DopJSign Envdopg ID". F804C11A-C66C4B32407>BI(UFAD4028 STMARK5 O S P l T A L FOUNDATION A Future Free From The Fear Of Bowel Disease ST MARK'S HOSPITAL FOUNDATION TRUSTEES, REPORT AND FINANCIAL STATEMENTS ST FOR THE YEAR ENDED 31 MARCH 2021 CHARITY NUMBER: 1140930 COMPANY NUMBER: 07532184 DopJSign Envelopg ID." F804CIIA-C66C4B324D7M1(t4FAD4028 St Mark's Hospital Foundation Tru81oo Report 2021 DopJSign Envdopg ID." F804C11A-C66C4B32407>BI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION Contents Page Trustees. Report Chairman's Statement Govemance and Management Risk and Inlemal Control Objectives and Activities for the Public Benefit Achievements and Activities 2020-2021: Fundraising Research Education Financial Review Statement of Trustees, Responsibilities Independent Audltors. Report Statement of Financial Activities Balance Sheet Statement of Cash Flows Notes to the Accounts Ref8renco and Admlnlstratlve Inforniatlon 10 12 15 18 19 22 23 24 25 DopJSign Envelopg ID." F804CIIA-C66C4B324D7M1(C4FAD4028 ST MARK'S HOSp￿AL FOUNDATION TrUSTEES' REPORT FOR THE YEAR ENDED 31- MARCH 2021 Chairman's Statement l am extremely proud of our Foundation and St Mark's clinicians who have shown extraordinary resilience and determination supporting the NHS in its fight against coronavirus. whilst doing their utmost to ensure patlents needing complex bowelwrelated treatment are being cared for without ompromise. Clearly, the pandemic is not over but wilh the re￿nI suc￿$$ of thg creation of a vaccine in record time followed by a very successful rollout in the UK, l arn cautiously optimistic we wlll slowly get back to normal, albelt a somewhat dlfferent new normal. St Mark's contlnues to remaln focused on delivering world class specialist care for patients and carrying out its mission to lead cutting edge research and educalion on a range of complex bowel issues. This past year also marked the 185" anniversary of St Mark's Hospital and the 25 anniversary of ils move lo the current site, both historic milestones worthy of recognition. However. in light of the pandemic, we chose to defer celebrations. We were very sad lo lose Paul Bouscarle. a long lime Iruslee. supporter and valued colleague of the Foundation, who died on 4th September 2021. Paul made a huge contribution lo St Mark's through his fundraising efforts and his wise advice to the Board of Tnjstees. He wll be much missed by us and of course his family. Within the span of a few weeks in early 2020. the coronavirus pandemic surprised and fundamentally changed the world we live in and lrfe as we know it. Understanding of the disease was limited and scientific guidance changed frequently, leading lo signrficanl uncertainty. In March 2020. the Northwck Park Hospital sile Iwhich includes Sl Mark's Hospital) was one of the first to receive patients critically ill with Covid-19. The impact was immediate for both clinical staff and patients of Sl Mark's. Our specialist clinicians were rapidly deployed and played a highly signrfi¢anl role Caring for patients on the quickly re-purposed Covid-19 wards and expanded Intensive Care Units. The Foundation staff quickly adapted lo supp(wt the hospitsl in many different ways without losing sile of ils main remit.. supporting the hospi181's research and education. In response lo the crisis, the Foundation team, through ils goodwll and efforts, also received some generous donations from new and existing supporters and pul these to very good use lo support the provision of urgenlty needed ilems. Amongst these were PPE venlilaled ho(xJs lor ICU staff and iPads for patienls lo communicate with their families in desperate ¢ircumstances. This last initiative was led by a team of our research felkjws who have been nationally recognised for their initiative. Throughout the year, Si Mark's has suffered from a number of waves of Covid -19 patients at Northwick Park Hospital and in response lo this, has moved some of Ihe specialist clinical services lo Ihe Central Middlesex Hospi181 site which h8s more capacity. Wherever our clinicians found Ihernselves during the18s1 year, we remained committed lo supporting the research and education programmes they continued to lead on despite all of their challenges. In this regard, the Foundation has fortunately had a very successful year and continued lo raise significant sums ol reslricled and unreslricled lunds. Tolal income for the year increased by 27./0 to £2.239,733 from £1,762,291 in 201 &20 which was remarkable given the Challenging environment for physical fundraising events. We are especially grateful lo a new donor who has made a significant contribution lo our fund raising income during the year and has indicated they will provide ongoing support. Unreslricled Reserves at year-end were £684,054. equivalent to 12 months, operating expenditure. Given the uncertain environment, my fellow Injslees and I feel this higher level of reserves as compared with the normal tsrget of 4-6 months is not unreasonable on a short-temi, temporary basis. Page 4 DopJSign Envelopg ID." F804CIIA-C66C4B324D7M1(C4FAD4028 ST MARK'S HOSp￿AL FOUNDATION TrUSTEES' REPORT FOR THE YEAR ENDED 31- MARCH 2021 The operational resilience of the Foundation and Academic Institute staff was remarkable as they adapted to new ways of working. They quickly adjusted lo a part remote working model but al the same lime the stsff who operationally support research and educatson worked from the hospital throughout the year lo support our clinical stakeholders. The success of the innovative online course webinars which began in June 2020 and the signature Frontiers conference in November 2020 as a fully online studio level digital broadcast with an audience of over 3,0(M) were highlights of the year. From a research perspective, we continued to support many of our ongoing projects and started a range of new research. details of which are sel out later in the report. On behaw of the Board and management team. I woukj like to thank all our donors for their support. particularly in these extraordinary limes. The Four)dalion is delem)ined to continue its mission to raise funds and help cure complex bowel related diseases. Sir Thomas Troubridg8 27th September 20211 Page 5 DopJSign Envelopg ID". F804CIIA-C66C4B324D7M1(t4FAD4028 ST MARK'S HOSp￿AL FOUNDATION TrUSTEES' REPORT FOR THE YEAR ENDED 31- MARCH 2021 The Trustees present their report and the audried financial stalements for the year ended 31, March 2021. Si Mark's Hospital Foundation is a