**----- Start of picture text -----**
Ending Fistula and
changing lives in
Ethiopia
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**Charity Registration Number: 1153053 Company Registration Number: 08457433 (England and Wales)**
**HAMLIN FISTULA UK (a company limited by guarantee) UNAUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2022**
**HAMLIN FISTULA UK**
|**CONTENTS**|**PAGE**|
|---|---|
|**Legal and administrative information**|**3**|
|**Trustees’ Report**|**4 - 14**|
|**Independent examiners report**|**15**|
|**Statement of financial activities**|**16**|
|**Balance sheet**|**17**|
|**Cash flow statement**|**18**|
|**Notes to the cash flow statement**|**19**|
|**Notes to the financial statements**|**20 - 30**|
2
**HAMLIN FISTULA UK**
## **LEGAL AND ADMINSTRATIVE INFORMATION Directors and Trustees**
Greg Morris - Chair Sarah Hewitt-Clarkson Alison Murray Libby Grundy MBE
## **Life President**
Malcolm Hewitt OBE
## **Company Secretary**
Helen Marriott
## **Registered Office**
4 Parade Buildings Nimmings Road Halesowen B62 9JJ
**Charity number:** 1153053
**Company number:** 08457433 (registered in England and Wales)
## **Independent Examiner**
BVSC 138 Digbeth Birmingham, B5 6DR
## **Bankers**
TSB Bank plc. 23 Hagley Street Halesowen, B63 3AY
## **Charities Aid Finance Bank**
Kings Hill West Mailing Kent, M19 4TA
## **Legal Advisors**
Anthony Collins Solicitors LLP 134 Edmund Street Birmingham, B3 2ES
## **Investment managers**
EFG Harris Allday 33 Great Charles Street Birmingham, B3 3JN
3
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
The trustees, who are also directors of the charity for the purposes of the Companies Act 2006, present their report and unaudited financial statements of the charity for the year ending 31 March 2022.
## **Trustees**
The trustees, who are also the directors for the purposes of company law, and who served during the year and up to the date of signature of the unaudited financial statements were: Greg Morris - Chair
Sarah Hewitt-Clarkson Alison Murray Libby Grundy MBE
None of the directors has any beneficial interest in the company. All of the trustees are members of the company and guarantee to contribute £1 in the event of winding up.
## **Structure, governance and management**
The trustees are the directors of the charitable company which is governed by the Articles of Association as amended by a Special Resolution dated 5 July 2013.The company is a company limited by guarantee and therefore does not have a share capital. The liabilities of the members, who are also the directors and trustees, together with details of their guarantees, are shown in the notes to the accounts. The company was registered with the Charity Commission for England & Wales on 24 July 2013.
The charity has a formal introduction process for new trustees. Regular financial reviews and reports are prepared for the trustees by the charity's administrative staff and presented at trustees’ meetings.
Details of the directors who served during the year are shown in the Reference and Administrative details on page 3.
## **Objects**
The objects of the charity, as set out in the amended Articles are:
1. To relieve the needs and advance the health of patients who have suffered from childbirth injuries in Ethiopia.
2. Such other charitable purposes in Ethiopia as the Board shall from time to time decide.
3. If the continuance of such charitable work in Ethiopia becomes in the opinion of the Board impracticable, such general charitable purposes in any part of the world as the Board shall from time to time decide.
4
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
## **Activities**
The charitable company supports Hamlin Fistula Ethiopia with cash, medical consumables or other requirements funded by means of regular donations made in tax-efficient ways by donors and income from investments held for the longer term.
In addition to Hamlin Fistula Ethiopia's headquarters hospital in Addis Ababa, Hamlin Fistula Ethiopia operates five regional fistula hospitals in Yirgalem, Bahir Dar, Harar, Metu and Mekelle. The organisation also founded and operates the Hamlin College of Midwifery to train and deploy midwives across Ethiopia, and Desta Mender – a rehabilitation centre for longer term patients.
As well as providing general funds used across these hospitals and centres, this charity has undertaken to cover the operating costs of the Yirgalem Regional Fistula Hospital. A combination of restricted and unrestricted funds are used to meet our commitment to fully fund Yirgalem Regional Fistula Hospital. Hamlin Fistula UK additionally coordinates the production of colourful knitted blankets by volunteers, which are sent to Hamlin Fistula Ethiopia to be given to each patient on their arrival at a Hamlin hospital.
## **Principal sources of funds**
Our income is derived in the main from individual donors, trusts and foundations and legacies. In addition, we received approximately £88,316 (2021 £109,883) from investment income. We would like to thank all our donors over the past year, who have included, among others, The Band Aid Charitable Trust, Eleanor Rathbone Charitable Trust, Ericson Trust, Hodge Foundation, Peter Stebbings Memorial Charity, Roughley Charitable Trust, The Big Give and EthiopiAid, the Sulney Fields Charitable Trust, Mark B and Helene and Martin Hayman. We would also like to thank all our generous individual donors, friends and volunteers and donors who wish to remain anonymous.
## **Strategic report**
## **Background**
Hamlin Fistula UK, a registered UK charity, is dedicated to restoring the health and dignity of women in Ethiopia who have survived the horrendous – and preventable – childbirth injury: obstetric fistula. Obstetric fistula can be repaired with a single life changing surgery. We exist to raise funds and awareness for Hamlin Fistula Ethiopia, to support the development and delivery of their services in Ethiopia.
