xt7b8g8fgj42 https://exploreuk.uky.edu/dips/xt7b8g8fgj42/data/mets.xml The Frontier Nursing Service, Inc. 2002 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. 78, No. 1, Summer/September 2002 text Frontier Nursing Service, Vol. 78, No. 1, Summer/September 2002 2002 2014 true xt7b8g8fgj42 section xt7b8g8fgj42 FRONTIER NURSING SERVICE  
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 US ISSN 0016-2116
TABLE OF CONTENTS ‘r
Introduction to FNS I
Courier News - Barb Gibson 2
Wendover News - Barb Gibson 4
Mary Breckinridge Healthcare News - Malle Noble 8
FSMFN News - Dr: Susan Stone 12
Website Information I3
Audit Report - Potter & Company 14
In Memoriam 39
Christmas Needs - Barb Gibson 46
Cover: Left to right - Betty Lester, FNS Nurse and Mary Breckinridge,
Founder of FNS.
Frontier Nursing Service Quarterly Bulletin
Published at the end of each quaner by the Frontier Nursing Service
Subscription Price $5.00 a year for Donors/$15.00 for Institutions
Volume 78 Number l Summer/September 2002 °
Periodicals postage paid at Wendover, Kentucky 41775 and at addi-
tional mailing offices. POSTMASTER: Send address changes to FNS, '
Inc. 132 FNS Drive, Wendover, Kentucky. Copyright FNS/Inc. 2000
All Rights Reserved.

 QUARTERLY BULLETIN 1
Frontier Nursing Service
Uyou have never been introduced t0 the Frontier Nurs-
ing Service we would like to take this opportunity t0 brief you 0n
’ the history and the 0n—g0ing work 0f the Service. Please share
this information with afriend.
Born in 1881 into a prominent American family, Mary
Breckinridge spent her early years in many parts of the world -
Russia, France, Switzerland and the British Isles. After the death
of her two children, she abandoned the homebound life expected
of women of her class to devote herself to the service of others,
particularly children.
Mrs. Breckinridge established the Frontier Nursing Ser-
vice (FNS) in Leslie County, Kentucky in 1925, then one of the
poorest and most inaccessible areas in the United States. Mrs.
Breckinridge introduced the first nurse-midwives in this country.
Riding their horses up mountains and across streams in blizzard,
fog or flood, the FNS nurses brought modem healthcare to fami-
lies throughout an area of 700 square miles.
Until her death in 1965, Mary Breckinridge was the driv-
ing force behind the work of the Service whose influence today
extends far beyond eastern Kentucky. Through the Frontier School
of Midwifery and Family Nursing, hundreds of nurses have been
trained and this important concept of family healthcare has been
carried throughout the world.
Today, FNS, Inc., is organized as a parent holding com-
pany for Mary Breckinridge Healthcare, Inc., Frontier Nursing
Healthcare, Inc., which includes four rural healthcare clinics (Com-
munity Health Center, Beech Fork Clinic, Kate Ireland Healthcare
Center # 1 and Kate Ireland Healthcare Center # 2) and for the
· Frontier School of Midwifery and Family Nursing - the largest
midwifery program in the United States.
Remarkably, the purpose and philosophy of the FNS has
' remained constant since 1925.

 2 FRONTIER NURSING SERVICE  
Courier Program News E
-Barb Gibson .
Kelly Short, who arrived during
June, left August l0 to pursue her plans   I
for becoming a nurse. Kelly wrote the C;. . p
following comments regarding her ex- _V , V- ·  
periencec 4 {
"Throughout my experience, I   i
have felt supported and challenged by F ‘  
FNS. I have been humbled and strengthened by the opportunities  
the Courier Program has provided me to both serve and be served."  
While here Kelly worked with the Patient Assistance Pro- ;
gram designed to make prescription medicines available to low  
income individuals, delivered lab specimens for analysis, trans-  
ported supplies and worked on patient education projects. Wen- I
dover and clinics staff held a "going away" dinner for Kelly at the  
Big House (pictured below).  
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Back row [ep to right: Kelly Short, Lynn Wilkening, Heidi
Froemke/Second row - Debi Karsnitz, Pat Caudle, Vivien .
Jutsum, Beverly May/Front row - Carolyn Wells, Tracy
Pennington, Phyllis Couch, HeatherAshe1; and Angela Mitchell

