The Trustees present their annual report and financial statements for the year ended 31 December 2023.
The accounts have been prepared in accordance with the accounting policies set out in note 1 to the accounts and comply with the Charity's Memorandum & Articles of Association, the Companies Act 2006 and the 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).
In this context the Trustees have complied with the duty in section 17 (5) of the 2011 Charities Act in giving due consideration to the Charity Commission's guidance on Public Benefit. The report is prepared in accordance with the small companies' regime (Section 419(2) of the Companies Act 2006).
Principal aims and objectives
“To save a life is to save the world. Nowhere is this clearer than at Shaare Zedek. A hospital not just with a heart but with a soul that makes the world a better place."
Quote from a relative of a Shaare Zedek patient
Our mission is to support, by all such means as may be charitable in law and for exclusively charitable purposes, Shaare Zedek Medical Centre (Shaare Zedek) in providing world class care for all patients irrespective of their ability to pay, nationality, age, race or religion. We provide financial support to fund services, capital projects, research and the purchase of equipment for the hospital.
History
Founded in 1902, Shaare Zedek has been known as the "Hospital with a Heart" for more than a century. This reputation as a patient's first choice of hospitals stem from its unwavering commitment to all its patients, regardless of race, religion, political view or country of origin. All patients who are admitted receive the most advanced medical treatment available in a compassionate, supportive and nurturing environment. The hospital’s ethos, "delivery of care and pioneering approaches to research", provides hope for us, hope for Israel and hope for the world.
Since it was founded, the Hospital has chartered the course of Jerusalem’s modern development and has been instrumental in the city’s growth. Over half of Jerusalem’s children live below the poverty line. Shaare Zedek was one of the first hospitals in Israel to recognise the need for specialist paediatric medical facilities and is home to Jerusalem’s only dedicated Women and Children’s Hospital.
Shaare Zedek 2023
Today Shaare Zedek is a 1,500-bed facility with close to 100 departments, treating 800,000 patients annually. As the fastest growing hospital in the region, the hospital continues to respond to and plan for the needs of Jerusalem’s uniquely diverse population. In 2023, the hospital opened its expanded Weinstock Department of Emergency Medicine. As home to a Level One Trauma Centre, the department stands as Jerusalem’s foremost urgent response facility, annually admitting over 100,000 patients and experiencing a ten percent increase in admissions each year. The newly expanded department was meticulously designed with the patient at heart, aiming to make it much easier for them to move through each section, allowing for faster and more effective patient admission, triage and treatment.
Following the attacks on October 7th, Shaare Zedek also faced many other challenges, including staff shortages, as many professionals were called up for reserve army service. The team at the hospital responded immediately to the needs of the community by opening a mental health emergency centre very quickly, as they recognised there would be an immediate increase in the requirement of such a services. This was in addition to focusing on emergency preparedness and fundraising focused on building and equipping a 70 bed ICU ward in the basement of the Helmsley Cancer Centre, should there be a full scale attack which would require patients to be treated in safety underground.
Message from Shaare Zedek Medical Centre’s Director General
Dear Friends,
On the morning of Simchat Torah, as masses of Jews were about to rejoice and pray, the most bestial massacre in Israel's history was raging in the south. On that day, I was leading an Israeli rescue team in Armenia. As soon as I heard what was happening in Israel, I knew it was extremely serious and I got straight on a plane to Cyprus that flew over Iran and Iraq. I was tense the whole flight and by that evening I was already in the hospital.
In all my time of working at Shaare Zedek and in my time as the Director of Trauma during 2007-2019 I have never experienced such a large number of wounded patients admitted to our Trauma department in such a short space of time. To date we have treated over 600 patients since October 7th and this number increases daily. While the ground initiative in Gaza is still going on, our medical teams are ready for every eventuality.
The times we live in are deeply challenging and tragic, but we see it as a great source of personal and professional pride to know that Shaare Zedek is serving in so many ways to offer professional, advanced and compassionate care for the people of Jerusalem and Israel and we thank you, our friends in the UK for digging deep and supporting us at this incredibly challenging time.
We continue to pray for the safe and secure return of all the hostages and our soldiers.
