xt7h9w08xm5j https://exploreuk.uky.edu/dips/xt7h9w08xm5j/data/mets.xml The Frontier Nursing Service, Inc. 2010 2011 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. 86, No. 2 and 3, December 2010 and March 2011 text Frontier Nursing Service, Vol. 86, No. 2 and 3, December 2010 and March 2011 2010 2014 true xt7h9w08xm5j section xt7h9w08xm5j *6-:    @@1 ss00   *2 0
I`] lx J       F
LQ ‘“ \***-` IFEYQGNTHIER NTURSQNG SH;R‘v UCB ‘ ‘"f#T_ _  
Dcccmbcr 2010 & Ma11‘cl120ll Issues `W
\*'<>lL1mc $6 — Numbers 2&3
85tl1,-\F\§T‘*4U·kL REPORT
: \ ` '“= ‘  
` `” an v_ "iT\
  ` `            
    ; _; W. ‘·        
Q _ __,, 4

US ISSN 0016-2116
The Joumey - Jane Leigh Powell 1
In Memory of Kate Ireland — Denise Barrett 3 ‘
Frontier School of Midwifery & Family Nursing Update
- Dr Susan Stone 6 ·
Faculty & Students Visit Guatemala - Christina King 9
Reflections of a Courier - Dorothy G. Morris Mudd 11
85th Annual Audit Report - Dean, Dorton & Ford 13
In Memoriam 24
Urgent Needs 32
Cover Photo - Mary Breckinridge Statue located at the entrance ofthe
Mary Breckinridge Hospital in Hyden, Kentucky. Photo courtesy of
Brooke Kemper.
Frontier Nursing Service Quarterly Bulletin is published at the end of
each quarter. Subscription Price $5.00 a year for Donors/S 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 p
its donor mailing list.

Q The Journey
  by Jane Leigh Powell,
Chairman QfB0ara' of Governors
As are hospitals and clinics nationwide, small, rural stand-alone
hospitals are struggling financially more than larger facilities. As
i Mary Breckinridge Hospital is one of those, I thought I would let
you know what the Board of Governors of the Frontier Nursing
, Service is doing to find a solution.
Sadly, we closed the Maternity Unit due to lack of patients in our
service area. Having reduced all staff salaries by 20% last spring,
  we had to lay off about seventy loyal employees in the fall for
,i the first time in our 85-year history.
i A With decreased Medicare and Medicaid reimbursement, reduction
. in the value of the endowment due to the recession, expensive
back tax payments to the IRS and not enough patients to sustain
the Hospital and Clinics, the Board realized it had to make some
hard decisions. There was just no way that we could afford to
keep the Hospital and Clinics open to provide the services that
the community wants and deserves. The result was a search for
i a buyer of our Healthcare Facilities which include Mary Breck-
1 inridge Hospital, the Home Health Agency and the Clinics.
i Since October, we have been negotiating with a local group to
Q purchase those facilities and we hope to know by early spring if we
i have a positive agreement. Our goal is for this group to stabilize
and continue healthcare in Leslie County while our dedicated staff
i continues to provide life—saving services during reorganization.
We are not considering selling Wendover, nor the land around it.
y Wendover will remain a FNS historic site. Future plans include
if re-opening the Bed and Breakfast, restoring the Courier Program
  and, hopefully, turning Wendover into a Retreat Center for small
groups. It will become part of The Frontier School of Midwifery

and Family Nursing and plans are underway to initiate a Capital i
Fund Drive in the future to raise money to preserve Wendover. I
Our good news is that The Frontier School of Midwifery and Fam- i
ily Nursing continues to increase in enrollment and graduation
numbers. At this time of change in national healthcare, Nurse- W
Midwives and Family Nurse Practitioners are in great demand all
over the country. Our enrollment has now passed the I,0O0 mark
with nearly 500 students each in the Nurse—Midwifery and Family _
Nurse Practitioner tracks; and enrollment in the new Doctor of
Nursing Practice Program is nearly fifty. i
We currently have students located in all fifty states and many I
foreign countries and over 60% of our students reside and work
in rural areas. Through the work of our students, graduates and I
faculty, we are fulfilling Mary Breckinridge’s mission to educate `
nurses and provide healthcare with a focus on rural populations.
The School is financially sound as is evidenced by the recent
positive audit.
This has been a very trying time for the Board and employees but
we are seeking changes that will continue the mission of Mary
Breckinridge. We will keep you informed of our progress and,
above all, we are so very grateful for your continued support of
the FNS.
*»r<************************************ _
Nobody can really guarantee the future. The best we can do is size
up the chances, calculate the risks involved, estimate our ability A
to deal with them and make our plans with confidence. i
—Hemjv F ord II