company limited by guarantee. incorporated on 16 February 2011 and not having a share nd capital. It was registered as a charity with the Charity Commission for EngL4nd and Wales on 2 March 2011. The Foundation commenced operations on 1" April 2011. when the assets and operations of Sl Mark's Hospital Foundation Trust, a charty registered wlh the Charity Commission for England and Wales under Charity Number 1088119, were transferred lo the corporate charity. The Foundation is operating under exactly the same principle and objects as the unincorporated Trust and eonlinues to support St Mark's Hospital. particulady by funding research projects, as well as managing and delivering a large programme of education. enabling the dissemination of best practice in the fiekl of bowel disease at Si Mark's Hospitsl. Governance and Management effectiveness of the Foundation's extemal audit. including appointment of the Audrtors. Monthly management accounts are provided to the Trustees, giving infomiab.on on income and expenditure and budget comparisons. Trustees are apF)oinled by Ordinary Resolution or by a simple majority of all the Trustees enlilled lo attend and vole at any meeting of the Trustees. Trustees hold office until the end of the first meeting of the Trustees following the third anniversary of appointment or re8ppoinlmenl. Trustees are permilled lo sland for re-election f further ￿ terms with duration of three years each. Amongst the Trustees there is a good mix of skills with both medical and non-medical represenlalives bringing medical, business and financial expertise to the Board. There is also diversity of gender and age. Fundralsing Committge This consists of the Chairman (Trusleel, three Trustees. Ihe CEO and Fundraising Manager. The role of the Fundraising Committee is lo provide oversight of the activities of the fundraising team, and lo ensure that fundraising activity is in accordance with the strategic goals of the Board of Trustees. The Committee is the key conduit for communication and reporting beNveen the fundraising team and Ihe Board. The Board of Trustees administers St Mark's Hospital Foundation, meeting quarterly. The day-tO- day operations of the Foundation are managed by the CEO, who reports to the Board on perfonnan against the strategic plans approved by the Trustees al quarterly meetings, when reports from the Clinical Director and the Dean of the Academic Institute are also received. R&s•arch Overslght CommStta6 This committee does not have any direct Trustee represenlalion.11 consists ol the Dean of the Academic Inslilule, the Clinical Director of Si Mark's Hospital. senior consullanls and the CEO of the Foundation. The Committee reviews applications for grant funding and makes recommendalions lo the Board. The Trustees do not receive remuneration or derive any other personal benefit from the aclivilies of the Foundation. The Trustees may delegate any of their powers to a committge consisting of fv40 or more Truslees. The following committees have been established.. Risk and Internal Control The Trustees have overall responsibility for ensuring that the Foundation has an appropriate system of interr)al cor)trols. financial and otherwise. They are also responsible for safeguarding the assets of the Foundation and hence for tsking reasonable sleps for the prevention and detection of fraud and other irregularrties and to provide reassurance that: Flnance and Audit Committee This consists of the Chairman ITruslee), Treasurer (Trusteel, CEO and Accountant. Expenditure is supervised by the Committee to ensure compliance with decisions taken by the Board of Trustees. The Committee presents the draft annual budget to the Board, oversees the performance of investments. helps lo idenlrfy, evaluate and manage risks and oversees the its assels are safeguarded against unauthorised use or disposilion; Page 6 DopJSign Envelopg ID." F804CIIA-C66C4B324D7M1(t4FAD4028 ST MARK'S HOSPThAL FOUNDATION TRUSTEES, REPORT FOR THE YEAR ENDED 31- MARCH 2021 {contSnuedl proper records are maintained and financial infomalion used within the Foundation or for publication is reliable., and the Foundation complies wth relevant laws and regulations. receiving UFMlates during the year on current research- and receiving updates during the year on postgraduate education. The above enables the Trustees lo satisfy As part of the Foundation's risk management themselves that the Foundation policies are being process, the Trustees acknowledge their implemented. that significant weaknesses of control responsibility for the Foundation's system of idenlified are being prompuy addressed and on the intemal controls and reviewing its effectiveness. It overall adequacy and effectiveness of the is also recognised by the Trustees that such a Foundation's system of intern81 control and risk system is designed to manage ralher than eliminale management. the risk of failure lo achieve the Foundalion's objectives and can only provide reasonable. not absolute, reassurance against material misslalemenl or loss. Objectives and Actlvities for the Publlc Benefit In line with th8 Charity Commission's guidelines on risk management, the Foundation has developed a risk register, outlining the potential risks the Foundalion could face, weighing the likelihood and potential impact of each and the current and proposed actions required lo miligale those ri$k$ a$ appropriate. The most significant risks for the Foundalion include.. ils ability lo fundraise SLrfficient unrestricted income lo cover core costs and lo generate a Surplus for Tru$lee$ to desbgnate lor resear¢h and education; the length of lime from receipt of funding to research project completion. The objecls of the Foundation. as set out in the Articles of Association, are restricted specifically lo the promotion of research into and education in disorders of the gastro-intestinal tract and pelwc floor. The policy adopled is lo provide support for research al Sl Mark's Hospital, by making grants for research projects approved by the Board of Trustees, and lo fund the Academic Instilule, postgraduate course5 and lectures and the observation of surgical procedures al Sl Mark's Hospital for medical students from around the world. A Multi-media Department. funded by the Foundation, is a valuable resource providing support for both research and education within Sl Mark's Hospital. The Trustees minimise risk lo the Foundation by: monitoring the risks by reviewing the risk register on a regular