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2022-06-30-accounts

IDIOPATHIC INTRACRANIAL HYPERTENSION UK (IIH UK)

TRUSTEES’ ANNUAL REPORT AND ACCOUNTS 2021-22

(Registered Charity Number – England & Wales 1143522, Scotland SC043294)

Charity Trustees during the report period

  1. The following represented IIH UK as trustees during the report period 1 July 2021 to 30 June 2022:

Michelle Williamson Chair Clare Parr Acting Secretary Betsy Clark Treasurer Amanda Denton Research Rep

Structure, Governance and Management

  1. IIH UK was founded in 2008 and established as a registered charity in England and Wales in 2011 and in Scotland in 2012. It is governed by its founding constitution, as subsequently amended on 12 May 2012, 21 June 2014 and 13[th] July 2019. The charity is constituted by association.

  2. All trustees have given their time voluntarily during 2021-22 and have not received remuneration or any other benefits in undertaking their duties. Trustees and Representatives are permitted to claim expenses to ensure they are not out of pocket whilst undertaking their volunteer responsibilities. (E.g., travel and accommodation.) Following endorsement by the 2014 Annual General Meeting (AGM), trustees are elected for a period of 3 years and remain empowered to appoint new trustees in-year by extraordinary trustee meeting, although trustees appointed in this way must seek re-election at the following AGM.

  3. IIH UK is a member of the National Council for Voluntary Organisations (NCVO), Rare Disease UK, the Neurological Alliance, the Health and Social Care Alliance Scotland, Genetic Alliance, Benefits and Work and an affiliate of the James Lind Alliance. We also support the Brain and Spine Foundation and hold a lotteries license with Sunderland City Council.

  4. We became General Data Protection Regulation (GDPR) compliant in March 2018.

  5. We bank with the National Westminster Bank. Facebook (Fb) has become our main platform for donations. Just Giving is our main platform for fundraising. We also accept donations via the Charities Aid Foundation. (See item z below.)

  6. At the year-end our team members are: Shelly Williamson, Trustee. Clare Parr, Trustee. Betsy Clark, Trustee. Amanda Denton, Trustee. Krystal Kirkby, Research Rep. Nisha Sedani, Research Rep. Katie Williamson, Shop Rep. Mellissa Fisher, Arts and Culture Rep. We currently have several positions open; these include Trustee/Secretary, Fundraising Rep, Newsletter Rep. Please email info@iih.org.uk if interested in finding out more about these positions.

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

Charity Objects

  1. The charity’s objects as amended on 13 June 2019 are as follows:

a. To provide the best possible support and advice network for people with Idiopathic Intracranial Hypertension (hereafter referred to as IIH) and their families.

b. To advance the education of the public in general, people with IIH and the medical community in particular on the subject of IIH.

Summary of main activities undertaken by IIH UK for the public benefit in relation to the objects

  1. IIH UK would not be able to exist without the small number of dedicated volunteers who freely give their time; many of whom have IIH themselves. They assist with the day- to-day running of the charity in areas such as fundraising, membership, publicity, merchandise, newsletter production. In planning and undertaking the activities during the report period, IIH UK trustees were cognisant of the Charity Commission’s guidance on public benefit. With the objectives in mind, the Charity’s key activities fall into 4 main areas: to provide an excellent support network for people with IIH and their families/friends/carers; to educate the public and the medical community in particular about IIH; to support and promote research into the condition, and finally, to raise the profile of IIH UK.

Summary of IIH UK’s achievements during 2021-22

IIH UK has been very proactive throughout the year, as shown below:

Support

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

We secured funding from the National Lotteries Community fund to fund this project for adults with IIH. During the year we also ran a HOPE programme for parents of children with IIH which we self-funded.

Our HOPE project created a virtual support community for people with IIH around the UK. Following stakeholder involvement in the development of the bespoke programme for IIH including focus groups, surveys and a steering group. In addition, participants have the opportunity to become facilitators of the HOPE programme and become involved in delivering the HOPE programme to future cohorts. If you have taken part in the HOPE programme and would like to know more about becoming a facilitator please get in touch.