i In Memory of Kate Ireland
~ A Lfetime Supporter ofthe Frontier Nursing Service,
; Kate Ireland Leaves a Lasting Legacy
· FW':  i.` _, f5,. _`
lie  _»··‘$?*~ ,,   *·{*‘J*
    ,   4;% ay  p ,   g _   
y 1  _   . `, A
F I , 1 ’ "’ -;:>·    
    il i   y Q ,5 r»·~  
    IO-`    if _» ‘,·
1   F     1 · L  
p Kate Ireland, a lifelong philanthropist and a guiding force of the
Frontier Nursing Service (FNS), passed away on Feb. 15, 2011,
1 at her home in northem Florida. Miss Ireland devoted her life to
I public service and her wide-reaching legacy includes her work
on behalf of the FNS and the Frontier School of Midwifery and
1 Family Nursing in Hyden.
i Kate was bom in Cleveland, Ohio, in 1930 into a family with
a tradition of supporting the vision of Mary Breckinridge.
g Her grandmother was a donor from the beginning of the City
  Committees established to support the demonstration of Frontier’s
p nursing service to the underserved families living in the remote
r _ regions of Southeastern Kentucky. Her mother was Chairman of
L the Cleveland Committee, and Kate’s sister served as a Courier
I in 1938.
1 3

Kate served as Courier during the summers of 1951-1954 and as
a part-time Courier hom 1959-1960. In her role as a Courier,
Kate looked after the horses and jeeps used by the FNS nurse-
midwives. Mrs. Breckinridge recognized Kate as a leader and
many people looked to her to get things done. She volunteered I
as Director of Volunteers for FNS from 1961-1975.
For nearly six decades, Kate lent her expertise, advice, hard work
and financial support to help FNS provide healthcare in Leslie _
County and educate nurse-midwives and nurse practitioners
across the globe. In Kate’s biography by David Treadwell, "Full
Speed Ahead: with cz Yiviizk/e in Her Eye, " Kate says of her p
calling to FNS that "going to Kentucky had always been in the i
cards for me."  
She was well-known in the Leslie County community. Kate, a 1
prominent member of Cleveland society, felt passionately about I
her work in Leslie County. Upon returning there in the early
‘60s, Kate built a beautiful home called Willow Bend overlooking
Hurricane Creek and the Middle Fork. Although a world traveler
with residences in Florida and Maine, while serving the people
of Leslie County Kate primarily resided at her home in the
community of Wendover with her lifelong friend and companion,
Anne Cundle, a fonner FNS nurse-midwife.
While living in Kentucky, Kate became involved in local interests
such as the LKLP and Hyden Citizens Bank and served as
Chairman of the Kentucky River Area Development District and
Trustee and Chairman of Berea College.
In 1963, in recognition of her strong leadership skills, Kate was ’
elected to the FNS Board of Governors and was Chairman ofthe
Development Committee in 1967; Vice—Chairman of the Board
in 1968; and National Chairman of the Board of Governors in i
1975, a post she held until 1992. In 1997 she was named National =
Honorary Chairman.  

