STMARK5 H O S P l T A L FOUNDATION A Future Free From The Fear Of Bowel Disease ST MARK'S HOSPITAL FOUNDATIW 2023 TRUSTEES. REPORT AND FINANCIAL STATEMENTS FOR THE YEAR ENDED 31ST MARCH 2023 CHARITY NUMBER: 1140930 COMPANY NUMBER: 07532184 ST MARK'S HOSPITAL FOUNDATION S, MA%AS Front * I ST MARK'S HOSPITAL FOUNDATION Contents Pag• Trustso8' Report Chaimian's Statement Govemance and Management Risk and Intemal Control Obj8ctives and Activities for the Public Benefft Achievements and ActiVi￿S 2021-2022: Research Education Financial R8W8W Statement of Trustees. Responsibilities Indopendent Auditors, Report Statement of Financial Actlvltlo• Balane• She•t Stat•ment of Cash Flows Notes to the Accounts Reference and Adminlstratlv• Infomiallon 14 19 21 22 25 26 27 28 37 ST MARICS HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 315T MARCH 2023 chai￿an.$ Statement St Mark's Hospital ¢onllnued lo establish itsetf at the new main ￿te al Centrdl Middlesex. From a clinical delivery point of view, l am extremely proud of the St Mark's clinical team as they continue to deliver théir specialist care for patients referred nationally as wo11 as wor￿ng lo meet the demarKls frcrfn an ever-increasing number of referred patients from within its geographical area. The St Mark's Hospital Foundal*)n and its staff are now fully embedded at the new sile wherg their acttvitses lo support research and education are now almost exclusively delivered. Although most of our research felk)ws are now based there, we sb"Il have fellows on dinical rotations at Northwick Park. which is the acute hub of the NHS Tiusl that Sl Mark's is part of. Our research collaborations have grown further this y88r with several new projects working wilh other healthcare and rgséarch cenlres nationally and inlemationally. TDlal income for the year wa5 £2.648,831 whilst total expenditure for the year wa$ £2.273.324. Total income increased by 54% when compared ￿th previous year's ino)me of £1,722,853. mainly du6 to an increas8 in legacy donations and education income Fundralslng for restricted researth prolects raised £1,283.208 which was an Increase of 32% at￿ve last year's income of £970.278. Academic income continues lo grow year on year and this yaar's income of £5C6.445 was 60% higher than last year. Sponsorship and ￿Urse delegate income continues lo grow strongly, malnly due to supp)rt of the sponsors of our in-pgrson and hybrid courses. The annual Frontiers conference in November 2022 saw our first ever synchronous hybrld cours8 with 150 del6gates attending in person 88¢h day at Glaziers Hall, and over 2.OCrf) attending online. Totsl expenditure was highor by 23% rgflecling an incr83se in spend on r8soarch proj•¢ls as w811 as higher oducation costs because ol our growing course prograrnme in¢luding a more substantial Fronts6rs cx)nference. Thg ¢OSt of raising funds as a percentage ol lolal expgndilure remained the 5am0 as th6 previous year, at 10%. l am pleased lo report Ihal the Foundatlon's unrestricted reserves continue lo maintain a healthy level at £862.196 whlch is equivalent to just under 12 months of total unreslricled expenditure. In addition. the Foundallon also hjlds a healthy balance of designatod funds 01 £558,694 and restricted research fvnds of £2,858,645. l am particularly proud of the outcomes of signrfi¢ant research proiects durfng Ihls year that the Foundalion has supported over Ihg years. Their impacts were particaJlarfy felt during Ihis peric#l. As a direct result of the initial funding provided by the Foundation for the cok)reclal ROBOTIC SURGERY programme, the benefits of using robolic laparoscopy for colorectal and anorectal surgery We￿ demonslraled. In eady 2023 Ihe NHS Trust began the process of purchasing three more surgical rotrK)Is. The funding of the CTC PERFECTS project proved thal with the dghl type of training. radiologists and radiographafs could stqnifieanlly increase Ihe detection rale of polyps using a CT scan. This now has béen dèveloped further with a grant from NHS England which is 8UPPOrting th& role OLrt of a national CTC accredrtation programme uslrwj the inspJhts arKI data from our PERFECTS research project. We hosted a very successful event for supporters of the Fou￿1a1]0n at Glaziers Hall on one of tha evenings during the Frontiers conference. This enabled our supporters lo hèar about Ihe lalesl actiMlie5 of th8 FoundatSon and the wlder hospital bul al the same lime. k8pI c05t5 d¢Jwn. since the venue had already bean paid for. As the hospital now builds its speaalist services further at the new Central MIdd￿SeX sile. Ihere are more opportunities for the Foundation lo support the improvements in the faalilies lor education and wsearch, including for the new endoscopy cenlre. We are calliThJ this opportunity endoscopy+ On t*half of the TnJstee Boar(J and management team, I would like to thank the FourKlotion staff and all our existing and new donors and supporters for their ￿mM[IMent and contributions. Sir Thomas TroutsTidg8 Page 4 ST MARK'S HOSPITAL FOUNDATION TRUSTEES, REPORT FOR THE YEAR ENDED 31ST MARCH 2023 Th9 Trustees present their r8POrt and the audited finanaol statements for the year ended 3151 March 2023. St ark's Hospital Foundalton is a company limited by guarantee, incorwrated on 16th February 2011 and not having a share Gaprtal. It was registered as a charity with the Charity CommissDn for England and Wales on 2 March 2011. The Foundatson comm8nced operab'ons on 1° April 2011. when th8 assets and operations of Sl ark's Hospital Foundation Trust. a charity registered with the Charity Commisslon for England and Wales under Charty Number 1088179, were transferred to the corporate charity. The Foundation is operating under ex￿tlY the same pri￿lpIe and objects as the unincofporaled Tnjsl and continues lo support Sl Mat1('s Hospital. particularly by funding resea¥ch projects, as well as managing and deliverrng a large programme of educalon. enabllng the dissemination of b051 practice in Ihe field of bowel disease al St IAark'$ Hospit81. Governance and Management incIL￿dIng appointment of th8 Auditors. Monthty managemenl accounls are provid&d lo tho Trustees. giving infornation on income and expenditure and bu(Jgel comparisons. Trustees are appointed by Ordinary ResolulK)n or by a simple majority of all the Trustees enlilled to attend and vole al any meeting of Ihe Tru51ees. Trustees hokl offlce until th8 end of the fitsl meeting of the Trustees following the third anniversary of appointment or reapwintment. Trustees are pemiitled lo stand for re4leclion for further tsvo terms with duration of three years each. Amongst the Trustees Ihere is a good mix of skills wlth both medical and non-medical representstives bringing me(lical, busln6ss and financial expertise lo the Board. Thwe 1$ also di¥er¥ity of gender and age. Fundralslng Commltt•o This consists of the Chaimian {Truste81, two Tru$lo9s. ts CEO 8nd Fundraising Manager. The role of the Fundraising Committee is lo pro￿de oveT¥HJhl of tho a￿l￿ts'e5 of the fundraising team. and lo ensure that fundr8islng actiwty is in accordance with the 51raleglc goals of the Board of Trustees. The Committee is the key condult for 0)mmuni￿tion and reporting ba￿een the lundraising team and the Board. The Board of Trustees 8dminlsters St Mark. Hospltal Foundation, meeting quarterfy. The day-ttr Rowrch Ovèrnlght Comrnltt•• day operations of the Foundation are managed by Thls ¢ommtitee does not have any direct Truste8 th& CEO. who ￿pOrtS lo the 8oard on perfomiance represenial￿n. 11 consists of the Dean of the against Ihe 