xt798s4jnc3b https://exploreuk.uky.edu/dips/xt798s4jnc3b/data/mets.xml The Frontier Nursing Service, Inc. 1999 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service, Vol. 75, No. 1, Summer/September 1999 text Frontier Nursing Service, Vol. 75, No. 1, Summer/September 1999 1999 2014 true xt798s4jnc3b section xt798s4jnc3b FRONTIER NURSING SERVICE  
Volume 75 Number I Summer/ScpLcml¤c1‘ 1999  
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 US ISSN 0016-2116
Mary Breckinridge Healthcare News — Mallie Noble 1
Frontier Nursing Service takes on the Y2k Bug - Brian Lane 3
Wendover News — Jeremy Bush 5
Courier Program News — Jeremy Bush 10
FSMFN/CNEP News — Susan Stone 13
FSMFN/CFNP News - Dr Julie Marfell 14
Website information 16
Seventy—Fourth Annual Report - Potter & Company 17
Report of Operations — Barb Gibson . 31
In Memoriam 36
Cover: Flat Creek Clinic · March 1977 (photo by Gabrielle Beasley).
Frontier Nursing Service Quarterly Bulletin
Published at the end of each quarter by the Frontier Nursing Service,
Wendover, Kentucky 41775
Subscription Price $5.00 a year for Donors
Subscription Price $15.00 a year for Institutions
VOLUME 75 NUMBER l Summer/September 1999 ,
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. 1999 All
Rights Reserved.

Mary Breckinridge Healthcare News
by Mallie Noble, Administrator
On March 31 I was appoint- § .g ,  ._ _   ..
ed Administrator of Mary Breckin-   ..,,     M 
ridge Healthcare, Inc. (MBHC) by     “ V   V I _;
Mrs. Deanna Severance, CEO. I  l   Q;
accepted this appointment with    
pride. I realize the responsibility    
and importance of this position and i%f’W   ».;., V.  
cherish the opportunity to serve this i   i i .
organization, the employees and the _   ” Q V ‘ A . _ F ,_M7_,, 2 _
patients in the community. iii    
Iam grateful indeed for the high measure of understand-
ing and support which has been given to me by Mrs. Deanna Sev-
erance, members of the FNS Board of Govemors, professional
staff members and the employees of MBHC.
We have had several changes in job duties at MBHC over
the past three months. These included: Nancy Couch, RN, Man-
ager of Medical/Surgical, being promoted to Interim Director of
Nursing; Denise Kilbum, RN, ER Manager as Interim Assistant
Director of Nursing and has also taken on the added responsibil-
ity of managing the Hyden Rural Health Clinic; Heidi Froemke,
FNR is working in the Hyden Extended Hours Clinic which is
doing very well. Heidi has also been promoted to District Clinic
Coordinator and Mary Lee Osbome, RN, OB Manager, has taken
on the added responsibility of managing the Kate Ireland Womens
We are continuously working toward improving the ap-
pearance of the facility and have recently re-upholstered the Medi-
cal/Surgical and OB Units patient room chairs - thanks to the gen-
. erosity of the Ladies Auxiliary. The new computer system for
billing is expected to be up and running by September l, 1999.
During July, a ‘“lump and bump" clinic was held at the
‘ Hyden Rural Health Clinic with our general surgeon Dr. Diaz
i performing the surgeries. The clinic was very successful and we
“ plan to continue having this clinic in the future.