Founded in 1968, we are part of the Hamlin family of international charities, which was established by pioneering Australian surgeons Drs Catherine and Reg Hamlin. Catherine and Reg were in Ethiopia to train midwives when they first discovered the overwhelming numbers of women suffering the plight of obstetric fistula and realised that little was being done to help them. They established the Addis Ababa Hamlin Fistula hospital, to provide the country’s first fistula services.
Today, Hamlin Fistula Ethiopia has expanded to include five regional hospitals, the Hamlin College of Midwives and Desta Mender, a rehabilitation centre for long-term patients. We also support a network of over 50 government rural midwifery clinics. To date, Hamlin has directly treated over 60,000 women.
5
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
## **Every Woman Matters**
## **Our work reflects a lifetime quest to provide world-leading treatment to some of the most marginalised women in the world.**
In 2022, no woman should suffer the indignity of an obstetric fistula, however in Ethiopia, sadly, this devastating childbirth injury affects an estimated 1,500 women each year. Survivors, often voiceless and marginalised, tend to live in impoverished rural communities, suffering in isolation. Additionally, whilst huge progress has been made in recent years, for a population of over 112 million, Ethiopia has fewer than 626 obstetricians / gynaecologists and just 17,000 trained midwives.
The burden of living with obstetric fistula was reported by the Institute for Health Metrics and Evaluation in 2017 as comparable to living with terminal cancer and double the burden of blindness.
## **However, fistula can be repaired with a single life changing surgery.**
**Our vision is to realise Dr Catherine Hamlin's dream for every Ethiopian woman to be free from devastating childbirth injuries and to gain access to quality maternal healthcare. Our mission is to support the treatment and prevention of childbirth injuries in Ethiopia.**
## **Our supporters' impact**
63+ years of continuous service
195 Hamlin Midwives 60,000+ women graduated since 2007 treated
Fistula surgery is described as a cost-effective intervention by The Life You Can Save
## **Aster's Story**
After four agonising days in labour in her remote village with no skilled birth attendant, Aster suffered a stillbirth and a double fistula. Fistula had never been seen in her village before and her family thought it was incurable – so she lived with the condition for two years. Eventually Aster’s father realised she couldn’t continue living that way and sold the family’s cow to buy food to help Aster regain her strength.
When she was ready, Aster made the two-day trek to the nearest health centre, where she was immediately transferred to Yirgalem Regional Fistula hospital and had a successful fistula surgery. **“The villagers were surprised when I returned back looking so well and recovered, above all my father cried in happiness. God helped me to get to Hamlin and receive such unconditional love and care for free.” Aster**
6
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
**How we are helping: achievements and results** _**UK Financial Year 2021-22**_
_**“Despite the odds, Hamlin Fistula Ethiopia has…navigated the difficult conditions posed by the pandemic through the extraordinary efforts of the clinicians and staff, the commitment of the senior management team, and the unwavering support of international partners”**_ **Tesfaye Mamo, CEO, Hamlin Fistula Ethiopia, October 2021**
## **Where we supported services**
The statement of financial activities shows that we contributed £645,607 to Hamlin Fistula Ethiopia during the period.
This supported medical expenses at Addis Ababa Fistula Hospital and other regional hospitals, the full operating costs of Yirgalem Regional Fistula Hospital in Sidama Region and contributed to overall programme and operating costs across all Hamlin centres and initiatives.
## **Hamlin Fistula Ethiopia programme results**
## **Prevention**
## **Hamlin College of Midwives**
Hamlin is growing the number of trained midwives in Ethiopia through training students in a BSc degree in Midwifery at The Hamlin College of Midwives. We were delighted to be able to congratulate the Hamlin College of Midwives graduating class in November 2021.
Twenty three fourth year students worked hard to complete their final modules and graduate, with a 100% pass rate. The new graduates have been deployed into rural government health centres across the country, close to their home villages, and will provide thousands of rural women with family planning services and skilled healthcare during pregnancy and labour.
_The graduating class of 2021_
In his keynote speech at the ceremony, CEO Tesfaye Mamo congratulated the graduates and their families _**; “I want to appreciate the strength of all the graduates today in successfully completing all the requirements to reach to your graduation day regardless of all the challenges you faced that were imposed by the pandemic. I am also confident that you will pass any challenge you may face in your future professional career. I promise you that we will always be on your side to support the quality service you provide to the community.”**_
7
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
This year, following consultation with government health bodies at the Federal level, for the first time the Hamlin College of Midwives focused new student recruitment entirely on students from the remote Gambela and Benishangul regions of western Ethiopia. Training students from these remote areas will have a significant impact on improving maternal healthcare services in both regions in the future.
In January 2022 the Hamlin College of Midwives also launched Ethiopia’s first ever Master’s in Clinical Midwifery with the first class seeing 31 practising midwives take their skills to the next level. Lasting two and a half years, the Masters course will train midwives in advanced clinical practice, including the skills to perform emergency caesarean deliveries for complicated cases. This will be hugely impactful, saving the lives of women and their babies.
## **Practising Hamlin midwives**
Practising Hamlin midwives provided vital continuing antenatal, delivery and postnatal care services to women in rural communities across Ethiopia during the pandemic. Hamlin supported 41 health centres where midwives are based with provision of essential drugs and equipment.
Across the health centres, midwives provided short term family planning to thousands of women, the recommended four ante natal appointments to 18,047 pregnant women and attended 18,874 deliveries – **all fistula free.**
During the period, due to civil unrest in Ethiopia's north, supported health centres in the Tigray region have not reported activity.