Professor Ofer Merin
Director General
Shaare Zedek Medical Centre
In order to achieve our key objectives, Shaare Zedek UK (SZUK) employs a small office team led by a Chief Executive working in partnership with trustees and other lay leaders, supported by a small number of energetic volunteers.
SZUK promotes awareness of the activities of Shaare Zedek. We also seek to promote support of the charitable activities of the hospital, and in particular its charitable activities for the public benefit in health welfare, medical and scientific advancement and best practice in patient treatment. We raise funds through donations, legacies, solicited mailings, events, direct approaches and special appeals.
Achievements and Performance
The impact of our fundraising
Shaare Zedek relies on its donors to provide the funds to enable the standard of care and innovation for which the hospital is known. Every day at Shaare Zedek brings new challenges and achievements. Shaare Zedek prides itself on its ability to adapt to any situation and provide excellent care when it is most needed.
Hope for Israel
On October 7th we woke to the devastating news that Israel was under attack. Whilst communities were preparing to celebrate one of the most joyful dates in the Jewish calendar news emerged of the atrocities perpetrated by Hamas.
When news began to trickle through, in the early morning hours, Shaare Zedek was already preparing. Setting up an emergency centre, a family call centre, nurse and doctor planning was underway and all departments in the hospital were prepped with the sole aim of providing solutions to whatever challenges patients were about to face.
For the first time in decades a nearby sports field became the hospitals helipad and patients were transferred both by MDA (Magen David Adom) medivac and military helicopters straight to Shaare Zedek. The hospital started to receive many victims from the south of Israel who were evacuated to safety. Among them civilians and soldiers and many pain-filled stories of loss.
In one particularly heart-wrenching case, the hospital treated two young children found abandoned on the border fence after their mother was taken into captivity. Their father had survived and brought them directly to Shaare Zedek.
Within hours of the declaration of War the hospital opened a mental health care unit within the emergency room for individuals suffering from shock and other emotional issues.
The solidarity of our staff, from all races and populations of the Jerusalem population, has been extraordinary and is indicative of the remarkable spirit of unity that has always defined Shaare Zedek.
Tragically, some of our staff have experienced personal losses. Yet, amidst the grief, a sense of unity prevails. Over 200 dedicated individuals from Shaare Zedek, including doctors, nurses, and staff from various departments, seamlessly transitioned from their medical roles to don IDF uniforms, as they were called up for their reservist army duty. While retired staff, motivated by a sense of community, re-joined the hospital's ranks to support their Shaare Zedek family.
The hospital stands as a beacon of strength and resilience, providing crucial medical care and unwavering support to the community, even in the face of adversity.
Hope for the World
Israeli Medical Team provides care in Armenia
On the 4th October 2023, Israel received a call from the Armenian government for help after hundreds of citizens were wounded after a fuel tank explosion.
Israel was the first country to land in Armenia with a medical delegation led by Professor Ofer Merin, Director General of Shaare Zedek. The delegation from Israel, made up of 14 medical professionals, were sent to provide intensive care treatment to hundreds of injured citizens including many burn victims.
Professor Merin shared "This is an unusual event on a global scale, with such a large number of burn victims. It is an honour and privilege to lead this worthy task, on behalf of the State of Israel, which is the first country to provide assistance.”
“I would like to thank the Ministry of Health for their commitment and the teams of Shaare Zedek and Soroka who immediately mobilized to embark on this important mission. Our preparedness at Shaare Zedek Medical Center is for the benefit of everyone, everywhere."
Tanzanian partnership
The work of Shaare Zedek and our medical professionals extends far beyond the walls of the hospital in Jerusalem and something we are so proud of is how our doctors give hope to the world through their research and teaching.
Professor Gabriel Izbicki, Director of the Pulmonary Institute at Shaare Zedek visited Zanzibar, Tanzania with colleagues from Shaare Zedek to learn about the lack of basic medical equipment and knowledge about lung diseases in Zanzibar hospitals.
Professor Izbicki shared, “Our project began about a year-and-a-half ago. We visited two hospitals and gave lectures on lung diseases, mostly COVID-19, asthma, and chronic obstructive pulmonary disease (COPD).”
At the Al-Rahma Hospital in the capital city of Zanzibar, the Shaare Zedek team were impressed by the level of the staff’s knowledge.