g "She was a great mentor and a very determined and forceful
T woman who had the gift of convincing others to agree to support
. her in whatever project she was interested in," said Jane Leigh
i Powell, Chairman of the FNS Board of Govemors and a friend of
` Miss lreland’s for nearly 50 years. "She maintained her interest
{ in Leslie County after moving to Florida and continued to be a
very loyal supporter of the FNS.”
. One example of Kate’s ability to see the potential for Mary
Breckinridge’s vision for nursing and midwifery was her support
for the creation of the Community—Based Nurse-Midwifery
, Education Program (CNEP). “We clearly would not have the
, successful, distance education programs that we have today
l without the support of Kate," reports Susan Stone, President and
  Dean of the Frontier School of Midwifery and Family Nursing.
T Kate was able, better than many, to see that such a program could
take the Frontier model of care out to the "wide neighborhoods’” of
mankind, which it is successfully doing as it prepares thousands
of nurse—midwives and nurse practitioners to care for families in
rural and underserved areas across the United States and abroad.
i Her support of distance education continued when, with Mary
Breckinridge’s cousin, Marvin Breckinridge Patterson, she
, established the Hrst endowed Chair of Midwifery in the United
States, The Mary Breckinridge Chair, to support faculty at the
Frontier School of Midwifery & Family Nursing. For support
, of students, she established and endowed the Kate Ireland and
Kitty Ernst Scholarships to be awarded to students annually. Her
footprints on the future of the School continue to make a lasting
 _ impact on faculty and students.

Frontier School of Midwifery & Family Nursing News  
by D12 Susan Stone, President & Dean  
»#%‘~I“f‘  ?:Lei  »·»I·.·. r .
  l     "‘·`    
  I »»t*  
fi  . .     '°*°   Yiici 1.  
  { ’»’:· .     4
. I `   — '   ...    V
      .     "  
  `\ `      ‘»-it J    . ·- '  
Times of Change  
The winds of change are blowing and change is never easy. I first I
came to Frontier Nursing Service as a student in the first class
of CNEP. I returned soon after graduation and have now worked
at Frontier Nursing Service for 18 years. It is hard to believe.
Through those years, I have watched the service go through good
times and bad. This is definitely by far the most difficult year l’ve I
seen. First I watched as the Board of Governors struggled to find  
t solutions to the financial problems of the healthcare side of FNS. I
We soon realized that the solution must include the closure ofthe
maternity service. This was heartbreaking. Later in the year we  
realized that we could no longer continue to operate the hospital, I
the clinics or the home health service. These decisions have been  
unbelievably difficult for everyone involved.  
The changes have caused times of introspection as I pondered their I
meaning and what it means to the Frontier Nursing Service. As I _
have done many times in the last 20 years, I thought about Mary A
Breckinridge, how hard she worked and what her goals were when
she started the Frontier Nursing Service. I went back and reread _
the minutes ofthe first organizational meeting of Frontier Nursing
Service (originally called The Kentucky Committee for Mothers Q
and Babies) held in Frankfort, Kentucky, on May 28, I925. On that  

, day, the group who gathered adopted several resolutions which
j included the following purpose statement and the direction for
the first demonstration region:
"The purpose ofthe Kentucky Committee for Mothers and Babies
g will be to safeguard the lives of mothers and young children by
`i providing trained nurse—midwives for rural areas where there are
no resident physicians.
"The value of this service shall first be demonstrated in a given
county (Leslie County having been selected by permission of
the State Board of Health) and in cooperation with a County
Branch Committee — with which the Kentucky Committee shall
. have reciprocal membership."Mary Breckinridge later expressed
i in other writings her desire to replicate the work of the Frontier
Nursing Service in other deserving areas. "
After reading these historical documents again, l decided to stop
feeling distressed about the past, look at the current successes of
Frontier and look forvvard to our bright future. We can do this by
looking at the work of the faculty, staff students and alumni of
the Frontier School of Midwifery and Family Nursing. Because
of the success of the School, we can continue to cany on the
. mission and purpose of the Frontier Nursing Service. Thankfully,
l the School is doing very well. We are now an accredited graduate
school with over 1,000 students and 2,000 alumni located in all
fifty states and in many foreign countries. Sixty-two percent
of our students come from rural areas compared to the general
population which is only 20% rural. Over 85% of our students
work in federally designated health professional shortage areas.
' This data indicates that we are fulfilling the original goal ofl\/{ary
Breckinridge and the FNS. We are educating nurse—midwives and
nurse practitioners and they are safeguarding the lives of mothers
i and young children. Our reach is further than ever before. This is
cause for celebration. This work must continue.