51ralegic plans approved by the Academic Inslilule. Ihe Cllnical Dlreclor of Sl Truslees al quarterly meetings, when reports from Mark's Hospital. senior ¢onsultants, and tha CEO of th8 Clinical Director and the Dean of the Academlc the Foundation. Tho Committee reviews all Instllute are al80 re¢eived. proposals for TeseaTch Projects and approves Ihose that meet It* criteria of Ihe hospital. Funds are raised for the approved proje¢ts in order of pnority sel by the c>)mmitt88. The Trustees do not ffj¢eive remunoral￿th or deriv8 any other personal bengfil Irom Ihe actiwtss of the Foundation. The Trustees may delegate any of their powers to a committe6 cnnsisling of ￿ or more Tru$lees. The followlng committees have been estsblished: Rlsk and Intornal Control The Truslegs have overall responsibilty for ensuring tt)al the Foundation has an 8ppropnate system of intemal controls, financial and othérwise. They are als9 responsible lor safeguarding the assets of the Foundation and hence for taking reasonable steps for the preventh'on and detection of fraud and other irregularities and lo provkle reassurance that Flnance and Audit Commltt This consists of the Chaimian IT￿￿te&l. Treasurer ITrus18el, CEO and AC(￿Untant. Expenditure is sup8rviseA by tha Committ88 to ensuw compliance wrth decisions taken by the Board of Trustees. The Committee presents the draft annual budget to the Board. oversees the performance of investments, helps to idenlfy. evaluale and manag9 risks and oversees the effectiveness of the Foundakn"on's external audit. its assets are Safeguarded against unauthorised use or disposthn.. P&ge 5 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31ST MARCH 2023 (continuedl proper records are maintsined. and financial informatson used within the FOundat￿n or for publication is reliable- and the Foundation complies wilh releTrrant Ws and regulations. rrfeiving upd81es during the year on Gurronl research,. and rec8iwThJ updates during the year on postgraduate education. The above enables the Truste8S to sallsfy As part of the Foundation's risk managemont themselves thal the Foundation wlicies ar8 being process, the Trustees acknowledge their implemented. that swJnifi¢anl weaknesses of control responsibilty for the Foundation's system of idenbfied arg baing promptly addressed and on Ihe inlemal controls and reviewing Ils effectiveness. It overall adequacy and effectsven9s5 of thè IS also recognised by the Trustees that such a Foundation's systom of inlamal control and risk system is designed lo manage rather than eliminate managemenL the risk of failure lo achieve Ihe Foundation's objectives and can only provide reasonab￿, not absolute, r8assuranc8 agalnsl malerial misslatemenl or loss. Objectlvas and Activltles for the Publlc Benefit In lin• wllh the Charity Commission's guidelines on The objects of the Foundation, as set out in the sk management. thè Fwndation has developed a Articles of Association, are reslrictad specifically to risk register. oullSning the potential iisks th6 the promots'on of research into and education in Foundation could face, weighing Ihe likelihood and disordèts of tha gastro-inleslinol Irad and pelvlc potential impact of each and tho current and floor. The p)licy adopted is to provhle support for research al Si Mark's Hospital. by making grants for proposed actions r¢qLbired lo mitigate those risks as research projects approved by the Board of appropriate. The most sKJnrficanl risks for th• Foundation Include.. Trustees. ond lo fund the Academic Inslilule'$ its ability lo fundraise sufficient unr8stricted po$tgradual8 courses and le¢lures and tha Income to COV8r core ¢osls and lo generate a observation of surgical procedu￿$ al Sl Mark's surplus lor Trustees lo designate for re$¢arch Hosprtal for medi¢al Students from around the workl. and educalion: the length of lime from receipt of furKling to rosearch project completion. A Multkmedla Department, funded by th8 Foundation. Is a valuable ￿sOurce provldlng support for both research and aducalion vllhln Sl Mark's H¢)8pitsI. The Trusleas minlmise risk lo the Foundation by.. monitoring the risks by Teviewing the risk r¢glstar on a regular basis.. setting a policy on eKwTrJilur6 aprxoval, signing of cheques arbd the authr￿saIion of onlin8 banking transactions; holding regular Trustee M8elings', holding a Chanty Care insurance pollcy with QBE UK Ltd. recèiving monthly management ac0￿nts comparing activty agalnsl budget; The Trustees refer to the guidance contained in the Charity Commis5i0n g&ner81 guidance on public benefit when roviewing the aims and objectives and in planning future activiligs. In particular, the Trustees consider how pknned activities will conlribule lo the aims and objectives that have bgen Page 6 ST MARK'S HOSPITAL FOUNDATION TRUSTEES, REPORT FOR THE YEAR ENDED 31ST MARCH 2023 Icontlnued) Achievements and Actlvltlas 2022-23: Overvièw St Mark's Hospital Foundation r8 (Ipdi¢aled to fundlng medical research al Sl Mark's Hospital that driv05 clinical improvoments and in¢rgases the Unde￿tandIng of complex tM)wel diseases. The Foundation also operationally facilitates the delivery of an extensive programme of oducation and income-generaling courses (both physical and wrtuall through the Sl Mark's A¢adgmi¢ Institute. These are delivered by the dinical staff al Sl Mark'5 Hospital to doths and other healthcare professionals who attend in-per50n and virtually from across the globe. The 2022-23 financial year slartod strongly as many of our researchers published and presonted papers al gaslroenlerology and Surgical ¢onf6rénces nalK)nally and inlemationally. Some of our existing strategic research projects in eady carKer detection and In￿vationS in endoscopy aThJ surgery developed further into NHS adoplion. W8 also began lo support new projects into personalised treatment pathways for patients with innammalory bowel disease. Two of our most slgnlflcanl aChIe￿MentS evidenced the valuo of our earfy-stage funding of research Inltiatlves. Following the success of the robotic surgery programme. most Sl Mark's surgeons now use the robot for many of their surgerles. SUrge￿s from acmss the Tn￿t in other speci811ie$ are also requesting a¢¢es$ lo surgical robots and the Trust is planning lo purchase al least more robots. Our re¥eaTch into polyp detection using CT scans has led lo an NHS Engl8nd gT8nt10 8UPFQrt th8 rol8 out of a national aCC￿￿1(all0n program￿￿ for CT Cotonography. Th¢ number of dlnical observers from abroad now exceeds the pre pandgmic levels and we also delivered more and larger courses than the year b6lore in our educatlon programme. Somo ol our key achievements ol Ihe year were: Our largesl and most successful Frontier$ ¢onferen¢e in lemis of numbers of debgales. th6 nsi$lenl positive delegate feedback, and the ino)me from sponsorship The estsblishmenl of the national accreditation programme for CTC Colonography Proving the case for wider adoption of robotic surgery acro55 our NHS Trust Ngw funding for research into earlier canw d8teclion lor higher risk patients Growing our income and research spend whilst also maintslning o high bv61 of reserves Despite contlnued and well documented challenges within the NHS. our pr(*3rammes of research and education have continued lo grow and dev8bp very well in the last 12 mc¥)ths. The Board is confident that Ihe Foundallon is in a strong position lo cA)ntinue to raise funds and supwrt the delivery of high- quality medical research and eduGalion al Sl Mark's Hospital. The CEO ¥￿Iked closely with the Clinical Director. lh& D&an and the Research Ove*sighl Committee lo agree the strategic research priorilies. Pagc 7 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31ST MARCH 2023 (contlnued) Major rosoarch projects funded from new and exlstlng funds SURGICAL & ENDOSCOPIC INNOVAnoNS Surylcal Rol)olics RoB￿r¢h Programm• fw colorectal and anoreclal surgery Whilst robotics had been established for other surgical speciath'es. nam8ly urobgy and gynaecology. il had not been widely researched and implemented for colorectal and ar)ore¢tsl surgery. This need was one that St M8rk's was delemiined lo address through ils funding of a Davind rot#)l and the estsbllshment of the roboti¢ programme wl¥ch started in 2018. Betsveen 2018 and 2022, almost 4CrfJ robotlc owathy)s were performed. In the first quarter of 2023. 