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US ISSN 0016-2116
Introduction to FNS 1
The Joumey — Nathan Lee 2
Field Notes — Barb Gibson 4
Beyond the Mountains — Barb Gibson I0
Frontier School of Midwifery & Family Nursing 12
-Dr Susan Stone, President & Dean
Former Courier and Staff News 17
Eighty-Fourth Annual Report 18
In Memoriam & In Honor Of 44
Urgent Needs 52
Cover Photo — Mary Breckinridge and her nurses - Thanksgiving Day
CORRECTION: The number of the last (September 2009) Quarterly
Bu//etin was incorrect. Should have been; Volume 85, Number 1, Sep-
tember 2009.
Frontier Nursing Service Quarterly Bulletin is published at the end of
each quarter. Subscription Price $5.00 a year for Donors/$15.00 for In-
stitutions. Periodicals postage paid at Wendover, Kentucky 41775 and
at additional mailing offices. POSTMASTER: Send address changes
to FNS, Inc. 132 FNS Drive, Wendover, Kentucky. Copyright FNS/Inc.
All Rights Reserved. The Frontier Nursing Service does not share
it’s donor mailing list.

Introduction to Frontier Nursing Service (FNS)
Mary Breckinridge spent her early years in many parts of the
world - Russia, France, Switzerland and the British Isles. After
the deaths of her two children, she abandoned the homebound life
expected of women of her class to devote herself to the service
A of others, particularly mothers and children.
Several years after graduating from St. Luke’s Hospital Training
School for Nurses in 1910, Mrs. Breckinridge established the
FNS in Leslie County, Kentucky, in 1925, as a private charitable
organization serving an area of 700 square miles. It was the first
organization in America to use nurses trained as midwives under
the direction of a single medical doctor/obstetrician, based at their
small hospital in Hyden. Originally the staff was composed of
nurse-midwives trained in England. They traveled on horseback
and on foot to provide quality prenatal and childbirth care in the
client’s own home.
Today, Mrs. Breckinridge’s legacy extends far beyond Eastem
Kentucky. FNS, Inc. is the parent holding company for Mary
Breckinridge Healthcare, Inc., Frontier Nursing Healthcare, Inc.,
which includes five rural healthcare clinics; Mary Breckinridge
Home Health Agency and the Frontier School of Midwifery and
Family Nursing which offers a Master of Science in Nursing de-
gree with tracks as a Nurse-Midwife, Family Nurse Practitioner,
Women’s Healthcare Nurse Practitioner and a Doctor of Nursing
Q Practice (DNP) degree.
A I Mary Breckinridge’s home, The Big House, located at Wendo-
ver, is a licensed Bed & Breakfast Inn. For more information or
reservations, call 606-672-2317 or e-mail: information@frontier-
nursing.org. You can also access our website:
Frontier Nursing Service - www.frontiemursing.org

The Journey
by Nathan Lee, President & CEO
As this issue reaches your mail- y _A ., y .» ~» V ~
boxes, many of us will recently Q   if   _, ,j$?*%¤_     `
have broken bread with friends l _ `   _' ,  -_  
Hlid family over a Thanksgiving   A4"'     `
meal. For many, the past year     elf  
h b l fi d` - 7‘7£~“ ‘.Y"’¢   · j '   I
as een one w ren n ing some _, V. { {   Nt i
thing for which to be thankful     ji  
has truly been a challenge. r   ‘”"   ?
You need only open the morning paper or tum on the evening  
news to see the suffering the "Great Recession" has wreaked on  
the entire nation . . . and indeed the world. More than a tenth of  
the nation’s workforce can’t find a job. Companies once thought J
as permanent as Gibraltar no longer even exist. Measures of y
optimism are down. Measures of pessimism are up. Arecent Wall i
Street Journal Report quantified what we have known for several .
months; charitable giving is down, particularly to organizations i
who, like ours, work to serve the poor and mothers and children  
at risk in this nation. 9
All this comes at a time when people need the services we offer  
more than ever, and this "perfect stonn" is all too visible in our  
audited operating results which follow in these pages. Even for W
a numbers person like me (or perhaps especially for a numbers (
person like me . . . ) it’s hard to find much for which to be thankful ,
in those figures.
It would seem easy, then, to simply skip over our opportunities to ·
give thanks this year. Nothing could be further from what Mrs.  
Breckinridge would have us do. Gratitude was always central in  
Mrs. Breckinridge’s life. As her cousin Marvin Patterson noted I
in her Foreword to Wide Neighborhoods, "She was wont to say,
‘Gratitude is an aristocratic Vll'[Ll€.,” One of the most famous
2 Q

