Registered number: 13809709 Charity number: 1203415 

MedAccess Trust 

(A Company Limited by Guarantee) Trustees' Report and Financial Statements For the Year Ended 31 December 2024 



MedAccess Trust (A Company Limited by Guarantee) 

## Contents 

||Page|
|---|---|
|Company Information|1|
|Report of the Trustees|2 - 8|
|Independent Auditors' Report to the member of MedAccess Trust|9 - 12|
|Statement of Financial Activities|13|
|Statement of Financial Position|14|
|Statement of Cash Flows|15|
|Notes to the Financial Statements|16 - 26|





MedAccess Trust (A Company Limited by Guarantee) 

## Company Information For the Year Ended 31 December 2024 

|Trustees|Nigel Keen, Chair|
|---|---|
||James Droop McPherson|
||Jane Edmondson|
|Company number<br>13809709<br>Charity number<br>1203415<br>Registered office<br>Thomas House<br>84 Eccleston Square<br>London<br>England<br>SW1V 1PX<br>Company secretary<br>Edward Collier<br>Independent auditors<br>Deloitte LLP<br>Four Brindley Place<br>Birmingham<br>B1 2HZ<br>Solicitors<br>Bates Wells<br>10 Queen Street Place<br>London<br>EC4R 1BE||



Page 1 



MedAccess Trust (A Company Limited by Guarantee) 

## Report of the Trustees For the Year Ended 31 December 2024 

The Trustees (who are also the directors of MedAccess Trust (the “Trust” or “Charity”) for the purposes of company law) are pleased to present their annual report along with the financial statements of the Trust for the year ended 31 December 2024, which are also prepared to meet the requirements for a directors’ report and accounts for Companies Act purposes. The financial statements have been prepared in accordance with the accounting policies set out on pages 16 to 19. 

The financial statements comply with the Charities Act 2011, the Companies Act 2006, the Articles of Association and the Charities Statement of Recommended Practice (“Charities SORP”) (applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland; FRS 102) issued in October 2019. 

## Objectives and Activities 

## Objectives 

MedAccess Trust is a UK charity that aims to raise funds and help improve affordability and access to health products in low- and middle-income countries ("LMICs"). 

The Trust’s objectives, as set out in its Articles of Association, are for the public benefit to: 

1. advance good health and the relief of sickness including without limitation by working with governments and partners in industry and civil society to support and enable access to appropriate and affordable healthcare products and services; and 

2. advance education and promote research including without limitation in relation to health outcomes and inequalities, the functioning of healthcare markets and the nature of (and barriers preventing) access to appropriate and affordable health products and services in different countries and markets, and to publish the useful results of such research. 

In each case with a particular focus on “Underserved Populations”. “Underserved Populations” means any population or segment of a population in any Official Development Assistance (“ODA”) Eligible Country which comprises people who, in the reasonable opinion of the Trustees, are in need and/or at risk of being excluded from or unable to access appropriate and affordable healthcare provision. 

By working with partners such as MedAccess Guarantee Ltd, governments, other industry participants and civil society, the Trust supports Underserved Populations to access the same level of healthcare consumed by highincome countries. See also Relationship with MedAccess Guarantee Ltd on page 8. 

## Activities 

## Charitable activities 

MedAccess Trust aims to achieve its charitable objectives by providing grants to organisations such as MedAccess Guarantee Ltd, which use innovative finance tools to support the delivery of more accessible healthcare products to underserved populations. The Trust’s grant funding aims to focus on how to overcome the barriers to accessing health products in LMICs, and provide education and promote research on related matters for the benefit of the public. The Trust aims to increase understanding and knowledge of the way in which healthcare systems work and why they fail, as well as supporting the solutions to address these failures. 

The Trust’s Grant Making Policy sets out the grant making process, including due diligence, reporting and monitoring requirements and the potential for clawback and repayment. 

Page 2 



MedAccess Trust (A Company Limited by Guarantee) 

Report of the Trustees (continued) For the Year Ended 31 December 2024 

## Objectives and Activities (continued) 

During 2024, the Trust continued its relationship with The Bill & Melinda Gates Foundation (now The Gates Foundation), with its ongoing five-year grant agreement for US$2,501,940 to explore the viability of a volume guarantee to vitamin A manufacturers that could be used to support large scale food fortification (“LSFF”) in LMICs. Vitamin A deficiency affects approximately 500 million people globally, mainly in Africa and Asia. It is particularly prevalent in LMICs due to food insecurity and limited dietary diversity. Potential negative health impacts of vitamin A deficiency include blindness, physical and cognitive stunting, increased severity of childhood infections and debilitating diseases, disproportionally affecting women of reproductive age and children. 

In children, vitamin A deficiency significantly increases the risk of illness and death from common infections, such as diarrhoea and measles. It is also the leading preventable cause of blindness.  In women of reproductive age, vitamin A deficiency increases the risk of maternal night blindness, infection, and other adverse outcomes during pregnancy and lactation. 

LSFF is a well-established, population-level intervention for combatting nutrient deficiency.  LSFF is not currently widespread in LMICs as demand side risks coupled with low margins make investment into building manufacturing capacity uneconomical leading to poor supply. Demand for vitamin A for use in LSFF is forecast to increase significantly between 2024 and 2028.  Without intervention, this growth in demand will not be matched by a corresponding growth in supply. 

This restricted grant was sub-granted to MedAccess Guarantee Ltd as the implementing partner to research and develop a volume guarantee expected to be entered into by MedAccess Guarantee Ltd. Under the sub-grant agreement, the Trust will retain in aggregate US$46,917 to cover its own expenses over the five years of the project. 