46 proceduros were ccmnpleted. A unique aspect of thè robollcs programme is the types of procedures being pgrform¢d. which are different lo other inslilutions. Specifically. over the lasl four years, the team has been developin9 their expertlse wrth.. Synchronous lIv•r￿OI ros•rtlon$'. Ihese hav8 been performwj in ¢>)Ilat￿lratIrrtj with surgical col￿a9UeS from Hammgrsmilh Hospital. London. Pelvlc exent•iatlons: this is major Gompiex ean(*r surgery which involves the removal of pelwc organs. Robotlc II•ollanal pou¢h surg•ry.' Ihis work has boen dovewd Into P￿)lica￿Dns and is an example of how we are disseminaling new knowledge. The robollcs plaffomi continued lo be u5etJ by urolcgy. gynaecology. and maxillo•facial surgical colleagues In ihe Tnjst. albeit Iho focus ol the Pmgramme, unliko In other UK hospitals. continued to be colorectsl 8urgory. To help meet the Programme's educational ¢)bjecbve to beo)me a national and inlefflalional trainin9 hub in robotic colorectal surgery. surgeons from UK and overseas hospitals conllnue lo be hosted for on day case observatsons. To data, more than 60 surgeons have spent a day al Sl Mark'5 observing and learniw from our robotically trained cobrectal surgeons, of which Ihere arg 9. There is also a tralning programme In plac8 for other St Mark's ￿rgeonS wantiryJ lo devew their robotic surgKal skills. W6 thank the donors who have helped us fulfil our role lo seed fund the programme. Finan¢ial responsibility has now transferred to the Lond￿ North West University Health Car• NHS Trust. and the Trust is looking to acquire al least addthonal robots. Rot)lon ￿nCer and Idenlblylng those Ihal may bemfit Irom more extensiv8 surgery. The results are planned to be publishod. DRIVEN was a coll81)or•live proio¢t be￿n St Math's and rndiology aThJ pathology t>)Ileagu88 at The Royal Marsden Hospltal and ts I￿trIute of Cancer Researth. Pr•dicling canc•r r•cuff•nc• in Infiammatory 8¢M•l DIMu• p•tl•nt• Ulceralivg coliti$ and Crohn's disease both have an associaled bowel cancer risk. The cancer risk inGrea$es wllh the severity and duration of the disease, such that about one in three people with lorKJ- 8landing disease will develop ￿ncer. To mitigate this risk. these paI￿nIS we offèred regular lonoscopies lo look for eady sons of cancer, enabling appropnale action lo be taken in good timo. However. colonoscopic surveillance would b8 improv&J rf we had a more ￿nSitIVe way lo predict which people are al hvJhesl risk of developing can¢ar. This project is looking 81 dyspLgsia in ulceralNe colitss. one ol the iwo most common forms of Inflammatory Bowel Disease, and will use genOrn￿ biomarkers to predict cancer rgcurrenc8 in patients who have undergone end08￿piC resection of these lesh)ns. Why do Sorng patlonts wlth Lynch Syndrorne develop cancer and oth•rs don't? Improvlng undèrstandlng of ynetlcs and Immunol¢)gy to support cancor prevention Funding for a research fellow lo lead this project was seujred in 2022-23. They have now commenc£d the work. whith is a C•)Ilaboration wlth the Institute of Cancer Research. This project will look at the key difference5 in healthy. pre•cance￿$ cancerous tissue in Pat￿15 with Lynch Syndrome, a type of familial can￿[ s￿d[orne which increases a pe￿On'5 risk of various cancers, including bowel cancer. The tissue that will be tested has been donated by patients dwn9 their routine colonoso)pies and stored in the biobank at Sl Mark's. Pag¢ll ST MARK'S HOSPITAL FOUNDATION TRUSTEE8' REPORT FOR THE YEAR ENDED 31ST MARCH 2023 {continu•dl By understandiThJ more about the genetics and IMMU￿ landscape of tissue and matching this to clinical dotails about individual patients. we hope lo understand more ab(yJl why some patients with family history of cancer develop the disease whibt othws do not The goal is lo prevent more cancer In young people. Cllnlcal Out¢om¢s in Perlanal Flstula Database Study The Study's aims and objectives are to store dinical, demographic and outcome data from patients with perianal fistula5 vllh infom)ed consent to identify factors correlated with treatment response. 11 will provide a better understsnding of the fa¢lofs that contribute toward5 wrianal fistula healing. Wg know that not all fbstulas respond to treatment. so we would like to investsgale ihe sel of cirGumstanGes in whlch 8 fistula is rn0￿ likety to close. More than 21)0 palienl8 have been re¢ruited and patients ￿ntinU8 lo provida consent to be part of study on a weekly basis at the Central Middlesex HospItsI 5itg. OTHER RESEARCH INITIATIVES Establl8hing tho I￿raStructur• for a now futurtrproof r•••arth r••ourc• at Sl Mark's The Sl Mark's 115$ue bank Is making il possible to ￿llect fistula tissue and othèr samples from patlenls with informed consent lor use in lulure research projects. Whilst a proportion of these samples will bo from pall8nts with very rare eondltions, others arg rare bul ¥9on in ￿49h W￿ume al Sl Mark'$ Hospital. The rate ol samplo ¢ollection has increased rthv that Ihere are freezers at b)th the St Mark's and C8nlral Middlesex Hospilal srtes. As of April 2023, 275 patients have been consented and $50 samples have been collected. As well as Ilssue samP￿s, blood and blood serum samP￿S ar8 also belng collected and. in tho future, Stool samples will also be ￿lleCted. The ts55￿ bank represents a futurtrproof research resource. Ovor lim8. il wlll provide a rich Sour￿ of data, whlch one will not bo able to find In any ott￿r inslrtulw)n In the UK in the same volume. Rosearch projects supported by designated funds Ub'lising the 'pouch MDr to improve outcomes for Fouch paI￿nts. Advances in the management of perianal Crohn's diseasg. R8s68rch into the palhogenesis and management of pithidal disease. Understanding and optimising the perioperative pathway of the complex cancer pati￿1. Understanding how best to counsel patients for restorative procloc4)leclorny. Age and ethnic dispar11￿S of risk and outcomes of Infiammatory Bowpl Disease as¥Q¢kqt8d dysplasia and ￿10reCta1 cancer in ￿l￿ratIve (x)litis. Understandlng the n￿P1aStiC risk of serrat&J ￿lonS in Infiammalory BcA¥el Diseas8. Page 12 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2023 (continued) Coming up in 2023-24 ENDOSCOPY+ St Mark's dellvers a cross-site endoscopy service from ￿￿1th¥￿ck Park aTrJ Central Middlesex Hospitals. One6 the refurbishments of the endoscopy units al bolh siles are complete. overall endoscopy capacity will increase from eight procedure rooms lo elevon. four at Ncrfthwi¢k Park and ¥even al Central Middlesex, the new hub of Sl Mark'8. The aspiration for endoscopy at St Mark'3 is- To dell¥er out8tandlng tr•atm8nt to local and t•rtlary patl•nts. undertake rosoarch that will Impact futuro endoscopy practlco, and dellver fIrst￿lasS teaching and •ducatlon In tho hospltal'• rol• as a Natlonal Tralnlng Contro for •ndosGopy. Endoscopy+ is how St Mark's will tran$fomi r•S￿rth. leaching. and training in ondos¢opy. The State￿f- Ihe4rt, cross-sile faeility will ben8fit and transcend local communities and improve the hospital's rgse8rch and education capabiliti'es. It will have a far￿eaChing impacl. Whilst the NHS has ts)mmilled a multi-mlllion-pound sum for the relurbishmenls of the endoscopy units, and provlded a capital budgel for some equipment. there is enough funding available to meet every need. A re3trb¢ted lega¢y will g81 fundralsir#J undevway. and wlth the support of other donors t￿. tho ambltions for Endoscopy+ wll be realised.. 