photographs ofthe early days ofthe FNS is called "Thanksgiving
Day" and pictures Mrs. Breckinridge and all the sewice’s nurse-
midwives on horseback, posed on the banks of the Middle Fork
River. Gratitude . . . from a woman who buried not one, but both
· of her children; a loss, thankihlly, most of us will hopefully never
` So allow me to give thanks. I am thankful for the challenges of
"thin coffers", for they mean that we have used our resources to
help those who need them. I am thankful for cramped quarters at
the Frontier School of Midwifery and Family Nursing, for they
mean that more students are matriculating through our programs
to go and serve their own communities. I am thankiiil for the
- challenges of sinking Hoors at the Big House, for they mean that
T we are blessed with the responsibility for a national treasure. I am
thankful for a staff who believes so strongly in our work that they
have helped to underwrite it through a ten percent pay reduction
l over the past several months and I am thankful that because of
their dedication and sacrifice, not a single FNS employee has had
. to be laid off during this most challenging time. I am thankful for
I the time I’ve spent travelling to various cities over the past year
on behalf of FNS to our now eight active city committees, for it
I means that interest in our work is stronger than it has been in many
years. I am thankful for friends and supporters who, despite what
I I know are their own challenging circumstances, continue to give
generously to our programs so that we can continue to serve those
` Mrs. Breckinridge would have us serve.
i I am thankful that though our path may boast signs for unexpected
turns, steep inclines and even some nasty drops, one we will never
. encounter is a stop sign. I am thankful that our journey continues.
And I am thankful that you make it with us.

Field Notes
by Barb Gibson, Assistant t0 CEO  
Nate T
In the last issue (September 2009) Field Notes, we printed that ‘
Edith Collett was the first from Leslie County to graduate from
the Frontier School of Midwifery & Family Nurse Practitioner
Program. Note that we are speaking of the Bridge Program (RN I
to MSN) — not the traditional FNP Program. I
The Christmas and Children K Fund Update f
by Benjamin Peak, Director of Clinics ·
Each Christmas season, in the tradition of Mrs. Breckinridge, the
Frontier Nursing Healthcare Clinics sponsor a holiday event for
the children in Leslie and Clay Counties. These events are special
times when FNS gives back to the community in the form of a .
visit from Santa, gifts for the children, cookies and hot chocolate,
and holiday meals for needy families. Each of the tive clinics
celebrates this time with their own event whether in the clinics I
or visits to the home of the patients we serve.
Last year, we were fortunate to touch the lives of nearly 1,000 I
children and their families. This year, our plans have grown and -
our hope is to reach out to more. While the event is sponsored in
large part by donations that we receive, our staff also contributes (
through personal donations, bake sales and giving of their time. E
Christmas is a special time in the eyes of a child and the excite- .
ment that we see each year brings joy to our hearts. _
lt is with our deepest sense of appreciation that we thank each of
you that contribute to this Fund. Without you, these events would »
not be possible. We will continue this tradition and make it grow.  
Again, thank you for making this possible.  

l Kentucky State Fair
  During May, staff began working on a display for the Kentucky
2 State Fair. A scene was built to resemble the front porch of a cabin.
  During August, FNS employees volunteered with the Hyden—Les-
‘ lie County Chamber of Commerce to represent Leslie County at
the Fair "Pride for the Counties".
T O H O • •
A · ° T v _ ° . ° . ’ ,
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  Leslie County State Fair Display
  Annual Mary Breckinridge Festival
T This year’s Mary Breckinridge Festival was the best yet with thou-
, sands in attendance. The theme was "Honoring the Past, Building
y Toward the Future". The Hospital kicked off the Festival events
with the Community-Wide Picnic and, despite the dreary weather,
had a record breaking turnout. The Hospital float won first place
i 1 in the Festival Parade. The float was a replica ofa home visit with
Q a nurse-midwife and a scene showing the Hospital. Covy Feltner,
FNS employee for over 50 years, was chosen to be “Grand Mar-
. shall” of the Parade (see photo on next page).
i s