Since the start of the agreement, the Trust has made grant payments totalling: US$1,185,262 to MedAccess Guarantee Ltd, which has scoped, diligenced and developed a potential volume guarantee in relation to the vitamin A markets in all LMICs except India. An appropriate vitamin A supplier was also identified and heads of terms for a volume guarantee were negotiated. The agreement was announced on 26 March 2025 at a side event during the Nutrition for Growth Summit in Paris. Given that during 2024, the grant was at the stage of scoping, diligence and developing the volume guarantee, it remains too early in the life of the grant for any impact on the Trust’s intended beneficiaries and accordingly the grant has not yet contributed to achieving the Trust’s charitable objectives. 

## Public benefit 

In considering the grant from The Gates Foundation and the related sub-grant to MedAccess Guarantee Ltd, the Trustees gave careful consideration to the Charity Commission’s general guidance on public benefit and judged that the arrangement met this guidance. In making this judgement, the Trustees were advised by the Trust’s legal advisers Bates Wells. 

## Renewal of US equivalency determination from NGOsource 

During the year, the Trust successfully renewed its certification by NGOsource as equivalent to a US public charity under the Internal Revenue Service’s Equivalency Determination standards. Equivalency Determination is a process by which a US grantmaker evaluates whether a non-US grantee is the equivalent of a US public charity. NGOsource’s continued certification will, it is hoped, assist with raising funds in the future from US grantmakers and philanthropies. 

Page 3 



MedAccess Trust (A Company Limited by Guarantee) 

Report of the Trustees (continued) For the Year Ended 31 December 2024 

## Achievements and Performance 

As noted above, during the financial year, the Trust continued its grant agreement with The Gates Foundation and a related sub-grant agreement with MedAccess Guarantee Ltd to explore the viability of a volume guarantee to vitamin A manufacturers that could be used to support LSFF in LMICs. 

While it remains too early in the life of the grant arrangements to make an assessment of impact on the Trust’s intended beneficiaries, the grant has made good progress, with the heads of terms of a volume guarantee being agreed and announced on 26 March 2025. 

## Financial Review 

During the year, the Trust recognised US$207,744 (2023: $290,158) in donations and US$Nil (2023: $1,195,262) of income from charitable activities, comprising grant funding. Donations were from MedAccess Guarantee Ltd in the form of cash and a write-off of a loan and were unrestricted in nature. No additional restricted grant funding was recognised from The Gates Foundation pursuant to the grant agreement dated 19 October 2023 This was due to an underspend of funds drawn down by MedAccess Guarantee Ltd during the initial phases of the project and it is expected the surplus funds will be utilised in subsequent years of the five-year grant agreement. The Trust also received the benefit of certain services shared with MedAccess Guarantee Ltd as disclosed in note 2.5 to the accounts. 

The Trustees believe that the Trust will be able to meet its liabilities as they fall due for a period of at least 12 months from the date of signing these financial statements and have concluded that it is appropriate to prepare the financial statements on a going concern basis. 

As at 31 December 2024, the Trust had net current assets and total funds of $49,634 (2023: $11,656), all of which was unrestricted and not otherwise committed. 

## Fundraising 

Fundraising activities were conducted on the Trust’s behalf by staff at MedAccess Guarantee Ltd, pursuant to a Framework Agreement with the Trust. The Trust incurred no direct fundraising expenditure during the year. 

In the financial year, the Charity did not actively fundraise from the public or run legacy campaigns or undertake similar fundraising activities in its own right or via a trading subsidiary or third party. 

The Trust’s fundraising strategy during the financial year underwent a review, in conjunction with MedAccess Guarantee Ltd. Fundraising proved to be extremely challenging in a time of economic and political uncertainty and no new funds were identified during the year, despite efforts on behalf of the Trust by MedAccess Guarantee Ltd (following a targeted sector specific approach). A number of funding requests were pursued during the year on behalf of the Trust and work on fundraising continues in 2025. 

Page 4 



MedAccess Trust (A Company Limited by Guarantee) 

## Report of the Trustees (continued) For the Year Ended 31 December 2024 

## Reserves Policy 

The Trust’s Reserves Policy was developed having had regard to the Charity Commission’s guidance (Charity reserves: building resilience CC19). As part of effective financial management, the Trust holds free reserves to ensure it can manage the financial impact of risk. There are a range of risks the Trust faces, including the risk of an unforeseen drop in income or unbudgeted increases in expenditure. 

Having regard to these risks, the Trustees considered that a minimum of three (3) months’ operating costs should be retained by the Trust in its current accounts with HSBC UK Bank plc. 

As at 31 December 2024, the Trust held US$90,955 in cash, all of which was unrestricted. The amount held in cash was in accordance with the Trust’s Reserves Policy. 

## Plans for the future 

The Trust expects to continue to fund MedAccess Guarantee Ltd in connection with the vitamin A LSFF project and will explore, with the support of MedAccess Guarantee Ltd, potential new projects aiming to achieve the Trust’s charitable objectives. 

The Trustees will continue the recruitment process to appoint at least one, and possibly two, new Trustees. 

## Risk management 

The Trustees believe that sound risk management is integral to both good management and good governance practice, as set out in the Trust’s Risk Policy. The Trustees believe that risk management should form an integral part of the Trust’s decision-making and should be incorporated within strategic and operational planning. Risks assessments are conducted on new activities and projects to ensure that they are in line with the Trust’s objectives and mission. Any risks or opportunities arising will be identified, analysed and reported at an appropriate level. 