The Fourth Annual Health Fair sponsored by MBHC  
Quality Improvement Department was held on August 9 with 3l  
healthcare/informational booths represented and an estimated 250 F
community members attending. The Central Kentucky Blood Bank
conducted a Blood Drive in conjunction with the Health Fair and {
obtained 17 units. 1
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Jackie Fugate, RN and Jennifer Johnson, Rotating Tech at
Home Health - participating in the Fourth Annual Health Fair

Frontier Nursing Service takes on the Y2k Bug
j by Brian Lane, Controller
The Frontier Nursing Service   · *    
  (FNS) and its family of not-for-profit    
l companies have not been able to es-      
  cape the effects of the Y2k bug. In    
E fact, the Y2k issue is more of a strug-    
g gle for not—for-profit companies, be-      
  cause of the drastic fiI121IlClEil bl1fd€H        ° # ;_      
l that comes with the year 2000 com- rrl.  5  p  `L `  r   
  pliance issues. The FNS family has 0  M
Q been diligently planning for January l, 2000 for about two years.
  FNS has had to spend several thousand dollars as well as several
j thousand personnel hours to upgrade not only their computer hard-
  ware and software, but also all equipment that is date sensitive.
  FNS has or is in the process of replacing all computer
l and software systems. A very small percentage of FNS’s com-
l puter and software systems were Y2k compliant. Therefore, FNS
I has had to purchase Y2k compliant computers for use at Mary
[ Breckinridge Healthcare (MBHC), the Frontier School of Mid-
l wifery and Family Nursing (FSMFN), and the Frontier Nursing
l Service. This is where the financial burden begins, but certainly
does not end. FNS and FSMFN have already spent close to $17,000
on new Y2k compliant networks and in addition to the network
hardware, they have spent another $36,000 just on personal com-
puters (PC’s). MBHC is in the process of converting to a Y2k
compliant network which is going to cost in the neighborhood of
$80,000 just for all the hardware. FSMFN also had to upgrade the
  hardware and software for the Banyan Tree which cost FSMFN
l about $2,000 and then had to spend another $6,000 on a new tele-
T phone system that is Y2k compliant. Another financial impact
from upgrading for the Y2k bug is the fact that FNS is not able to
resell any of the equipment that is being replaced.
( Now that the Frontier Nursing Service family has already
spent approximately $ 141 ,000 just to upgrade the hardware com-
ponents, they still have to be concemed with all of the software

which is just as critical as upgrading the hardware. FN S, MBHC,  
and FSMFN started two years ago identifying software that would ,,
not be Y2k compliant. Some of the software that was identified in  
this process included, but was not limited to, the accounting soft- E
ware that FNS, the parent company, uses for all five companies; ·
the student database software at FSMFN; and the patient account- l
ing system that MBHC uses. The total cost to purchase software  
that is Y2k compliant just for these three software packages will l
or has cost FNS’s Real Estate, Inc. approximately $250,000. This  
is only for the cost of the software; that price does not include all l
of the personnel time that has been or will be spent on leaming l
and installing the new system, or the cost of training which is }
about $15,000. That brings the total estimated cost for planned or
completed conversions to $406,000.  
The hidden financial effect of the Y2k bug may be the  
items that will no longer function as of January l, 2000, but that s
FNS at the current time cannot afford to replace. One such item  
that falls into this category is one of MBHC’s ultrasounds. Cur-
rently, MBHC has two ultrasounds that they use for two different
ultrasound functions. One is Y2k compliant and will properly func-
tion after January l, 2000. The second, however, will no longer l
be of use as of January 1, 2000. To replace the non-compliant one ‘
would cost in the neighborhood of $175,000. Since we do have a
second ultrasound, we did not make it a priority, considering the
other systems we had no choice but to upgrade or replace.
FNS is ready for January l, 2000, but not without the A
financial burden that accompanies the Y2k bug that has infected
the technology world. Aproblem that seems to go unnoticed when
discussing the Y2k issue, especially with not—for-profits, is that
by having to spend close to halfa million dollars on Y2k compli-
ant equipment, hardware, and software, other capital purchases .
that are needed have to be put on hold in order to accommodate .
the Y2k purchases. Even with the financial hardship that has ac-
companied the coming of the year 2000, the family of the Fron- `
tier Nursing Service is well prepared to move forward into the j
2 l st century. i