## **Treatment**
Obstetric fistula can mostly be repaired with a single life-changing fistula treatment surgery. For some, this can take no more than two hours.
Hamlin’s health professionals welcomed women to 6,424 outpatient appointments to ensure they get the help they need across five Hamlin fistula hospitals in Addis Ababa, Bahir Dar,Harar, Metu and Yirgalem*.
Women requiring surgery for childbirth injuries were admitted and despite the challenges of Covid-19, our surgical teams delivered 2,338 operations for women with childbirth injures including obstetric fistula, prolapsed uterus and other obstetric and gynaecological conditions.
This figure is on target for the period and is testament to the hard work and dedication of our team in Ethiopia.
* Mekelle Regional Fistula Hospital in Tigray region was not active during the year due to civil unrest in northern Ethiopia.
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**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
Patients also received additional services including physiotherapy, stoma care, urodynamics and psychiatric counselling.
Hamlin’s surgical work also took a big step forward this year with the engagement of an Ethiopian specialist diversion surgeon, Dr Wondwossen. Diversion surgery can offer a lifeline for women with severe fistula injuries. For some women, fistula can result in extensive damage to their bladder or lower urinary tract which sadly is not always possible to cure. For these women, the offer of diversion surgery – to provide them with a urostomy (stoma) bag – can enable them to begin the journey to getting their lives back.
In the past Hamlin was reliant upon support from European surgeons for diversion surgery, which often led to long waiting times for patients. Dr Wondwossen’s engagement is already making a significant difference to Hamlin’s work for women.
## **Community outreach**
Community outreach remains a key part of our programme. Outreach activity to raise awareness of fistula and identify women in need of support had to stop for a period of time due to Covid-19, however these activities resumed in areas where it was safe to do so this year.
Each Hamlin hospital has a resident patient identification officer who is dedicated to undertaking regular outreach activities including one on one and group education sessions, door to door outreach, as well as leading mass and local media campaigns, to dispel misconceptions about fistula and empower women to reach out for support.
Patient identification officers have worked to: Identify patients who have not presented because of fears around Covid-19 and/or travel and security restrictions; Identify women who have been living with fistula for many years, who are often harder to find, as they are more likely to be in remote rural communities; Ensure that new patients are still coming forward and not being affected by ongoing fears or concerns.
We are already seeing the impact of this work, and have been able to make a direct association this year between delivering higher activity at Hamlin’s Harar Fistula Hospital and local FM radio advertising.
## **Research and training**
Hamlin surgeons are continually refining the techniques they use to treat more complex fistulas and academic research projects are an important contribution towards achieving this. In 2021, Hamlin's medical specialists participated in the development of six research project proposals, which it is hoped will begin activity in 2022/23.
9
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
The Addis Ababa Fistula Hospital remains a world recognised training facility for fistula surgeons. Hospital teams regularly train visiting doctors and nurses and empower surgeons with advanced skills as part of the International Federation of Gynaecology and Obstetrics (FIGO) Fistula Training Initiative. This year training for international health professionals reached two surgeons from Afghanistan and Nepal.
## **Rehabilitation**
Fistula can have a devastating impact on a woman’s life. Not only have patients suffered the devastation of having had a stillbirth and a traumatic injury, in many cases women are then divorced by their husbands, abandoned by their families and even cast out by their communities.
Hamlin provides physical therapy and livelihoods training to women following surgery, restoring their self-esteem and capacity to generate their own income after returning home to their communities.
This year our specialist staff across all Hamlin hospitals provided 1,227 women with literacy and numeracy training.
For women that need more support, our specialist rehabilitation centre Desta Mender offers three-month residential rehabilitation and training.
226 women completed training at Desta Mender in a range of livelihoods skills from farming and pottery, to catering and business skills and 100 women were re-integrated to their communities with seed funding support to start a business.
## **“Great work #HamlinFistulaEthiopia”**
_**– Lia Tadesse, Minister, Ministry of Health Ethiopia, Twitter, August 2021**_
## **Future plans**
The charitable company will continue to support Hamlin Fistula Ethiopia and carry on the legacy of Dr Catherine Hamlin. The level of support will depend upon the hospital's requirements which are set out in their annual budget.
If considered necessary, we may decide to realise some of the investment portfolio.
10
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
## **From fistula to freedom: Asmira's story**
Asmira, 40, pictured, lives in a remote village in Ethiopia’s North together with her husband Lemma. They have been happily married for 25 years and have two daughters. But unfortunately Asmira’s third pregnancy ended in tragedy when she suffered a stillbirth and fistula.
Asmira lived with her fistula for a long time, and from her remote community did not know where to access help. She told us: **“** _**Before my fistula surgery and rehabilitation I had nothing to eat or wear. We used to live by luck. We spent all the money we had searching for a cure for my fistula”.**_
Eventually the family heard about Hamlin’s treatment programme at Bahir Dar Fistula Hospital, and after saving up and making the long trip to the hospital, Asmira was able to have her first surgery.
Unfortunately, her condition was complex, and as is with a small percentage of women each year, Asmira’s fistula and incontinence could not be completely cured. However, the nurses and doctor at Bahir Dar counselled Asmira to provide her with the option of having diversion surgery to provide her with a stoma which would cure her incontinence.
Five years ago, she took the decision to have diversion surgery at Hamlin’s Addis Ababa Fistula Hospital and was provided with extra support for her recovery at Desta Mender rehabilitation centre. After her training, she received a supported return home with seed funding (c.£300) to invest in a business.