Under the Risk Policy, a risk register covering key strategic risks has been developed by the Trust Manager and Company Secretary. This is regularly updated and presented to the Trustees. As a result, the Trustees consider that appropriate systems have been established to ensure that the major strategic, business and operational risks which the Trust faces are monitored and mitigated. 

The principal risks and uncertainties facing the Trust concern fundraising and its reliance on MedAccess Guarantee Ltd. Fundraising remains challenging in the current economic climate and affected by the significant changes to the global health financing landscape. The Trust has faced significant challenges in raising unrestricted funds whether from Ultra High Net Worth donors, philanthropies or other potential funders. 

The Trust is heavily reliant on MedAccess Guarantee Ltd for core funding, fundraising capabilities and backoffice capabilities. It is also the Trust’s major grantee, so the Trust relies on it to help achieve its charitable objectives. 

Page 5 



MedAccess Trust (A Company Limited by Guarantee) 

Report of the Trustees (continued) For the Year Ended 31 December 2024 

## Structure, governance and management 

## Corporate structure and governance document 

The Trust is a company limited by guarantee governed by its Articles of Association and was incorporated on 20 December 2021 with company number 13809709.  It is a registered charity with number 1203415. 

Certain minor amendments to the Articles of Association were approved by the Trustees on 18 May 2023 and the sole member on 19 May 2023. 

## Appointment of Trustees 

The Trustees who have served during the year and since the year end are: 

- Nigel Keen (Chair) 

- Baroness Lindsay Northover (resigned on 3 March 2025) 

- James Droop McPherson 

- Jane Edmondson (appointed on 27 February 2025) 

The Trust’s Articles of Association provide that all Trustees automatically retire from office at the third “Annual Retirement Meeting” (being the meeting of the Trustees at which the accounts of the Charity are adopted) following the commencement of his or her term of office. Potential new trustees are identified using a combination of the Trust’s existing networks and, where appropriate, advertising.  Any person who is willing to act as a trustee and is not otherwise disqualified from acting, may be appointed by a decision of the Trustees. 

New trustees are provided an induction pack which includes copies of relevant Charity Commission guidance, the Trust’s Articles of Association and the Trust’s Operating Manual. They also have the opportunity to meet with the Chair, the Trust Manager and Company Secretary and certain key employees of MedAccess Guarantee Ltd. Trustees are encouraged to receive appropriate training where it will facilitate the undertaking of their role. 

## Change in Trustees 

During the year, the Trust undertook a process to recruit new Trustees. The Trust welcomed Jane Edmondson as a new Trustee, pursuant to a resolution of the Board passed on 27 February 2025. Jane has worked for many years in UK public service and international development, mainly in the health sector. She was a civil servant in the Department for International Development (“DFID”) and the Foreign, Commonwealth & Development Office until 2021, most recently as Director for East and Central Africa. Before that, she worked in Uganda, Pakistan and Bangladesh and as Head of Human Development in DFID’s Policy Division. She has represented the UK government on international health bodies, with a particular focus on health systems, sexual and reproductive health and rights, demography, nutrition and malaria. 

Baroness Lindsay Northover resigned as a Trustee on 3 March 2025. The Trustees are extremely grateful to Lindsay for her commitment, enthusiasm and energy in guiding the Trust in our initial start-up phase and our first charitable activities. 

Page 6 



(A Company Limited by Guarantee) 

## MedAccess Trust 

Report of the Trustees (continued) For the Year Ended 31 December 2024 

## Structure, governance and management (continued) 

## Organisation 

The Board of Trustees, which must comprise at least three Trustees, administers the Trust and aims to meet quarterly where possible. 

The day-to-day management of the Trust is delegated to the Trust’s only employee, the Trust Manager and Company Secretary. A Delegation of Authority Policy sets out the decisions and actions delegated by the Trustees to him to facilitate effective operations. These include expending the Trust’s money in accordance with the annual budget approved by the Trustees and carrying out certain other operational activities in relation to finance, legal and regulatory compliance. 

## Pay policy 

The Trustees and the Trust Manager and Company Secretary comprise the key management personnel of the Trust in charge of directing and controlling, running and operating the Trust on a day-to-day basis.  All Trustees give their time freely and no Trustee received remuneration in the year. No expenses were claimed by Trustees during the year. 

The Trust Manager and Company Secretary’s pay and remuneration is set by the Trustees by reference to MedAccess Guarantee Ltd pay scales which in turn are benchmarked against BII, MedAccess Guarantee Ltd’s shareholder. Any increase is considered on an annual basis, having regard to any increases in the UK Consumer Price Index. 

## Relationship with MedAccess Guarantee Ltd 

The Trust’s sole member is MedAccess Guarantee Ltd.  A Framework Agreement, dated 13 December 2022, between the Trust and MedAccess Guarantee Ltd, sets out the framework within which dealings between the them shall be carried on, including the sharing of resources and the management of the relationship between the parties.  The Trust may elect in its absolute discretion and in advancement of its charitable purposes to provide grants to MedAccess Guarantee Ltd from time to time.  The LSFF sub-grant agreement described above is the only such grant arrangement in place with MedAccess Guarantee Ltd. 

MedAccess Guarantee Ltd also provides funding to the Trust through donations in the form of cash and a writeoff of a loan and were unrestricted in nature. The Trust also received the benefit of certain services shared with MedAccess Guarantee Ltd as disclosed in note 2.5 to the accounts. 