1. To develop anej contlnue hlgh quality re8earch wlh the potential to impact futuro end08LYJPy pracllce and quality of care to patients. 2. To transform the quality of the leaching and training Sl Mark's can ddiver. Page 13 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31ST MARCH 20231wntlnuod> Educatlon St Mark's Academic Institute. whlch is funded by the Foundalk)n and SUPFQrted by course fees and swnsorship revenue. is dedicated to education and dissemination of best practice in tha field of bowel disease al Sl Ma￿'S Hospital. Drawing on the medical. surgitsl. and nursing expe￿'se t#)th at the Hospital and further afigld, the Academic Institute runs specialist courses attractbng more than 2,000 practitioners from the UK and overseas. The Foundation operationally suppK)rts over 30 research felbws undèrtaking either MDS OT PhD5. Thg Ac8dernic Institute sUPPOrts and promotes a vibrant research ethos. F￿on¢k Salmon founded St Mark's Hospital bn 1835 as the Benevolenl Oispgnsary for the Relief of the Poor Afflicted with Fistula. Piles aTrJ oth8r Diseases of the Rectum and Lower Intestines. Although the Hospital now has a far broader remiL it Is fitting that Salmon's goal, benefitting the patient. remains the objecllve of the educat￿n81 ¢ourses we offer today. A¢ademlc In8tituto dopartment staff wlthln tho Foundatlon Multi-media webcast producerlaudiowvtsual Cftrordlnator Course and education mana9er Course and digital admSnlslralor R98earth Cowordinator Acadomlc Instltut• Cours• Ovorvl•w A8 the flrsl hospi181 in ts world to specialis8 in color•ctal disease, St ma￿.5 Hosprtal h85 embraeéd the educ81ion of others. SinG¢ th8 1950's doctors have Come lo Sl Mark's Hospitsl from all over the world lo leain, with many reluming lo establish the ¥pgualism in their own country. The Ireatmant of intestinal and colorectal disease has now becomg a specialty throughout the workl and al St Mark's. The Sl Mark's Academic Instftute has a￿￿$$ lo a wealth of highly qu8ltfied and experlenced staff who have a proaGliv¢ attrtude lo education. Courses vary in length and attract a broad range of poslgraduat• medical stsff. All educabonal courses are advertlsed on the intemet and wa th8 medical 8nd p8ramedlcal press. Allendees. for the Sl Mark's Hospitsl's Fronliefs meeting and postgraduate teachlng ￿urse8, arg frorn thro￿hOUl the UK as well as all around the wortd. Academic Institut• 2022-23 In contrast to 2021-22, when we experienced the aftennalh of COVIt>19. 2022-23 was very refreshing in terms of overseas visilofs. We were able lo welcorne 8 great number of ws110ts. Wa had 39 overseas clinical v¢silors in this peric*J. Some of them were general observers. some were clinical attachments and other were clinical assislanls. They came from Spain. Ilaty. Israel. Australia. Chikg. India, Greece. Turkey, Brazil, Belgium, Poland, Taiwan. Portugal. Saudi Arabba, Norway. Mexico. Switzerland. Netherfands. Hungary and Singapore and spent drfterent kThJth5 of lime wilh us. Pag¢ 14 ST MARK'S HOSPITAL FOUNDATION TRUSTEES, REPORT FOR THE YEAR ENDED 31ST MARCH 2023 (continued) STMARKS O¥¥EL MOSPIT Alberft) Gm'cirt Pir¢ro, Sofo¥is Pmi*leipMoiiins & .lthi'co DoiiiiiFICI STMARK5 AC 4 O e M • ¢ l N S T l T U T E Tho thallgnges of the COVltk19 pandemic meant new ways to delNer our edwalion. The preferred mode lo deliver our courses seemed to change from online only {due to the COVID restrictions) to a hybrid mode where allendees can join us Trper50n or online. This year. we delivered the last of the series of courses of our ENDOcation series. The series was very successful and most of the c¢xJrses in the seri85 wer8 fully booked 15LXI registrations) and we had a h*3h numw of attendees. These o)urses have aL80 been Page 15 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 313T MARCH 2023 Icontlnuèd) uploaded to our website and are openly available. In this way we spread our teachings nationally and internationalty. We had 8 new course In Oclobw called Pefvic Floor and Compbx Proctology. This ¢OUf8e was aimed at surgeons. trainees. and tsJnsull8nts. It was a IAYo-day course which provided updates on the various aspects of p8lvic floor surgery and compl8x proctobgy aimed al colorectal surgeons.11 was a hybrid event, where attendees jolned us in person al Sl Mark's Hospital as well as online. The firsl day wa5 primarily pelviG floor and the second was be airned at complax proctdogy. It was hlghly $u¢cessful and welcomed by all the attendees with very gocd feedback. Our flagshlp ¢ourse in November 2022. 'Frontiers in Colorectal and Intestinal Di804$9'. 'Spotlight on Inflammatory Bowel Disease,. was an &nom)ou$ $u¢¢ess. The event was a synchronous hybrid event h&ld in-person al the Glaziers Hall. in London and online using hKJh quality d￿lIa1 streaming from our custom designed broadcast studio and was very well supported through sponsorship income. 11 was very professional, highly engaging, inleractivg and thought provoking. We had 150 in-pers(In attendegs ea¢h day and 2,880 wewers, from 60 d￿erent C*)unlries, induding those who viewed th8 conference online after the ¢vanl. We received extremely positive feedbad( from attentjees on the overall delivery and content of this course in person and online. "l Ih) l¢xl Ihal Ns by for Ihe bos1 cob)r•ct 9￿*1h•oPpCthth (lol I•B• The 'Hofizons in Inle$tinal Rehabilitation & Home Parent¥al Nulritlon. course look place in Dacernber. It was delivered as a hybrid event. with attendees ioining us in-person at the Royal College of Physicians in London and online. Even though. we faced a few challenges with snowy weather and train strikes, the Page 16 ST MARK'S HOSPITAL FOUNDATION TRUSTEES. REPORT FOR THE YEAR ENDED 31- MARCH 2023 (contlnuod) attendance of this course was excellent., 220 peotAe joingj u5 onhne aTrJ 65 Peop￿ attended in person. We had atten(lees joinir#J in from all over the wothl. This year, we had two patient infomialion evenings run by the Familial & Inherited Cancer team.. The Polyposis Registry inforniation evening and the Lynch syndrome patient information event. These sessions gave infomialion about Lynth s￿droMe and Polyposis syndrome to patients and their relatives. Both events were well attended arKI welcomed by paI￿nts. and we will support them again next year. Changing the delivery mode of educalion. di(1 r￿1 onty open the opportunlty lo ￿ath particbpants in corners of the worfd we dld not reach before. but it also brought us the opportunity lo deliver a high standard ol education wllh Un￿striCted numbers of attendees in a more sustainab18 fomial. There arg plans lo ￿ vamp and revise courses that were offered pre-covid lime. however. we need to address some challenges lo the physical course venue al Ihe hospttal before ￿ ¢an prowde more ¢ourses. Cour$6s are charged al a starnlard and rJ)mparabl8 rate for gducational CoU￿S n Ihls r￿d and dls¢ounlgd place are often Fyovided lor