 . QUARTERLY BULLETIN 3
I Former Courier News
Winter ‘98 Couriers (Karen Thomisee, Mariah Mottley, Susan
Mathew, Catherine Thompson and Jennifer Swisher) wrote that
I they got together in Helen, Georgia, for their 2002 reunion. They
reported that Jennifer graduated from medical school during June
j and is going to Terre Haute, Indiana, for family practice residency;
I Catherine is a nurse at Mt. Sinai in New York City; Mariah is
. back in New York with her dog, Juno, and is about to graduate
. from college; Susan fmished her masters in London in September
. and is working in Washington, DC, and Karen is a writer and
  photographer at a newspaper in North Carolina.
p Gretchen Landwehr (‘91) - Barb Gibson saw Gretchen at a Na-
p tional Health Service Corp. Conference in Arlington, Virginia, dur-
i ing June. Gretchen graduated from Yale School of Nursing for
Nurse-Midwifery.
' Rebecca Lesser (‘01), Berkeley, Califomia, wrote that she was
accepted to Yale School of Nursing for Nurse-Midwifery.
  Tom Doran (‘94), Providence, Rhode Island, wrote that he is a
Q "swamp yankee," a Rhode Islander. He said that he has rediscov-
  ered a call to "plant seeds of light" in his cormnunity and will be
  working with Americorps. Tom said his experience at FNS will be
  a great help in his work.
  Krista Nickerson (‘95), Albuquerque, New Mexico, stopped by
l Wendover during August. She will be attending nurse-midwifery
[ school at the University of New Mexico. She has worked in Ver-
i mont as an RN for two years. Krista reported that David Randall
U . (‘95) is living in Vermont and will be getting married this fall.
l Heidi Ho_@‘”man (‘93), Palo Alto, California, wrote that she is a
£ . radiologist now and just finished five years of residency at Emory
University in Atlanta, Georgia. Heidi is at Stanford University for
a year doing a fellowship in "abdominal imaging".

 4 FRONTIER NURSING SERVICE {
  l
Wendover News  
by Barb Gibson y.
The summer has been long and hot   ~ N
and we anxiously await cooler temperatures!     p ·
Housekeeping and maintenance staff are be-   '     i
ginning work on "fall" projects including      
painting and giving things a fresh look. We   if
look forward to the annual Mary Breckin- V   _ ` {
ridge Festival October 5 with "open hOus€" `  2-  _ 5
at Wendover following the Festival. We are also looking forward i
to CNEP graduation on October 19 in conjuction with the FNS °
Board of Governors fall meeting. Fall is a beautiful time to visit i
Wendover. Call for your reservations! i
E
We entertained/hosted the following guests and functions  
since the last report:  
May 16 University of Cincinnati Nurse Midwifery stu-
dents (l 0 students/ faculty).
May l7 Team Management Meeting (16). T
June 4 Mary Breckinridge Festival Committee meeting
(7). F
Joanne Schoenbachler and friends, Louisville,
Kentucky (3).  ¤
June 7 Venita Caldwell & family, Hyden, Kentucky
(5).  4
June ll Mr. & Mrs. Clay Hinkle, Busy, Kentucky. ; l
June 12 Team Management Meeting (16). ~ —
June 24 -27 Loren Crawford & daughter, Chicago, Illionis. i