` TI " ‘ `  
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azzié A , /`__`   N __,   `
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Covy F eltner - Grand Marshall of Parade  
Healthland Connect 09 Update  
September 20th—24th, Bob Besten, Vice—President of Finance; p
Linda Craft, Director of Nursing; Kevin Couch, MBH Control- I
lcr; Benjamin Peak, Director ofClinics; Bruce Withers, Revenue l
Cycle Manager; Frank Baker, IT Manager; Brenda Morgan,  
Admitting Manager and Mallie Noble, MBH Administrator, at-  
tended the Healthland Connect O9 Conference in Dallas, Texas. .
Healthland is the computer system adopted by Mary Breckinridge  
Hospital and Clinics. ,
Employee Wellness Program Update I
Total employee weight loss through the Employee Weight Watch-
ers Program is 4,4l I .2. ,·
Linda Craft, Director of Nursing, recently achieved a Master’s
of Nursing Science degree with a ceitilicate in nursing education
from Indiana Wesleyan University. Congratulations, Linda!

E Frontier Nursing Healthcare Clinics Update
  by Benjamin Peak, Director of Clinics
  This is an exciting time as FNS ventures forth to new endeavors.
T October 3rd, after much planning and hard work, an announce-
E. ment was made to the public that the Anne Wasson Clinic and the
Christian Family Healthcare Clinic would be consolidated into
one new clinic which will provide improved quality of care and
— convenience in provider location. The ground breaking ceremony
caused staff to reilect on the mission of FNS. Participants in the
l ground breaking ceremony were: Lonnie Hendrix, Mayor of
j Hyden; Mary Ethel Wooton and Rhonda Brashear, FNS Board of
. Governors; Nancy Hinsely, Nurse—Midwife; Sr. Joan Gripshover,
’ FNP; Dr. Anita Comett, Intemist; Dr. Roy Varghese, lntemist;
T Lany Sparks, Board of Education; Jim Robinette and Tony Wherle,
i overseers of building construction; Ben Peak, Director of FNS
· Clinics and Nathan Lee, FNS CEO & President.
l   l
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P Ground Breaking Ceremony

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Construction ofthe clinic will begin soon and the project should be  
completed within 9-12 months. In keeping with our roots, the new  
clinic will be named "Frontier Nursing Service Hyden Clinic".  
Beginning in January 2010, clinics will change their existing .
electronic medical records and begin utilizing the same system
as Mary Breckinridge Hospital.
Wendover Guests .
From September 1, 2009 - December 1, 2009, Wendover hosted  
a total of 1,231 guests. This number includes ovemight guests,  
tour groups and special luncheons/events.  
Wendover Employee Fall Festival  
October 30th, Wendover Staff hosted the Annual Fall Festival  
at The Livery. Employees from across the organization enjoyed  
food prepared again this year by the Big Creek Fire Department.  
Games included a Pie Eating Contest, Sack Race and Cake Walk. §
Kevin Couch and Jeffery Hall won the Pie Eating Contest this r
year. A special thanks to Ben Peak, Director of Clinics and Rhonda  
Brashear, FNS Board Member, for providing entertainment.  
I   ‘¤-      i
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Fall Festival Pie Eating Ca test in .