l Wendover News
V by Jeremy T Bush
i “Where are the songs ofSpring? Ay, where are they?
f Think not of them, thou hast thy music too, - - -
{ While barred clouds bloom the soft-dying day,
  And touch the stubble-plains with rosy hue;
i Then in a waih'ul choir the small gnats mourn
  Among the river swallows, borne aio/i".
i -John Keats, "To Autumn"
i Wendover Weather
i We are in great anticipation
I of autumn here at Wendover. We V { tr‘»   A
l have had eighteen consecutive days   A
I of 90+ degree heat with very little   _ ‘ 1 `
I rain. According to existing weather  
records this is the longest string of    
_ 90+ degree weather since 1936.    
l Many counties in the region were  
` forced to issue water alerts and  i e;
rationing. Some of our local citi-  
zens’ wells dried "plumb up"! Cooler temperatures and low hu-
_ midity will be a welcome sight here in the hazy Appalachians.
Allied Health Tech Prep Wsit
The Frontier Nursing Service was pleased to have the
Allied Health Tech Prep students from the Medina Memorial
. Hospital in Medina, New York, visit us the week of August 2. The
i students came to be exposed to rural healthcare in action. They
l~· shadowed home health nurses and clinic staff at the Beech Fork
_ and Community Health Centers. They had a wonderful dinner at
` Wendover on August 4 complimented by one of my tours and a
. complete history of FNS. The students also had the rare opportu-
J nity to experience Appalachian culture at Appalshop, the Pine

Mountain Settlement School and with George and Sherman  
Wooton. They left us with a fresh new look at rural healthcare  
and Appalachian culture.  
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Back row, left to right: Lisa MacEvoy, Alisha A. Hodgins, Erin
Stahl, Sarah Tucken Eva Leopardi, John Huber. Front Row,
left to right: Theresa Sands, Jacqueline Parks, Sarah Jordan,
Ryan Quinn
Walt & Elaine Morrison Visit
We were pleased to have Walt and Elaine Morrison from
West Salem, Ohio, visit us for lunch on July 7. Mr. and Mrs.
Morrison were passing through the area and wanted to see the .
beautiful sights of Wendover. They had a delightful lunch and
walked around in awe of Wendover’s glorious blanket of flowers
and greenery. They left us with warm smiles and happy hearts. `

E The Osborne Brothers at Wendover
  The famous Osborne Brothers stayed at Wendover again
l this year during their annual Homecoming Festival at the Richard
  M. Nixon Center in Hyden, Kentucky, on August 6 and 7. The
g Osbome Brothers chose Wendover for their accommodations be-
cause of its quiet seclusion and serene setting. Unlike motels and
hotels, the Big House at Wendover is a traditional bed and break-
fast. Guests, like the Osbome Brothers, can stay in a hassle—free
environment far from the maddening crowd. We alsoioffer some
of the best home cooked food right from our own kitchen. The
Osbome Brothers and their band can testify to the savory meal
that they ate early on Saturday, August 7.
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Sonny Osborne (end of table) and friends at the Big House
FNS 75th Year Celebration - May 20, 2000
_ Mark you calendars for May 20, 2000. Plan to
join us in Lexington, Kentucky for our 75th year
` celebration! For information regarding accommo-
dations, etc., call Barb Gibson at 606-672-23 l 7.
 -_ More details in the next Quarterly Bulletin.

Former F SMFN Graduate Visits l
During the spring we were honored to have Beulah  
(Olson) Fomess, 1955 graduate of the Frontier School of Mid- _
wifery and Family Nursing, visit Wendover. Mrs. Fomess’s dau gh- ·
ter, son-in—law and granddaughter accompanied her. During Mrs. A
Fomess’s reminiscing, her granddaughter and she put on FNS  
uniforms and had this beautiful picture taken. Ms. Fomess wrote I
the following note regarding their stay: r
"A big thank y0u f0r such a nice stay in the Big House.
What a thrill I had t0 have my granddaughter and I sleep in Mrs. V
Breckinridge ls r00m ".’
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Beulah F orness and Granddaughter Q