basis., setting a policy on expenditure approval. signing of cheques and the aulhorisalion of online banking transactions.. holding regu18r Trustee Meetings-, holding an Hiscox Charity Care insuran policy., receiving monthly management accounts comparing activity against budget- The Trustees refer to the guidance contained in the Charity Commission general guidan￿ on public benefit when reviewing the aims and objectives and in planning future activities. In particular, the Trustees consider how planned activities wll eontn.bute to the aims and objectives that have been set. Pagc 7 DopJSign Envelopg ID". F804C1IA-C66C4B324D7￿1CuFAD4O28 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2021 (continued) Achievements and Activities 2020-21: Overvlew Sl Mark's Hospital Foundation is dedicated lo funding healthcare research al Sl Mark's Hospital that drives clinical improvements and improves the understanding of complex bowel diseases. The Foundation also operationally facilitates the delivery of an extensive programme of education and income-generaling courses (both physical and virtuall through the Sl Mark's Ac8demic Inslitule. These are delivered by the medical staff al Sl Mark's Hospilal lo doctors and other healthcare professionals who attend in-person and virtualty from across the globe. The 2020-21 financial year started in the midst ol a global healihcare crisis. Al a local level, we fell the effects of the virus acutely as we were one of the ffirsl responders lo the Coronavirus ICovid-19} pandemic in London. However, we did not allow this lo impact our research and education activities as we adapted lo new ways of working. The Foundation showed tremendous resilience to the ever-changing nature of the pandemic over the course of the year. Developing relationships wilh new supporters was one such example that arose as a consequence of the pandemic. We are grateful for the conlribulions received from our new relationships as well as our existing Supporters to fund our ￿search activity as well 8$ strengthen our operations. In light of the above, the pnorily for this year has been to: Support néw and 8xi$ling priority strategi¢ research proie¢ts a¢ros$ all disciplino$. somo of which have Iransfomied in importance and relovan¢e in the wake of the Coronavirus (Covid-191 pandemic., continue to execute on our projects using the existing restricted funds; enable the Surgical Robot to evolve lo a clinical delivery service managed by the hospital; adapt our Academic Education course programme from in-person lo virtual leaching., meet the changing needs of siakeholders including staff, hospilal's medicallnon-medical staff, donors and strategic supporters,. and respond to the needs of the hospital and ils staff during the Covid-19 crisis.. implement new working practices such as remote working lo protect our staff to the extent possible whilst continuing to operate wthout material disruption. Significant progress has been made over Ihe past iwelve months. The Board is confident that the actions implemented have strengthened the Foundation and wll better enable the organisation lo raise funds for high quality medical research at St Mark's Hospital. The CEO worked closely with the Research Oversight Cornmittee to agree the strategic research priorities. The Surgical Robotics Research Programme continued lo attract funding, and granis were also secured for the projects profiled in the section 'Major research projects funded from new and existing Restricted Funds, Ibelowl. Page 8 DopJSign Envelopg ID". F804CIIA-C66C4B324D7MI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2021 (continued) Impact of Covid-19 The Covid-19 pandemic forced all healthcare professionals across the county lo re-orient their activities and join the frontline lo fight the virus. Whilst this had to become the n81ion's priority, Sl Mark's clinicians remained acutely aware that the challenges for patients with bowel cancer, Inflammatory Bowel Disease and other complex bowel conditions had not gone away. And so, at the same time as uniting with their colleagues across the country, they continued lo deliver some of their core services in a different formal. such as by telephone or online video call I'telemedicine')- Our co-localion wlh Northwick Park Hospitsl meant that Sl Mark's specialist doctors and nurses were redeployed immediately in March 2020. wth many of our research fellows supporting their colleagues in intensive care for as long as three months. As the number of Covid-19 hosptslisalions reduced over th8 summer after an intense pericmy of working that involved supporting thousands of people to recover from the virus. providing conlinuily of care to our gastroenterology and colorectal patients remained a wiority. However. the scale and mode of delivery of this care was impacted. Between September and November, inleTrsive care staff had some respite, bul we knew that the wnler period was going lo be made significantly more challenging by Covid-19. From October 2020. some Sl Mark's clinical services were relocated lo Central Middlesex Hospital, which offers a clean sile for clinlcal care. This enables us to maintain outpatient and surgical care during future surges of CoMd-19. Whil$l the first few month$ of 2021 ¢oin¢ided with another surge of Covid-19. the global effort to produce a safe and effective vaccine and the efficient rolkjut of the vaccination programme in the UK marked a slgnificanl milestone in our nation's roadmap lo recovery. The first quarter of 2021 saw Sl Mark's moving lo a position of clinical and research recovery, which has been greatly assisted by the move of some clinical services to Central Middlesex Hospital,. another hospital within the London North Wesl University Healthcare Trust. We remain immensely grateful lo our supporters, both longstanding and new, who have rallied round the hospitsl with in-kind and financial donations. We are also grateful for the grants we have continued to attract for research projects that have become more important and relevant in the wake of Covid-19. Like all charities, the pandemic's impact on our tradilw)nal fundraising methods, specrfically mass participation and other community events. was significant. We thank our supporters for embracing the national calls lo partake in virtual challenges, and for also finding other innovalive ways lo support us. These efforts have not fully recovered the lost income we have experienced from traditional fundraising events not being able to go ahead as