“They understood quite well the diseases, types of treatments, and the various inhalations, but when I asked them if they do tests to diagnose asthma and COPD, they said no. I was surprised and asked them if they referred patients to another hospital, and they again said no. I asked why, and they said that neither of them had the necessary medical equipment.”
Professor Izbicki discovered that doctors did not even have a spirometer, a basic lung function device that measures the amount of air you can exhale in one second and the total volume of air you can exhale in one forced breath. ‘It is impossible to distinguish between asthma and COPD without this device’ and misdiagnoses due to inadequate equipment can lead to further problems.
Professor Izbicki was saddened by what he saw in Zanzibar, and upon his return to Israel, set about trying to help the people he met on his trip. After almost a year of planning, he arranged for a medical delegation to visit Israel for a week of essential learning. Not only that, he was also able to arrange donations of essential medical equipment to be taken back to the region.
Dr Bukoro Nestori who was among the group that came to Israel had never been on a plane before,but had dreamt of visiting Israel.
Professor Izbicki and his team were able to enrich Dr Bukoro’s medical know how with valuable hands-on experience as well as impart important medical knowledge that Dr Bukoro was able to take back to Zanzibar.
A very special trip that will help change the future of Pulmonary care in Tanzania.
Global first at Shaare Zedek
In August 2023, Shaare Zedek Medical Center became the first hospital in the world to perform a complex spinal surgery using augmented reality combined with robotic technology.
Dr Cezar J Mizrahi performed the incredible procedure on a 25-year-old patient who had been admitted to the hospital’s Emergency Department after being seriously injured in a work-place fall. The trauma team at Shaare Zedek swiftly diagnosed an unstable spine fracture that put the man at immediate risk for paralysis and other severe neurological damage. He was quickly transferred into the care of Dr Mizrahi, a Spinal Neurosurgeon from the Spine Surgery Unit, and the Department of Neurosurgery.
The combination of AR (Augmented Reality) and robotics allowed Dr Mizrahi to perform a precise and minimally invasive procedure. “It made my life amazingly easy. I would even say a child could do a surgery with all this technology. The AR and robotics helped with positioning, trajectory, and planning,” he said.
The combination of AR, which is an interactive experience that combines the real world and computer-generated content, with robotic technology, did not speed up the surgery, but rather made it more ‘effective.’
The successful operation has given Dr Mizrahi hope that the technology may become an integral part of spinal surgeries going forward, but he knows that these things take time to get fully implemented.
“It is a slow process. If I had to speculate, I would say that in about 10 years it will be standard to use AR and robotics for complex cases,” he said.
And although this technology is currently only used to perform spinal surgeries, Dr Mizrahi said he can see it being used for injuries on the entire body in the future.
UK funding
Donors choose to support any of the hospital’s 100+ departments with which they have a personal affinity as well as responding to our appeals to support the needs of specific departments as dictated by the Board of the hospital. This year donors supported a variety of departments by funding equipment, rooms, facilities and scholarships.
There is a strong British footprint in every one of the hospital's 14 internationally recognised Centres of Excellence. Fundraising in the UK has always been conducted in close partnership with the leadership of the hospital in Jerusalem. Collaboration between professional colleagues and board members grows each year. This year our new Chief Executive made her first visit to the hospital. We have enjoyed a close working relationship with both the President and Director General of the hospital and their teams. This year the UK team once again joined a call bringing the international offices fundraising for Shaare Zedek together to discuss further collaboration. We look forward to a continued partnership with Professors Halevy and Merin and are indebted to them for their visionary leadership and continued service. We are grateful to the entire fundraising team at Shaare Zedek Medical Centre who support our fundraising efforts on the ground in Israel.
The description under the headings "Achievements and performance" and "Financial review" meet the company law requirements for the Trustees to present a strategic report.
The current economic climate continues to impact on our ability to raise new funds. Given the tough climate we were delighted to have raised £2,228,474 (2022: £1,641,822). We have maintained a healthy financial position with closing fund balances totalling £1,106,290 (2022: £984,187) of which £71,219 (2022: £70,319) relates to restricted funds and £42,465 (2022: £42,465) to general endowment fund. Furthermore, £16,320 (2022: £84,353) within the closing unrestricted fund balance is designated for specific purposes. Hence, the general unrestricted funds the charity holds amounts to £976,286 (2022: £787,050) at the end of the reporting period after making allowance for restricted and designated funds. We are delighted to have raised significant funds enabling us to send £1,708,473 (2022: £1,280,758) to Shaare Zedek in Jerusalem in relation to our charitable activities and support costs. This year we were in a position to send over 75% of our total income directly to the hospital, the balance being held in reserves in the UK.