In the last Quarterly Bulletin, I wrote about my visit with
I the Daughters of the American Revolution (DAR) at Bluegrass
l Committee member Mary Ann Carrico-Mitchell’s house. For me
it was such an honor to be asked by the DAR to speak about the
. Frontier Nursing Service.
~ I received the following poem written in my honor by
1 Mary Ann Carrico -Mitchell!!
  A Storyteller Came
  Yesterday, a boy came to talk to us.
{ He came to tell us a story.
3 His tie paraded Disney, with Cinderella, and
I Tweetie Bird.
It could have been of his Alice of Wonderland
I that he spoke. . .
  Or of his grandmother . . . his sweetheart?
i His passion told us his story — not the date
I and events.
[ He loved her for all she had given him.
t Though dead for many years now, he sought
to restore her very dwellings;
To show to others the paths she walked, the
flowers she planted.
She was Mary Breckinridge, adopted daughter
of Kentucky.
. And he, the storyteller, a minion and product
of her spirit’s largesse . . .
if The pride of the Frontier Nursing Service.
·». Dedicated t0 Jeremy Bush June 3, l999 by Mary Ann Carrica-

Courier Program News  
by Jeremy T Bush ·
We are preparing t0 say a good—bye to our summer Cou- i
riers. Here are some anecdotal notes that reveal much about them
and the work they have done for FNS over the summer.  
While visiting Dr. Diaz (MBHC Surgeon), I found that  
Erin Lyons is quite famous among the nurses. Apparently, she l
has eamed the nickname of "Band—Aid Girl" for her willingness  
to quickly locate and retum supplies to the nurses in surgery. This
dedication to service, even in the unglamorous "dirty work" at l
FNS, is the pure essence of what being a Courier is all about. We E
are all proud of Erin and the hard work she has done here. I
Garry Finke has worked with Dr. Raghuverra (MBHC l
Pediatrician) much of the summer. Garry wants to become a Pe- l
diatrician himself in the near future. From what we have seen of
Garry with his peaceful fortitude and gentle nature, we know that
he will certainly be a great asset to any healthcare organization.
Carrie Szejk has been accepted into Case Westem Re-
serve University’s nurse-midwifery program! Carrie has thor-
oughly enjoyed working with our full—time midwives, Cyndy
Perkins and Debbie Karsnitz. Carrie also loved being involved
with Level III classes at the Hyden campus of the Frontier School
of Midwifery and Family Nursing. We wish her well and many
happy "catches"!
Rachel Maski, who aspires to be a doctor, has also been
working with our midwives. Rachel was involved with the Level
III classes in Hyden and has been willing to do anything at any— il
time for FNS. She has been a dependable member of the summer
group who never fails to have a sunny disposition. _

  All of these Couriers were involved in a locally spon-
`_ sored "Footsteps to the Future" summer camp. This camp allowed
y young people in the county, ages 11-14, to experience a fun learn-
ing experience before going back to school. The young people
. were involved in activities such as tie-dying, constructing dream
k catchers and playing soccer. The camp was quite an experience
1 for all involved.
5 Former Courier News
l Danielle Olds (‘98) - wrote from beautiful Mexico. She
said that Guadalajara is a busy and culturally rich city. She will
i be starting nursing school at Case Western Reserve University
1 September 1, 1999.
l Catherine (Cat) Thompson ( ‘98) — wrote to say that she
had a great visit at Wendover over Memorial Day weekend. She
said that Kentucky will always hold a special place in her heart.
Beth Muzzy (‘97) - is a psychology major in Women’s
Studies at the University of Vermont and plans to become a di-
rect—entry midwife or work in clinical psychology. Below is Beth
and her "love".
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Tarah Somers (‘96) - just finished her BSN at Johns l
Hopkins School of Nursing. She has already started the master’s .
Nursing and Public Health programs at Hopkins and will finish
the dual masters in December 2000. Tarah worked in Nepal with
"Save the Children" for six months before beginning nursing ‘
Ann DeB0urcy (‘98) wrote to say that after extensive j
decision making she has decided to pursue a career in medicine, l
most likely pediatrics. Ann wrote that she remembers coming  
home from MBHC and euthusiastically describing to Barb the l
details of all of the surgeries she had observed that morning.  
Ann is working in a hospital this summer and will apply  
to medical school after graduation in 2001. i
Preview 0f Fall 1999 Couriers i
Norna Ludeman is a Senior Human Biology major at j
Stanford University in Stanford, California. She plans to spend a  
few years volunteering in order to get a first—hand look at health- 4
care before pursuing an MD or an MPH. l
Kimberly H0uk0m graduated from Stanford University l
in 1997 with a major in English with pre—med courses. She is
thinking about applying to medical school. Kimberly has spent
some time teaching science in outdoor settings to grade school p
children. She has also been leading backpacking trips in the Tetons  
of Wyoming.
Julie Wilbur graduated this year from Colby College in
Waterville, Maine. She plans to apply to medical school in the ;
ran Or 2000.   ..