i C0urier Program Update
l Katherine Caddle, Bridgton, ME; Emily Hop, Holland, MI, and
  Roseann Bertone, Downingtown, PA, - seniors at Case Westem
{ Reserve University, Cleveland, Ohio, came to FNS for their Cap-
· stone Proj ect during September, October and November. Marielle
Basttiston, Lincoln, RI, participated in the Program during October
and November. Marielle attends Dartmouth College and hopes to
‘ pursue nurse-midwifery.
  In addition to shadowing providers, the Couriers worked with
  COLLY (County of Leslie Lifting Youth) compiling data for
  school—located clinics. FNS collaborates with COLLYQ a non-profit
i organization, in developing health and education programs for
i children. Since its beginning in 2004, COLLY has been instru-
  mental in Dolly Par“ton’s Imagination Library, a dental screening
  and follow-up treatment program, school—located healthcare clin-
l ics, health education activities and after school programing. FNS
E Couriers play a large role in COLLY’s health education and after
g school program at elementary schools.
J ’ Ti:
5 rt ¤   =   4*%,
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C nuriers Marielle Basttistan, Katherine Cuddle, Emily Hap and

Beyond the Mountains
City Cammittees Update
The Annual Louisville Committee Luncheon was held September
17th at the Louisville Country Club with 41 guests. Special thanks ·
to Betty Brown for hosting this event and to all of our faithful  
friends in the Louisville area.
The Annual Bluegrass Committee Luncheon was held Septem— L
ber 29th at the Lexington Country Club with 66 guests. Special
thanks to Linda Roach, Helen Rentch and Fra Vaughn for hosting
this event.
Saturday, November 14th, Nathan Lee and Barb Gibson traveled
to Devon, PA, for a luncheon with FNS friends — some who were
formerly involved in the FNS Philadelphia Committee and some
new friends. The Philadelphia Committee has been inactive for
several years and we are hoping to re-kindle interest.
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Philadelphia Friends of FNS I

  The luncheon was hosted by Mary Hodge, former Chairperson of
  the Philadelphia Committee, and her husband, John Hodge, cousin
  to Mrs. Breckinridge. Also in attendance were: Laura Caterson,
  Kitty Ernst, Alexandra Wack, Camille Wack, "Bubbles" Townsend
‘* Moore, Annette von Starck, Jennifer Stevens and Mary Dressler.
Everyone is enthused about next year’s event and we’ve already
started making plans!
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  Le]? t0 right: Nathan Lee, Bubbles M00re and Mary Hodge
  During the visit to Devon, Barb had the opportunity to visit
  with Frontier School of Midwifery & Family Nursing graduates
_ Marsena Howard (1980) and Sharon Lehman Trani (1985) at their
homes in Lancaster, PA. Marsena has a very successful home birth
practice in Lancaster County in the Mennonite community and
. Sharon works as an FNP at a practice in Lancaster. It was great
Q rerniniscing about our work together at the FNS.
A ll

Frontier School of Midwifery & Family Nursing
i by Dr Susan St0ne, President & Dean
Strategic Plans - Past and Future
FSMFN has a well defined strategic planning process that has i·
served the School well over the past ten years. Every five years
the FSMFN Board of Directors and the faculty work to define a
set of goals to guide the work ofthe School for the following {ive `
years. ln 2005, the following goals were adopted: _
Strategic Goals 2005-2009 I
1) Create appropriate advanced practice nursing offerings to
maintain national and international leadership as the preferred
Nursing College of midwifery and primary care preparation; 2)
Design and execute a portfolio of activities designed to seek new
insights into care delivery through critical inquiry; 3) Continuously
improve the information technology abilities of the faculty, staff
and students; 4) Continuously improve the infrastructure of the
School; 5) Optimize revenues through development programs,
services and grants.
These goals were turned into an annual work plan for each of the
years 2005-2009. This process served to help us stay focused and
move successfully forward toward meeting those goals. There have
been many accomplishments during these past five years. New
programs have been developed including post masters certificate
programs for nurse-midwives and nurse-practitioners (2005), an
Associate Degree to Master of Science in Nursing Degree program ,
(2007) and a Doctor of Nursing Practice Program (2008).
We successfully obtained over 2 million dollars in grant funding ,
to assist in the development of these programs as well as our
technology initiatives. The grants also allowed us to implement .
a Personal Digital Assistant program that facilitates the students’
ability to seek point of contact healthcare information while at I
their clinical sites, as well as track their progress in completing i