 QUARTERLY BULLETIN 5
i June 27 - 29 Mary Lou Bradbury, Spokane, Washington, FNP
t` interview.
July 8 Mary Breckinridge Festival Committee meeting
, (7)-
z
July 10 Marc Cobane & James Fereday, Lexington,
Kentucky.
" July 15 Karen Duquette, Okemos, Michigan.
July 16 - 17 Martin Joplin, Cleveland, Ohio. FNP position
interview.
July 17 Heidi Froemke, FNP Coordinator, and six guests
for dinner.
July 21 Anne O’Connell, Chicago, Illinois.
Christine & Darlene Palmer, Cooperspound,
I New York. Christine was a Courier in 1963.
s
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Darlene and Christine Palmer

 6 FRONTIER NURSING SERVICE  
July 22 Emily Wright, Midland, Texas. E
Becky Fletcher, Lexington, Kentucky. I
Mary Breckinridge Festival Committee meeting ·
(10).
¤
July 23 CNEP & FNP Level III dinner (20 students!  
faculty). I
July 27 Becky Fletcher, Lexington, Kentucky.  
l
July 31 Allied Health Tech, Medina, New York (10).  
August 1-2 Osborne Brothers Hometown Festival group  
(5)-  
John & Ruth Thomas, Jamestown, Ohio.  
Donna Prewitt, Dayton, Ohio.  
I
August 2 - 3 Bemice Pruitt, Huber Heights, Ohio.  
l
Steve Owen & Brenda Slater, Huber Heights,  
ohio. I
1
Quinton Howard, N. Alex, Ohio.  
I
Noel F emandez, Pomona, New York.  
l
Ronnie & Erma Kemble, Lexington, Kentucky. l
I
August 5 Krista Nickerson & Kim Feltovic, Baltimore,   .
Maryland. Krista was a Courier in 1995.  
August 7 Kelly Short (Courier) - “going away” dinner   ·
(13).

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1 QUARTERLY BULLETIN 7
I August 9 Patty Stewart, Lexington, Kentucky.
3 August 12 - 13 James Maddeningly, Femandina Beach, Florida.
* Bill Maddeningly, Louisville, Kentucky.
E August 13 Wayne & Betty Besaw, Annville, Connecticut.
  August 14 Dick & Colette Lallier, Meriden, Connecticut.
  August 17 Berea College Faculty, Berea, Kentucky (15)
  August 20 Mary Halley, Lexington, Kentucky.
  Jeanna R. Conder, Winchester, Kentucky.
  August 23 Frontier Bound (50 students/faculty).
i
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  Tours
l July 31 Allied Tech Prep, Medina, New York (10
  students/faculty.
l August 17 Berea College, Berea, Kentucky (13 faculty).
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 8 FRONTIER NURSING SERVICE {
Mary Breckinridge Healthcare, Inc. News  
by Mallie Noble, Administrator  
Annual Health Fair I
Mary Breckinridge Healthcare, Inc., ir
conducted the Seventh Amrual Health Fair at  
the Richard M. Nixon Center on July 26,   .·._...  
2002. The Quality Improvement Department I   _ ii il 3
organizes this event each year. This year ’s     - '  I g
theme was “Caring is our Business." The   g A
health fair is an event to increase community
awareness of the available healthcare services in the community
and in eastem Kentucky. Information was available for prevention
of heart disease, strokes, diabetes, nutrition and Alcoholics Anony-
mous. Sixty-two vendors participated and 400 guests attended the
event. Thanks to the Quality Improvement and Care Committee
employees for their hard work. · 
Sympathy l
We extend heartfelt sympathy for the following employ- I
ees during the loss of loved ones: Patty Smith - father; Vanessa ’
Melton - grandmother; Mona Howard - grandmother; Martha  
Williams - husband; April Bowling — uncle; and Lena Bishop - I
aunt.  
Nurse Aide Week
The week of August 5 - 9, we celebrated Nurse Aide Week.
All nurse aides received a gift and free lunch certificates were . I
provided. A scavenger hunt and surprise circle contest were held.
Thanks to our nurse aides for their hard work and caring.
D1: Ray Mirghese - Irreplaceable .
Roy Varghese joined the FN S, Mary Breckinridge Health- .
care, Inc., staff March I6, 1992, and is referred to by staff and
community members as "irreplaceable”. Dr. Varghese is board cer- ·
tified in lntemal Medicine, has a fellowship in Infectious Diseases,
is an ACLS Instructor and HIV-AIDS Education Trainor. He is