t Frontier School of Midwifery and Family Nursing
S by Susan Stone, CNEP Program Director
· CNEP continues to be an ex-   v·.V; . vVV·’   I i · r   - 
{ citing and busy program. This past   S if it,'  
} spring we celebrated a Decade of ·VVV z j  
E Excellence at the Convention of the   Ay__ v_  
{ American College of Nurse-Mid-        
wives. We are very proud to have ed-       {
r ucatcd over 760 nurse-midwives in * V‘ii~ ` if     -
K the past decade using the Community /,.`  
as the Classroom concept. Our grad-    
i uates now represent every state in   ·L *·.'
V the USA.
We are currently working diligently to place our courses
on our Web Site. This has been a challenging task but our multi-
media group is up to the challenge. The group consists of Heather
East, Mary Ann Mullins, Cherie Bunch, and Shelley Gottbrath.
To see samples of their creative work, visit our Web Sites at
www.midwives.org and the www.frontierfnp.org. We believe that
the on—line delivery of courses will be more convenient for stu-
dents, provide a more interactive leaming environment, and al-
low links to relevant material on the World Wide Web.
This is an exciting time for the FSMFN as we reintro-
duce the Family Nurse Practitioner program. We have worked
very hard to incorporate the new FNP program into every part of
our school literature such as the student handbook, the faculty
handbook, and the new school catalog. We are working with the
J FN P faculty to develop core courses that will be taken by both the
_ midwife and FNP students. This interdisciplinary approach prom-
i ises to make both programs stronger through the sharing that will
* occur.
We are busily preparing now for a very inspiring time of
  year in Hyden. This is our annual graduation ceremony that will
be held on October 16, 1999 at the Richard Nixon Center in Hyden.

There is nothing more rewarding than seeing our students
graduate as nurse—midwives. This is the time of year when the ,
entire faculty gathers in Hyden for our annual faculty meeting
and to celebrate the success of our students. With the leaves in
full color on the mountains, it is almost a magical time.  
As we head forward to a new millennium, I like to think  
that Mrs. Breckinridge would be proud of the progress that we  
are making towards bringing high quality health care to the l
underserved in every part of our nation. {
Frontier School of Midwifery and Family Nursing  
by Dr: Julie Marfell, Assistant CFNP Program Director  
The CFNP Program received all i
official notification in June from Dor— I  
othy Brooten, PhD, FAAN, Dean of y . { i'~.. I    ,
Nursing at the Frances Payne Bolton ~   it -5  
School of Nursing at Case Western     ``AV ` `fiii ` V _Q  i ·,  Q  
Reserve University (CWRU) that the _ g f       L
extension of the affiliation with the    ,     "  
Frontier School of Midwifery and 2,    ''‘‘i     if '‘`` mf  
Family Nursing (FSMFN) was ap-   """‘ I I ·"'°
proved by the Board of Trustees. This affiliation provides accredi-
tation by the National League of Nursing and the North Central
Association of Colleges and School Commission on Institutions
of Higher Leaming. The students who successfully complete the
Community—Based Family Nurse-Practitioner Program will be
awarded a Masters of Science in Nursing Degree from CWRU. y,
In July, we received notification from the Kentucky Coun-
cil on Postsecondary Education the FSMFN license to operate as L
a non—public institution in Kentucky was amended to include the I
Certificate in Family Practice Nursing, Post-RN program. It con-
tinues to be an exciting time for the CFNP at FSMFN.