planned however donations from corporate supporters, individual donors and different types of events have more than compensated for Ihis. As the situation with the pandemic improves. the funding environment will likely remain challenging. However, wlh new ways of working wlh our various stakeholders, we are cautiously oplimislic as we look ahead to the new financial year. Research holds the promise of better futures for our patients. We therefore remain fully committed to securing funding for projects that have the potential lo improve survival and quality of life, and to delivering an ongoing extensive programme of education to share best practice in colorectal and intestin81 medicine. Page 9 DopJSign Envelopg ID". F804CIIA-C66C4B324D7M1(UFAD4028 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2021 {continued) Major research projects funded from new and existing Restricted Funds Highlighted ongoing projects Surglcal Robotles Research Programme for colo￿tal and anorectal surgery The Foundation continued lo financially support St Mark's Hospitsl's Surgical Robotics Research Programme. The Programme is researching the polenlial of rot*)lic technology lo improve the long-term health outcomes for people who require surgery for colorectal cancer and other bowel conditions, such as Inflammatory Bowel Oisease IIBDI. Since the arrival of the Da Vinci RotKJt at St Mark's in April 2018. the Sl Mark's robotic team has performed over 240 robotic coloreel81 operations on bowel cancer and IBD patients, which is a significant achievement. This is despite Ihe Da Vinci Robot not pul to use temporarily al the height of the pandemic last year. The surgical robotics platfomi has also been used by our surgical colleagues from the wider hospital's urology, gynaecology and maxillo-facial departments, albeit the main focus of the programme, unlike other UK hospitals. is colorectsl surgery. The Foundation has successfully funded the initial conlractual cosl in accordance with the lemis of the agreement. Investlgatlng and Improvlng the quallty of IBD surg•ry Eviden￿ suggests there is variation In the delivery of IBD services and outcomes following18D surgery across IBD surgical units in England. One approach lo narrow the qu81ily gap between organisalions is to learn from those that are considered lo be Ihe highest ￿rf0Mers. Studying high perfom)ing units for quality improvement has been well described in the lileralure. This project has identified high perfomiing units in England using outcome d818 from six IBD operations, and in4Jeplh analysis of these units has bèen performed lo understand how they achieve iheir resurts. Our leamings will be shared nationwide and have the potential lo improve surgical outcomes and reduce quality inequity between IBO surgical units across the UK through a national quality improvement programme. PERFECTS CT colonography {CTCI is an allemative lo traditional colonoscopy and can be used for frail. older and fearful patients lo identify pre-cancerous and cancerous growths. However, il is widely recognised that the accuracy levels for identifying those growths varies significantly across tho UK. from 14.kn in somo cenlres to almost 100010 at Sl Mark's Hospital. The PERFECTS research programme aims lo train radiologists practicing VC in the UK to a hwh standard of proficiency and provide professional accreditation. PERFECTS has the potential lo reduce the UK-wide variations in scan reporting of pre- cancorous and cancerous growths via CTC which is leading to missed cancers. by improving the national skill level ol radiologists practising this technique. Principles established by PERFECTS have led lo the creation of the National CT Colonography Training & A￿reditatIOn Programme, which aims to train, test and performance monrtor radiographers and radiologists vtho perfomi and interpret CTC. PROGRESS Bowel cancer screening and Surveillan￿ in the UK has been carried out for many years in a slandardised way bul does not consider a patient's risk of developing bowel cancer. This means that some patients are undergoing loo many colonoscopies whereas others may nol be re￿Iving enough surveillan￿. PROGRESS is Using cutting*dge molecular pathology techniques, to more accurately predict who will develop bowel c8ncer. This is wth a view lo person81ise Ire8tmenl to individual cancer risk and ensure that scarce resources are targeted more accurately lo where the needs are greatest. This is a collaborative project wilh Barts Cancer Institute and St Mary's Hospital. Our preliminary results show differen￿$ between polyps that became cancerous compared with those stayed benign. In addition, for the first lime. the endoscopic resuhs of a large dataset of patient5 that had colonoscopies and were followed up over a len year pericxj have been compared with the revised 2019 British Society of Gaslroenlerology guidelines. This reveals that, had these guidelines been in place in 2010, 600/0 of patients would have been discharged with no risk of colorectsl Can￿r$ being missed. These insights Page 10 DopJSign Envelopg ID". F804C1IA-C66C4B324D7￿1CuFAD4O28 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2021 (continued) could help target resources more accurately on high risk can￿r patients in the future. The final research reports will be published in 2022. Precision Medicine in IBD: Can genetic clues from an inflammatory b¢)wel disease patient's gut predict whether or not they will respond to treatment? The terms personalised medicine and precision medicine are used interchangeably but they are united by a single vision." that patients with the same diagno&s do not receive the same treatment, bul the treatment that is appropriate for their disease. This palient-centred approach improves survival outcomes and health-relaled quality of life, and il also means Ihal scarce healthcare reSoUr￿S are directed more appropriately, helping those most in need. The need lo relieve the growing pressures on clinical services in the wake of Covid-19 has never been greater. This project is a slep towards a future where precision medicine can be realised for Crohn's disease and ulceralive colitis, the conditions colleclively known as Inflammatory Bowel Disease {IBDI. Understanding which chemicals drive inflammation in IBD may reveal predictors about which drugs patients will and will not respond lo. This means the right treatment can be started earlier and patients stsy well for longer. Our project could ￿ad to larger trials to investigate