 j QUARTERLY BULLETIN 9
  an asset to our hospital and community. He is a very kind and
  compassionate person who has always been willing to help pa-
T tients and employees. He goes above and beyond his normal call
{ of duty and is respected by all.
“~ Dr. Varghese lives in Hyden at the Joy House with his
wife, Dr. Lilly Varghese. They have four daughters: Dr. Liza Roy
Varghese; Dr. Nisha Roy Varghese; Linda Roy Varghese and Asha
Roy Varghese. They have three grandchildren: David, Grace and
, Sarah Elizabeth. We love you, Dr. Varghese!
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l E quqrment Upgrades
Our goal at Mary Breckinridge Healthcare, lnc., is to pro-
vide the best healthcare possible. We recently were able to pur-
chase/ lease a new ultrasound machine and a CT scammer. The CT
T scarmer is a high speed scanner with Auto Smart mA which re-
duces the amount of radiation patients receive during scanning.
The ultrasound machine performs 3D imaging including harmonic
“ imaging and cardiac, abdomen, OB and vascular imaging. See
photos on next page.

 l0 FRONTIER NURSING SERVICE I
 
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Ultrasound Machine
We extend a special "thank you" to Mrs. Philip
Vaughan, San Marino, Califomia, for making a
donation toward a supply cart for the Purchasing
Department. A

 l
QUARTERLY BULLETIN ll
Tean Pregnancy Prevention Lock-In
) ln 1999, Debi Karsnitz, CNM and Karen Sallee, Social
i Worker, decided they wanted to make an impact on teen pregnancy
in Leslie County. They became the coordinators for the annual
. Teen Pregnancy Prevention Lock—ln where teens age l2-l6 enjoy
a night of food, music, dancing, games, sports, door prizes and
  teaching sessions on pregnancy and STD prevention, peer pres-
y sure and date rape. This year there were 320 participants.The Lock-
J In is supported through donations from local businesses. We are
T very thankful to Walmart in Hazard, Kentucky, for their giit this
M year of$l,000.00.
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j Left to right - Mike Huber, Walmart Manager and Karen Sallee,
  Social Worken In background on right - Marbeth Joseph, Hu-
  man Resources Directon
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l2 FRONTIER NURSING, SERVICE  
Frontier School of Midwifery and Family Nursing News  g
by Dr: Susan Stone, CEO & President il
Fall is here again and brings with it ~..
thoughts of` the October graduation cere- , t
monies. Although FSMFN allows students      
to actually graduate at the time they take       ‘
their comprehensive exam, our graduation      
is held once each year in October in Hyden,   "  
Kentucky. Last year, due to the generosity   i  
of our many donors, we were able to award over $30,000 to our f
graduates in scholarships.  
These awards at the time of` graduation are most appreci—  
ated. More than 80% ofthe F SMFN students participate in the l
federal financial aide program. The average age of an F SMFN  
student is 35 years old. They are adults with the typical adult re-  
sponsibilities of jobs and families. When they return to school, '
they obtain loans for tuition, books, travel, computers and living l
expenses. The result is that they graduate with large student loans. V
Awards last year included scholarships from the follow-
ing F unds: Arronson; Daughters of Colonial War; Kate Ireland;
Kitty Emst Award and Scholarship; Lisa Scherer; Mardi Perry;
Margaret Ferguson; Nancy B. Taylor; and the May Scaife Schol-
arship. The Betty Lou Johnson Scholarship was awarded earlier
in the year. We will soon have two new scholarship awards includ-
ing the Dr. Anne Wasson Scholarship and the Suzanne Preston
Wilson Memorial Scholarship. l want to express my deepest grati- -
tude to the donors who support our students and graduates as they
pursue graduate nursing education. I
Other big news includes the fact that we will have three .
CF NP graduates attending the ceremony this year. We are thrilled i_
to see the results of` our hard work to develop an excellent Family
Nurse Practitioner Program based on the CNEP model. It is very
rewarding to finally have Family Nurse Practitioner graduates join = .
the festivities this year. The first graduates of the CFNP include gr
Karen Orberson, Vickie Delluryue, Barbra Keller, Cecelia Watson i