We recently went to visit Asmira and see how she is doing at her home farm in the North. Asmira and her family showed us around their new home and she explained:
_**"Since my surgery and rehabilitation training my life has changed. The education I received equipped me with confidence to fight for my rights and resulted in the legal return of farmland that had been taken from me after my fistula. Now together with my husband I harvest enough food to feed my family. With careful management the seed funding I received from Hamlin five years ago has now grown and I have constructed a new and better home.”**_
_Asmira with one of her cows_
Her husband Lemma, who has stood by her side throughout added: **“** _**Because of her devastating fistula, for so long my wife was restricted to the home, unable to support herself let alone the family. Now after her surgery and support from Hamlin she can visit markets with friends, go to church, eat and drink whatever she wants and protect her health. The seed money you gave her changed our life. We have been working hard to raise our income. I work on the farm and she handles the market each week. Currently we have enough food to feed our family for over a year, we have a new house, two cows and planted cash crops on our farm. The seed money was the start of all of this. You brought happiness back to our home and I can’t thank you enough for your supporters’ generosity.”**_
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**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
## **Reserves policy**
## _**Unrestricted funds**_
It is the policy of the trustees to hold significant funds in the form of listed investments and bank deposits held by the Investment Managers. At 31 March 2022, the charity held investments with a market value of £2,659,376 (2021: £2,834,519) and bank deposits held by the Investment Managers for re-investment purposes of £49,025 (2021: £40,360). This level of investment fund is considered necessary in order to generate investment income to contribute to the ongoing operations of the charity. Within these funds, operating costs equivalent to approximately three months expenditure are held, in line with the policy of the trustees, to enable the charity to operate in the event of a decrease in incoming resources whilst consideration was given to replacing income or changing activities.
At 31 March 2022, general undesignated unrestricted funds, excluding those held in listed investments and bank deposits held by the Investment Managers, for re-investment purposes amounted to £134,100 (2021: £166,421).
## _**Revaluation Reserve**_
The difference between the historic cost of investments and their revalued amount, if positive, is included in the balance sheet as a Revaluation Reserve.
## **Investment policies and objectives**
Investments are held with a view to producing income and as a protection against inflation in view of the long-term commitment of support for Yirgalem Regional Fistula Hospital and other projects. The charity's investment powers are prescribed by The Trustee Act 2000. The trustees confirm that the investments, the majority of which are held in the UK, are held in accordance with their powers.
## **Public benefit**
Under the Charities Act 2011, charities must demonstrate that their purposes are for the public benefit. The trustees confirm that they have taken regard of the Charity Commission's guidance on public benefit. Key features of public benefit included an identifiable benefit, to the public or a section of the public and people on low incomes must be able to benefit.
The charity supports the work of Hamlin Fistula Ethiopia which provides free treatment to women suffering from childbirth injuries, irrespective of race, background or religion. The trustees have therefore concluded that Hamlin Fistula UK meets the key principles as described above.
## **Risk management**
The trustees use a Risk Register to regularly review and manage risks to which the charity may be exposed. Throughout the year, the world has seen the ongoing effects of the Covid-19 pandemic and economic impacts of conflict in Ukraine. This has led to a decrease in donations from individuals and fluctuations in the value of the investment portfolio.
12
**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
To address the decrease in donations from individuals, and to maintain and continue to grow our funding of Hamlin Fistula Ethiopia in the future, we have taken a range of measures including continuing to seek grants from charitable trusts and foundations, carrying out regular appeals to existing donors and takings steps to recruit additional regular donors via digital channels.
Trustees and staff continue to monitor investment portfolio valuations regularly and work closely with the charity’s investment management company to manage risk.
## **Donated services**
In addition to financial donations, we receive contributions from supporters in the form of knitted blankets and baby clothes which are sent to Ethiopia for distribution to patients across Hamlin hospitals. These gifts are donated freely. We have not put a financial value to these gifts in these financial accounts.
## **Results**
The financial statements have been prepared in accordance with the Statement of Recommended Practice "Accounting and Reporting by Charities" which was published in 2015 ("SORP 2015") and Financial Reporting Standard FRS 102.
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**HAMLIN FISTULA UK**
## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT) YEAR ENDED 31 MARCH 2022**
## **Statement of Trustees responsibilities**
The trustees (who are also the directors for the purposes of company law) are responsible for preparing the Report of the Trustees and the financial statements in accordance with applicable law and United Kingdom Generally Accepted Accounting Practice.
Company law requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charitable company and of the incoming resources and application of resources, including the income and expenditure, of the charitable company for that period. In preparing those financial statements, the trustees are required to
- Select suitable accounting policies and then apply them consistently;
- Observe the methods and principles in the Charity SORP;
Make judgements and estimates that are reasonable and prudent;
- State whether applicable UK Accounting Standards have been followed, subject to any material departures disclosed and explained in the financial statements;
- Prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in business.
The trustees are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the charitable company and to enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
## **Approval**
The Trustees Report was approved by the Board of Trustees and signed on its behalf by:
Trustee
Dated: 21 September 2022
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**HAMLIN FISTULA UK**
## **INDEPENDENT EXAMINERS REPORT**
## **TO THE TRUSTEES OF HAMLIN FISTULA UK**
I report to the trustees on my examination of the financial statements of Hamlin Fistula UK for the year ending 31 March 2022.
## **Responsibilities and basis of report**
As the trustees of the charity (and also its directors for the purposes of company law) you are responsible for the preparation of the financial statements in accordance with the requirements of the Companies Act 2006 (the 2006 Act).