The first class of the CFNP begins September 29, with
r CFNP Bound at the Hyden campus. In the tradition of CNEP, this
orientation period introduces the students to the program, Level I
3 courses, each other, and the faculty. It is an opportunity to build a
·¤ community among the students of each class.
i Part of the tradition of this orientation period is to bring
out the rich heritage of FNS and FSMFN. As part of this tradi-
tion, we have invited Jean Fee, a 1959 graduate of the FSMFN
midwifery program and a certified FNP to join us for dinner at
Wendover on September 29.
E Jean came to FNS in 1958 from Alberta, Canada, to work
on the "general side" of the old hospital. In 1959, Jean graduated
as a midwife and began district nursing at the Wolf Creek Clinic
and then at Beech Fork. Jean retumed to Alberta in 1960 and
  continued working in public health and various hospitals. She
married and had two daughters.
..V,-v   ,v·,... ~ . , · "' I 1 _
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ii Jean Fee at the Beech Fork Clinic during June 1998

In 1973, Jean retumed to McKee, Kentucky. She worked
in a physician’s office and then at Manchester Memorial Hospi— ,
.. tal. In 1980 she became certified as a FNP and in 1986 shejoined
the White House Clinic, a rural family practice clinic in McKee
where she continues to work today. Jean was honored this year as Z
Kentucky Nurse—Practitioner of the year, an award of the Ameri-
can Academy of Nurse—Practitioners administered locally through
the Kentucky Coalition of Advance Practice Nurses. We are thrilled
that Jean has graciously accepted our invitation to dinner and to
speak with our students about her experiences.
We are also grateful to Dr. Anne Wasson for organizing a
scholarship for FNP students in her name. Dr. Anne is an original
founder of the first FNP program at FSMFN, has served as an
interim director of FNS and spent more than 13 years providing
medical services at FNS. She has continued to lend support to
FNS as medical director emeritus and as an FNS board member.
Dr. Anne recently said in the article done about FNS in the Lex-
ington-Herald Leader that one of the best parts of the job was
teaching nurses. We have invited her to share her experiences and
wisdom with the class during dinner at Wendover September 29.
Frontier Nursing Service — www.frontiernursing.org
Frontier School of Midwifery and Family Nursing Community-
based Nurse-Midwifery Education Program (CNEP) -
Frontier School of Midwifery and Family Nursing Community- W
based Nurse-Practitioner Program (CFNP) — www.frontierfnp.org

For the Fiscal Year
May 1, 1998 to April 30, 1999
As has been our custom since we were one year old, we present
our annual report of the fiscal affairs of the field operations of the
Frontier Nursing Service, Incorporated.
We have, as in previous years, divided our report into two sec-
tions. One section is about money, and one is about work.
The figures that follow are taken from the Balance Sheet, the
Exhibits and Schedules of the Audit for the fiscal year which ended
April 30, 1999.

_ To the Board of Governors K
FNS, Inc. and Affiliates
Wendover, Kentucky `
We have audited the accompanying combined statements of financial position of FNS, Inc. and
Afhliates as of April 30, 1999 and 1998, and the related statements of activities and cash flows
for the years then ended. These Hnancial statements are the responsibility of the Service's
management. Our responsibility is to express an opinion on these financial statements based
on our audits.
We conducted our audits in accordance with generally accepted auditing standards. Those
standards require that we plan and perform the audit to obtain reasonable assurance about
whether the financial statements are free of material misstatement. An audit includes
examining, on a test basis, evidence supporting the amounts and disclosures inthe Hnancial `
statements. An audit also includes assessing the accounting principles used and significant ,
estimates made by management, as well as evaluating the overall tinancial statement
presentation. We believe that our audits provide a reasonable basis for our opinion. `
ln our opinion, the financial statements referred to above present fairly, in all material respects, I
the financial position of FNS, Inc. and Affiliates at April 30, 1999 and 1998, and the changes in  
its net assets and its cash flows for the years then ended in conformity with generally accepted I
accounting principles.
pwlf/~ f   LU
August 25, 1999