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  QUARTERLY BULLETIN 13
l
  and Christine Larson. To help us to celebrate our first group of
lg. CFNP graduates, our graduation speaker this year will be a na-
tional educator and FNP, Dr. Michael Carter. Dr. Carter is the
former Dean of Nursing at the University of Tennessee Health
¤i Science Center.
{ To add to our excitement this fall, we are awaiting the
  birth of Dr. Julie Marfell’s second baby. Julie is the Chairperson
I of the Department of Family Nursing at FSMFN. Baby Rose is
g due to arrive just about the time of graduation. More news and
i hopefully a picture in our next Quarterly Bulletin.
 
j OOOOOOOOOOOOIOOOOOOOOOOOO
  wiznsmas
  Frontier Nursing Service - www.frontiemursing.org
l F SMFN Community Based Nurse-Midwifery Education
l Program (CNEP) — www.midwives.org
F SMFN Community Based Nurse-Practitioner Program
(C FNP) - www.frontierf'np.org

 ` {
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14 FRONTIER NURSING SERVICE  
1
SEVENTY-SEVENTH ANNUAL REPORT ~‘
OF i`
THE  
FRONTIER NURSING SERVICE E
f
For the Fiscal Year  
May 1, 2001 to April 30, 2002 i
E
Preface  
As has been our custom since we were one year old, we present  
our annual report ofthe fiscal affairs of the field operations ofthe  
Frontier Nursing, Incorporated.  
We have, as in previous years, divided our report into two sec-  
tions. One section is about money, and one is about work.  
I
Fiscal Report i
I
The figures that follow are taken from the Balance Sheet, the Ex-  
hibits and schedules of the Audit for the fiscal year which ended i
April 30, 2002. {

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i` INDEPENDENT AUDITOR’S REPORT
l
To the Board of Governors
FNS, Inc. and Affiliates
I Lexington, Kentucky
l We have audited the accompanying combined statements offinancial position of FNS, Inc. (a non-
· profit organization) and affiliates as of April 30, 2002 and 2001, and the related combined
statements of activities and changes in net assets and cash flows for the years then ended. These
combined Hnancial statements are the responsibility of the Service's management. Our
responsibility is to express an opinion on these combined financial statements based on our audits.
l We conducted our audits in accordance with auditing standards generally accepted in the United
I States of America. Those standards require that we plan and perform the audit to obtain reasonable
I assurance about whether the combined Hnancial statements are free of material misstatement. An
I audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the
i combined financial statements. An audit also includes assessing the accounting principles used and
  signihcant estimates made by management, as well as evaluating the overall financial statement
  presentation. We believe that our audits provide a reasonable basis for our opinion.
i In our opinion, the combined financial statements referred to above present fairly, in all material
  respects, the financial position of FNS, Inc. and afhliates as of April 30, 2002 and 2001, and the
L changes in its net assets and its cash flows forthe years then ended in conformity with accounting
[ principles generally accepted in the United States of America.
k
l
&»iZLlJ./ ig   / LLP
POTTER & COMPANY, LLP
i July 25, 2002
i