## Statement of Trustee's responsibilities 

The Trustees (who are also the directors of the Trust for the purposes of company law) are responsible for preparing the annual report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice) including FRS 102 "The Financial Reporting Standard applicable in the UK and Republic of Ireland". 

Company law requires the Trustees to prepare financial statements for each financial year which give a true and fair view of the 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. 

Page 7 



ModAcce$s Trust
IA Company Limlted by Guaranteg)
Report of the Trustses Icontlnuedl
For the Year Ended 31 December 2024
Statoment of Trustee's responsibilities (Gontinued)
In preparing these financial statements, the Trustees are required to..
select suitable aG¢ounting policies and then apply them consistently,.
observe thè methods and principles in the ChaTilies SORP.,
make judgements and estimates that are reasonable and prudent.,
slate whether applicable UK Accounting Standards have been followed, subject lo any material departures
disclosed and explained in the financial statements., and
prepare the financial statements on the going concern basis unless It is inappropriate to presume that the
Charity will continue in business.
The Trustees arè responsible for keeping adequate accounting records that disclose with reasonable accuracy
al any lime the financial Position of the charitable company and enable them to ensure that the financial
statements comply wlh the Companies Act 2006. They are also responsible for safeguarding the asset5 of the
Charilablo company and hence for taking reasonable steps for the prevention and detection of fraud and other
irregularilie8.
Staternent as to d15closure to the audhors
In so far as the Trustees are aware at the time of approving this Annual Report,
there is no relevant information, being information needed by the auditor in connection with preparing their
report, of which the Trusvs auditor Is unaware.. and
the Trustees, having made enquires of fellow directors and the Trust's auditor that they ought to hav8
individually taken, have each taken all steps that helshe is obliged lo lake as a director in order lo make
themselves aware of any relfrvanl audit infomiation and lo establish that the auditor Is aware of that
inforrn81ion.
Audltors
The auditors, Deloitte LLP, will be proposed for reappointment in a¢¢ordance with Section 485 of the Companies
Act 2006. D8loitte LLP have expressed their wi15ingne5s lo continue in office.
Small companles oxemption$
In preparing this report. the Directors have taken advantage of the small companies exemptions provided by
section 415A of the Companies Act 2006.
Approval
This èpport was approved by the Twstees on
q 20¥
and signed on their behalf by..
Nl
en
Page 8

MedAccess Trust (A Company Limited by Guarantee) 

## Independent Auditors' Report to the Member of MedAccess Trust 

## Report on the audit of the financial statements 

## Opinion 

In our opinion the financial statements of MedAccess Trust (the ‘charitable company limited by Guarantee’): 

- give a true and fair view of the state of the charitable company’s affairs as at 31 December 2024 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended; 

- have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice, including Financial Reporting Standard 102 “The Financial Reporting Standard applicable in the UK and Republic of Ireland”; and 

- have been prepared in accordance with the requirements of the Companies Act 2006 and Charities Act 2011. 

We have audited the financial statements which comprise: 

- the statement of financial activities; 

- the statement of financial position; 

- the cash flow statement; 

- the statement of accounting policies; and 

- the related notes 1 to 21. 

The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 “The Financial Reporting Standard applicable in the UK and Republic of Ireland” (United Kingdom Generally Accepted Accounting Practice). 

## Basis for opinion 

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the auditor's responsibilities for the audit of the financial statements section of our report. 

We are independent of the charitable company in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the Financial Reporting Council’s (the ‘FRC’s’) Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. 

## Conclusions relating to going concern 

In auditing the financial statements, we have concluded that the Trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate. 

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charitable company’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue. 

Our responsibilities and the responsibilities of the Trustees with respect to going concern are described in the relevant sections of this report. 

Page 9 



MedAccess Trust 

(A Company Limited by Guarantee) 

Independent Auditors' Report to the Member of MedAccess Trust (continued) 

## Other information 

The other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. The Trustees are responsible for the other information contained within the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. 

Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit, or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. 

We have nothing to report in this regard. 

## Responsibilities of Trustees 

As explained more fully in the Trustees’ responsibilities statement, the Trustees (who are also the directors of the charitable company for the purpose of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the Trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. 

In preparing the financial statements, the Trustees are responsible for assessing the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the Trustees either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so. 

## Auditor's responsibilities for the audit of the financial statements 

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. 

A further description of our responsibilities for the audit of the financial statements is located on the FRC’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. 

## Extent to which the audit was considered capable of detecting irregularities, including fraud 

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below. 

We considered the nature of the charitable company’s industry and its control environment, and reviewed the charitable company’s documentation of their policies and procedures relating to fraud and compliance with laws and regulations. We also enquired of management and the Trustees about their own identification and assessment of the risks of irregularities, including those that are specific to the charitable company’s business sector. 

Page 10 



MedAccess Trust (A Company Limited by Guarantee) 

## Independent Auditors' Report to the Member of MedAccess Trust (continued) 

## Extent to which the audit was considered capable of detecting irregularities, including fraud (continued) 

We obtained an understanding of the legal and regulatory framework that the charitable company operates in, and identified the key laws and regulations that: 

- had a direct effect on the determination of material amounts and disclosures in the financial statements. This included the UK Charities Act and the UK Companies Act; and 

- do not have a direct effect on the financial statements but compliance with which may be fundamental to the charitable company’s ability to operate or to avoid a material penalty. This included the Charity Commission for England and Wales (Charity Commission) regulations. 