the utility of our findings in wder clinical practice. Hlghllghts of some of thè nèw projècts started In 2020 Stratlfylng IBD patlents In accordance wlth cancer rfsk Developing new methods lo effectively stratify IBD palienls by their risk of developing cancer is an inlernalionally collaborative project that Sl Mark's Hospital is al the heart of. The primary aim of thi$ research is lo create and then clinically te$1 molecular biomarkers that a¢¢urately determine ¢ancer risk in IBD patients. Following the successful first stage funded by one of our strategic supporters the team Is discussions with International collaborators to launch the next phase of this project. The WAVE sludy Colonoscopy is one of the main investigations lo detect and prevent bowel cancer. Colonoscopy services in the UK are experiencing growing pressures.. the failure lo meet national wailing time largels is delaying procedures and bowel cancer diagnoses. In response lo the growing pressures, endoscopy units have been extending opening hours and offering weekend Pro￿dureS,. this not sustsinable, especially in the Covid-19 era which is intensifying Ihe pressures on clinical services. In a resource- constrained environment, the endoscopy profession has lo find new ways lo improve efficiency and quality. The WAVE study is one of our responses lo this need. For the first lime, a controlled trial will compare two colonoscopy techniques {waler and waler & carbon dioxide Ihybridll lo identify which should be used lo open up the bowel wall to see the lining of the tM)wel. Understanding which technique is better al reducing pain. the procedure lime and need lo reposrtion patients, as well as being the most effective al improving the detection of pre2020 The Trustees continued lo review the Cash held on deposit, holding sufficient short-tem) cash lo meet current obligations. Net incoming resources for the year amounted lo £740,661. Totsl funds al the end of the year were £4.022.363. compared wilh £3.281,702 in the previous period. Funds and Reserves The Trustees are satisfied that adequate funds are available in each fund. as shown in the notes to the accounts, for the Foundation lo meet tts obligations. Restricted Funds are for particular areas of research as specified by the donors. Designated Funds are Ihose funds set aside for future research or educational projects as approved by the Trustees. The Trustees have a policy of holding Reserves. Unrestricted ReseNes are required for designation to fund the future planned activity of the Foundation, including research and education projects that the Trustees may wish lo support. They are also required to provide regular cash flow to finance on-going Page 16 DopJSign Envelopg ID". F804CIIA-C66C4B324D7MI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2021 (continued) expenditure and core support costs and to protect the Foundats"on's actimties from any urrforeseen fluclualions in income. The Trustees reviewed the reserves policy in the year and agreed the policy remain tjnchanged, wth a tsrget level for unreslricled reserves equivalent to four to six fflonths, operating expendilure1£280,000 - £420,000). Unreslricled Reserves at the year-end were £684.054, equivalent lo 12 months, operating expenditure, which include the Academic Inslitule's course costs. Trustees agreed that this is reasonable level of reserves given the ￿n￿rtaInty caused by COVID-19 and provides adequate contingency cover. The Foundation has forecast income and expenditure for 12 months from the date of this report, taking into consideration the likely impact of the Covid-19 pandemic on both fundraising and the Academic Instilule's expected income from c4)urses. Based on the forecast. Unrestricted ReseNes al the end of the twelve months are estimated lo come down lo the 6 monlhs expendilure level. which is the upper end of the Trustees approved reserves policy of four to six months range. Reslricled Reserves (representing funds raised for specrfic projects currentty in progress) were £2,614,273 al the year-end compared with £2,449,561 al year-end in the prior year. Investments The objective of the Foundation's treasury Fdrcy is lo produce the b8sI financial retum wthin an acceptable level of risk. The Trustees have continued the policy of holding the financial assets of the charity in fixed-tem sterling deposit accounts. The funds are deposited across several financi81 institutions and the cash position and fixed deposit returns are monitored on a regular basis. The Finance Manager reports al the regular Trustee Meetings on the perfornance of the deposils. Page 17 DopJSign Envelopg ID". F804C1IA-C66C4B324D7￿1CuFAD4O28 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2021 (continued) Statement of Trustees, Responsibilities The Trustees (who are also Ihe directors of the St Mark's Hospitsl Foundation for the purposes of company lawl are responsible for preparing the Report of the Trustees and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice), including Financial Rewrting Stsndard 102 Yhe Financial Reporting Standard applicable in ihe UK and Republic of Ireland". Company law requires the Trustees to prepare financial statements for each financial year which give a true and fair view of the $18te of affairs of the charitable company and of the incoming resources and applicalion of resources, including Ihe income and expenditure, of the charitable company for that period. In preparing those financial statements. the Trustees are required lo select suitable accounting policies and then apply them consislenlty observe the methods and principles in the Charity SORP make judgements and estimates that are reasonable and prudent prepare the financial slalemenls on the going concem basis unless il is inappropriate to presume that the charitable company will continue in EMJsiness The Trustees are responsible for keeping proper accounting records which disclose with asonable accuracy at any lime the financial position of the charitable company and to 8nable them to ensure that the f1nancial stslements cornply wlh the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for takin9 reasonable steps for the prevention and detection of fraud and other irregularilies. In so far a$ the Tru$lees are aware.. there is no rel8vanl audit infomiation of which the ¢haritable companls auditors are unaware,. and the Trustees have taken all steps that they ought to have taken to make themselves aware of any relevant audit information and lo establish