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FNS, INC. AND AFFILIATES i
COMBINED STATEMENTS OF FINANCIAL POSITION `
April 30, 2002 and 2001
s,
2002 2001
ASSETS I
I
Current assets:  
Cash and cash equivalents $ 772,319 $ 1,240,195 I
Receivables:  
Patient, less allowances for uncollectible I
accounts of approximately $842,000 and
$963,000 in 2002 and 2001, respectively 2,685,411 2,824,773
Student tuition, less allowances for uncollectible
accounts of approximately $18,372 and I
$15,000 in 2002 and 2001, respectively 187,986 170,450 I
Bequest receivable 500,000 0 [
Other 96,383 900 I
Investments 21,940,777 25,396,202  
Inventories 254,188 260,116  
Prepaid expenses and other assets 431,463 331,750 I
Total current assets 26,868,527 30,224,386 I
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Property and equipment, net 2,648,925 2,470,509  
I
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Other assets; I
Beneficial interest in outside trusts 1,772,000 1,899,853 I
Investments held in perpetuity 3,969,022 3,919,022 I
Total other assets 5,741,022 5,818,875 I
Total assets $ 35,258,474 $ 38,513,770
See accompanying notes. 2

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E &
I LIABILITIES AND NET ASSETS
I Current liabilities: _
I Accounts payable $ 837,945 $ 1,010,246
I Accrued salaries and withholdings 305,257 381,087
I Accrued vacation expense 352,409 385,129
Deferred tuition, students 518,273 513,413
Self-insured reserve 99,798 321,845
Estimated third-party payor settlements 450,000 458,639
I Capital lease payable - current portion 0 94,712
I Notes payable - current portion 207,287 15,879
I Bond payable - current portion 122,330 106,919
a Other liabilities 593,390 628,568
I Total current liabilities 3,486,689 3,916,437
I
I Commitments and contingencis
  Long term liabilitesz
I Notes payable, net of current portion 37,322 54,606
I Bond payable, net of current portion 89,589 211,395
I Total long term liabilities 126,911 266,001
I Total liabilities 3,613,600 4,182,438
I Net Assets:
I Unrestricted:
I Board designated 16,897,018 19,425,154
Undesignated 4,945,294 4,908,796
I Temporarily restricted 4,061,540 4,178,507
I Permanently restricted 5,741 ,022· 5,818,875
Total net assets 31,644,874 34,331,332
Total liabilities and net assets $ 35,258,474 $ 38,513,770
3

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FNS, INC. AND AFFILIATES =‘.r
COMBINED STATEMENTS OF ACTIVITIES AND CHANGES IN NET ASSETS `
Years ended April 30, 2002 and 2001
i
@2 @
Change in unrestricted net assets; `
Revenues and gains: ‘
Net patient service revenue $ 13,188,196 $ 14,250,646 `
Contributions 592,297 689,148  
Education revenues:  
Tuition and educational fees 1,475,710 1,562,281 Y
Federal grants 112,225 113,786  
Other grant revenue 45,836 79,944 Y
Other revenue:  
Investment return (1,472,291) (3,096,388)  
Other revenue 199,152 269,933 5
Net assets released from restriction due to l
satisfaction of program requirements 250,428 67,501  
Total revenues and gains 14,391,553 13,936,851  
Expenses:
Salaries and wages 7,565,146 7,988,893 ~
Fringe benefits 1,278,084 1,429,429 i
Medical services, supplies, and  
other expenses 5,385,675 6,924,364 ‘
Facility costs 1,234,232 1,718,572 g
Provider taxes 196,619 181,398 ,
Provision for bad debts 1,223,435 1,113,242  
Total expenses 16,883,191 19,355,898 i
Change in unrestricted net assets (2,491,638) (5,419,047)  
Change in temporarily restricted net assets:  
Contributions 590,692 85,852  
Investment return (523,552) (288,327)  
Change in annuity payable 66,321 34,165
Net assets released from restriction due to
satisfaction of program requirements (250,428) (67,501)
Change in temporarily restricted net assets (116,967) (235,811)
Change in permanently restricted net assets;
Contributions 50,000 2,212,500 ,
Beneficial interests in outside trusts (127,853) (205,817) )
Change in permanently restricted net assets 77,853 2,006,683 _
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See accompanying notes. 4 (
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 _.~ FNS, INC. AND AFFILIATES
COMBINED STATEMENTS OF ACTIVITIES AND CHANGES
IN NET ASSETS (CONTINUED)
Years ended April 30, 2002 and 2001
a
2002 2001
, Change in net assets (2,686,458) (3,648,175)
1 Net assets, beginning of year 34,331,332 37,979,507
  Net assets, end of year $ 31,644,874 $ 34,331,332
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I See accompanying notes. 5