Having satisfied myself that the financial statements of the charity are not required to be audited under Part 16 of the 2006 Act and are eligible for an independent examination. I report in respect of the examination of the charity’s financial statements carried out under section 144 of the Charities Act 2011 (the 2011 Act). In carrying out my examination I have followed all the applicable Directions given by the Charity Commission under section 145(5)(b) of the 2011Act.
## **Independent Examiner’s Statement**
I have completed my examination. I confirm that no matters have come to my attention in connection with the examination giving me cause to believe that in any material respect:
1. accounting records were not kept in respect of the charity as required by section 386 of the 2006 Act; or
2. the financial statements do not accord with those records; or
3. the financial statements do not comply with the accounting requirements of section 396 of the 2006 Act other than any requirement that the accounts give a true and fair view which is not a matter considered as part of an independent examination; or
4. the financial statements have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice for accounting and reporting by charities applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102).
I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the financial statements to be reached.
Paul Bowater ACA Birmingham Voluntary Service Council First Floor, Livery Place 35 Livery Street Birmingham, B3 2PB
Dated: 21 September 2022
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**HAMLIN FISTULA UK**
## **STATEMENT OF FINANCIAL ACTIVITIES (INCLUDING INCOME AND EXPENDITURE ACCOUNT) YEAR ENDED 31 MARCH 2022**
|**Income from;**
Donations, legacies and grants
Charitable activities
Investments
**Total income**
**Expenditure on;**
Charitable activities
Raising funds
**Total resources expended**
Net gains/(losses) on
investments
**Net expenditure for the**
**year/Net movement in funds**
**Opening fund balances**
**Transfer between funds**
**Closing fund balances**
3
4
5
6
7
**Note**
**Unrestricted**
**funds**
**2022**
**£**
219,086
48
_88,316
307,450
639,066
_51,038
690,104
143,894
(238,760)
3,041,300
-
__________
2,802,540|**Restricted**
**funds**
**2022**
**£**
104,826
-
________-
104,826
64,865
______-
64,865
**_______-**
39,961
-
-
_______
39,961|**Total**
**2022**
**£**
323,912
48
_88,316
412,276
703,931
_51,038
754,969
143,894
(198,799)
3,041,300
-
__________
2,842,501|**Total**
**2021**
**£**
306,377
215
109,883
416,475
543,373
_39,097
582,470
588,679
422,684
2,618,616
-
__________
3,041,300|**Total**
**2021**
**£**
306,377
215
109,883|
|---|---|---|---|---|
|||||416,475|
|||||543,373
_39,097
582,470|
|||||588,679|
The statement of financial activities also complies with the requirements for an income and expenditure account under the Companies Act 2006.
16
**HAMLIN FISTULA UK**
## **BALANCE SHEET AS AT 31 MARCH 2022**
|**BALANCE SHEET**
**AS AT 31 MARCH 2022**|||
|---|---|---|
|**Fixed assets**
Investments
**Current assets**
Debtors
Cash at bank and in hand
**Creditors: amounts falling**
**due with one year**
**Net current assets**
**Total assets less current**
**liabilities**
**Income funds**
Restricted funds
Unrestricted funds
10
12
13
14
**Note**|**£**
5,734
134,333
**140,067**
(5,967)
________
134,100
2,842,501
39,961
2,802,540
__________
2,842,501
**2022**
2,708,401
--------------|**£**
15,328
161,009
**176,337**
(9,916)
**_________**
166,421
3,041,300
**2021**
2,874,879
--------------|
|||-
3,041,300
|
|||__________
3,041,300|
For the year ending 31 March 2022 the company was entitled to exemption from audit under section 477 of the Companies Act 2006 relating to small companies. No members have required the company to obtain an audit of the financial statements for the year ending 31 March 2022 in accordance with section 476 of the Companies Act 2006.
The trustees acknowledge their responsibilities for complying of the Act with respect to accounting records and the preparation of financial statements.
These financial statements have been prepared in accordance with the provisions applicable to companies subject to the small companies regime.
The financial statements were approved by the Board of Trustees on 21 September 2022, and signed on behalf of the board by:
Trustee
17
## **HAMLIN FISTULA UK**
|**CASH FLOW STATEMENT**
**AS AT 31 MARCH 2022**
**Cash flow from operating activities**
**Net cash provided by (used in) operating**
**activities**
**Cash flow from investing activities**
Dividends and interest from investments
Purchase of investments
Proceeds from sale of investments
**Net cash provided by (used in) investing**
**activities**
**Change in cash and cash equivalents**
**during the year**
**Cash and cash equivalents at start of**
**year**
**Cash and cash equivalents at end of year**
1
2
2
**Note**|**2022**
**2021**
**£**
**£**
(425,364)
88,316
(994,997)
1,305,369
**__**
398,688
(26,676)
161,009
________
134,333
(253,947)
109,883
(1,177,107)
1,168,175
**__**
100,951
(152,996)
314,005
**_________**
161,009|**2022**
**2021**
**£**
**£**
(425,364)
88,316
(994,997)
1,305,369
**__**
398,688
(26,676)
161,009
________
134,333
(253,947)
109,883
(1,177,107)
1,168,175
**__**
100,951
(152,996)
314,005
**_________**
161,009|
|---|---|---|
|||100,951|
||**_**|**__**
(152,996)
314,005
**_________**
161,009|
18
**HAMLIN FISTULA UK**
## **NOTES TO THE CASH FLOW STATEMENT AS AT 31 MARCH 2022**
## **1. Reconciliation of net income/(expenditure) to net cash flow from operating activities**
|Net (expenditure)/income for the year
Adjustments for:
(Gains)/losses on investments
Dividends and interest on investments
Decrease in debtors
(Decrease)/increase in creditors
Net cash (used in) provided by operating
activities
**2. Analysis of cash and cash equivalent**
**Cash at bank and in hand**
**Total cash and cash equivalents**|**2022**
**£**
(198,799)
(143,894)
(88,316)
9,594
__
(3,949)
(425,364)
**2022**
**£**
134,333
________
134,333|**2021**
**£**
422,684
(588,679)
(109,883)
19,554
___
2,377
(253,947)|
|---|---|---|
|||**2021**
**£**
161,009
________
161,009|
19
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **1. Accounting Policies**
## **Accounting convention**
The accounts have been prepared in accordance with the Companies Act 2006 and “Accounting and Reporting by Charities: Statement of Recommended Practice (SORP) applicable in the UK and Republic of Ireland (FRS 102)” (as amended for accounting periods commencing from 1 January 2016). The charity is a “Public Benefit Entity as defined by FRS 102.