trai￿. Howevèr. th6s year has brought about an evolution to more spon501 led education proposition. We have been abb to offer many of our ¢ourses as frets lo attend thanks to the generosi ofours nsors. Course nam• and doscrl on Abdomlnal Carg- 20 cr•dlt degrno- Unlvernlty module ree-lev81 module for healthcare rofessional$ ENDOcatlon •ndo8Gopy W•blnarn Series ol webinars lor education In endos Frontlorg In InlMtlnal and ¢oloreGlal dlsoa A flagship three4ay annual inlem81ional conference covering a broad fdriety of lopbcs. Ilvo sur erylendoscopy aThJ slate of the art ke note tslks Ga8trolnt•stlnal Anatixny and Phyiiology 20 Cr•dlt O•9￿- L•v•l Modul• A course for he8llhc8re professionals with an interest in caring for ￿oPle with gastrointestinal condlllons and diseases.. ainln a universil award at 20 credits Gastrolnt••tinal H•althcar• Asslstant Study Day A virtual one-d8y_ slud da for heallhcare assistants wilh an interest in Ga$trolnt•stinal pathology study day Identifying and re ortin on aslToinleslinal tho Gastrolnt•stinal study day for nurs•s siurn lor nurses lo Increase their underslaThJin of a variel ol Horlzong In Inlestln•l Rehabllltatlon & Homa P8r•nt•ral Nulrltlon 3-day online course with Lectures and bre8kout seminafs looking 81 chronic and acute Intesllnal failure and home arenleral nutrition Independent Study 20 Cr￿11 d•grthlevol unfvornlty modulo For healthcare rofessionals lo undertake a bes ke module on a Low Antèrlor Rose¢tlon Syndrorne Mastorclass For hÈallh¢are ofessionals, articularl nurses who care for Lynch Syndromo pallgnt Infommtlon ev•nlng Inlomalion evenin for lienls with a dia nosis of L ch s Polvlc Floor & Proctology Cou A Iwo-day course which promded updates on the v8ri0US 8spects of pelvic floor surgery and complex proctology for the col￿act81 surgeon. The first day vras primarily pelvic flwr and the second was aimed al lex roclol Pelvic Exonteration Masterclass A maslerclass for heaKh¢are rofessionals such who care for Polyposi¥ Registry patlent infommlion evening lnfofmakn.on evening for patients with a diagnosis of a rM)Iyp05is syndrome and they famil matters astrointe51inal care astrointe8tinal t Ics stvointestinal to ic of their choice after rectal cancer sur ndrom8 and their families le unde oin IMC 8xenleration Page 17 ST MARK'S HOSPITAL FOUNDATION TRUSTEES, REPORT FOR THE YEAR ENDED 319T MARCH 2023 (contlnued) 2111 Century Nurslng Managmnt Mastwdass A virtual masterdass for nurse mana98rs aTrJ aspiring nU￿e manaws Incomlng projècts and challfrnges With the change in trend in course delivery mc*Je. wo had a few techni¢al challenges du8 lo the ouldaled infrastructure currently available at thè Avery Jon8s Education Centre, at the Central Middlesex site.11 has become apparent that there Is a need for a signrfant rofurbishmenl of the Lecture Theatre. New infrastructure is needed to delivef in-house courses from our hOS￿al lo keep UP with the naw trend of hybrid courses and deliver excellent quality courses. Medium lo L4rge ts)urses had to be delivered elsewhere lo maintain a high stsndard of Quality. Our NHS Trust h88 also acknowledged Ih8S8 issues and have agreed to improve tho AV infrastructurè for the education ￿ntre. The FoundatSon 1$ r8vle*ing opportunili8S to support part funding the improvements. Other NoLibl• Educatlonal Aetlvltl•s RMtrUc￿re ol our EdUc￿lOn Team and cour• At the beginnlng of 2022. we wer8 delighted lo welcome Mr Akash Méhta as our new Director of Education. Wilh his help, the Academic Inslilule wll be in an èven better p)sition to meet its aim lo bo 0 Slrong leader in coloreGtsI education. We have also started lo chang8 the way we daal with applicallons for visiting fell¢)ws. The aim is lo slructure th6 process by inlroducing a new applic81ion fom for each year staling th¢ different m￿all1￿ ol obsthwership and dales awailabi8 for them. We are now in the process of revamping som• ¢ourses that wer8 onco very popular but are now not as relevant. For example, our F#)slgraduale lea¢hing lemi COUTSe. We have received a few educational offers from China that we aTr procassing and analysing. These offers open a wide spectrurn of benefits for the St Mark's edu¢atlon brand and is being carefully explored for inclusion in our wider aGademic strategy. RM•arch C4>0rdlnallon The department's full-lime research co-ordinator supports thg Research Fellows in a number of key ways, including their medlcal granl applications and research impact measuromenl reporting. The research process can be adminislralively o)mplex. and we have SUc￿$fUllY developed relaliorsships and collaborations wlth other researth institut￿n$, fonn81ised the proG8s5 for eollecllng research metrics and developed a programme of talks for the Research Forum. Nurne Educatlon The gaslroinlestlnal care palhway and the indivKIu81 ￿¥XIUleS continue to nm each year al l)oth degre- level and maslers-level. accredibj by BlrmlrvJham City University. During this year 74 nurses and allied health professionals attended university ac(xediled modules, 2 completed a degree-level award ar￿ 102 intemal staff attended frée educational sessN)ns. Nurses, healthcare assislantS, Student nurses and pharmacists aTbd 99 intem81 and external stsff attended one of three study daylma51grGlass. We also welcomed 11 Spantsh nurses for a bespoke edu¢at"on day. Pag¢ 18 ST MARK'S HOSPITAL FOUNDATION TRUSTEES, REPORT FOR THE YEAR ENDED 31ST MARCH 2023 (continu•dl Financlal Review Income The Foundation received donations from a *rdri8ty of source5 and is not dependent on the support of any particular individual, corporation or class of donor. Totsl income lor the year was £2,648.83112021-22'. £1.722,8531, an increase of $4%. The main driver wa5 an inuease in legacy and education income. Donations linG1￿￿lng lega¢y gifts) were £1,981,629120￿2l.. £1,283,887). an increas8 of 54%. The increase inlogacies and education income has changed the ir*x*me mix in the currgnt 2022123 year. Income from legacies represented 29% of total 1￿Me, as shown in the 2022123 chart below. This compares wth 14% in the previous year. In absolute tems, legacies generated £772.753 in 2022123, an increase of 211% over £248,277 in 2021122. Income frcffi edU￿t￿n Gourses represented 21% of Ihe total Ineome as compared with 22% in the prior year. However. In absolute value terms, income from education courses increased by 45% frorn £375.469 to £544,020. Legacy income can vary significantly betsveen years due to its inherent nature. 