 FNS, INC. AND AFFILIATES  
COMBINED STATEMENTS OF CASH FLOWS V
Years ended April 30, 2002 and 2001
l,
ALE. @
Cash flows from operating activities: ,
Change in net assets $ (2,686,458) $ (3,648,175) l
Adjustments to reconcile changes in net assets ,
to net cash used in operating activities: `
Present value of beneticial interest Q
in outside trusts 127,853 205,817  
Provision for bad debts 1,223,435 1,113,242 Q
Depreciation 293,264 739,166  
Realized (gains) losses on sales Q
of investments 610,272 (2,608,270) i
Unrealized losses on investments 2,111,435 7,128,911 i
Permanently restricted contributions (50,000) (2,212,500) `
(Increase) decrease in;
Patient receivables (884,073) (1,884,442)
Student tuition receivables (28,590) 225,645 ~
Bequest receivable (500,000) 0 `
Other receivables (95,483) 874,821
Inventories 5,928 93,187
Other assets (99,713) (226,452) `
Increase (decrease) in: (
Accounts payable (172,301) 237,520  
Deferred tuition, students 4,860 (158,575) ,
Self-insurance reserve (222,047) (99,540) i
Estimated third-party payor settlements (8,639) (110,896)
Other liabilities (143,728) 193,808  
Net cash used in operating activities (513,985) (136,733) ~
Cash flows from investing activities: l
Purchase of property and equipment (471,680) (286,272)
Net proceeds (purchase) of investments 494,772 (2,619,957) (
Net cash provided by (used in) i
investing activities 23,092 (2,906,229) (
Cash flows from financing activities:  
Borrowings from notes payable 190,000 40,472 (
Payments on notes payable (15,876) (11,679)  
Payments on capital leases (94,712) (132,373) l
Payments on bond payable (106,395) (100,314) I `
Investment subject to long-term restrictions 50.000 2,212,500 {
Net cash provided by financing activities 23,017 2,008,606  
See accompanying notes. 6  
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 Y FNS, INC. AND AFFILIATES
COMBINED STATEMENTS OF CASH FLOWS (CONTINUED)
Years ended April 30, 2002 and 2001
k,
2002 2001
Net decrease in cash and cash equivalents (467,876) (1,034,356)
Cash and cash equivalents, beginning of year 1,240,195 2,274,551
` Cash and cash equivalents, end of year $ 772,319 $ 1,240,195
I Supplemental cash flow information:
Cash payments for interest $ 37,156 $ 47,547
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  See accompanying notes. 7