The financial statements are prepared in sterling, which is the functional currency of the charity.
The financial statements have been prepared under the historical cost convention. The principal accounting policies adopted are set out below.
## **Going concern**
At the time of approving the financial statements, the trustees have a reasonable expectation that the charity has adequate resources to continue in operational existence for the foreseeable future. Thus the trustees continue to adopt the going concern basis if accounting in preparing the financial statements.
## **Charitable funds**
Unrestricted funds are available for use at the discretion of the trustees in furtherance of their charitable objectives unless the funds have been designated for other purposes.
Restricted funds are subject to specific conditions by donors as to how they may be used. The purposes and uses of the restricted funds are set out in the notes to the financial statements.
## **Incoming resources**
These are included in the Statement of Financial Activities (SOFA) when:
- The charity becomes legally entitled to the resources after any performance conditions have been met;
- The trustees are virtually certain that they will receive the resources; and The monetary value can be measured with sufficient reliability.
Income from donations and legacies is included when receivable, except as follows:
- Where donors specify that donations given to the charity must be used in future accounting periods, the income is deferred until those periods;
- Where donors specify that donations are for particular restricted periods, which do not amount to pre-conditions regarding entitlement, this income is included in incoming resources when receivable.
20
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **1. Accounting Policies (continued)**
Investment income is accounted for when receivable.
## **Resources expended**
Charitable activities includes all costs relating to general administration which support the charitable purpose.
Grants offered subject to conditions, which have not been met at the year-end date are noted as a commitment, but not accrued as expenditure.
Expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to the category. Where costs cannot be directly attributed to particular headings that have been allocated to activities on a basis consistent with the use of the resources.
## **Incoming resources with related expenditure**
When incoming resources have related expenditure (as with fundraising or contract income) both are reported gross in the SOFA.
## **Investments**
Investments are stated at fair value measured by reference to closing market prices. Any gain or loss on revaluation is taken to the Statement of Financial Activities.
## **Cash and cash equivalents**
Cash and cash equivalents include cash in hand, deposits held at call with bankers, other short term liquid investments with original maturities of three months or less, and bank overdrafts. Bank overdrafts are shown within borrowings in current liabilities. Cash held by the investment Mangers for re-investment purposes are included in long term investments.
## **Financial instruments**
The charity has elected to apply the provisions of Section 11 “Basic Financial Instruments” and Section 12 “Other Financial Issues” of FRS 102 to all of its financial instruments.
21
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **1. Accounting Policies (continued)**
Financial instruments are recognised in the charity’s balance sheet when the charity becomes party to the contractual provisions of the instrument.
Financial assets and liabilities are offset, with the net amounts presented in the financial statements, when there is a legally enforceable right to set off the recognised amounts and there is an intention to settle on a net basis or to realise the assets and settle the liability simultaneously.
## _**Basic financial assets**_
Basic financial assets, which include debtors and cash and bank balances, are initially measured at transaction price, including transaction costs and are subsequently carried at amortised cost using the effective interest method unless the arrangement constitutes a financing transaction, where the transaction is measured at the present value of the future receipts discounted at a market value of interest. Financial assets classified as receivable within one year are not amortised.
## _**Basic financial liabilities**_
Basic financial liabilities, including creditors and bank loans are initially recognised at transaction price unless the arrangement constitutes a financing transaction, where the debt instrument is measured at the present value of the future payments discounted at a market rate of interest. Financial liabilities classified as payable within one year are not amortised.
## _**De-recognition of financial liabilities**_
Financial liabilities are derecognised when the charity’s contractual obligations expire or are discharged or cancelled.
## **Pensions**
The charity operates a defined contribution pension scheme and the pension charge represents the amounts payable by the charity to the fund for the year.
## **Hire purchase and leasing commitments**
Rentals paid under operating income are charged to the Statement of Financial Activities on a straight line basis over the period of the lease.
## **Taxation**
The charity is exempt from Corporation Tax as all its income is charitable and applied for charitable purpose.
The charity is not registered for Value Added Tax. Expenditure therefore includes non-recoverable VAT where applicable.
22
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **2. Critical accounting estimates and judgements**
In the application of the charity’s accounting policies, the trustees are required to make judgements, estimates and assumptions about the carrying amount of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from these estimates. The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised where the revision affects only that period, or in the period of the revision and future periods where the revision affects both current and future periods.