Legacy gifts continue to be a vital source of income, with 30% of all donations this year being from legacy gifts in donors’ wills. Legacies are unpredictable, at times materialising without our prior knowledge and we continue to maintain and develop this income whilst recognising the need for a diversification of income from other sources to maintain the level of support we currently provide to the hospital.
General donations, including major gifts, totalled £1,557,335 (2022: £1,041,396). Although we continue to enjoy the support of our loyal donors, the economic situation continues to be challenging. In common with other charities, we continue to find ways to engage new donors in a challenging climate. Some existing donors are lowering their donations due to reduced income to their Trusts or changes in personal circumstances, or because of the attacks on October 7th have chosen to support other Israeli charities.
Reserves policy and going concern
It is the policy of the Charity to maintain unrestricted funds, which are the free reserves of the Charity, at a level that takes account of the likely administration costs of the Charity over the next 24-month period. The Board has the power to invest in such assets in secure money market instruments. The intention of the Charity is to make further payments to the Hospital in Israel as and when required in the future. This policy will provide adequate funds to meet current and anticipated future liabilities and provide financial flexibility in the event of an adverse drop in donations received.
Risk management
The Board has assessed the major risks to which the charity is exposed, in particular those related to the operations and finances of the Charity and is satisfied that systems are in place to mitigate its exposure to those risks. Significant risk areas include:
Financial risks - the variability of incoming donations create risk that the Charity will not have sufficient funds to continue its charitable activities. The Trustees regularly review the financial performance and position of the charity to manage this risk, and have done so successfully historically by ensuring that planned charitable activities are in-line with anticipated donations and level of funds available.
Plans for the future
In May 2023 our Executive Director decided to leave the charity after dedicating herself to the role for 10 years. She finished working with us in July 2023. An experienced fundraiser was appointed as a successor in the post of CEO and started work in June. The trustees worked closely with our outgoing and incoming CEO’s to ensure a smooth transition, which focused on the continuity of donor relationships.
In October 2023, we appointed a new Fundraising Manager, who will be working closely with the CEO and trustees, to develop a programme of fundraising events, as well as helping to raise the profile of SZUK across the community.
As an organisation, it was agreed that we would invest in our CRM and work to future proof our technologies, by further developing our website so that we can truly personalise our supporter journey. This will be implemented in 2024-2025.
Recruitment, appointment and terms of office of Trustees
Trustees are appointed in accordance with the Charity's Memorandum & Articles of Association. In 2023, three new Trustees were appointed.
Trustee induction and training
New trustees are made aware of the organisation structure of the charity and are shown financial statements of the charity for the three preceding years.
All trustees are now already familiar with the practical work of the charity. Induction procedures are in place for new trustees.
Safeguarding
Shaare Zedek UK has a Safeguarding Policy. The charity makes regular enquiries of the hospital with regard to its own robust safeguarding policies and notification of any relevant safeguarding issues of which we should be aware.
The charity is a company limited by guarantee, incorporated on 14 December 2010 and registered as a charity on 8 August 2011. The charity's reference and administrative details are as set out within these accounts. The company was established under a Memorandum of Association which established the objects and powers of the charitable company and is governed under its Articles of Association.
The Board of Trustees
The Trustees, who are also the directors for the purpose of company law, and who served during the year were:
Key personnel
The following individuals whilst not statutory members of the charity were involved in an advisory capacity:
Dan Adler
David Bernstein
David Cohen
Geoffrey Goldkorn
Eva Greenspan
John Jay
Margot Lew
Angela Margolis-Raz
Marcus Margulies
Hilary Natoff
Jonathan Paull
Marcus Pearl
Margaret G Rothem
Simon Sackman
Nolan Wengrowe
Michael Ziff
Emma Pearl
Recruitment, appointment and terms of office of Trustees
Trustees are appointed in accordance with the Charity's Memorandum & Articles of Association.