But what about Leslie County where our work has been centered l
for over 85 years? My hope and plans are that we will continue to
have a positive presence in Leslie County. We will seek to form r
positive collaborative relationships with healthcare providers T
and the residents of Leslie County. Our home base, including the I
campus and Wendover, is located in Leslie County. It is the home [
of the Frontier Nursing Service. {
We plan to operate Wendover as a Bed and Breakfast and as _
a national retreat center for nurses, nursing students and other
organizations who need a beautiful place to retreat to, to think,
to plan and to recharge their energy. We know that Wendover is a .
perfect place to do this. We plan to reestablish and reinvigorate the I
Courier Program by establishing partnerships with other health-
care providers and service organizations in the surrounding area.
Even though our education programs are implemented using
distance education, every single student comes to Hyden for
orientation and class intensives. Last year we brought over 800
students to Hyden and introduced them to the history of FNS and
the beauty ofthe region. ln summary, Leslie County will continue
to be the center of operations for the work of the Frontier Nursing
It will be difficult to think of an FNS which is not operating a
hospital and clinics in Leslie County. But we must remember
that FNS is educating nurse-midwives and nurse practitioners. In i
the future we may be able to think about our faculty and students I
providing healthcare through collaborative relationships with
other organizations who are operating hospitals and clinics. There
are many opportunities for us to continue to fulfill the mission
ofthe Frontier Nursing Service. As always, l want to thank all of ’
you who are reading this today for your continued support of our
work. This is a new chapter in the FNS story, a story with many
chapters to come. V
8 I

r Frontier School 0fMidw#ery & Family Nursing
Faculty and Students Wsit Guatemala
I Building upon the mission and philosophy ofthe Frontier School
j of Midwifery & Family Nursing, students and faculty have
. the opportunity to participate in a Global Health Experience.
This service—based experience offers selected participants the
i opportunity to travel to a developing area of the world and work
with local agencies to provide healthcare to vulnerable populations.
The following is an update of one of those experiences:
November 7, 2010, by Christina King, FSMFN CNEP Class 59
j Student: "My first week in Guatemala manifested itself in a long
i process of reflection. Witnessing the power of strong will as it
relates to the people’s iight for health in Guatemala has been
inspiring. This was immediately recognized when we arrived at
the clinic of Vamos Adelante at seven in the morning to a crowd
of several patients waiting outside the clinic for our arrival.
Apparently, word had spread to the people in the villages that
there was an opportunity to be evaluated by Dr. Rene as well as
faculty and students from the Frontier School of Midwifery &
Family Nursing at the clinic, and many people came. For many
of them, the journey to get there consisted of a one—hour bus ride
and a two-hour walk from their small villages. They traveled in
spite of being sick. One had chest and back pain, another foot
pains, and another had abdominal pain from being brutally beaten
l by her husband. But, incredibly, they still made the long journey.
i According to F elina, one of the health promoters employed by
Vamos Adelante, access to the nearest hospital often required
an even longer journey than the one to the clinic. Felina further
explained that she remembers the times when a man walked
» several hours carrying a laboring woman in a chair tied to his back
because that was the only way to get her to the hospital. l found
this type of determination admirable as we often take for granted
’ the amenities of healthcare service that are easily accessible to
T us in the United States.
i 9

"The difficult access to the hospital made the role of Vamos
Adelante’s health promoters a vital one. The health promoters’
function as primary care providers in their villages, was to give out
medications for acute and chronic illness (depending on whether
they are available), care for wounds, and act as consultants for
pregnant women. During our stay with Felina in the village of
Ceylan, many people came to her house at all hours of the day N
seeking treatment for injuries and illnesses and prenatal care. With
motivation, compassion and making the most out of everything she F
had, she stretched her wings to great lengths to serve them. Her
skills and knowledge from much experience was impressive, yet
she and the other health promoters still wanted to learn more from
us. I found their desire to learn inspiring. They had no motives
of gaining a title or making more money; they wanted to leam
because they understood the value of health and wanted to be able
to service their community with a highter level of healthcare. With
that said, I know we were there to try to help them, but I think
they helped me more. They helped me understand that the pursuit
of health is a commitment to the people who make trails and I am
humbled to be a part ofit."
Plea for Knitted Lap Quilts, Baby Caps and Scarves
The Frontier School of Midwifery & Family Nursing Midwifery
students present lap quilts or baby caps to the first baby they
deliver. The Family Nurse Practitioner students present lap quilts
or scarves to their elderly patients.
FNS receives these items from our "knitting" friends. As the
School continues to grow by leaps and bounds, we need more and
more of these items. The size needed for lap quilts is approximately
40" by 42”. Yarn should be worsted weight.
10 J