The Hope Project has provided the people we support with the knowledge, skills and confidence to cope with many of life’s challenges, frustrations, fears and isolation. To help people reach their potential by supporting them at the earliest possible stage, Coventry University’s evaluation of the HOPE Programme has shown that people are emotionally and psychologically healthier and more resilient in the face of ongoing stress. Further, the course improves people’s quality of life through teaching important life skills such as goal setting, relaxation and stress management. It builds strong relationships in and across community, people who attend HOPE courses often remain in touch with each other after the course ends and provide each other with ongoing peersupport and encouragement. This is important in a rare condition as many people do not know anyone else with their condition. Online delivery will support the further development of an IIH peer support community across the UK.

There are currently two programmes: 1. For adults with IIH. 2. For parents of children with IIH.

We are amalgamating the courses in 2023.

You can read about the HOPE programme here: - https://www.h4c.org.uk/hope programme

Statistics for IIH Hope Courses.

Date of Course Enrolled Not active Completed Course
Parent 20/09/2021 23 6 17
Adult 22/03/2022 71 18 53
Adult 22/03/2022 69 22 47
Adult 12/05/2022 83 22 61
Parent 08/06/2022 13 2 11

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

Education

What is IIH

What is IIH without Papilloedema (IIHWOP)

Optic Nerve Sheath Fenestration

IIH and Weight

Headache

Acetazolamide

Information for friends, family and carers

ICP Monitoring IIH and Education

Benefits information

Employment with IIH

Medication Overuse Headache in IIH

Shunts and IIH Stents and IIH

Topiramate Visual Problems in IIH

When I go to the Eye Clinic

Leaflets coming soon: Lumbar Puncture Pappilloedema Pregnancy and Family Planning with IIH IIH and Flying

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

Greater Occipital Nerve Block (GON)

BOTOX/ Calcitonin Gene-Related Peptide (CGRP)

In 2022 IIH UK was delighted to be invited to be a partner for a bid to support a research network called N- CODE. IIH UK were delighted to hear that the bid led by researchers at Birmingham University was successful and has received funding from the ESPRC. You can follow N-Code on Twitter: @ncode_network

Information on N Code: EPSRC-funded Network+: Neurotechnology for enabling community-based diagnosis and care – to be known as N-CODE.

The N-CODE network has been funded by the EPSRC for 3 years and will launch on 10th October 2022. The focus is the development of technologies that shift the emphasis of diagnosis and management of neurological conditions from hospital to the community. We will work with partners and stakeholders to develop digital solutions built around neural interfacing, signal processing, machine learning and mathematical modelling as enabling technologies. These offer significant potential for addressing many challenges currently faced by people with neurological conditions and those responsible for their care. We will work with people with lived experience and their communities to address these challenges together.

Research

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

neuro-ophthalmologists and orthoptic led clinics that management IIH patients around the United Kingdom.

The IIH Life Registry is an excellent resource being used by the Birmingham team since 2013. It enables the IIH team to record information including: visual test results, Quality of Life measures, headaches, medication usage, related conditions, heights and weights. The benefits for this including being able to link changes between these markers to show how they affect each other and also the impact that IIH is having on a person's life.

The Birmingham team have used the database for two studies which are both free to read.

One was comparing Birmingham’s IIH patients with those in Atlanta, USA https://www.nature.com/articles/s41433-019-0359-5

The other study helped them track trends following COVID-19 pandemic https://jnnp.bmj.com/content/early/2020/12/23/jnnp-2020-325519

Dr Mark Thaller, Clinical Research Fellow at Birmingham, is currently using the rich resource of the IIH Life database for his research into fertility, polycystic ovarian syndrome, Quality of Life and the hormonal basis for IIH. He aims to add to the knowledge base beyond the visual and headache aspects. Dr Thaller has received two awards for his research, the IIH UK CSF award and the Junior Academic Prize from the Midland Ophthalmology Society.

The registry will help future care of IIH patients by researchers being able to use it for their research questions. Roll out to other hospitals was halted due to legal regulations, however they are now in a position to start to build out.

n. IIH Intervention Trial.