Trustee Induction and Training
New trustees are made aware of the organisational structure of the charity and are shown financial statements of the charity for the three preceding years.
All trustees are now already familiar with the practical work of the charity. Induction procedures are in place for new trustees.
Operations and staffing
Up until the end of July 2023, the trustees delegated day to day management of the charity to the Executive Director, Simona Bennett to deliver the aims and objectives of the charity. Oshrit Cowan, who started with the charity in June 2023, has now been appointed as Simona's successor.
Safeguarding
Shaare Zedek UK has a Safeguarding Policy. In 2019 the Executive Director completed safeguarding training with the NSPCC. The charity makes regular enquiries of the hospital with regard to its own robust safe-guarding policies and notification of any relevant safeguarding issues we should be aware of. All SZUK staff will now be required to undergo safeguarding training and DBS checks as we expand our outreach work into the community.
Related parties
Aggregate donations received from related parties without conditions amounted to £520,740 (2022: £421,374) for the year.
Aggregate remuneration of key management personnel in 2023 amounted to £100,523 (2022: £91,167).
None of the Trustees (or any persons connected with them) received any remuneration or benefits from the Charity during the year.
In accordance with the company's articles, a resolution proposing that RDP Newmans LLP be reappointed as auditor of the company will be put at a General Meeting.
The Trustees' report, including the strategic report, was approved by the Board of Trustees.
The Trustees, who are also the directors of Shaare Zedek UK for the purpose of company law, are responsible for preparing the Trustees' Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (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 charity and of the incoming resources and application of resources, including the income and expenditure, of the charitable company for that year.
In preparing these financial statements, the Trustees are required to:
- select suitable accounting policies and then apply them consistently;
- observe the methods and principles in the Charities 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; and
- prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charity will continue in operation.
The Trustees are responsible for keeping adequate accounting records that disclose with reasonable accuracy at any time the financial position of the charity and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
The Trustees are responsible for the maintenance and integrity of the charity and financial information. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.
Opinion
We have audited the financial statements of Shaare Zedek UK (the ‘charity’) for the year ended 31 December 2023 which comprise the statement of financial activities, the balance sheet, the statement of cash flows and the notes to the financial statements, including a summary of significant accounting policies. 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).
In our opinion, the financial statements:
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 charity in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including 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.
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 charity’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.
Other information
The other information comprises the information included in the annual report, including the trustees’ 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.
Opinions on other matters prescribed by the Companies Act 2006
In our opinion, based on the work undertaken in the course of our audit:
the information given in the Trustees' report for the financial year for which the financial statements are prepared, which includes the directors' report and the strategic report prepared for the purposes of company law, is consistent with the financial statements; and
the strategic report and the directors' report included within the Trustees' report have been prepared in accordance with applicable legal requirements.
In the light of the knowledge and understanding of the charity and its environment obtained in the course of the audit, we have not identified material misstatements in the strategic report or the directors' report included within the Trustees' report.
We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 requires us to report to you 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
we have not received all the information and explanations we require for our audit.
As explained more fully in the statement of Trustees' responsibilities, the Trustees, who are also the directors of the charity 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 charity’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.
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.
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.
Our approach to identifying and assessing the risks of material misstatement in respect of irregularities, including fraud and non-compliance with laws and regulations, was as follows:
the engagement partner ensured that the engagement team collectively had the appropriate competence, capabilities and skills to identify or recognise non-compliance with applicable laws and regulations;
we identified the laws and regulations applicable to the charitable company through discussions with directors and other management, and from our commercial knowledge and experience of the charity sector.
we focused on specific laws and regulations which we considered may have a direct material effect on the financial statements or the operations of the charitable company, including the Companies Act 2006 and The Charities Act 2011 together with the Charities SORP (FRS102), General Data Protection Regulation (GDPR), and employment legislation.
we assessed the extent of compliance with the laws and regulations identified above through making enquiries of management and inspecting legal correspondence; and
identified laws and regulations were communicated within the audit team regularly and the team remained alert to instances of non-compliance throughout the audit.
We assessed the susceptibility of the charity's financial statements to material misstatement, including obtaining an understanding of how fraud might occur, by:
making enquiries of management as to where they considered there was susceptibility to fraud, their knowledge of actual, suspected and alleged fraud; and
considering the internal controls in place to mitigate risks of fraud and non-compliance with laws and regulations.