Reflections of a Courier
by D0r0th_v G. Morris Mudd
I attended Bennington College from 1944-1948. Bennington
College had a unique program of sending students off to work
H (or study), known as the Winter Work Program. It was up to each
student to find a job or work as a volunteer.
, For my work term in my second year of college (1945), I elected
to go to the Frontier Nursing Service with my close college friend,
Ann Pratt (Ladd). We both had done a fair amount of riding in
the West as kids and knew the rudirnents of taking care of horses
— watering, feeding, saddling, currying, etc. Anne’s experience had
been at a ranch/camp in Wyoming, and I had leamed to ride by
leasing half of a horse at a boarding school in Putney, Vermont.
We applied to FNS and were accepted.
We were just at the point of joining forces to take the train to
Louisville when, to my horror, the day before departure I was
asked my age and was informed that the FNS could not allow
me to serve as a Courier since I was under age and could not be
insured. So, no volunteerjob.
My mother and l were having dinner that very night with Corrin
and Alice Strong. Corrin Strong’s mother, Hattie Strong, was
one of the original underwriters (I think) of the FNS, she having
been a nurse at the turn ofthe century (1900) in Alaska. Anyway,
Corrin Strong immediately called his friend, Mrs. Breckinridge,
and undertook to be the backer for any liability I might incur as
a Courier. That was a stroke of luck! So, underwritten by Corrin
Strong, my friend, Anne Pratt, and I were off to be Couriers.
When we arrived at Wendover, the first night as 1 recall, I was
told that I needed to ride with one ofthe midwives to one of the
outposts (1 would never know where — l totally lack a sense of
direction) to take care ofa sick horse at the outpost. Of course, I
J 11

knew nothing about sick horses but they told me to ride the horse -.
back and if she lay down on the road, take one of the bottles in
the saddlebag and pour it down her throat and then follow with l
the second bottle. For some reason that didn’t seem a daunting
task at the time although now, looking back, I can’t imagine how
I would have undertaken this little maneuver had the sick horse f.
decided to lie down.
I spent the night with other nurses at the outpost and the next day ,
I was presented with the sick horse named "Marvin", and told to
ride her back to headquarters. I had no idea where I was and where
Wendover was located, but I didn’t want to let on. So, Marvin and
I, with saddlebags, were off.
Mounted on Marvin, I was very thankful that she seemed to
know where to go, and we started off at a terrific speed (she was
a Tennessee Walker) which seemed really frightening but very
comfortable. No matter what I did, Marvin would not slow down
- she was off and, of course, she knew where she was and where
she was going. The snow was coming down and I couldn’t stop
Marvin and so had to do without a rest stop. It was cold, and we
clip clopped down the road for what seemed like hours on end.
I wonder how long it took. I have no idea, but it was probably
about 25 miles. I would guess that a Tennessee Walker goes about
five miles an hour so in about five hours we arrived at Wendover!
Marvin became my horse, was never sick, and covered ground
at a terrific pace whenever we went with the midwives or down
to Hyden each day to pick up the daily mail and all sorts of other
l must say, of all my winter work terms at Bennington College, the i
winter spent working with the FNS was doubtless one ofthe most
interesting and educational of all. I loved riding down the trails _
and greeting the people on the road with their special language. I
would love to return and see Wendover again and hope to do so
in the near future.