‘ April 30, 1999 and 1998
i 199.9 1.99.8
Cash and cash equivalents $ 1,433,198 S 1,248,213
Accounts receivable, less allowances for
uncollectible accounts of $479,000 in 1999
and $893,000 in 1998 2,804,227 2,010,785
Accounts receivable-students tuition, less allowance
for uncollectible accounts of $31 ,000 in 1999 and
$44,000 in 1998 209,933 92,321
Investments 26,564,169 23,760,453
l Inventories 413,533 370,527
‘ Prepaid expenses and other assets 88,252 121,996
, Property and equipment, net 3,296,973 3,604,130
Present value of benehcial interest in outside trusts 1,927,326 739,439
  Total assets $ 36,737,611 $ 31,947,864
Accounts payable S 1,517,125 $ 342,746
Accrued salaries and withholdings 341,982 329,570
Accrued vacation expense 372,806 274,142
Deferred tuition, students 243,675 222,242
Self-insured reserve 435,300 161,448
Payable to third-party programs 755,141 575,738
Capital lease payable 351,519 478,386
Bond payable 513,210 602,384
Other liabilities 655,572 727,436
Total liabilities 5,186,330 3,714,092
I Commitments and contingencies
` Unrestricted 26,592,815 23,901,643
Temporarily restricted 724,403 1,461,913
_, Permanently restricted 4,234,063 2,870,216
Total net assets 31,551,281 28,233,772
i Total liabilities and net assets $ 36,737,611 $ 31,947,864
See accompanying notes.

Years ended April 30, 1999 and 1998 q
Changes in unrestricted net assets: ti
Revenues and gains:
Net patient service revenue $ 13,885,188 $ 14,624,871
Contributions 914,790 830,873
Education revenues:
Tuition and educational fees 1,546,645 2,131,025
Federal grants 210,145 301,056
Other grant revenue 43,143 29,868
Net realized and unrealized gain on investments 3,268,576 4,233,769
Other revenue:
Investment income 801,270 802,475
Other revenue 332,656 636,835
Net assets released from restriction due to
satisfaction of program requirements 783,700 418,902
Total unrestricted revenue 21,786,113 24,009,674
Salaries and wages 8,807,834 9,055,788
Fringe benefits 1,602,775 1,676,300
Medical services, supplies, and other expenses 6,039,829 6,697,000
Facility costs 1,430,824 1,376,558
Provider taxes 438,541 347,784
Provision for bad debts 775,138 797,089
Total expenses 19,094,941 19,950,519
Increase in unrestricted net assets 2,691,172 4,059,155
Changes in temporarily restricted net assets:
Contributions 46,190 58,909
Net assets released from restriction (783,700) {418,902)
Decrease in temporarily restricted net assets (737,510) g359,993)
Change in permanently restricted net assets:
Contributions 175,960 55,696
Present value of beneficial interests in outside trusts 1,187,887 200,124
Increase in permanently restricted net assets 1,363,847 255,820
Increase in net assets 3,317,509 3,954,982
Net assets, beginning of year, as previously reponed 28,233,772 23,893,662
Prior period adjustment 0 385,128 ~‘
Net assets, beginning of year, restated 28,233,772 24,278,790
Net assets, end of year S 31,551,281 $ 28,233,772
 ‘“"‘  "'**” )
See accompanying notes.

Y Years ended April 30, 1999 and 1998 199.8
Cash flows from operating activities:
Change in net assets $ 3,317,509 $ 3,954,982
Adjustments to reconcile changes in net assets
to net cash provided by operating activities:
Present value of beneficia