10 of our Top ten areas for IIH research is ‘What is the best type of intervention to treat IIH’. We do not yet know which of the current available treatments is the best to treat IIH and were delighted to be invited to the steering group to discuss the development of a new Stent v Shunt trial. We found out in March that Prof Sinclair was chosen to lead this research which aims to establish the best surgical intervention (shunt vs stent) in people with IIH to prevent blindness. Finding out the most effective method of surgery is vital to improve the management and quality of life of people with IIH.

IIH UK was consulted and involved in a successful research bid (National Institute for Health Research NIHR) led by Birmingham University to investigate Shunt and Stent interventions in people with IIH. IIH UK were involved in the grant bid and are continuing to be involved in reviewing trial documentation etc to ensure that it is easy to understand for people with IIH. IH UK will be part of future steering group meetings (Dec2022)

Birmingham University have the following to say about the IIH Interventions trial and why it is important.

‘IIH Intervention Trial is a randomised clinical trial that will compare two interventions for patients with Idiopathic Intracranial Hypertension (IIH) and progressive visual loss: Cerebrospinal fluid (CSF) shunting and Dural venous sinus stenting (DVSS).

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

Both interventions reduce intracranial pressure and preserve vision, but there has been no direct comparison between them and we still do not know which one is more effective. This is an important clinical question and the trial will change practice at national and international level. We have engaged patient groups (IIH UK) and opinion leaders from across the country in order to design high-quality research methodology, while providing our study participants with an exceptional research experience. The trial will enrol 138 patients from 15 UK hospitals who will be randomly allocated to one of the two interventions. We will assess which one is better at preserving vision, more cost-effective, their possible complications, and their impact on headaches and on quality of life. The trial will last for 5 years and we commit to delivering patient-centred scientific research with integrity and strong ethics. Our vision is to advance knowledge, develop treatments and improve the care of patients with IIH.’

o. Physical activity, quality of life and headache impact in people with Idiopathic Intracranial Hypertension survey.

Research Reps Amanda Denton and Dr Krystal Hemmings and a Physiotherapy researcher from Plymouth University Dr Hilary Gunn carried out and analysed this survey. An online survey was sent to people with IIH (pwIIH) to complete. The survey contained measures of physical activity, quality of life and headache impact. 164 people with IIH took part and their information was anonymously analysed. The results showed that pwIIH have low levels of physical activity and take little exercise. Physical activity is related to quality of life in pwIIH. Physical activity was not related to age, current or diagnosis BMI (Body Mass Index) or headache impact score in people with IIH.

The results suggest that improving physical activity in people with IIH could positively impact on quality of life. Ways to increase physical activity such as exercise should be further explored in pwIIH.

p. Following the results from our Physical activity, quality of life and headache impact in pwIIH survey. We put out a Physical Activity in IIH funding call in November 2021 to further

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

research this neglected area. Dr Sui Wong and her team at Guy’s and St. Thomas Hospital NHS Trust, London won this call and was granted £9996.00 plus a reserve of £2500 to pay the open access fees of the research paper once published.

(Note we have paid the open access fees for several previous research papers as we feel it is important that pwIIH have the opportunity to read research articles in journals that usually require a subscription.)

Summary of Dr Wong’s research funding bid .

Idiopathic intracranial hypertension (IIH) is associated with excess body weight, and research has shown that weight loss may lead to remission of IIH. This has also been prioritised by people pwIIH as an important area of research.

Physical activity is a key aspect of successful and sustainable weight management, and can also improve other health conditions associated with IIH, including cardiovascular and metabolic health conditions.

At Guy’s and St Thomas’ NHS Foundation Trust (GSTT), they have a track record of working in partnership with pwIIH to develop services that empower them, including group consultations that facilitates peer-to-peer learning and lifestyle support to empower pwIIH to better manage their condition; and wellbeing workshops to support sustainable lifestyle measures including physical activity. Their multidisciplinary IIH team includes physiotherapists who support physical activity for pwIIH.