 1  rpm ruruulluult lulrinerr inI:·ixur.r
( Independent Auditors‘ Report
` Board of Directors
` FNS, Inc. and Affiliates
We have audited the accompanying consolidated statement of financial position of FNS, Inc. and Affiliates (the
Service) as of April 30, 2010, and the related consolidated statements of activities and cash flows for the year then
ended. These financial statements are the responsibility of the Service's management. Our responsibility is to
express an opinion on these financial statements based on our audit. The consolidated financial statements of the
Service as of and for the year ended April 30, 2009, were audited by Dean Dorton Ford, PSC, whose report dated
November 24, 2009, expressed an unqualified opinion of those statements.
We conducted our audit in accordance with auditing standards generally accepted in the United States of
America. 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 in the financial statements. An audit also includes assessing the
accounting principles used and significant estimates made by management, as well as evaluating the overall
financial statement presentation. We believe that our audit provides a reasonable basis for our opinion.
In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the
financial position of FNS, Inc. and Affiliates as of April 30, 2010, and the changes in its net assets and its cash
flows for the year then ended in conformity with accounting principles generally accepted in the United States of
The accompanying financial statements have been prepared assuming that the Service will continue as a going
concem. The Service has a deficiency of working capital of $2,660,632 and has an unrestricted net deficit of
$2,690,564. These conditions raise substantial doubt about its ability to continue as a going concem.
Management's plans in regard to these matters are described in Note 18. The financial statements do not include
any adjustments that might result from the outcome of this uncertainty.
Our audit was conducted for the purpose of forming an opinion on the consolidated financial statements taken as
a whole. The consolidating information included in the schedules on pages 29 — 32 is presented for purposes of
additional analysis of the consolidated financial statements rather than to present the financial position, results of
operations, and cash flows of the individual corporations. Such information has been subjected to the auditing
procedures applied in the audit of the consolidated financial statements and, in our opinion, is fairly stated in all
material respects in relation to the consolidated financial statements taken as a whole.
Da ( " Q
(···r·J., {I,
Q/vx A}/{Wm L.
February 1, 2011
’ Lexington, Kentucky
] W, _-_.. _.     .· ;  i._, -  
I JZ? ·`'.   f =Y£i{,Z..ZQ I   if i —.»~i‘ Z=L:=» c
2 1 `/I .=»: ~ ·-_,·;,. I
V   .. .x.x.i¢.,··..  

Consolidated Statements of Financial Position
April 30, 2010 and 2009  
2010 2009
Assets '
Current assets:
Cash and cash equivalents S 2,629,505 SS 631,873
Patient accounts receivable, net ot' estimated uncollectibles of
$1,300,127 and $2,133,214 for 2010 and 2009, respectively 2,976,630 2,882,169
Student tuition receivable, net of estimated uncollectibles of
$27,307 and $26,882 for 2010 and 2009, respectively 257,169 208,332
Estimated third-party payer settlements receivable 13,383 -
Other receivables 13,324 63,704
Investments 1,500,481 1,506,217
Supply inventories 451,264 338,534
Prepaid expenses and other current assets 164 439 89 465
Total current assets 8,006,195 5,720,294
Property and equipment, net 5,220,835 5,834,751
Other assets:
Beneficial interest in outside trusts 1,729,775 1,436,371
Investments held in perpetuity 2,556,781 3,956,522
Other donor restricted cash and investments 5,435,703 4,592,637
Physician loan receivable 217,449 242 897
Total other assets 9 939,708 10 228 427
'l`otal assets $ 23 166 738 S 21 783 472

2010 2009
' Liabilities and Net Assets
Current liabilities:
Accounts payable S 2,532,431 $ 2,698,802
Accrued expenses 4,148,805 3,598,629
Estimated third-party payor settlements payable - 422,855
Deferred tuition, students 1,561,953 1,113,744
Current portion of lines of credit - 1,530,530
Current portion of long—term debt 565,666 619,554
Note payable 458,231 -
Total current liabilities 9,267,086 9,984,114
Long-term liabilities:
Lines of credit, net of current portion 5,740,129 4,215,858
Long·term debt, net of current portion 1,127,828 1 468,207
Total long-term liabilities 6,867,957 5 684,065
Total liabilities 16,135,043 15,668,179
Net assets (deficit):
Unrestricted net deficit (2,690,564) (3,870,237)
Temporarily restricted net assets 5,435,703 4,592,637
Permanently restricted net assets 4,286,556 5 392,893
Total net assets 7,031,695 6 115 293
Total liabilities and net assets 5 23,166,738 $ 21 783,472
See the full audit report for notes to these Financial Statements,