To address the risk of fraud through management bias and override of controls, we:
performed analytical procedures to identify any unusual or unexpected relationships;
reviewed and tested journal entries to identify unusual transactions and other adjustments for appropriateness, and evaluating the business rationale of significant transactions outside the normal course of business;
assessed whether judgements and assumptions made in determining the accounting estimates set out in note 2 were indicative of potential bias; and
investigated the rationale behind significant or unusual transactions.
In response to the risk of irregularities and non-compliance with laws and regulations, we designed procedures which included, but were not limited to:
reviewing and agreeing financial statement disclosures and testing to underlying supporting documentation; and
enquiring of management as to actual and potential litigation and claims.
reviewing correspondence with HMRC and bankers and reviewing minutes of board meetings.
No instances of material non-compliance were identified. However, the likelihood of detecting irregularities, including fraud, is limited by the inherent difficulty in detecting irregularities, the effectiveness of the entity’s controls, and the nature, timing and extent of the audit procedures performed. There are inherent limitations in our audit procedures described above. The more removed that laws and regulations are from financial transactions, the less likely it is that we would become aware of non-compliance. Auditing standards also limit the audit procedures required to identify non-compliance with laws and regulations to enquiry of the directors and other management and the inspection of regulatory and legal correspondence, if any.
Material misstatements that arise due to fraud can be harder to detect than those that arise from error as they may involve deliberate concealment or collusion.
A further description of our responsibilities is available on the Financial Reporting Council’s website at: https://www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor's report.
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.
Investments
Costs of raising funds
Payments to hospital
The statement of financial activities includes all gains and losses recognised in the year.
The statement of financial activities includes all gains and losses recognised in the year. All income and expenditure derive from continuing activities.
Shaare Zedek UK is a private company limited by guarantee incorporated in England and Wales. The registered office is 4 Theobald Court, Theobald Street, Borehamwood, Hertfordshire, WD6 4RN, United Kingdom.
The accounts have been prepared in accordance with the charity's memorandum and articles of association, the Companies Act 2006 and “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)” (as amended for accounting periods commencing from 1 January 2019). 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. Monetary amounts in these financial statements are rounded to the nearest £.
The financial statements have been prepared under the historical cost convention. The principal accounting policies adopted are set out below.
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 of accounting in preparing the financial statements.
Unrestricted funds are available for use at the discretion of the Trustees in furtherance of their charitable objectives.
Designated funds comprise unrestricted funds that have been set aside by the Trustees for particular 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.
Cash donations are recognised on receipt. Other donations are recognised once the charity has been notified of the donation, unless performance conditions require deferral of the amount. Income tax recoverable in relation to donations received under Gift Aid or deeds of covenant is recognised at the time of the donation.
Income tax recoverable in relation to investment income or gift aid donations is recognised at the time the relevant income is receivable.
Legacy income is included in the SOFA when the Charity's entitlement has been established with a sufficient level of certainty, normally on receipt of the legacy or a letter confirming that it will be sent.
Grants received are accounted for as receivable as and when the charity is legally entitled to the income and the amount can be quantified with reasonable accuracy. Income from charitable activities includes income received under contract.
Trading income is recognised as and when monies are received and stated after trade discounts .
Trading income related to events is recognised in the year the events took place.
The charity is not registered for VAT.
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 are allocated on the portion of the asset’s use.
Expenditure is recognised when a liability is incurred. Contractual arrangements and performance related grants are recognised as goods or services are supplied. Other grant payments are recognised when a constructive obligation arises that result in the payment being unavoidable.
Costs of generating funds are those costs incurred in attracting voluntary income, and those incurred in trading activities that raise funds.
Charitable activities include both the direct and support costs relating to these activities.
Governance costs include the cost of any legal advice to trustees on governance or constitutional matters, external accountancy and audit costs.
Support costs include central functions and have been allocated to the different categories of activities based on the time spent on each activity.
The charity is not registered for VAT so all expenses shown in the SOFA and notes to the accounts are shown gross (i.e. inclusive of VAT).
Tangible fixed assets are initially measured at cost and subsequently measured at cost, net of depreciation and any impairment losses.