We discussed among the audit engagement team regarding the opportunities and incentives that may exist within the organisation for fraud and how and where fraud might occur in the financial statements. 

In common with all audits under ISAs (UK), we are also required to perform specific procedures to respond to the risk of management override. In addressing the risk of fraud through management override of controls, we tested the appropriateness of journal entries and other adjustments; assessed whether the judgements made in making accounting estimates are indicative of a potential bias; and evaluated the business rationale of any significant transactions that are unusual or outside the normal course of business. 

In addition to the above, our procedures to respond to the risks identified included the following: 

- reviewing financial statement disclosures by testing to supporting documentation to assess compliance with provisions of relevant laws and regulations described as having a direct effect on the financial statements; 

- performing analytical procedures to identify any unusual or unexpected relationships that may indicate risks of material misstatement due to fraud; 

- enquiring of management concerning actual and potential litigation and claims, and instances of noncompliance with laws and regulations; and 

- reading minutes of meetings of those charged with governance. 

## Report on other legal and regulatory requirements 

## Opinions on other matters prescribed by the Companies Act 2006 

In our opinion, based on the work undertaken in the course of the audit: 

- the information given in the Trustees’ report, which includes the Directors' Report, prepared for the purposes of company law for the financial year for which the financial statements are prepared is consistent with the financial statements; and 

- the Directors’ Report included within the Trustees’ report has been prepared in accordance with applicable legal requirements. 

In the light of the knowledge and understanding of the charitable company and its environment obtained in the course of the audit, we have not identified any material misstatements included within the Trustees' report. 

Page 11 



MedAccess Trust (A Company Limited by Guarantee) 

Independent Auditors' Report to the Member of MedAccess Trust (continued) 

## Matters on which we are required to report by exception 

Under the Companies Act 2006 we are required to report in respect of the following matters if, in our opinion: 

- adequate accounting records have not been kept, or returns adequate for our audit have not been received from branches not visited by us; or 

- the financial statements are not in agreement with the accounting records and returns; or 

- certain disclosures of Trustees’ remuneration specified by law are not made; or 

- we have not received all the information and explanations we require for our audit; or 

- the Trustees were not entitled to take advantage of the small companies' exemption from the requirement to prepare a strategic report. 

We have nothing to report in respect of these matters. 

## Use of our report 

This report is made solely to the charitable company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company’s members those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and the charitable company’s members as a body, for our audit work, for this report, or for the opinions we have formed. 


Andy Fern (Senior Statutory Auditor) 

For and on behalf of Deloitte LLP, Statutory Auditor Birmingham Date: 09 June 2025 

Page 12 



MedAccess Trust (A Company Limited by Guarantee) 

Statement of Financial Activities (incorporating income and expenditure account) For the Year Ended 31 December 2024 

|Note<br>Income from:<br>Donations<br>4<br>Total income<br>Expenditure on:<br>Charitable activities<br>5<br>Total expenditure<br>Net movement in funds<br>Reconciliation of funds:<br>Total funds brought forward<br>14<br>Net movement in funds<br>Total funds carried forward|Unrestricted<br>funds<br>2024<br>$ 207,744<br>207,744<br>169,766<br>169,766<br>37,978<br>11,656<br>37,978<br>49,634|Total<br>funds<br>2024<br>$ 207,744<br>207,744<br>169,766<br>169,766<br>37,978<br>11,656<br>37,978<br>49,634|Total<br>funds<br>2023<br>$ 1,485,420<br>1,485,420|
|---|---|---|---|
||||1,476,860<br>1,476,860|
||||8,560<br>3,096<br>8,560<br>11,656|



The Statement of Financial Activities includes all gains and losses recognised in the year. 

The notes on pages 16 to 26 form part of these financial statements. 

Page 13 



M•dk¢ess Trust
IA Company Llmltod by Guarantee)
R•glst¢red number.. 13809709
Statement of Flnancial Position
As at 31 De¢emb•r 2024
2024
2024
2023
2023
Note
Current ass•ts
Debtors
Cash at bank and in hand
319,484
36,812
90,955
90,965
356,296
Current Ilabliities
Creditors.. amounts falling dtje within one
yaar
12
{41.321}
1344,6401
Net current a55ets
49.634
11,656
Total assets less current liabillties
49.634
11,656
Totsl net a8s0ts
49,634
11.856
¢harlty funds
Restricted funds
Unreslricled funds
49,634
11,656
Total funds
15
49.634
11,656
The Trustee$ acknowledge their responsibilities for complwng with the requirements of the Companies Act 2006
with respect lo accounting records and preparation of financial statements.
The financial slalemenls were approved and aulhorised for issue by the Trustees on
on their behalf by..
q &zs
and signed
Keen
Chai
The notes on pages 18 to 26 form part of these financial 5talemenls.
Page 14

MedAccess Trust (A Company Limited by Guarantee) 

|Statement of Cash Flows<br>For the Year Ended 31 December 2024|||
|---|---|---|
|Note<br>Cash flows from operating activities<br>Net cash provided by operating activities<br>16<br>Cash flows from investing activities<br>Net cash provided by investing activities<br>Cash flows from financing activities<br>Net cash provided by financing activities<br>Change in cash and cash equivalents in the year<br>Cash and cash equivalents at the beginning of the year<br>Change in cash and cash equivalents due to exchange rate movements<br>Cash and cash equivalents at the end of the year<br>17<br>The notes on pages 16 to 26 form part of these financial statements.|Year ended<br>2024<br>$ 54,964<br>-<br>-<br>54,964<br>36,812<br>(821)<br>90,955|Year ended<br>2023<br>$ 28,372<br>-<br>-<br>28,372<br>6,000<br>2,440<br>36,812|



Page 15 



MedAccess Trust (A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 1. General information 

MedAccess Trust is a private company limited by guarantee with charitable status, incorporated in England and Wales under the Companies Act 2006 and the Charities Act 2011. The address of the registered office is shown on the company information page. The nature of the Trust's operating and financial activities is outlined in the Report of the Trustees. 