that the auditors are aware of that information. Members of the Foundation guarantee to contnbule an amounl not exceeding £110 the assets of the Foundation in the event of wnding up. The lolal number of such guarantees al 31. March 2021 was eight. The Trustees are Members of the Foundation bul this entitles them only to voting rights. The Trustees have no beneficial interest in the Foundation. AUDITORS The auditors. Knox Cropper LLP, will be proposed re-appointmenl al the f¢Nthcoming Annual General Meeting. This report has been prepared in accordance wth the special provisions of Part 15 of the Companies Act 2006 relating lo small companies. Approved by order of the board of Trustees on 27Th September 2021 and signed on ils behalf by.. Sir Chaiman Page 18 DopJSign Envelopg ID". F804CIIA-C66C4B324D7MI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION INDEPENDENT AUDITORS. REPORT ST FOR THE YEAR ENDED 31 MARCH 2021 Oplnlon We have audited the financial statements of St Mark's Hospital Foundation (the 'charitable company'l for the year ended 31 March 2021 which comprise the Statemenl ol Finanaal Activities, the BalanrE Sheet, Statement of Cash Flows and notes to the financial statements, including a summary of significant accounting policies. The financial reporting fr8fflework th81 h85 been applied in their prepar8tion is 8pplicable18w and Uniltrd Kingdom Accounting Stsn¢Jards, including Finantial Reporting Standard 102 The FAn8n¢i81 Reporting Standard applicable in the UK and R8publi¢ of Ireland (United Kingd￿ Generally A¢¢epled A¢¢ounling Praclicel. In our opinion the financial statements.. give a true and fair view of the state of the charitable companys affairs as at 31 March 2021 and of ivs income and expenditure for the year then ended., have been propedy prepared in accordance with United Kingdom Generally Accepted Acojunting Practs'ce., and have been prepared in accordance with the requirements of the Companies Act 20C6. Basls of oplnlon We ¢ondu¢led our audit in accordance wth Intemational Slandards on Auditing IUKI IISAS IUKII and applicab18 law. Our restx)nsibilits'es under those standards are furth8r described in th8 Auditor's responsibilities for the audit of the financial statements section of our report. We are independent of the charitable company in accordance wilh the ethical requirements ihat are relevanl to our audit of the financial slalemenls in the UK, including the Financial Rep)rting Council's IFRCI Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit ewdenc8 we have obtained is sufficient and appropriate lo piovide a basis for our opinion. Con¢lu$lons relatlng to golng concem In auditing the financial statements, we have ￿nC￿￿ed Ihat the Iruslees, uso of Ihe going concern basis of accounting in the preparabon of the financial statements is appropriate. Based on the work we have perfomed. we have not idenlified any material uncertainties relating lo events or conditions Ihal. individually or collectively. may casl significant doubl on the charitable company's ability lo continue as 8 going concern for a period of 81 least twelve months from when the financial statements are authorised for issue. Our responsibilities and the responsibilities of th8 truste8s wth r8sp8Ct to going concern are describ8d in thg relevant sections of this report. Other information The other information comprises the infomalion induded in the annual report, other than the financial stslemenls and our auditors, report ther￿. The Trustees are responsible for the other infomiation. Our opinion on the financial stalements does not cover the other infomiation and. except to the extent otherwise explially stated in our reporl, we do not express any form of asSUrar￿e condusion thereon. In connection with our audit of the finan￿al statements. OUT responsiknlity is to read the other information and, in doing so, consider whether the other infomation is materially inwnsislenl wth the financial slalements or our knowledge obtained in th$ audit or otherwse appears to be materially misslated. If we identify su¢h material inconsistencies or apparent material misstalements, we are required to detem)ine whether the￿ is 8 material misstatement in the finanaal statemenis or a malerial misstatement of the other inforniation. If, based on the work we have performed, we condude that there is a material misstatement of this other information., we are required lo report that fact. We have nothing lo report in this regard. Page 19 DopJSign Envelopg ID". F804CIIA-C66C4B324D7MI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION INDEPENDENT AUDITORS. REPORT ST FOR THE YEAR ENDED 31 MARCH 2021 Oplnlon on other matt•rs pr•$¢rlb•d by th• Companl¢s Act 2006 In our opinion, based on the work unde￿ken in the Course of the audit". the infomialion given in the Trustees, report, which indudes the d1￿ClOrS, report prepared for the purposes of company law, for the financial year for which Ihe finanaal statements are prepared is consistent wilh the finanaal statements., and the directors. report included within the Trustees. rep￿1 has been prepared in ar£ordan￿ with applicable legal requirements. Matters on whlch we are requlred to report by exceptlon In the light of the knowledge antl un¢Jerstsnding ol the chaiitsble company and ils enwronmenl obtsined in the course of the audit, we have not identified material misstatements in the dire¢tors' report included within the Trustees, report. We have nothing to report in respect of the following matters where the Companies Act 2006 requires us lo report lo you if, in our opinion.. adequate accounting records have not been kept. or relums adequate for our audit have not been received from branches not visited by us.. or the financial slalemenls are not in agreement wlh the accounting records and retums., or certain disclosures ol Trustees, remuneration specified bylaw are not made,. or we h8ve nol received all the infomialion and explanalions we require for our 8udil,' or the Iruslees were nol enlilled lo Prepa￿ the financial slatements in accordance with the sm811 companies regime and take advantage of the small companies. exempbons in preparing the trustees, report and from the requirement to prepare a strategic report. Ro8pon8ibllbtle8 of Truste¢¥ As explained more fully in the Trustees. Responsibilities Statement, the Trustees Iwho are also the directors of the charitable company lor the purposes ol company lawl are responsible for the preparation of the flnanoal slalements and for being satssfied