are all revamped. **** (new page 5, old page 7) Section 2 They created a 2nd President-Elect **** (old page 9) Section 2 is removed.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Finance Committee reviewed and approved the Form 990. It was provided to the Board of Directors, who had an opportunity to review the return prior to filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>All Trustees annual conflict of interest statements are on file with the OREF CEO. The CEO reviews meeting agendas prior to the meeting and notifies leadership of any issues that need to be addressed before the discussions take place. Any individual who gives notice of a potential conflict is to abstain from participation in discussions related to that item.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Foundation has a formal process to determine the compensation of its CEO. The process includes the following: 1) Review and approval by the Board of Trustees or Compensation Committee; 2) Use of comparable compensation data; 3) Contemporaneous documentation and record keepping.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The Foundation made its governing documents, conflict of interest policy, and financial statements available to the public upon request for the period of disclosure set forth in IRC Section 6104(d).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Orthopaedic partner endowment distribution -15,888. Change in cash surrender value of life insurance policies 44,641. Change in charitable remainder trust receivable -12,513.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XII, line 2c:</FormAndLineReferenceDesc>
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