## 2. Accounting policies 

## 2.1 Basis of preparation of financial statements 

The financial statements have been prepared in accordance with the Charities SORP (FRS 102) - Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019), the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Companies Act 2006 and the Charities Act 2011. 

The presentational and functional currency of the financial statements is US dollars. Values have been rounded to the nearest US dollar. 

MedAccess Trust meets the definition of a public benefit entity under FRS 102. 

Assets and liabilities are initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy. 

## 2.2 Going concern 

The Trustees believe that the Company will be able to meet its liabilities as they fall due for a period of at least 12 months from the date of signing the financial statements and have concluded that it is appropriate to prepare the financial statements on a going concern basis. 

Page 16 



MedAccess Trust 

(A Company Limited by Guarantee) 

Notes to the Financial Statements For the Year Ended 31 December 2024 

## 2. Accounting policies (continued) 

## 2.3 Income 

All income is recognised once the Trust has entitlement to the income, it is probable that the income will be received and the amount of income receivable can be measured reliably. 

Grants are included in the Statement of Financial Activities on a receivable basis. The balance of income received for specific purposes but not expended during the period is shown in the relevant funds on the Statement of Financial Position. Where income is received in advance of entitlement of receipt, its recognition is deferred and included in creditors as deferred income. Where entitlement occurs before income is received, the income is accrued. 

Gifts in kind donated for distribution are included at valuation and recognised as income when they are distributed to the projects. 

On receipt, donated professional services and facilities are recognised on the basis of the value of the gift to the Trust which is the amount it would have been willing to pay to obtain services or facilities of equivalent economic benefit on the open market; a corresponding amount is then recognised in expenditure in the period of receipt. 

Voluntary income and donations are accounted for when there is entitlement, probability of receipt, and the amount can be measured with sufficient reliability, unless the donor has specified that the donation or grant relates to a future period or certain pre-conditions must be fulfilled before use. 

## 2.4 Expenditure 

Expenditure is recognised once there is a legal or constructive obligation to transfer economic benefit to a third party, it is probable that a transfer of economic benefits will be required in settlement and the amount of the obligation can be measured reliably. Expenditure is classified by activity. The costs of each activity are made up of the total of direct costs and shared costs, including support costs involved in undertaking each activity. Direct costs attributable to a single activity are allocated directly to that activity. Shared costs which contribute to more than one activity and support costs which are not attributable to a single activity are apportioned between those activities on a basis consistent with the use of resources. Central staff costs are allocated on the basis of time spent, and depreciation charges allocated on the portion of the asset’s use. 

Expenditure on charitable activities is incurred on directly undertaking the activities which further the Trust's objectives, as well as any associated support costs. 

Grants payable are charged in the year when the offer is made except in those cases where the offer is conditional, such grants being recognised as expenditure when the conditions attaching are fulfilled. Grants offered subject to conditions which have not been met at the year end are noted as a commitment, but not accrued as expenditure. 

All expenditure is inclusive of irrecoverable VAT. 

## 2.5 Donated services 

The Trust receives services donated from MedAccess Guarantee Ltd, primarily comprising staff time. These are measured and included in the accounts in income and expenditure on the basis of the value of the gift to the Trust, which is the amount that the Trust would pay in the open market. 

Page 17 



MedAccess Trust 

(A Company Limited by Guarantee) 

Notes to the Financial Statements For the Year Ended 31 December 2024 

## 2. Accounting policies (continued) 

## 2.6 Foreign currencies 

Monetary assets and liabilities denominated in foreign currencies are translated into dollars at rates of exchange ruling at the reporting date. 

Transactions in foreign currencies are translated into dollars at the rate ruling on the date of the transaction. 

Exchange gains and losses are recognised in the Statement of Financial Activities. 

## 2.7 Taxation 

The Trust is considered to pass the tests set out in Paragraph 1 Schedule 6 of the Finance Act 2010 and therefore it meets the definition of a charitable company for UK corporation tax purposes. Accordingly, the Trust is potentially exempt from taxation in respect of income or capital gains received within categories covered by Chapter 3 Part 11 of the Corporation Tax Act 2010 or Section 256 of the Taxation of Chargeable Gains Act 1992, to the extent that such income or gains are applied exclusively to charitable purposes. 

## 2.8 Debtors 

Trade and other debtors are recognised at the settlement amount after any trade discount offered. Prepayments are valued at the amount prepaid net of any trade discounts due. 

## 2.9 Cash at bank and in hand 

Cash at bank and in hand includes cash and short-term highly liquid investments with a short maturity of three months or less from the date of acquisition or opening of the deposit or similar account. 

## 2.10 Liabilities and provisions 

Liabilities are recognised when there is an obligation at the Statement of Financial Position date as a result of a past event, it is probable that a transfer of economic benefit will be required in settlement, and the amount of the settlement can be estimated reliably. 

Liabilities are recognised at the amount that the Trust anticipates it will pay to settle the debt or the amount it has received as advanced payments for the goods or services it must provide. 