## **3. Donations, legacies and grants**
|**Income from;**
Donations
Legacies
Community fund raising
Grants
Total for the year
**Analysis by fund**
Unrestricted funds
Restricted funds
**Unrestricted**
**funds**
**2022**
**£**
136,788
43,092
22,706
16,500
________
219,086
24,961
3,365
-
76,500
________
104,826
**Restricted**
**funds**
**2022**
**£**
**4. Income from charitable activities**
Book sales
Total for the year
**Analysis by fund**
Unrestricted funds
Restricted funds|161,749
46,457
22,706
93,000
________
323,912
219,086
104,826
________
323,912
**Total**
**£**
**2022**
**£**
**2022**
__48
__48
48
___-
_48|223,186
33,070
121
50,000
________
306,377
**Total**
**2021**
**£**|223,186
33,070
121
50,000
________
306,377
**Total**
**2021**
**£**|
|---|---|---|---|
|||221,877
84,500
________
306,377||
||||**2021**
**£**
__215
__215
215
___-
_215|
|||||
23
## **HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
|**5. Investment income**
Income from UK listed investments
Income from overseas investments
Bank and other interest
Total for the year
**Analysis by fund**
Unrestricted funds
Restricted funds
**2022**
**£**
85,459
2,180
___
677
88,316
88,316
______-
88,316
**6. Expenditure on charitable activities**
Hamlin Fistula Ethiopia
Hamlin Fistula Ethiopia
- Restricted
**Direct**
**costs**
**£**
**Support**
**costs**
**Governance**
**costs**
**£**
**£**
580,742
64,865
________
645,607
54,643
-
________
_54,643
3,681
-
________
__3,681|106,202
3,125
____
556
109,883
109,883
_______-
109,883
**2021**
**£**
**2022**
**Total**
**£**
639,066
64,865
________
703,931|**2021**
**Total**
**£**
458,873
84,500
________
543,373|
|---|---|---|
24
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **6. Expenditure on charitable activities (continued)**
|**Support costs**
Occupation costs
General office
Staff costs
Staff training and recruitment
Staff welfare
Travel expenses
**Governance costs**
Independent examination
Trustee indemnity insurance
**7. Expenditure on raising funds**
Fund raising costs
Fundraising consultant|**2022**
**2021**
**£**
**£**
4,901
16,470
32,376
521
154
___221
54,643
2,730
__951
3,681
5,192
11,170
31,289
1,084
-
____59
48,794
2,730
__767
3,497
**2022**
**2021**
**£**
10,029
41,009
51,038
4,711
34,386
39,097|**2022**
**2021**
**£**
**£**
4,901
16,470
32,376
521
154
___221
54,643
2,730
__951
3,681
5,192
11,170
31,289
1,084
-
____59
48,794
2,730
__767
3,497
**2022**
**2021**
**£**
10,029
41,009
51,038
4,711
34,386
39,097|
|---|---|---|
|||39,097|
## **8. Trustees**
## **Remuneration**
None of the trustees (or any persons connected with them) received any remuneration from the charity during the year (2021 - £nil).
## **Expenses**
None of the trustees (or any persons connected with them) received any expenses from the charity during the year (2021 - £nil).
25
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
|**NOTES TO THE FINANCIAL STATEMENTS**
**AS AT 31 MARCH 2022**|||
|---|---|---|
|Wages and salaries
Social security costs
Other pensions costs
**9. Employees**|**2022**
**£**
30,000
-
_2,376
32,376|**2021**
**£**
27,898
-
3,391|
|||_
31,298|
The average number of employees during the year was 1 (2021 – 1). No employee received emoluments in excess of £60,000. There is a volume of willing volunteers, throughout the UK, who raise funds for the charity by organising various events, such as coffee mornings. It Is not possible to estimate their total numbers.