their clinical experience. IPODS have become an integral tool for
our students allowing them to seek library information "on the
p go" and to download lectures and videos developed by faculty to
assist in their leaming.
We implemented a new Leaming Management System called AN-
GEL that has made course delivery over the Intemet streamlined
` and efficient. This software allows students and faculty to com-
_ municate regularly with each other as if they were in a classroom
together. In addition, the system allowed the implementation of
. on-line testing. Students now take their exams at home while using
a secure browser and timed exams to maintain security.
We purchased and implemented a new Student Management Sys-
tem called Power Campus allowing students, faculty and staff to
access all information about students including contact infonna-
tion, grades, full transcripts, Hnancial aid and billing information
from anyplace where the Intemet can be accessed, while maintain-
ing the security of that information for each person. This system
allows automatic billing, saving many hours of staff time.
Last, but maybe the most difficult endeavor, was to change the
school schedule from an open ended one where students could
start and finish courses whenever they so desired to a system of
twelve week terms. All courses now start at the same time and
finish twelve weeks later allowing four quarters in each year. This
has allowed us to move the agenda of collaborative leaming for-
, ward through the formation of cohorts who work through courses
together enhancing their learning through the interaction and the
support they provide to each other.
During this very busy agenda ofthe last five years the School also
. has experienced tremendous growth. In December of 2004, the
total enrollment was just over 200 students. Today, in December of
I 2009, total enrollment is 759 students. Increased numbers of stu-
i dents means increased numbers of faculty and indeed our faculty
i 13

has grown from a total of 24 in 2005 to a current total of 58. Last,
‘ we developed a plan to improve our facilities through renovations
of current buildings as well as the addition of a new learning facil-
ity. Needless to say, it has been a very busy five years.
FSMFN Student Body
November 2009
Total Students = 759 ·
Non Maine, 18
`  ‘=· ¤·  .. crnnsla
Q at - .   $·-z  
 `” °  .  
CNEP, 340
So where do we go from here'? It is time to develop goals for the I
next five years. The Board of Directors appointed a sub-commit-
tee to facilitate the strategic planning process this past summer. p
Members included Michael Carter, Marion McCartney, Rhonda  
Brashear and Jane Leigh Powell. The faculty also met and made .
recommendations to the Board. Both the Board of Directors and ·
the Faculty approved the goals for the next five years in Octo-
The resulting set of strategic goals for the next five years is as l
follows: E
14 l

Five Year Goals 2010-2014
l) Continue to expand current programs and explore new programs
that support and enhance the mission of FSMFN; 2) Develop a
post-masters Doctor of Nursing Practice program designed to
" provide second certification as nurse practitioner and/or nurse-
midwife for current nurse practitioners and/or nurse—midwives;
3) Develop diverse intemational clinical experience opportuni-
` ties; 4) Develop a post baccalaureate Doctor of Nursing Practice
program; 5) lmplernent the Community of Inquiry (COI) program
at FSMFN - a) Redesign courses according to the COI Model; b)
Enhance faculty and staff skills in the use of technology to enhance
teaching and learning; c) Improve student learning outcomes.
Research and Scholarship
Use the ESMFN Statement of Scholarship to develop and imple-
ment an active agenda designed to improve healthcare outcomes
for families and educational outcomes for students.
I) Engage in activities designed to develop, support and promote
the FSMFN faculty and student scholarly abilities through teach-
ing, research and practice.
Faculty and Stajf
Promote excellence in faculty scholarly work and staff develop-
l) Engage in a variety of activities for faculty and staff professional
_ development; 2) Encourage faculty and staff activity in innovative
uses of technology to improve learning and practice; 3) Support
and encourage staff development with a focus on service and use
, of technology to improve service.
  Faculty Practice
$ In collaboration with other FNS stakeholders and the Leslie
  County Community, develop and irnplernent a county wide pro-
  gram designed to prevent and decrease substance abuse.
{ 15