2022.2023 2021-2022 0.1% 4% 4X 45% 14% 29% 59% 22% 21% Expandhure Total expenditure lor the year wa$ £2.273.32412021-22'. £1,841.1881. The increase in ts odu¢alion costs changed the expenditure mlx in the current year. Education exF*￿IllUre as a percentage of lolal •xpendllure increased ty 5%. Research expenditur8 made up a lower share of the total expenditure, down from 73% of total exp6ndilufe in 2021-22 10 66% in 2022-23. In absolute lems. r8sèarGh expenditure incroased by 12%. compared to the previous year. Th8 cost ol raising funds as p¢rcenlage of totsl expenditure remained the same, al 10%, bul irKroased in absolute lemis. ZOU.Z02a io% 2316 É6% The Trustees continued to rewew th8 cash held on deposit. holdirwJ sufficient short-tenn cash to meet current obligations. Net incoming rEsource5 for the year amounted to £375.507. Total funds at the end ofthe year were £4,279,535, ccffnpar&J with £3.904.028 in the prewous perK)d. Page 19 ST MARK'S HOSPITAL FOUNDATKIN TRUSTEES, REPORT FOR THE YEAR ENDED 31ST MARCH 2023 Icontlnued) Funds and Reserves The Trustees are satisfied that ad&4uate fvnds ar& availablg. as shown in the notes to the accounts, for the Foundatlon lo meet its obligations. R8slricled Funds are for Part￿Ular 8reas of research as specified by the donors. Designalgd Funds are funds set aside for future research or educabonal FWjèCts as approved by the Trustees. Unrestricted Funds are reserves to primarily support the Foundation from any unforeseen fluGtuations in income. From tim8 to time and sutr4.ecl lo the Quantum of unreslricled reserves, the Tnjstees may designate a wtion of funds from these reserves for important research and educallon projects not already wvered by ongoiThJ projects Irom rnstricted funds. The Trustees revlewed the reserves policy in tha year and agreed a policy of o lar9el for unrestricted reserves equivalent lo a minimum of six months operatsng eXpend￿re. Unrestn'cted Reserves at the year.end w&re £862,196. equivalent lo just under ￿e1ve monlh5' total unreslricled expendrture. Although the acluals are higher than the six months minimum. the Trustees agreed It is prudent to hold highor18v81 of reserves providing reasonable contingency cover. The Foundation has lorecast incom& and expendiluffj for 12 months from the dale of Ihis report. Based on the forecast. Unr￿tricted Reserves at thè and of the next tsyolvo months are ests'maled lo be within the trustees reserves policy. Restricted Reserves {represenling funds raised specific projects currenuy in progress) wero £2,858,645 al the year-end, compared vAth £2,743,281 al y8ar4nd in ihe prior ye8T. Investments The obleclive of the Foundallon's treasury policy is to yoduce the best financial rolum vAthln an acceptable levol of rlsk. The Truslaes have continued the policy of hokJirvJ the financial assets of th8 charlty In fixed-tem sterling deposit accounts. Thg funds are deposited 8cro$$ several financial institutions and the cash position an¢J fixed deposlt turns are monitored on a regular basis. The Finance Manager reports al regular Tmstee Meetings on th8 perfcfinance of the deposits. Page 20 ST IIARlfS HOSPITAL FOUNDAnoN TRUSTEES. REPORT FOR THE YEAR ENOED 31- IAARCH X123 {continuedl Statement of Trustees, R•sponslbilltles The Twst••s Iwho arn also trts directors of the St ma￿.$ Hospital Found8tion kn the PUTposes of comp8fty Lawl responsibk for preparirwJ the Rèwrt of tha TN8tees and the financkgl slatemgnls In accord8nce with applrable law and United Kngsom Accounting Standards Iunited Kingdc Generalty Accepted Accourrting Pr8CtKe}. indrjjing Finanwl RepNb'rg Stsndard 102 Yhe Financi&l Re￿rtIng Standard appl￿￿￿ In th8 UK and RewtAr crf Iroknf. Company law requiTe8 the TrLK8lee8 to prepare f(nanaal statwts for eath financigr year wh 9rve a tru* and fair vivA Of1￿ srate of affairs of the chorr1a￿e (Y￿panY of the uKoming re80ur¢es and appI￿*￿n of rex)Ur￿. incbjdirg the and expen¢Jrturg. ollhe tharitsb company for that per*)d. In pre￿ring tho¥B fnancml slaternnts. the Tru$t6e8 are requ￿ed to • select suitsbb ac4)￿nt￿9 pth'es and then *pty them consist￿ty • observè the methc#JB ￿ prinupl88 in the C￿nty SORP • make Njdganents eslknates Ihat arp reasonable aThJ prudent • prepare the fin￿￿81 st8teffw18 on the going (x>￿*M basi8 unbB8 it is I￿PPrOpn&ta lo pr•wme that th• charltable wll bu8bwss The Trusle&s are re8F0nS**￿ fc* kerying propw ￿Counti1￿ records which di￿￿)80 wilh re88crable accuracy al ary Ilrm the fn8n¢ig1 p08thn of the tha11t￿le company and lo ￿able them to ensure that the financial statements o)mpty with the compan￿ kl 2CQ6. TIK*y are 8180 responsibk8 for Salty￿rdi￿ the assets of ts thantable cunpany and h8n(x tskn'ng msongble 8teps for th• preventicffl and detectKJn of fraud aTrJ ot￿r irwul81ittes. In 80 for a8 the Trustees are awar•". • there18 no relev￿1 audit infcfflwtirm of whJ¢h the thaiilth cMip4nY8 •ulMors a unaworn., arKI • the Trust8e8 have t&k6n all 8*p8 that tw ought to have tak￿ kn make thernsel¥o8 awarn of any ￿levant tr**)ThnatK￿ ar￿ to eBIAbliJh thatthe a￿11￿ we aware of Ihat IrrfDrnal#)n. Membern ofthe F￿ndati¢￿ guarantee L¥xtrilyJl8 arn￿￿ not exc*etlvig £110 the assets of the F¢)undatk)n in the event of wir*Jing up. Tho totsl numberof suth gLwrnnleB8 81 31" March 2023 B evJhl. TnJ8tees are Membews of the FtyJThJatJon. trArt this entitb8s them onty to vol￿9 dghts. The TNstee$ h8¥e no benefickgl intere8t in ￿ Foundatbn. AUDITORS The auditors, Knox Cropper LLP, wlll for rHFpClr￿ •1 th• f￿cOMing General Meth'r4. This reFQrt has been PfBpared In &c£*rdance with the wlal PmiB#ins crf Part 15 oftr Comp8ni¢$ A¢1 2006 re￿irt9 to small Apwov•J by order ofthe bcord of Trwl•e8 on d svJned beh#llby'. SirTkn*8 Trouwe Chaim*n Pa8¢ 21 ST MARK'S HOSPITAL FOUNDATION INDEPENDENT AUDITORS, REPORT FOR THE YEAR ENDED 31ST MARCH 2023 Oplnlon We have audited the finaNial stslem8nts of St Ma￿'S Hosiital Foundation (the 'charitab18 tt&mpany'l for the year ervJ8d 31 March 2023 which comprise the Statement of Fina￿la1 ACtI￿tIeS, the Balance Sheet. Stslement of Cash Flows and note8 to the fina￿al statem8nts. incI￿j￿￿ a sunrnary of significant accounting Ildes. Th8 financial reForting framework that h85 been applied in their p￿paration is applicabbe law WKI Uni18d lQThJdom Accounting Standards. Ir￿l￿j1￿g FinarKial RepK)rtiny Standartl 102 The Financial Repyting SlandarLI applicable in the UK and RepuL* oflr8land{Ur¥ted Kin￿kn1 Generalty Actepted Ac￿unting Practice). In our O￿nIOn the financial statements: glve a true and fair View of the stat6 of thè charttabk• compan￿8 8ffalr8 88 at 31 March 2023 aTrJ of if5 income and expondrture for the year then ended: have been pmperfy prepared in a￿)rdence with Unitod KIr￿d￿n Generalty A￿pted Accounting Proctice,. and have been wepared In accordar￿ wllh th8 requirements ofth8 Comp8Thes Ac¢ 20(ffj. Ba818 of oplnlon We corKluct8d our OLNJit in a¢xonlanc6 wth Irrtèmatknnal star￿ath on Aud￿ng IUKI IISAS IUKII aThJ applicable law. Our responsibdities under those staThJards are further descdbed In the Audltorfs responsibilit￿S for the audh of Ihe flnanclal slat8m8nt8 Se¢tlon of our r8FQrt. Wa arg Indop8ndenl of the charilabb company in aceordance ¥￿th lh8 @th￿al r8quir8ment8 Ihal are relevant io our audit of th8 financlal statements in the UK. IndLkllng the Financral R6porliThJ Coundl's IFRCI Ethical Sl8ndard. and we have fU￿lled Ouf other ethical responsibilitie3 in a(￿)rdance with Ihese requireffents We believe that the audit evidence we have obta1￿￿19 8ullbd8nt and aF¢Kor￿al6 to rThlde 8 ba￿$ for our opinb)n. ConcI￿lon* relatbng to golng ¢onurn In auditing the financial statements. ￿ have 0)nd￿Jed that the trustees, use of the going o)n¢fjm bo￿3 of xmling in Ihe preparatlon of the finaft¢￿ stslem8nt8 18 apwoptrlats. 8ased on the work we tthi6 perfomiod. we have kJonllfi8d matsrf81 unc8rtalnlo8 relatlng to evonts or ndltlons thal, in¢Jividu811y or collactively. may cast sl9nif￿nt doubt on the charitable company's gbility ¢0 continue as a golng corcfjm for a pen'od ol at least months Irom when the fin8nd￿ slalemonts arg authortsod lor I￿U8. Our r98Fonsit*lities and the Ye8ponsknllttlos of the trwtees *ith re3￿Ct to ￿lI¥j oJn¢em are dexdbed In th• relevant seclions of thls report. Other Informatlon The other inforrnation (x*mpri$88 thg inforni81ion induded in the 8nnu81 report. other than th8 ffinandol 8tatemenls and our auditors, r8port thereon. The Tnjstees are resporrib￿ for the other Infomiation. Our oplnlon on the finondal slalements does MI cthier the other infomiatlon arnl. except lo the exlenl otherwise explicit￿ stalod In our report w• do expr•88 any fomi of 888wanc8 conclusion thw8cffl. In COnn￿li0n our audlt of the financial statements. our ￿3￿nSIbIl￿ is to ￿8￿ ts other information and. In doSng so. consider whether the other infomialion is malerialty Inex$n￿$tenl vAlh the fin8noal st8tsments or our knowledge obtsined in the audit or otheThvise appears to te materially misstated. 