This research aims to develop recommendations and practical implementations on physical activity for pwIIH. The work will include research into current evidence and gathering new evidence through research in partnership with pwIIH, including focus groups, questionnaires and data gathered from pilot work on the effectiveness of group education sessions. Appropriate video guidance will also be developed in partnership with pwIIH. The work will be incorporated with current work on the HOPE programme for pwIIH. The gaps in knowledge in this area will also be identified.

Output from this research will be shared with the IIH UK trustees and members. This will also be disseminated to health professionals to advocate support and better care for pwIIH.

q. IIH EVOLVE Trial Update

3 of our James Lind Alliance Priority Setting Partnership is ‘Can new therapies for IIH be developed which are effective, safe and tolerable and potentially help with weight loss as well as reducing brain pressure.’

Currently there are no drugs designed to treat IIH, all current mediations used to treat it are used off label. There is a need for new safe and effective treatments for IIH and Invex Therapeutics (Invex) is developing a once per week injectable formulation of Exenatide to treat IIH.

Invex Therapeutics is an Australian biopharmaceutical company co-founded by Professor Sinclair which is focused on the repurposing of an already approved drug, Exenatide, for efficacious treatment of neurological conditions involving raised intracranial pressure. Invex’s primary focus is on the disease Idiopathic Intracranial Hypertension, a condition with

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

no regulatory approved treatments to date. Invex has trademarked its repurposed Exenatide as Presendin.

Presendin is a sustained release (SR) formulation of Exenatide which will be delivered via a once per week, sub-cutaneous injection, and moving into Phase III development. This injection would be done at home by the patient (or care giver) once training has taken place. Exenatide is a small peptide and a synthetic version of the GLP-1 agonist exendin-4, which is currently approved for the treatment of type 2 diabetes (but does not cause dangerous lowering of blood sugar levels). Exenatide has been licensed for use in type 2 diabetes since 2005 so there is a wealth of knowledge about the drug safety. Common side effects of Exenatide include nausea, loss of appetite and dizziness, which are typically short lived. Exenatide can also cause weight loss.

IIH EVOLVE is a randomised, placebo-controlled, double-blind Phase III clinical trial that will randomise 240 adult patients with newly diagnosed IIH with papilloedema to determine the efficacy and safety of Presendin versus placebo, administered once weekly over 24 weeks. The primary endpoint of IIH EVOLVE will assess efficacy of Presendin to reduce ICP over 24 weeks compared to those on placebo. Secondary endpoints will assess changes in vision and papilloedema, it will also measure headache. Invex intends to open up to 40 clinical sites across the UK, Europe, Australia, Israel, New Zealand and the USA. Information on the trial is available at clinicaltrials.gov under Identifier NCT05347147.

IIH UK has been involved in both Patient and Public Involvements meetings and have supported researchers to link with international IIH non-profit organisations.

r. Obesity Stigma in IIH

In 2021 IIH UK carried out a survey to explore obesity stigma and the management of weight in IIH. We were overwhelmed with responses from over 500 people within a week and closed the survey at 625 responses. (the mazimum allowed on or survey monkey subscription) Thank

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

you all for your input into this survey which is an emotive subject for people with IIH. We are already liaising with medical teams to action your responses to improve the dialogue about weight in IIH. The responses already show clearly significant room for improvement in how the topic of weight is discussed and that a lack of evidence based support being offered. We are aware that researchers have already used our data in when applying for funding. This is an emotive but important subject and we will endeavour to keep up the conversation about Obesity stigma in IIH with professionals that treat people with IIH.

Read Discussing weight with people with Idiopathic Intracranial Hypertension, Results of an online survey: Stigma, support and changing the dialogue on our website here: IIH UK Obesity Stigma survey results

s. We added 3 more Plain English Summaries to our website. Medical articals are notorious for being difficult to read which is why we request easy to read/understand versions.

i. IDIOPATHIC INTRACRANIAL HYPERTENSION AND COGNITIVE CHANGES This summary is to explain new research in IIH. This research focus is on cognition which is the ability to perceive and react, process and understand, store and retrieve information, make decisions and produce appropriate responses.