 FNS, INC. AND AFFILIATES 0
NOTES TO THE COMBINED FINANCIAL STATEMENTS  
April 30, 2002 and 2001
NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES `
This summary of significant accounting policies of FNS, Inc. and Affiliates (the Service) is presented
to assist in understanding the Service's financial statements. The Hnancial statements and notes are
representations of the Service’s management who is responsible for their integrity and objectivity.
These accounting policies conform to accounting principles generally accepted in the United States
of America and have been consistently applied in the preparation of the financial statements.
Organization:
Mary Breckinridge established Frontier Nursing Service in Leslie County, Kentucky, as the Kentucky
Committee for Mothers and Babies in 1925. The name later changed to Frontier Nursing Service in
1928. The Service’s original purpose was to provide needed health services in the Appalachian
area, introducing the first nurse-midwives in the United States. During its early years, the Service
was the only provider of health services in the area and it remains the largest provider of health
services in Leslie County and the portion of surrounding counties comprising its service area. In
1939, the Service established a midwifery school. As established today, FNS, Inc. currently operates
as a holding company for an accredited midwifery and family nursing school, a home health agency,
and a hospital, and provides primary care services through the Hyden Clinic, the Kate Ireland
Women's Health Care Center, and District Nursing Clinics. The Service has historically been
dependent on charitable contributions to fund a signihcant portion of the costs of service and
programs.
Principles of Combination:
The Service consists of the following nonproHt entities:
FNS Inc. - Parent holding company ofthe Service.
Mag; Breckinridge Health Care Inc. - Entity responsible for operating the hospital, home health
agency, and clinics,
Frontier School of Midwifeg; and Family Nursing Inc. - Entity responsible for operating the
midwifery and family nursing school.
Frontier Nursing Service Foundation Inc. - Entity responsible for maintaining the investment ,
portfolio of the Service and contributions from donors. ~
FNS Real Estate Inc. - Entity responsible for holding and managing the real estate and fixed  
assets owned by the Service. I
The combined financial statements include the accounts and transactions of the above entities. `
lntercompany transactions and accounts have been eliminated in combination. I _
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 of FNS, INC. AND AFFILIATES
" NOTES TO THE COMBINED FINANCIAL STATEMENTS
April 30, 2002 and 2001
` NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Basis of Presentation:
The accompanying financial statements have been prepared on an accrual basis in accordance with
accounting principles generally accepted in the United States of America.
The Service reports information regarding its financial position and activities according to three
classes of net assetst unrestricted, temporarily restricted, and permanently restricted.
Contributions and donations that are restricted by the donor are reported as increases in
unrestricted net assets if the restriction expires in the reporting period in which the support is
recognized. All other donor-restricted support is reported as an increase in temporarily or
permanently restricted net assets, depending on the nature of the restriction. When a restriction
expires (that is, when a stipulated time restriction ends or purpose restriction is accomplished),
temporarily restricted net assets are reclassified to unrestricted net assets and reported in the
statement of activities as net assets released from restrictions.
Use of Estimates:
The preparation of consolidated financial statements in conformity with accounting principles
generally accepted in the United States of America requires management to make estimates and
assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent
assets and liabilities at the date of the consolidated financial statements and the reported amounts
of revenues and expenses during the reporting period. Actual results could differ from those
estimates.
Cash and Cash Equivalents:
Cash and cash equivalents consists of cash and highly liquid investments having an original maturity
of three months or less. The carrying amount of cash equivalents approximates fair value.
Accounts Receivable, Students and Deferred Tuition, Students:
The Service provides a midwifery and family nurse practitioner education program to eligible
students. The program generally takes 24 months to complete. The tuition forthe programs is due
~ ratably every six months. The Scho0|'s policy is to recognize tuition revenue ratably over 24 months.
_ Allowance for Doubtful Accounts:
I The Service provides an allowance for doubtful accounts receivable based upon prior experience
and management’s assessment of the collectibility of existing accounts.
; 9
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 FNS, INC. AND AFFILIATES
NOTES TO THE COMBINED FINANCIAL STATEMENTS
April 30, 2002 and 2001
NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED) `
Investments:
The Service carries investments in marketable securities with readily determinable fair values and all
investment in debt securities at their fair values in the statement of financial position. Unrealized
gains and losses are included in the change in unrestricted net assets in the accompanying
statement of activities, unless