11 we identify such material irunsistencies or apparent materlal mi$ststements. we are requi￿ to delemiine vthelher Ihern is materi81 mis$t8tsmenl in the financial statements or a rnatsrial misstatement of the other information. If. based on the work we have Ferformed, w6 corrdLMJe that is 8 materi81 M￿sts18m8nI of this othar informath)n.' we are required to report Ihal We have nothiNJ to in llis regard. Pag¢ 22 ST MARK'S HOSPITAL FOUNDATION INDEPENDENT AUDITORS. REPORT FOR THE YEAR ENDED 31ST MARCH 2023 Oplnlon on oth•r mattern prescrib•d by th• C(MryMnl•s Act 2006 In our opinion. based on Ihe WO￿ urrfjertsken ￿ the course of ts audit.. the infomialion given in the Trustees. reForf. inGludes the directorn, rewrt Prepared for the PUT￿ of ¢x)rnP8ny law. for tho fina￿la1 year lor vthich the ffinanc4al statements are prepared 1$ consistent the finanoal statements.. and the directors, report i￿luded vAlhin Ihe Trustses. re￿rt has bean prBpaTed in &xordance wth apklicable l¢go1 rgquirements. Matt•rs on whlch w• ar• r•qulr•d to r•port by •xc•ptlon In the light of the krK)wleilge and understanding of tho charitat4e compary aTrJ its enwronment obtained In th8 courso of the aLKlil, we have not identsfi8d materiAI rnisstatements in the directors. report included wthin thè Trustees. r8Kx)rt. We have nothing to report In T88Fect of IhB follthling matters the Companies Act 2(￿ requiTe8 US to rewrt to you if. in our OFxnion: adequats ac￿u￿tir0 re￿1¢58 have been kfjpt. or retum adequate for our aLbJil hove not b8en rec¥lved from branches not vlslted by us: or th6 financlal statements are not In agreement with th8 xcounlirwj records aTrJ retU￿ra. or certain disGto$ures of Tnotees, remuneralkjn B￿cthd bylaw ao rK)t m8de', or we hov8 not recelved all Ihe Infomwtion 8nd èxpl#rwllon8 wo rw4uiffj for our aL*d￿.. or the Iru8lees were not entitled to pr8p8re the fi￿ntial stsl¢ments in wth the Small companles regime arKI tsk8 advantsge of the $m811 compani&s' ex8mptions in preparing the lru8le88' report and from the roquiremDnl to VeP8ro 8 8trate9￿ rgwrt. R••pon•lbllltl•s of Tru•t• A8 explaln8d more fully In tho Trustees. Resp)rnibilitie5 Statement. the Trustees (W￿ are also the directors ol the ¢harttable company for the purFrf)ses of company Iwl are r&spon$ible for the preparallon of the n8ncial statements and for being 8aUsfied that they glve a true and 18lr vl8w, an(1 for 8uch intemal control as the Truslees detsmiine Is necessary lo enabkn the proparalon of financial Btatsmonts that are free from material misstslemenl. whelhw dug to fra￿j or error. In pfeporlng thè fln8ndal 8ts1eman18, the Trustees are responslble for a8888slng Ihg charftablè compgnY8 8bS11ty to continue a8 a goirvJ concem, di8clowThJ. as 8ppli¢oty9. matters relatod to golThJ COr￿¢M and uslng going conc8m ba818 of accounting unless the Trusloes oilher intend lo liqildale the company or lo cease operallon8. or hava no ro8lith"c altemalive but to do so. AudltoV• r••ponslbllltl•s lor th• audlt ol th• flnanclal stat•m•nts Our objeth'ves are lo obtain re8sonable assuran¢8 about vth8th8r the financial stat8m8nts as a whole are fr•e frorn malerial mis8tstement. whether to fraLKI or erTor. and lo issue an audilorfs report that includes our oplnlon. Re8sonable ossurarKe is a h*3h level of assur8￿, but is not a guar8nteè that 8n 8LKlit conducted in accordance ¥￿th ISAS IUKI wll always detect 8 materi81 misstslement when il exisls. Mi55181emonts can Irom fraud or error arKI are considered malerial rf. irK1ividu81ty or in the aggregate. tlw could rÈ8son8bly be expected to infiver￿ the &corKJmi¢ ¢Je0$￿n¥ of users taken on the ba￿8 of these fina￿JaI ststements. Irregulaiili88. Ir￿[l*jing fraud. are instances of non-tx)mrAlance with laws and wulalions. We dèsign procedures in line w7lh our rBsponsibilities. ouUin•Y atrthfg. to detect material misststsmenls In respect of irregularities. indudirvJ fraud. The extent to which our procedures are capatde of detsctirwJ irregu18ritie8. Icludlng fraud is detailed tr*k)w'. The Charitable Company is required to comFty with o)mpany law and ch8rity law and, based on our kno¥￿edge of its actNities. we identified that the legal requlrgment lo a￿urd1efy account for restricted funds was of key s1gntrKan￿. Pag¢ 23 ST MARK'S HOSPITAL FOUNDATION INDEPENDENT AUDITORS. REPORT FOR THE YEAR ENDED 315T MARCH 2023 We gained an undersl8rKling of how the charitsble cornpany wmFAied vAth its legal and regulatory framework. includi￿J the requirementto propedy account for rnslricted fijnds. thrOL￿h discussions wllh management and a review of the documented pdIc￿s, Pro￿dureS and controls. The audit 188m. which is experienced in the 8￿jrt of thanb"es. considered the charTt8ble company's susceptibility to material mi5Staternent and fraud may occur. thJr con5thrallons included Ihe rfsk of management override. Our 8pproach was to ¢heo* thal all re8lrthd irK£4ne vras F￿Operty idènknfi&l and 8epargtsly accounl8d for and lo ensur8 that only valid and apKwopriate expenditure was chary￿ to restricled funds. This Induded reviewing ioum81 adjustments arnl unLL8ual tranSaC￿n8. A fijrther doscription ofour responsitsliiies fDr the audit of the fina￿al statements18 locatsd on the FInar￿181 Reporting Councll's website at.. www.frc.or .uklaudil ibilities. Thi8 desCripl￿ft fomis part of our audilorf8 r6Wrt. ot lh• audlt r•port This report is made solely lo th8 charits￿e componY$ members. as a body. In accordance wth Chapter 3 of Part 16 of the Companies Act 2006. Our audit WO￿ ha8 been uThJortaken. so that we might slate to th8 chorilable company's MeMt*￿ IIKJSO matterB are Tequired to stale lo Ihem in an audil0rf8 rO￿rt arKI for no olher purpK$8e. To the ful￿3{0X18￿I permitted bylow, ￿ do rwl a￿¢pl or assume Te3w)nsibility to anyong other Ihan the charftatrAe company arKI the charitsble ¢ompaWs memb8TS 88 a body, for our audit work. for this report or for tho opin￿n3 we have fom1￿. 14 Dec 2023 Slm4)n Goodrldg• S•nlor Statutory Audltor for and on b•half of Knox Cr¢)pp•r LLP Statutory Audltorn 65 L•ad•nh•ll Str8•1 London EC3A 2AD Page 24 ST MARK'S HOSPITAL FOUNDATION STATEMENT OF FINANCIAL ACTMTIES (INCORPORATING THE INCOME AND EXPENDITURE ACCOUNT) FOR THE YEAR ENDED 318T MARCH 2023 Noto Unrestricted Dosignated Restridod Funds Funds Funds Total Funds 2023 Total Funds 2022 Income and Endowmwrts Donallons and Legaci88 Investment Income Income from Charitable Activities.. Education c￿r5eS Other Incoming Resources 839.484 19.694 1.142.145 1.981,629 1,283,887 19,694 2,458 ,445 37.575 103,488 544,020 375.469 103,488 61,039 Total InGom• and Endv*m•nts 1365.623 1283 208 1648.831 1.722.853 Expgnditur• Costs of Raising F￿d3 Charitable AclMIi8s 235.783 667,063 157 1,216,115 235,940 182,793 2.037,384 1.658,395 154,J Total Exp•ndituro 902.846 2 273 324 1,841,188 Not Incomol{Expgndltw•) 462.777 {154.2￿) 66.936 375,507 (118.3351 Transfers between funds N•t Mov•m•nt In Fund• 12113 214,800 247,977 166 372 12.166 48,428 115,364 375.507 {118,3351 Balanco at 111 Aprfl 2022 8alanc• at 31•1 March 2023 614,219 546.528 2,743,281 3.904.028 4,022,363 862.196 S58.694 2.858,645 4.279,535 3,904,028 Pa8¢ 25 ST IAARK'S HOSPITAL FOUNDATION BALANCE SHEET AS AT 31- W4RCH 2023 2023 2022 Flxed Assots Tangible Assets Curr•nt Au•ts Debtors Nottt deFosits Cash at bank and in hand 10 15 15 540,375 400,000 6n.027 4,611402 201.552 9￿,c￿0 2,989.214 4.090,788 Creditor8'. Arnunls f8llhw d within ono year 11 333.887 186.738 Net Curr•nt As••ts 4271335 3.904,028 Not A•••ts 4,279.