## 2.11 Financial instruments 

The Trust only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value. 

## 2.12 Pensions 

The Trust operates a defined contribution pension scheme and the pension charge represents the amounts payable by the Trust to the fund in respect of the year. 

Page 18 



MedAccess Trust 

(A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 2. Accounting policies (continued) 

## 2.13 Fund accounting 

General funds are unrestricted funds which are available for use at the discretion of the Trustees in furtherance of the general objectives of the Trust and which have not been designated for other purposes. 

Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the Trust for particular purposes. The costs of raising and administering such funds are charged against the specific fund. The aim and use of each restricted fund is set out in the notes to the financial statements. 

## 3. Critical accounting estimates and areas of judgement 

The Trustees have not made any significant judgements or estimates in applying accounting policies during the year. 

## 4. Income from donations 

||Restricted|Unrestricted|Total|
|---|---|---|---|
||funds|funds|funds|
||2024|2024|2024|
||$|$|$|
|Donations|-|207,744|207,744|



Donations include $49,789 (2023: $147,465) of donated services and $7,955 (2023: $23,142) of a loan write-off from MedAccess Guarantee Ltd. 

|Donations<br>Grants<br>Total 2023|Restricted<br>funds<br>2023<br>Unrestricted<br>funds<br>2023<br>$ $ -<br>290,158<br>1,183,262<br>12,000<br>1,183,262<br>302,158|Total<br>funds<br>2023<br>$ 290,158<br>1,195,262<br>1,485,420|
|---|---|---|



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MedAccess Trust (A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 5. Analysis of expenditure by activities 

||Support|Total|
|---|---|---|
||costs|funds|
||2024|2024|
||$|$|
|Charitable activities|169,766|169,766|



Total expenditure for the year was $169,766 (2023: $1,476,860), of which $Nil (2023: $1,183,262) was restricted and $169,766 (2023: $293,598) was unrestricted. 

||Grant|||
|---|---|---|---|
||funding of|Support|Total|
||activities|costs|funds|
||2023|2023|2023|
||$|$|$|
|Charitable activities|1,183,262|293,598|1,476,860|



## Analysis of support costs 

|Wages and salaries<br>Other staff costs<br>Other support costs<br>Governance<br>Technology<br>Losses/(gains) on foreign exchange<br>Donated staff costs|Total<br>funds<br>2024<br>$ 49,576<br>4,830<br>1,401<br>61,346<br>2,452<br>372<br>49,789<br>169,766|Total<br>funds<br>2023<br>$ 32,035<br>32,073<br>237<br>84,158<br>4,058<br>(6,428)<br>147,465<br>293,598|
|---|---|---|



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MedAccess Trust 

(A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 6. Analysis of grants 

|Grant to MedAccess Guarantee Ltd<br>7.<br>Governance costs<br>Auditor's remuneration — fee for statutory accounts<br>Accountancy fees<br>Insurances<br>Corporate professional services<br>Legal costs<br>Trustee expenses<br>Trustee meetings|Grants to<br>Institutions<br>Year ended<br>2024<br>$ -<br>2024<br>$ 27,179<br>22,112<br>2,674<br>9,226<br>-<br>-<br>155<br>61,346|Grants to<br>Institutions<br>Year ended<br>2023<br>$ 1,183,262<br>2023<br>$ 21,644<br>16,690<br>2,431<br>5,078<br>38,079<br>86<br>150<br>84,158|
|---|---|---|



Governance costs relate to the audit and other professional services in connection with governance of the Trust. All other costs are allocated to charitable activities where they are incurred within the Trust. 

All governance costs in the current and preceding year were unrestricted. 

## 8. Staff costs 

|Wages and salaries<br>Social security costs<br>Contribution to defined contribution pension schemes<br>Other employee benefits|2024<br>$ 40,862<br>2,150<br>4,903<br>1,661<br>49,576|2023<br>$ 26,276<br>2,606<br>3,153<br>-|
|---|---|---|
|||32,035|



Support costs include $49,789 (2023: $147,465) of donated services comprising staff costs from MedAccess Guarantee Ltd, which has not been included in the above disclosure. 

Page 21 



MedAccess Trust (A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 8. Staff costs (continued) 

The average number of persons employed by the Trust during the year was as follows: 

||2024|2023|
|---|---|---|
||No.|No.|
|Employees|1|1|



No employee received remuneration amounting to more than $60,000 in either year. 

## 9. Trustees' remuneration and expenses 

During the year, no Trustees received any remuneration or other benefits (2023: $86). 

None of the Trustees were paid remuneration or received any benefits from any employment with the Trust during the current or prior year. 

During the year ended 31 December 2024, expenses totalling $Nil (2023: $86) were reimbursed or paid directly to any Trustee relating to travel or otherwise. 

## 10. Net incoming resources for the year 

This is stated after charging/(crediting): 

||2024|2023|
|---|---|---|
||$|$|
|Auditors' remuneration|27,179|21,644|
|Foreign exchange losses/(gains)|372|(6,248)|



## 11. Debtors 

||2024|2023|
|---|---|---|
||$|$|
|Due within one year|||
|Accrued income|-|319,484|



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MedAccess Trust 

(A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 12. Creditors: amounts falling due within one year 

|Trade creditors<br>Amounts owed to MedAccess Guarantee Ltd<br>Social security & other taxes<br>Other creditors<br>Accruals and deferred income<br>Grants payable|2024<br>$ 5,116<br>-<br>567<br>401<br>35,237<br>-<br>41,321|2023<br>$ 1,564<br>2,431<br>937<br>388<br>28,045<br>311,275|
|---|---|---|
|||344,640|



## 13. Financial instruments 

|Financial assets<br>Financial assets measured at amortised costs through income and<br>expenditure<br>Financial liabilities<br>Financial liabilities measured at amortised costs through income and<br>expenditure|2024<br>$ 90,955<br>2024<br>$ 40,754|2023<br>$ 356,210<br>2023<br>$ 343,703|
|---|---|---|



Financial assets measured at amortised costs through income and expenditure comprise cash and accrued income. 