Depreciation is recognised so as to write off the cost of assets less their residual values over their useful lives on the following bases:
The gain or loss arising on the disposal of an asset is determined as the difference between the sale proceeds and the carrying value of the asset, and is recognised in the statement of financial activities.
Fixed asset investments are initially measured at transaction price excluding transaction costs, and are subsequently measured at fair value at each reporting date. Changes in fair value are recognised in net income/(expenditure) for the year. Transaction costs are expensed as incurred.
At each reporting end date, the charity reviews the carrying amounts of its tangible assets to determine whether there is any indication that those assets have suffered an impairment loss. If any such indication exists, the recoverable amount of the asset is estimated in order to determine the extent of the impairment loss (if any).
Cash and cash equivalents include cash in hand, deposits held at call with banks, 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.
The charity has elected to apply the provisions of Section 11 ‘Basic Financial Instruments’ and Section 12 ‘Other Financial Instruments Issues’ of FRS 102 to all of its financial instruments.
Financial instruments are recognised in the charity's balance sheet when the charity becomes party to the contractual provisions of the instrument.
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 rate of interest. Financial assets classified as receivable within one year are not amortised.
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.
Trade creditors are obligations to pay for goods or services that have been acquired in the ordinary course of operations from suppliers. Amounts payable are classified as current liabilities if payment is due within one year or less. If not, they are presented as non-current liabilities. Trade creditors are recognised initially at transaction price and subsequently measured at amortised cost using the effective interest method.
Financial liabilities are derecognised when the charity’s contractual obligations expire or are discharged or cancelled.
The costs of short-term employee benefits are recognised as a liability and an expense, unless those costs are required to be recognised as part of the cost of stock or fixed assets .
The cost of any unused holiday entitlement is recognised in the period in which the employee’s services are received.
Payments to defined contribution retirement benefit schemes are charged as an expense as they fall due.
Volunteers
A substantial contribution to the activities of Shaare Zedek UK is supplied in the form of voluntary services for raising funds. The financial benefit of these non-cash donations have not been recognised in these accounts as by their nature it would be impractical to quantify in monetary terms.
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.
Specifically, the Trustees have made judgements on the apportionment of support and governance costs across the various charitable activities (see note 8 for further details) - the basis of this apportionment has remained consistent to prior years.
In the view of the Trustees, with the exception to the above, there are no significant accounting estimates and judgements applied.
Costs of generating donations and legacies
Payments to hospital
Other costs
Support costs excluding staff costs which cannot be directly attributed have been apportioned equally between costs of raising funds and the charitable activity of payments to the hospital. Within support costs, other costs include telephone costs, postage costs, travel costs, computer running costs and staff training costs.
Staff costs have been apportioned on an estimated basis of the allocation of time spent on each specific activity.
The analysis of auditor's remuneration is as follows:
None of the Trustees (or any persons connected with them) received any remuneration, nor reimbursement of travelling expenses during the year or prior year.
The average monthly number of employees during the year was:
The remuneration of key management personnel is as follows.
Audit fees
Legal and professional fees
The charity is exempt from taxation on its activities because all its income is applied for charitable purposes.
The income funds of the charity include restricted funds comprising the following unexpended balances of donations and grants held on trust for specific purposes:
Bikur Cholim Campus is a separate campus hospital that merged with Shaare Zedek Medical Centre in Jerusalem. The fund is dedicated to fund the general running of the hospital. The surplus of £3,660 will be used next year to fulfil the objectives of the project.
The Emergency Department was set up to develop and extend the existing size of the old department. The fund is dedicated to cover running costs for the department. A surplus of £552 is being carried forward to next year.
The Neurosurgery and Neurology Department at the Shaare Zedek Medical Center treats a wide range of diseases involving the nervous system, with the aim of preserving and restoring brain and spine function and has a designated operating theatre which includes a new navigating system, intra-operation ultra-sound and an innovative robot enabling procedures such as tumor tissue biopsy with great precision. The fund is dedicated to provide equipment and cover general running costs for the department. The surplus of £1,272 is being forward to the following year.
Included within Others are various smaller funds which relate to various activities including CT Scanner, various pieces of equipment, Haematology Department, Urology Department, pending allocation, Geriatrics Department, Cardiology Department and LDA Educational Institute. A surplus of £58,359 is being carried forward to meet the project objectives of these departments.