Consolidated Statements ot Activities
Years ended April 30, 2010 and 2009
2010 2009
Unrestricted revenues, gains and other support: I
Net patient service revenue $ 21,333,495 S 20,084,106
Contributions 982,934 360,535
Education revenues:
Tuition and educational fees 8,720,285 6,431,842
Federal grants 1,031,284 644,382
Other revenues:
Investment income (loss) 1,234,026 (400,066)
Other revenue 359,262 564,407
Net assets released from restriction 820,814 1 584,120
Total unrestricted revenues, gains and other support 34,482,100 29,269,326
Salaries and other wage costs 16,452,497 17,483,710
Medical services, supplies and other expenses 11,338,704 10,370,022
Facility cost 2,028,051 2,137,169
Interest expense 360,573 361,850
Depreciation 1,451,426 1,378,849
Impairment of goodwill - 242,195
Provider and other taxes 242,563 277,047
Provision for bad debts 1,428,613 2 818,700
Total expenses 33,302,427 35,069 542
Change in unrestricted net assets 1,179,673 (5,800,216)

Consolidated Statements of Activities, continued
Years ended April 30, 2010 and 2009
Change in temporarily restricted net assets:
' Contributions 120,150 75,437
Investment income (loss) 143,925 (2,455,448)
Changes in annuity payable 64 (512)
Net assets released from restriction 578,927 (1 584,120)
Change in temporarily restricted net assets 843,066 (3,964,643)
Change in permanently restricted net assets;
Change in beneficial interest in outside trusts 293,404 (520,565)
Net assets released from restriction (1 399 741) —
Change in permanently restricted net assets (1,106 337) (520 565)
Change in net assets 916,402 (10,285,424)
Net assets, beginning of year 6 115,293 16 400,717
Net assets, end of year S 7,031,695 $ 6115 293
See the full audit report for notes to these Financial Statements.

Consolidated Statements of Cash Flows
Years ended April 30, 2010 and 2009
Cash flows from operating activities:
Change in net assets $ 916,402 55 (10,285,424)
Adjustments to reconcile change in net assets to net cash
provided by operating activities:
Change in beneficial interest in outside trusts (293,404) 520,565
Provision for bad debts 1,428,613 2,818,700
Net realized and unrealized investment (gain) loss (975,270) 3,419,777
Depreciation 1,451,426 1,378,849
Gain on sale of assets - (10,853)
Forgiveness of physician loans 25,448 25,450
Goodwill impairment - 242,195
Permanently restricted assets released (1,399,741) —
Increase (decrease) in cash due to changes in:
Patient accounts and student tuition receivables (1,571,911) (1,631,938)
Other receivables 50,380 82,283
Supply inventories (112,730) (13,242)
Prepaid expenses and other current assets (74,974) 67,895
Estimated third·party payer settlements (436,238) 1,487,321
Accounts payable 375,600 1,487,540
Accrued expenses 550,176 651,110
Deferred tuition, students 448,209 30 143
Net cash provided by operating activities 381,986 270,371
Cash flows from investing activities:
Capital expenditures (725,664) (1,486,110)
Decrease in investments, net 1,537,681 2,226,946
Proceeds from sale of assets · 11 685
Net cash provided by investing activities 812,017 752,521

Consolidated Statements of Cash Flows, continued
Years ended April 30, 2010 and 2009
Cash flows from financing activities:
Net payment under line of credit agreements (6,259) (270,947)
Proceeds from issuance of long-term obligations 231,390 261,358
Principal payments on long-term obligations (737,503) (668,990)
Principal payments on notes payable (83,740) —
Permanently restricted net assets released 1 399,741 -
Net cash provided by (used in) financing activities 803 629 (678 579)
Increase in cash 1,997,632 3-14,313
Cash, beginning of year 631,873 287 560
Cash, end of year S 2 629,505 S 631 873
Supplemental disclosures of cash flow information:
Cash paid during the year for:
Interest S 360,573 S 339,17