ii. INTRACRANIAL PRESSURE DIRECTLY PREDICTS HEADACHE MORBIDITY IN IDIOPATHIC

INTRACRANIAL HYPERTENSION This research focus is on what was learnt regarding headaches in people with IIH from the IIHWT clinical trial.

iii. IIH COGNITION This research focus is on cognition which is the ability to perceive and react, process and understand, store and retrieve information, make decisions and produce appropriate responses.

iv. POOR MENTAL FUNCTIONING (‘BRAIN FOG’) IN PEOPLE WITH IDIOPATHIC INTRACRANIAL HYPERTENSION The main goal for this research study was to show the changes in mental function in people with Idiopathic Intracranial Hypertension.

t. Other notable research published during the year.

i. Obstructive sleep apnoea (OSA) found to be common in IIH-prevalence 47%, and is associated with changes in papilloedema independent of BMI. Whether OSA treatment has beneficial impact on papilloedema warrants further evaluation. https://link.springer.com/.../10.1007/s00415-021-10700-9.pdf

ii. The Patients perspective on the burden of IIH. https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186

iii. Cognitive performance in idiopathic intracranial hypertension and relevance of intracranial pressure. https://pubmed.ncbi.nlm.nih.gov/34704028/

iv. Intracranial pressure directly predicts headache morbidity in idiopathic intracranial hypertension. https://pubmed.ncbi.nlm.nih.gov/34620087/

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

v. Managing idiopathic intracranial hypertension in pregnancy: practical advice https://pn.bmj.com/content/22/4/295?fbclid

Raising the Profile of IIH

British Association for the Study of Headache (BASH). July 21 - online

HIS & EHF joint congress. September 21 - online

Genetic Alliance Members Meeting October 21 - 0nline

Neurological Alliance Members Meeting November 2021 - online

Rare Voice in Policy meeting October 21 - online

Stent v Shunt Trial Steering Group Meeting April 22 - online

HOPE Programme discussion May 2022 - Zoom online livestream.

European Neuro-ophthalmology Society Conference . June 2022. Birmingham.

Attending other organisations’ conferences/meetings, albeit virtually this year, provides an opportunity for Trustees and Team Members to meet other attendees and develop

friendships with other likeminded organisations enabling us to raise the profile of IIH.

x . IHC and EHF joint congress

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

of September was once again a huge success due to the shares and retweets the posts received. We kicked the month off with Rachel Turners (founding member) poem which alone was viewed by 54,183 people! A great start to IIH Awareness Month. Once again, we created profile photos for people with IIH to share on the fb and twitter profiles. This year 163 people contacted Shelly to ask her to create a new profile photo for them.

This year our Trustee Shelly created profile photos for everyone to add to their profile photo on Facebook. The theme for this year was ‘Rare is strong, rare is many, rare is proud’. All in all, it was a perfect day spent spreading awareness and raising the profile of Idiopathic Intracranial Hypertension.

30[th] June 2022

Michelle Williamson. Chair

IIH UK ANNUAL REPORT AND ACCOUNTS 2021-22 Website www.iih.org.uk; Twitter @IIHUK E-mail info@iih.org.uk