$38 3.904.028 Fund• Re8lrlcted De8ignated Unrestnct8d 13 12 2.858.846 558.694 882.198 4.279.535 2,743,281 S46.528 814,219 rotal Fund• 3,904,028 The8e fin￿claI ￿&tem￿s 8Fprov&l ty the Tru8tee8 on behalf by l• L38nd slgned on thefjr Sr Tlx)ma$ TroubThlg• Company Numtér. 07532184 Page 26 ST MARK'S HOSPITAL FOUNDATION STATEMEKf OF CASH FLOWS FOR THE YEAR ENDED 31ST MARCH 2023 2023 Statemont of Cash Flow 2022 Cash flows from opornting actlviti8•: Net c¥•h ovldèd s•d In Cash flows from investing activities.. Divid8nds. interest and rents from iiveslments Proceeds of sale of investrnents N•1 cash provldod by Inv•stlng acdvltl•8 actlvltl•s 549.805 19,694 2.458 19.694 2.458 Cash flows from fimncing actlvlti•8 Nel cash rovided b I used in rinanryn activiti88 Change In cash and cash equival•nts In the reporting perlod Cash and cash •quival•nts at th• *inning of th• r•porting p•rlod Cash and cash • ulval•nts •t th• •nd of th• r• rtln od 183.813 552,263 3,889.214 3,336,951 4 073.027 3.889,214 Reconclllatlon of P4•t IExpendlturoVlncomo to Not Cmh Flv* from Operatlng Adlvltlés 2023 2022 Nel Incom8llexp8ndilurel for Ihe ￿￿tir￿d wriod (a$ per the statement of financial aclivit5esl Adjustments for. Depreclalion charges Losses on investments Dividends, intere51 and r8nls Irom investments Decreaselllncreasel in debtor8 Increasel Decrease in Creditors Net cash rovlded b I used In 375,507 1118.335) 119.6941 1338,8231 147.129 164.119 12,458) 644,105 26.493 549.805 atln acti¥ltlo8 An•lysi• of Cash and Cash Equiv#lBnts 2023 2022 Cash in hand Notice de sils Total cash and cash equivalents 673.027 2,989,214 3.400.000 0,000 4,073.027 3.889.214 Page 27 ST MARK'S HOSPThAL FOUNDATION NOTES TO THE ACCOUNTS FOR THE YEAR ENDED 318T MARCH 2023 {contlnuedl ACCOUNTING POLICIES {al Ba8is of Prgparatlon The financial statements have bsen prepared Ni accordance wilh Accounting and Reporting by Charities: Slatemenl of Rècommended Practice applicable to charities preparing their account5 in accy)rdance wlh the Financial ReFQrting Stsndard applicabl& In the UK arKI Republic of Ireland IFRS102) (second edits'on - October 20191 and the Companies Acl 201￿. The dwrity conslitutes a public be￿rrt entlty as defined by FRS 102. Crltlcal accounting •stlmates and ar•as of Judgoment Preparation of the financial statements requires the Truslges and manag8m8nl to mak8 Signlficant judgements estimates. The items in the ffinanclal statements where th888 ludgem•nts and 8stimales have been made include: Assessing Ihe probability of receipt of legacy income: Determining the apportionment of expendituro be￿￿en the Categ￿￿9 of expenditure on charitable activit￿$. Ic) Golng ¢onc•rn The Trustees have assessad whether the use of the going concern assumptson 18 appropriate in preparing these financial slalemenls. The Tru51ets have made this assessmgnl in respect lo a period of one year from lh8 dale of approval of these financial statements. The Charity remains a going concern. Pro￿dad there are suffKient Unrastricled Reserves lo meet thè charity's oFeraliThJ expendlture lor the foresgoabbe future. At 31 March 2023 the ¢harfty had the equivoienl ofjust under ts¥elve months, operating expendiluTg in unrestricted restsrves {£862.1961. Forecast ¢ash flows for 12 months from the dale of this report inditste that these Unrestricted Reserves will be $uffi¢ient to meel opgrating expenditu￿. Accordingly the Trvstees of the ch8nty have ¢ondud8d that there no m8lerlal ncertainlies related lo events or corKlitions that may cast significant doubl on the abilty of the chanty lo continue as a going ¢oneem. The Trustees are of the opinion that the Charty will have sufficient rosources lo meet its liabilities as they fall due. Id) Research Expendlturn Liabilities are recognised as resource$ expaThJe(l a$ sty)n as there is 8 legal or constructive obligation committing the charity lo the expendtture. All expenditure is accounted for on an aecTuals basis and has been dassified under headings that aggregale all costs related lo ￿ category. The expendlture is accounted for vthere either Trustees have agreed lo pay wllhoul condit￿n and the recipient has a ￿aSOnal￿e expedalion that they will recèive an award. or any condit￿n attaching lo th8 expgnditure is outside the control of the Foundation. Page 28 ST MARK'S HOSPITAL FOUNDATION NOTES TO THE ACCOUNTS 8T FOR THE YEAR ENDED 31 MARCH 2023 (continued) ACCOUNTING POLICIES IcoDtinu•d) (•) Tanglbl• Flx•d Ass•t• and Dyeclatlon All assets costing more than £1.(M)O are capitalised and all assets are valugd at historic cost. Depreciation of rued assets is calculated on ￿st at rates estimated to wrfle off thg assets. by @qual instalmonls. over th￿"r 8xpectod working lives. Fixtures and fittings and office equipment are written off over five ￿ats. Computers are written off over three years. The mrAlular building wa5 depreryated over fwr years. Incom• Researd) funding in¢orro is recognised in the year in which th6 charity receives a wdllen commitment Irom the fuThJer. Research fundiTrJ is deferred only when th8 charity has lo fulfil conditions before becoming entitled to il or donor has speclfied that the Income ha$ to b6 Spent in a futwo poriod. All other Incoming resources are included n the Statement of Flnancial Activiti08 ISOFAI when the FoUndat￿n 15 legally entr"tlg(I lo tho in¢crfng and tho arTvJunt can be quantlfled with ffja$onablé accuracy. (gl Value Add•d Tax The Fount18lion regislered for VAT from Augusl 2019. appIl￿ble. all costs and expenditure incurred on tradlng actlvilies are exthsw of VAT. (h) AlloG*lon of Support C￿ts Support ￿St5 have been allocated be￿een charftsble actlvllles and fvndralslng. Support costs Telating lo Charitab￿ activilies have been apportioned based on a welghled salary porconlago basis. Tho ailo¢•bon of 8UPPOrt costs is analysod in note 6. Co•t8 of Ralslng Fund¥ The cost ol generatiThJ and administgring voluntary incom8 indudes fundraising costs. invoslm8nl managers, fees and a proportion of staff costs. ti) Ch•rltabl• Actlvltle• Costs of tharitable activths indude grants made and an apportionment of overhead 8nd support costs as shown in nole 5. 0￿rhead L7>sts are apportioned based on the staff time spent on the charitable acliwlies. Ik) Funds Unreslrfcted funds are funds whic* can b8 used al ￿ Trustees, dkcrelh)n. Restricted Funds are funds wtK)se purposas have bgen rgstricled by the donor. Oesignalad Funds are unrestri¢led funds which have been eamarkad by Iho Tnjstees for parts'cular Purposes. Volunlary Incom• Unrestricted Funds Restricted Funds 2023 2022 Donations and Grants Legacies 316,731 522.753 839,484 892,145 250.CKXI 1.142.145 1,208.876 772.753 1,981.629 1.035,610 248,277 1,283,887 Page 29 ST IAARK'S HOSPITAL FOUNDATION NOTES TO THE ACCOUNTS FOR THE YEAR ENDED 3191 MARCH 2023 {contlnuedl Invfrstm•nt Income 2023 2022 Bank Interest 19.694 19.694 2,458 2.458 Exp*ndlture on Ralslng Funds Unrestrlcted Funds Rostrlcl•d Funds 2023 2022 Fundfaising Costs Governance Costs Ovetheads Staff Costs 59.398 4,386 22.098 149,901 235.783 157 59.555 4,386 22,098 149,901 235,940 29,575 3.618 12,896 136,704 182.793 157 Analys1• of Charltable Actlvlll•• Olr•¢t Expendfturfr Support Costs 2023 2022 Research Expenditure Education 1,388.713 479.425 1.868.139 115,929 53.317 169.245 1.504,643 532,742 2.037,384 1.342,808 315.587 1,658.395 Unr•strlcted D•slgnat•d R•strlct•d Funds Fut￿* Funds 2023 2022 Dlr•ctly In¢urr•d Re