that they give a true and fair view. and foi such internal control as the Trustees determine is necessary lo enable the pieparation of financial stalem8nts that are Ire8 from material misstat8mgnt, wh8th8r dua to fraud or error. In preparing Ihe financial stalemenis. the Truslees are responsible lor assessing tha charitabb company'5 ability lo continue as a going concern, disclosing, as applicable, matters related lo going wncern and using the goin9 concern basis of accounts'ng unless the TnJstees either intend to liquidate the CL)mpany or to ceasè operations, or have no realistsc altemaiive but lo do $0. Auditor's responsibilities for the audit of the financial Statements Our objectives are to ob18in reasonable 8ssurance about whether the financi81 stslemenls as 8 whole are free from material misstatement. whether due to fraud or error. and to issue an auditor's report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAS IUKI will a￿VayS detect a material misstatement when it exists. Misstalemenls can arise from fraud or error and are considered material if, indiwdually or In the aggregate, they could reasonably be expected to Influen￿ the economic decisic￿S of Use￿ taken on the basis of these financial statements. Irregulari118s, including fraud, 8re instances of rKJn<(xnpliance wlh laws 8nd regulations. We design procedures in line with our responsibilities, outlined at)ove, to detect material misststements in respect of irregularities, including fraud. The extent to which our procedures are Capab￿ of detecting irregularilies. including fraud is detailed below.. The Charitable Company is required to comply with both company law and charity law and. based on our knowledge of ils activities, we identified that the legal requirement to accurately acwunt for restricted funds was of key significan￿. Page 20 DopJSign Envelopg ID". F804CIIA-C66C4B324D7MI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION INDEPENDENT AUDITORS. REPORT ST FOR THE YEAR ENDED 31 MARCH 2021 We gainad an understanding of how the charitable company complied with its legal and regulatory framework, in¢luding the requirement to propedy a¢counl for restri¢ted funds, through discussions with management and a review of the dr￿UMented poliues, procedures and controls. The audit team, which is experienced in the audit of charities. considered the charitable company's susceptibility to material missiatement and how fraud may (mir. Our considerations included the risk of management override. Our approach was to check that all restricted income was property identified and separately accounted for and lo ensure that only valid and appropriate expenditure was charged lo restricted funds. This included reviewing joumal adjustments and unusual transactions. A further description of our responsitylities for the a￿111 of the financial ststemenis is Iwaled on the Financial Reporting Council's website at.. www.frc.o .uklauditorsres nsibilities. This description fomis part of our auditor's report. Use of th• audlt report This report is made solely lo the charitable company's members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our av¢Jil worf( has been undertaken, so that we might slate lo the charitable company's members those matters we are required lo stale to them in an auditor's report and for no other purpose. To the fullest extont perniiited by law. we do not accept of assume responsibility to anyone other than the charitable company and the charitable cLJmpany s members as a body. for our audit work, for this report or for the opinions we have formed. Slmon GoodrSdgo Sensor Statutory Audltor for and on behalf of Knox Cropper I Statutory Auditors 65 Lo8denhall Street London EC3A 2AD October 5, 2021 Vage21 DopJSign Envelopg ID." F804CIIA-C66C4B324D7M1(t4FAD4028 ST MARK'S HOSPITAL FOUNDATION STATEMENT OF FINANCIAL ACTIVITIES (INCORPORATING THE INCOME ANO EXPENDITURE ACCOUNT) ST FOR THE YEAR ENDED 31 MARCH 2021 Note Unrestricted Designated Restricted Funds Funds Funds Total Funds 2021 Total Funds 2020 Income and Endowments Donations and Legacies Investment Income Income from Charitable Aclivilies.. Education Courses Other Incoming Resources 1,028.100 5.337 1,022,651 2,050,751 1,259,133 5,337 34,916 149.486 14.362 19,797 163.848 450,751 19,797 17,491 Total Income and Endowmonts 1.182.923 1.056.810 2,239,733 1,762,291 Expenditure Costs of Raising Funds Charitable Activities 176.818 407.360 649 177.467 200.563 902.690 1,321.605 1,611,149 11,555 Total Ex •ndltur• 584.178 11.555 903,339 1,499,072 1,811.712 Nèt Incom•l(EX￿nd1tura) 598.745 {11.555) 153,471 740,661 {49.4211 Transfers between funds Net Movgmgnt In Funds 12113 316,738 282.007 305.497 293.942 11,241 164,712 740,661 149,4211 Balance at 1. Aprll 2020 Balance at 31. March 2021 402.047 430,094 2,449.561 3.281.702 3,331.123 684.054 724,036 2.614.273 4.022.363 3,281,702 Page 22 DopJSign Envelopg ID". F804CIIA-C66C4B324D7M10C4FAD4028 ST MARK'S HOSPITAL FOUNDATION BALANCE SHEET 5T AS AT 31 MARCH 2021 Note 2021 2020 Fixed Assats Tan ible Assets 1,809 1,809 Current Assets Debtors Notice deF)osits Cash al bank and in hand 10 14 14 845.657 900.000 2,436,951 4,182.608 96,316 2.900,000 719.531 3,715,847 Creditors.. Amounts falling due within one ar 160.245 435.954 Net Current Assèts 4.022.363 3.279.893 Net Assets 4,022,363 3,281,702 Funds Restricted Designated Unreslricled 13 12 2,614,273 724,036 684,054 4.022,363 2,449,561 430,094 402,047 3,281,702 Total Funds These financial statements were approved by th8 Trustees on 27th September 2021and signed on their behalf by Sir ThomasYrouYn8ge Chaimian Company Number. 