----- Start of picture text -----
Idiopathic Intracranial Hypertension UK No. 1143522
Receipts and payments accounts CC16a
For the period Period start date Period end date
To
from 7/1/2021 6/30/2022
Section A Receipts and payments
Unrestricted Restricted Endowment
Total funds Last year
funds funds funds
to the nearest
to the nearest £ to the nearest £ to the nearest £ to the nearest £
£
A1 Receipts
Donations & Fundraising 906 - - 906 871
Just Giving 8,371 - - 8,371 6,639
Facebook 7,949 - - 7,949 10,252
Paypal Giving Fund 2,313 - - 2,313 1,765
Other 11,383 - - 11,383 1,698
Membership Fees 2,313 - - 2,313 1,902
Conference Tickets - - - 165
Merchandise 2,206 - - 2,206 3,366
Bank Interest 6 - - 6 2
Refunds 9 - - 9 153
- - - -
- - - -
Sub total(Gross income for
35,455 - - 35,455 26,814
AR)
A2 Asset and investment sales,
(see table).
- - - -
- - - - -
Sub total - - - - -
Total receipts 35,455 - - 35,455 26,814
A3 Payments
Governance - - - £2,094
IT £1,600 - - 1,600 £9,343
Merchandise (Stock Purchase) £726 - - 726 £2,881
Paypal Fees £187 - - 187 £243
Postage & Packaging £662 - - 662 £952
Printing & Stationery £446 - - 446 £240
Transport - - - £0
Misc - - - £113
Refunds £43 - - 43 £6
Justgiving Membership £216 - - 216 £216
Other Membership £60 - - 60 £255
AGM/Patient Conf - - - £0
Symposium/Conference - - - £63
Partnership Donations £12,946 - - 12,946 £500
Education - - - £773
Research & Alliance - - - £0
Surveys £372 - - 372 £312
Representatives & Trustee Expenses £518 - - 518 £0
Publicity and Profile - - - £0
Focus Meetinsg - - - -
Life Registry - - - 5,000
Hope Program Child 1,500 1,500
Hope Prgram - Adult Donation 4,020 4,020
Events - - - -
Sub total [ 23,296 ] - - 23,296 22,990
----- End of picture text -----

----- Start of picture text -----
A4 Asset and investment
purchases, (see table)
- - - -
- - - -
Sub total [ - ] - - - -
Total payments [ 23,296 ] - - 23,296 22,990
Net of receipts/(payments) [ 12,159 ] - - 12,159 3,825
A5 Transfers between funds - - - - -
A6 Cash funds last year end 39,715 - - 39,715 35,890
Cash funds this year end [ 51,874 ] - - 51,874 39,715
----- End of picture text -----

Section B Statement of assets and liabilities at the end of the period at the end of the period at the end of the period at the end of the period
Unrestricted Restricted Endowment
Categories Details funds funds funds
B1 Cash funds Bank Accounts
Paypal
Petty Cash
Total cash funds		 to nearest £
49,614
2,190
71
51,874


to nearest £
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(agree balances with receipts and payments
account(s))		 OK
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Unrestricted Restricted Endowment
funds funds funds
Details to nearest £ to nearest £ to nearest £
B2 Other monetary assets Stock -
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charity’s own use






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behalf of all the trustees		 Signature Print Name Date of
approval
Mrs Michelle Williamson 1/16/2023

CHARITY COMMISSION FOR ENGLAND AND WALES Independent examiner's report on the accounts Section A Independent Examiner's Report Report to the tru$legs1 members of Idiopathic Intracranial Hypertension UK On accounts for the year end•d 30th June 2022 Charlty no 111 any) 1143522 Set out on pages PAGE10F2 I report lo the trustees on my examination of the accounts of the above charity I'lhe Tnjst") for the year ended Responsibilities and As the charity Iruslees of the Trust, you are responsible for tho preparation basls of report of the accounts in ac¢ordan¢e with the requirements of the Charrties A( 2011 I'lhe Act I I report in respect of my examination of the Trust's accounts carried out under section 145 of the 2011 Act and in carrying out my examination, I have followed the applicable Directions given by the Charity Commission under section 14Sl5llbl of the A¢X. I have completed my examination. I confim that no matersal matters have come to my attention lolher than that disdosed below") in connection with the examination which give$ me cause lo believe that In. any material respect.. accounting records were not kept In a¢cordance with section 130 of the Act or the accounts do not accord wth the accourrting records Indepond•nt •xaminerfs stst•m•nt I have no concerns and have come across no other matters in Connèction with the examination lo which attention should be drawn in order to enable Proper understanding of the accounts to be reached. Hease delete the words in the brackets rfthey do not 8ppIy. Signed: Narng: Relevant prof88slonal qualiflcationlsl or body lif any): Address: IER October 2018

Section B Disclosure Only complete If the examiner needs lo highlight matters ol GonGern (see CC32, Independent ex8min81ion of charity accounts. directions and guidance for examiners). Giv? briof d￿118 of any iterns that the examingr wishgs to disclose. IER October 2018