Financial liabilities measured at amortised costs through income and expenditure comprise trade creditors, accruals, grants payable, amounts owed to group undertakings and other creditors. 

Page 23 



(A Company Limited by Guarantee) 

## MedAccess Trust 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 14. Summary of funds 

Summary of funds — current year 

|General funds<br>Summary of funds — prior year<br>General funds<br>Restricted funds|Balance at 1<br>January<br>2024<br>$ 11,656<br>Balance at 1<br>January<br>2023<br>$ 3,096<br>-<br>3,096|Income <br>$ 207,744<br>Income <br>$ 302,158<br>1,183,262<br>1,485,420|Expenditure<br>Balance at<br>31 December<br>2024<br>$ $ (169,766)<br>49,634<br> Expenditure<br>Balance at<br>31 December<br>2023<br>$ $ (293,598)<br>11,656<br>(1,183,262)<br>-<br>(1,476,860)<br>11,656|
|---|---|---|---|



The restricted fund relates to amounts received for from The Gates Foundation to explore the viability of a volume guarantee to vitamin A manufacturers to support large scale food fortification in low- and middle-income countries. 

15. Analysis of net assets between funds 

Analysis of net assets between funds — current year 

|Unrestricted<br>funds<br>2024<br>$ Current assets<br>90,955<br>Creditors due within one year<br>(41,321)<br>Total<br>49,634|Total<br>funds<br>2024<br>$ 90,955<br>(41,321)<br>49,634|
|---|---|



Page 24 



MedAccess Trust (A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 15. Analysis of net assets between funds (continued) 

Analysis of net assets between funds — prior year 

|Restricted<br>funds<br>2023<br>Unrestricted<br>funds<br>2023<br>$ $ Current assets<br>311,275<br>45,021<br>Creditors due within one year<br>(311,275)<br>(33,365)<br>Total<br>-<br>11,656<br>16.<br>Reconciliation of net movement in funds to net cash flow from operating activities<br>2024<br>$ Net income for the period (as per Statement of Financial Activities)<br>37,978<br>Adjustments for:<br>Foreign exchange movement<br>372<br>Decrease/(increase) in debtors<br>319,484<br>(Decrease)/increase in creditors<br>(302,870)<br>Net cash provided by operating activities<br>54,964<br>17.<br>Analysis of cash and cash equivalents<br>2024<br>$ Cash at bank and in hand<br>90,955<br>Total cash and cash equivalents<br>90,955|Total<br>funds<br>2023<br>$ 356,296<br>(344,640)<br>11,656<br>2023<br>$ 8,560<br>-<br>(325,912)<br>345,724<br>28,372<br>2023<br>$ 36,812<br>36,812|
|---|---|



Page 25 



MedAccess Trust 

(A Company Limited by Guarantee) 

## Notes to the Financial Statements For the Year Ended 31 December 2024 

## 18. Analysis of changes in net debt 

||||Changes in||
|---|---|---|---|---|
||||market||
||||value and||
||At 1||exchange|At 31|
||January||rate|December|
||2024|Cash flows|movements|2024|
||$|$|$|$|
|Cash at bank and in hand|36,812|54,964|(821)|90,955|



## 19. Pension commitments 

The Charity operates a defined contribution pension scheme. The assets of the scheme are held separately from those of the Trust in an independently administered fund. The pension cost charge represents contributions payable by the Trust to the fund and amounted to $4,903 (2023: $3,153). Contributions of $401 (2023: $388) were payable to the fund at the reporting date and are included in creditors. 

## 20. Related party transactions 

## MedAccess Guarantee Ltd 

During 2024, donations of $207,744 (2023: $290,158) were received from MedAccess Guarantee Ltd. This included a conversion of a loan to the Trust into a donation of $7,955 (2023: $23,142) and donated services of $49,789 (2023: $147,465) as well as a cash donation of $150,000 (2023: $119,551). 

Also during 2024, the Trust paid grants of $Nil (2023: $1,183,262) to MedAccess Guarantee Ltd, of which $Nil (2023: $311,275) was outstanding at year end in creditors. The Trust also has a balance of $Nil (2023: $2,431) outstanding as at year end in relation to insurance coverage and other recharges that was paid upfront by MedAccess Guarantee Ltd and later recharged to the Trust. The whole of the balance was converted into a donation (see above). 

In addition, following entry into a five-year grant agreement with The Gates Foundation in 2023, the Trust entered into a sub-grant agreement with MedAccess Guarantee Ltd, as its implementing partner, pursuant to which $2,501,940 will be granted to explore the viability of a volume guarantee to vitamin A manufacturers to support large scale food fortification in low- and middle-income countries. During the year $Nil (2023: $1,195,262) was recognised in relation to this agreement, as a result of underspends during the initial phases of the project. At year end, $Nil (2023: $319,484) was held within debtors in relation to this agreement. 

## 21. Controlling party 

MedAccess Trust has no controlling party. 

Page 26