Our state of the art new ICU was upgraded in 2017 the first major upgrade and renovation of this Unit since the hospital moved to its current location in 1979. The Unit is now equipped with the latest technology and care methods in the most advanced setting possible. The risk of infection is a top priority for intensive care patients. The redesigned ICU gives each patient their own largely self-sufficient room to minimise the spread of infection. Almost all of the equipment is wall or ceiling mounted, meaning the room can be kept to a higher standard of cleanliness. There are 14 patient rooms in total, almost all of which are in constant use.
The Cardiology Department provides a comprehensive response to the gamut of cardiac and cellular diseases. Our team performs catheterization, installs stents in the coronary arteries and implants pacemakers, defibrillators and valves without open heart surgery. There is also a state-of-the-art Cardiac Imaging Institute which uses 3-D Echo, CT and MRI. We can also administer advanced treatment for congenital and structural disorders. The department stresses preventative care and accompanies patients throughout the post-heart attack rehabilitation process.
Robotic surgery is a field which has developed in recent years, increasingly becoming a standard and indispensable approach to care in a variety of surgical disciplines. It allows extremely fine and complex movements in a tight space, without the need to open large cavities that can involve more complications and a longer, more painful recovery period. Appreciating that this represents the future of modern surgery, we are proud that Shaare Zedek Medical Centre, which currently sees around 35,000 surgical procedures performed each year, has been a local pioneer in introducing advanced robotic approaches to the Israeli medical community.
In terms of the outpatient clinic, out of the 800,000 patients who are treated at Shaare Zedek Medical Center each year, the vast majority are treated on an ambulatory basis in our more than 70 outpatient units and clinics. In general, the trend in modern medicine is to reduce the need for inpatient hospitalization wherever possible, as this increases costs, emotional and practical challenges for the patient and is also less desirable from a medical perspective. For all these reasons, outpatient care is the growing trend in modern hospital care and Shaare Zedek has firmly embraced this trend with increased investment in these services. The central area for the large majority of our ambulatory services is in the Margulies Outpatient Clinics which are divided between the Fourth and Fifth Floors of The Next Generation Building.
The Paediatrics department has a surplus of £300 at the year end to be expended in the following year.
The Neonatal Intensive Care Unit (NICU) at the Shaare Zedek Medical Center treats infants born from week 24 of pregnancy. The complex includes 70 beds (with another 20 at the Bikur Cholim Campus), and state-of-the-art respiratory and monitoring equipment which provides precise data 24/7 on each of the babies in the unit. The fund is dedicated to provide equipment and cover general running costs for the department. A surplus of £6,857 is being carried forward to the following year.
Our Intensive Care Unit treats the most severe urgent care cases in the hospital. 70% of cases are post-surgery while others are complex cases referred from the Internal Medicine Departments. A surplus of £201 is being carried forward to the following year.
The Coronavirus department still has a surplus of £18 which is being carried forward to the following year.
The trustees are satisfied that sufficient resources are held in an appropriate form to enable each fund to be applied in accordance with any restrictions.
Endowment funds represent assets which must be held permanently by the charity. Income arising on the endowment funds can be used in accordance with the objects of the charity and is included as unrestricted income. Any capital gains or losses arising on the assets form part of the fund.
The income funds of the charity include unrestricted funds, within which designated funds have been set aside by the trustees for specific purposes:
The Neo-natal and Paediatric Oncology funds were set up to support running costs for the department.
The Pending Allocation Fund relates to a single donation which is yet to be remitted to the Shaare Zedek Medical Centre for a specific department.
Hemsley Cancer Centre fund was set up to support running costs for the department.
The Nursing Scholarships fund was set up to provide support and training for student nurses.
The Coronavirus Fund was set up in the wake of the global Covid-19 pandemic to treat Covid-19 positive patients safely in isolation.
The General Unrestricted Fund relates to "free reserves" after allowing for all designated funds.
At the reporting end date the charity had outstanding commitments for future minimum lease payments under non-cancellable operating leases, which fall due as follows:
Aggregate donations received from related parties without conditions amounted to £520,740 (2022: £421,374) for the year.
The charity had no material debt during the year.