07532184 Page 23 DopJSign Envelopg ID". F804CIIA-C66C4B324D7MI(UFAD4028 ST MARK'S HOSPITAL FOUNDATION STATEMENT OF CASH FLOWS ST FOR THE YEAR ENDED 31 MARCH 2021 2021 2020 Statement of Cash Flow Cash flows from operating adivities: Net Cash rovided b I used in •ratin Cash flows from investing activitses.. Dividends. interest and rents from investments Proceeds of sale of investments Net cash provided by investing activities activilies 287,917 206,532 5.337 34,916 S,337 34,916 Cash flows from flnanclng actlvltles Nel cash rovided b I used in financin activities Change In cash and cash equlvalents In the reportlng period Cash and cash equlvalents at the beglnnlng of the reporting perlod Cash and cash equivalents at the end of the reportin period 1282,5801 241,448 3,619,531 3.378,083 3,336,951 3,619,531 Reconclllatlon of Net (Expondltureinncome to Not Cash Flow from Op8ratlng Actlvltlos 2021 2020 Nel incomellexpenditur81 for the reporting per￿1 {as per Ihe slalemenl of financial activiliesl Adjuslmenls for.. Depreciation charge$ Losses on investments Dividends. interest and rents frcrfn investrnents Ilnueaseydecrease in debtors Decrease increase in creditors Net cash provlded b I used In operatln 740,661 149,4211 1,809 2,117 15,3371 134.9161 1749,341) 20,306 275,709 268,446 287,917 206.532 actlvltles Analysls of Cash and Cash Equivalents 2021 2020 Cash in hand Notice de osils Total cash and cash equNalents 2,436.951 719,531 900.000 2,900,000 3,336.951 3.619.531 Page 24 DopJSign Envelopg ID". F804C1IA-C66C4B324D7￿1CuFAD4O28 ST MARK'S HOSPITAL FOUNDATION NOTES TO THE ACCOUNTS FOR THE YEAR ENDED 31" MARCH 2021 Icontinuedl ACCOUNTING POLICIES la) Basis of Preparation The financial slalemenls have been prepared in accordan￿ with Accounting and Reporting by Charities.. Sl8temenl of Recornmended Practi￿ applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland {FRS1021 (second edition - October 20191 and the Companies Act 2006. The charity ￿nStItuteS a public benefit entity as defined by FRS 102. Ib) crftlcal accounting estlmates and areas of judgement Preparation of the financial statements requires the Trustees and management to make signtficanl judgements 8nd estimates. The items in th8 financial stslements vthere these judgements and eslimal8s have been made include.. Assessing the probability of receipt of legacy income.. Determining the apportionment of expenditure between the e21egories of expenditure on charitable activities. Going conc8m The Trustees have assessed whether the use of the going eoneem assumption 1$ appropriate in preparing these financial statements. The Trustees have made this assessment in respect lo a pericrtl of one year from the date of approval of these financial stalemenls. The Charity remains a going concem. promded there are sufficient Unreslricled Reserves lo meet the charity's operating expenditure for the foreseeable future. Al 31 March 2021 the charity had Ihe equivalent ofjusl over fftlve monlhs. operating expendilure in unreslricled reserves1£684,0541. Forecast cash fkjws for 12 months from the dale of this report indieale that these Unreslrieled Reserves will be sufficient to meet operating expenditure taking into account the Covid-19 pandemic. Accordingly the Truslees of the charity have concluded that there are no material uncertainties related lo events or conditions that may cast significant doubl on the ability of the charity lo continue as a going concem. The Trustees are of the opinion that the Charity wll have sufficient resources to meet its liabilities as they fall due. Id) Research Expenditure Liabilities are recognised as resources expended as soon as there is 8 leg81 or conslruclive obligation committing the charity lo the expenditure. Al expenditure is accounted for on an accnjals basis and has been dassrfied under headings that aggregate all costs relaled to the category. The expenditure is accounted for where either the Trustees have agreed lo pay without condition and the recipient has a reasonable expectslion that they will receive an award, or any condition attaching lo the expenditure is outside the control of the Foundation. Page 25 DopJSign Envelopg ID". F804CIIA-C66C4B324D7M1(UFAD4028 ST MARK'S HOSPITAL FOUNDATION NOTES TO THE ACCOUNTS 5T FOR THE YEAR ENDED 31 MARCH 2021 (continued) ACCOUNTING POLICIES {contlnuedl 19) Tangible Fixed Assets and Depr8ciation All assets costing more than £1.000 are capitalised and all assets are valued at historic cost. Depreciation of fixed assets is calculated on cost at rates estimated to write off the assets, by equal inslalments, over their expected vlorking lives. Fixiures and fittings and office equipment are wrillen off over five years. Computers are wrillen off over three years. The modular building was depreciated over four years. ifj Incom• Research funding income is recc#Jnised in the year in which the charity receives a wrillen commilmenl from the funder. Research funding is deferred only when the charity has lo fuffil conditions before becoming entitled lo It or the donor has specified that the income has to be spent in a future period. All other incoming resources are included in the Stslemenl of Financial Activities ISOFAI when the Foundalion is legally entill8d to the income and the amount can be quantified with reasonable accuracy. Ig) Value Added Tax The Foundation registered for VAT from August 2019. Where applicable, all costs and expenditu￿ in¢urred on trading a¢tivilie$ I￿ ex¢lu$ive of VAT. (h) Allocatlon of Support Costs Support costs have been allocated betsveen charitable activities and fundraising. Support costs relating lo chariiable aclivilies have been apportioned based on a weighted salary P8rc8ntage basis. The alloealion of support Costs Is 8nalysed in nola 6. Costs of Ralslng Funds The cost of generating and administering voluntary income includes fundraising costs, investment managers, fees and a proportion of staff costs. u) Charltable A¢tlvltles Costs of charitable activities include grants made and an apportionment of overhead and support costs as shown in note 5. Overhead costs are apportioned based on the staff lime spent on the charitable aclivilies. (k) Funds Unrestricted ftjnds are funds which can be used at the Trustees. discretion. Restricted Funds are funds whose purposes have been reslricled by the donor. Designated Funds are unrestricted funds whith have been earmarked by the Trustees for particular purposes. Voluntary Income Unrestricted Funds Restricted Funds 2021 2020 Donations and Grants Legacies 883,462 144,638 1,028,100 877.651 145.000 1.022.651 1.761.113 289,638 2,050,751 733,813 525,320 1,259,133 Page 26 DopJSign Envelopg ID". F804CIIA-C66C4B324D7M1(UFAD4028 ST MARK'S HOSPITAL FOUNDATION NOTES TO THE ACCOUNTS FOR THE YEAR ENDED 31°, MARCH 2021 (continued) Investment Income 2021 2020 Bank Interest 5,337 5.337 34,916 34,916 Expendituro on Raising Funds Unrestricted Funds Restricted Funds 2021 2020 Fundraising Costs Governance Costs Overheads Stsff Costs 22,809 4,323 9.666 140.020 176,818 649 23,458 4,323 9,666 140,020 177,467 30,132 5,035 10.070 155.326 200,563 649 Analysls of Charltable ActlvltS08 Oirect Expendlturo Support Costs 2021 2020 Researeh Expenditure Educalion 937,985 247,650 1,185,635 93.789 42.181 135,970 1.031,774 289,831 1.321,605 1,100,546 510,603 1,611,149 Unrestrl¢ted Deslgnaled Restrlcted Funds Funds Funds 2021 2020 Dlrectly Incurred Re