1) Seek and implement innovative solutions to assist currently
" addicted persons to a path of wellness.
Further develop a successful and diverse student body with excel-  
lent scholarly abilities.
l) Develop the scholarly ability of students; 2) Increase the number `
of students from underrepresented groups from 9% to 15%; 3)
Decrease attrition equal to or less than 15% for each class.
1) Current plans for facility renovations and new facilities are
Development i
1) Continually seek funding to support development of programs p
and projects; 2) Develop and implement an effective campaign to
fund the new building. .
Financial Control
Develop a long—range financial plan to support the strategic plan-
ning process.
1) Enhance the generation of cash flows for the funding of future
program development and other development projects; 2) System- .
atically review processes and practices to ensure sound internal `
controls and optimal efficiency of staff operations j
This is an ambitious agenda for FSMFN but we are confident that
with the systems we have in place and the support we receive from ,
our loyal alumni and friends, we can accomplish these goals. Many I
thanks to all of you who have supported us in the accomplishments
of the last five years and who we know will continue to support i
us in our new endeavors. Happy Holidays to all of you and best `
wishes as we usher in a new year.  
16 K

Former Courier and Staff News
Q "Old T imers"’ Dinner
_1_ Friday, October 2nd, a group of former FNS employees and
some current employees gathered at The Big House for a time of
reminiscing and "catching up" on everyone’s lives. Those present
. were: Barb Gibson, Debbie Woods, Skip Spell, JG & Juanetta
, Morgan, Ruby Moore, Charlotte Fannon, Glenna Couch, Jewell
Sizemore, Eveline Couch, Carolyn Estep Myers, Marie Mitchell,
j Margaret Jones Hamblin, Janet Lewis, Barb French, Clara J efferis,
{ Marietta Smith Maggard, Jerry Maggard, Christine Collins, Sr.
l Joan Gripshover, Arlene Baker and Sue Lazar.
4 The above listed employees have given a total of 417 years of
l service to the FNS.
I Plans are to make this an annual event in conjunction with the
l Mary Breckinridge Festival. Mark your calendars and plan to
  attend next year!
  E ` _ 1,;,
l -0 ·` ·   ·
                  _ , .=     `
,       `\.·      
i       .     .  
.       7.   ..—.   
l ». ·=i.   _     `  ·.     
·   I "   ,-~ l          
E _ _     . »       W     ’$<—¥·a`§_h equrvalents S 631,873 S 287,560
Patnent accounts 1'L'C(!I\'»`lI)lL', net of estimated tmcullectihles of
S·2,I33,21·1 and $901,905 fur 2009 and 2008, re>pect¤vely 2,882,169 3,991,750
Student tuition 1'n‘[L'I\'·1lJI\‘, nrt of t··~timat•·tI unrullevtilwles uf
526,807 and SZILSSZ t't»r2t1tl*).¤m1 200}%, rcspecltvely 208,332 ZB5,533
Other receivalwlt·s 63,704 l»15,9H?
` Investments 1,506,217 3,18%%,297
Supply nuvenlnries 338,534 325,292
Iieatnmaletl tlurd·p.1r1ypayersetllemenle- - l,0(>·1,·1(>t»
I’rep.1itl expenses and ollwr current assetw 89 465 157 360
'l`tvl.¤l current ¤I5$\.'I> 5,720,294 ‘J,~1¤1l>,225
I’r0purty and eqtnipmcnl, nel 5,83·|,75'I 5,408,078
Other assets
Beneficial interest in uutsitlu lmssls 1,436,371 l,95(»,‘)3(»
Investments held an perpetuxty 3,956,522 3,956,522
Other donor re>tr1ctetI rash and iuvestnwnts -1,592,637 5,557,280
l‘hys1cian loan receivable 242,897 268,317
Intangible}; · 242195
l Total other assets 10,228,427 1—1 981 280
Total assets S 21 783 472 5 29 S35 5H?

2009 2008
ljabililius and Nc1Asscls
Current linbiliticsz
Accoums pnynhlc S 2,698,802 S 1,211,262
Accruuv.1 uxpunacw 3,598,629 2,947,519
Estuunicd third-pnrly payer sclllumunts 422,855 » `
I1cfcrr•:dlui1u•u, S1m1un1< 1,113,744 1,083,601 Q
Currcnt portion of liuus uf crudil . 1,530,530 1,000,000
Currcnl purliunnflvug;-1¤:rn\ club! 619 554 597 566
Tom] currcnl lmlwi