|**10. Investments**|**2022**|**2021**|
|---|---|---|
|**At fair market value**|**£**|**£**|
|UK listed investments|2,303,709|2,226,076|
|Overseas investments|_
355,667|_
608,443|
||2,659,376|2,834,519|
|Cash held by Investment Managers|49,025|40,360|
||__________|__________|
|Total|2,708,401|2,874,879|
||**2022**|**2021**|
||**£**|**£**|
|**Movement in the fair value of investments**|||
|Fair value at 1 April|2,874,879|2,277,268|
|Proceeds of disposal|(1,305,369)|(1,168,175)|
|Acquisitions|986,342|1,278,457|
|Increase/(decrease) in investment bank|||
|balances|8,655|(101,350)|
|Net gains/(losses) on revaluation at 31 March|143,894|588,679|
||__________|__________|
|Fair value at 31 March|2,708,401|2,874,879|
||||
||**2022**|**2021**|
|**Realised/unrealised gains/(losses)**|**£**|**£**|
|Realised|197,535|98,445|
|Unrealised|(53,641)|490,234|
||143,894|588,679|
26
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **10. Investments (continued)**
|**10. Investments (continued)**|||
|---|---|---|
|Historical cost at 31 March
**Investments representing 5% or more of the**
**total value**
Taylor Maritime Investments Limited
BB Healthcare
Greencoat Wind PLC
Seraphim Space Investment Trust
Primary Health Properties
Tritax Big Box REIT
Tritax Eurobox PLC
SDCL Energy Efficiency Inc Trust
BBGI Global Infrastructure SA
GCP Infrastructure Inv Ltd
RTW Joint Venture Fund
Augmentum Fintech PLC
Ruffer Inv Co Ltd
**11. Financial instruments**
**12. Debtors**
**Carrying amount of financial assets**
Financial — assets at fair value through net income
and expenditure
-Fixed asset investments
**Carrying value of financial liabilities**
Measured on amortised costs
-Accruals
**Amounts falling due within one year**
Income tax recoverable under Gift Aid
Prepayments and accrued income|**2022**
**£**
2,423,853
**2022**
**£**
272,500
228,500
152,400
157,500
259,525
181,350
211,200
-
174,200
220,800
-
133,000
-
**2022**
**£**
**2022**
**£**
2,659,376
2,280
4,186
1,548
5,734|**2021**
**£**
2,423,853|
|||**2021**
**£**
-
236,875
-
-
266,760
269,250
-
168,000
171,400
205,800
212,568
159,000
289,000
**2021**
**£**
2,834,519|
|||**2021**
**£**
2,520
13,151
_
2,177
15,328|
27
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
|**NOTES TO THE FINANCIAL STATEMENTS**
**AS AT 31 MARCH 2022**|||
|---|---|---|
||**2022**|**2021**|
|**13. Creditors: amounts falling due within one year**|**£**|**£**|
|Trade creditors|-|3,705|
|Social security and other taxes|1,484|1,489|
|Pensions|198|198|
|Other creditors|2,005|2,004|
|Accruals and deferred income|2,280|2,520|
||5,967|9,916|
## **14. Restricted funds**
The income funds of the charity include restricted funds comprising the following unexpended balances of donations and grants held on trust for specific purposes:
## **Movement**
|||**Movement**||||
|---|---|---|---|---|---|
|**Current year**||**in funds**||||
||**Balance at**|**Incoming**|**Resources**|**Transfer to**|**Balance at 31**|
||**1 April 2021**|**resources**|**expended**|**general funds**|**March 2022**|
||**£**|**£**|**£**|**£**|**£**|
|Grants received re||||||
|Yirgalem Hospital|-|61,500|(61,500)|-|-|
|Grants received re||||||
|Prevention Project|-|15,000|-|-|15,000|
|Donations re Prevention||||||
|Project|-|24,961|-|-|24,961|
|Legacies re Addis Ababa||||||
|Fistula Hospital|__________-|__
3,365|_
(3,365)|_________-|______
-|
||___________|104,826|(64,865)|__________|39,961|
|||||||
|**Previous year**||**Movement**||||
|||**in funds**||||
||**Balance at**|**Incoming**|**Resources**|**Transfer to**|**Balance at 31**|
||**1 April 2020**|**resources**|**expended**|**general funds**|**March 2021**|
|Grants received re||||||
|Yirgalem Hospital|-|50,000|(50,000)|-|-|
|Donations received re||||||
|Yirgalem Hospital|-|16,000|(16,000)|-|-|
|Legacies re Addis Ababa||||||
|Fistula Hospital|__________-|18,500|(
18,500)|__________-|__________-|
||__________|84,500|(
84,500)|__________|__________|
|||||||
|||28||||
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
|**15. Analysis of net assets between funds**
Investments
Current assets
Current liabilities
**Unrestricted**
**funds**
**2022**
**£**
2,708,401
100,106
(5,967)
__________
2,802,540
**Restricted**
**funds**
**2022**
**£**
-
39,961
-
_______
39,961
Investments
Current assets
Current liabilities
2,950,370
100,846
(9,916)
__________
3,034,300
-
-
-
_______
______-
**Unrestricted**
**funds**
**2021**
**Restricted**
**funds**
**2021**
**£**
**£**|**Total**
**2022**
**£**
2,708,401
140,067
(5,967)
__________
2,842,251|
|---|---|
||**Total**
**2021**
**£**
2,950,370
100,846
(9,916)
__________
3,034,300|
## **16. Related party transactions**
Malcolm Hewitt our Life President and a former Chairman of Trustees, is a director of Hamlin Fistula Ethiopia (Australia) Limited, operating as Catherine Hamlin Fistula Foundation a charitable company registered in Australia. There were no transactions with this charity during the year (2021 – None).
Donations from 3 Trustees or related parties during amounted to £515 (2021 – Nil).
The Trustees are not aware of any material transactions, contract or other arrangement with any connected person other than that disclosed above.
## **17. Operating lease commitments**
|**Payments due**|**Land and**|**Other**|**Land and**|**Other**|
|---|---|---|---|---|
||**Buildings**||**Buildings**||
||**2022**|**2022**|**2021**|**2021**|
||**£**|**£**|**£**|**£**|
|Within one year|4,500|2,108|4,500|2,108|
|Between one and five years|11,250|2,108|15,750|4,216|
|Total amounts due to break|||||
||_______|______|_______|______|
|point|15,750|4,216|20,250|6,324|
29
**HAMLIN FISTULA UK**
## **NOTES TO THE FINANCIAL STATEMENTS AS AT 31 MARCH 2022**
## **18. Company status and controlling party**
The company is limited by guarantee. As such there is no share capital. Under the terms of the Articles of Association, each Trustee who is also a Director, is a member of the company.
Every company member has promised, that if the company is wound up whilst they are a company member or within one year of ceasing to be a Director, to contribute a maximum of £1 towards winding up the company.
At the balance sheet date there were six company members so the amount subject to guarantee was £6.
Each member’s vote ranks pari- passu and there is no controlling party or person of significant interest.
30