xt7djh3d0j1g https://exploreuk.uky.edu/dips/xt7djh3d0j1g/data/mets.xml The Frontier Nursing Service, Inc. 2006 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. 82, No. 1, Summer/September 2006 text Frontier Nursing Service, Vol. 82, No. 1, Summer/September 2006 2006 2014 true xt7djh3d0j1g section xt7djh3d0j1g \.   ``,. \
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 US ISSN 0016-21 16
TABLE OF CONTENTS
Introduction to FNS 1
The Journey - Jane Leigh Powell 2
Field Notes 3
Beyond the Mountains 6
Former Staff, Courier and Alumni News 7
The Courier Program — Michael C laussen 8
FSMFN News - Dr. Susan Stone 9
Eighty First Annual Report 1 1
In Memoriam 32
Urgent Needs 39
Cover: FNS Board of Governors: front row left to right — Mary Ethel
Wooton, Nancy Hines, Jane Leigh Powell, Marion McCartney, Ken
Tuggle. Back row left to right- Rhonda Brashear, John Foley, Dr. Michael
Carter, Mike Rust (Dr. Charlie Mahan not pictured). Lower left corner -
‘“Snippet", Jane Leigh Powell’s dog.
ERROR - Cover page of last two Bulletins were incorrect. Volume 81,
Number 3 should have been Winter/March 2006. Volume 81, Number 4
should have been Spring/June 2006. We are back on schedule with this
one. Sorry for the inconvience this may have caused. -Barb Gibson
Frontier Nursing Service Quarterly Bulletin is published at the end of
each quarter. Subscription Price $5.00 a year for Donors/$15.00 for Insti-
tutions. Periodicals postage paid at Wendover, Kentucky 41775 and at .
additional mailing offices. POSTMASTER: Send address changes to FNS,
Inc. 132 FNS Drive, Wendover, Kentucky. Copyright FNS/Inc. All Rights
Reserved. The Frontier Nursing Service does not share it’s donor ·
mailing list.

 QUARTERLY BULLETIN 1
Introduction to Frontier Nursing Service (FNS)
Mary Breckinridge spent her early years in many parts of the
world — Russia, France, Switzerland and the British Isles. After
the 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 mothers and children.
Mrs. Breckinridge established the (FNS) in Leslie County, Ken-
tucky in 1925, as a private charitable organization serving an area
of 700 square miles. It was the first organization in America to
use nurses trained as midwives under the direction of a single
medical doctor/obstetrician, based at their small hospital in Hyden.
Originally the staff was composed of nurse-midwives trained in
England. They traveled on horseback and on foot to provide qual-
ity prenatal and childbirth care in the client’s own home.
Today, Mrs. Breckinridge’s legacy extends far beyond Eastern
Kentucky. FNS, Inc. is the parent holding company for Mary
Breckinridge Healthcare, Inc., Frontier Nursing Healthcare, Inc.,
which includes six rural healthcare clinics; Mary Breckinridge
Home Health Agency and the Frontier School of Midwifery and
Family Nursing which offers a Master of Science in Nursing de-
gree with tracks as a Nurse—Midwife, Family Nurse Practitioner
and Women’s Healthcare Nurse Practitioner.
Mary Breckinridge’s home, The Big House, located at Wendover,
is a licensed Bed & Breakfast Inn. For more information or reser-
vations, call 606-672-2317 or e—mail fnstours@yahoo.com. You
can also access our websites:
Frontier Nursing Service — www.frontiernursing.org
Community Based Nurse Midwifery Education Program
www.midwives.org
Community Based Nurse Practitioner Program
www.frontierfnp.org

 i 2 FRONTIER NURSING SERVICE -
The Journey
Jane Leigh Powell .
National Chairman 0fB0ard 0f G0vern0rs
  ·; i
‘  *·°‘ =    F
·éi r ·  e-
ii U!
Jane Leigh P0well  
On May 19th, our wonderful CEO, W.W. (Bill) Hall, Jr., suffered
a stroke. Bill has been undergoing physical and speech therapy
and has made tremendous progress in his recovery.
With Bill’s vision for and love of the FNS, the Board and staff
miss his leadership very much but want him to take as much time
he needs to recuperate. When he feels he is ready to retum, we
will welcome him with open arms and hearts. I hope you will keep
Bill and his wife, Teresa, in your thoughts and prayers.
If you would like to drop Bill a note or send a card, his address is
104 Clubhouse Drive, Nicholasville, Kentucky 40356.
During Bill’s absence, Nathan Lee, Vice-President of Finance, is I
serving as Interim CEO. He can be reached at our new Lexing-
ton office at 170 Prosperous Place, Lexington, Kentucky 40509.
Nathan’s telephone is 859-253-3637, ext. 5006. y .

 QUARTERLY BULLETIN 3
Field Notes
Former FNS Physician Wsits
During May, Dr. James (Jim) Parshall and his wife Carole, spent
I I the night at The Big House Bed & Breakfast Inn. Dr. Parshall
worked at Mary Breckinridge Hospital as an OB/GYN physician
from 1984-1988. The Parshalls live in Northville, Michigan.
I
 
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T Dr: James (Jim) Parshall and wife, Carole
  Congratulations to Suzan Ulrich
1 Suzan Ulrich, Frontier School of Midwifery & Family Nursing
Q Chair of Midwifery & Women’s Health Program, recently had an
  article published in the American Association of Birth Centers
p News during May 2006 entitled "Preceptor Pearls".
U Certified Nurse-Midwives Staffing Update
1 ' July 31, 2006, Elissa Miller, Director of Midwifery Services re-
  signed. Nurse-Midwife Laura Mann-James accepted the Interim
  _ Director position. National recruiting is underway for a perma-
§ nent Director.

 i 4 FRONTIER NURSING SERVICE ‘
Certified Nurse Midwives Laura Mann—James, Sharon Adams and
- Nikki Demetriou have been to training in CenteringPregnancy ·
groups with the first prenatal group being held August 2, 2006
(see www.centeringpregnancy.org for more information).
Laura and Nikki attended the American Academy of Family Prac-
tice Physicians’ Advanced Life Support in Obstetrics (ALSO)
course and were certified as providers; Nikki took advanced training
to become an instructor. An ALSO course for maternity services
providers and MBH house supervisors/ER staff is being planned
soon. Sharon became certified as a Neonatal Resucitation Pro-
gram Instructor during May.
Guests at Wendover y
From May 1 - August 1, 2006, Wendover hosted 604 guests. This
number includes ovemight guests, luncheon/dinner guests, tour
groups and other functions.
June 23 and 24, 2006, 20 Travel Writers with Geiger and Associ-
ates spent the night at The Big House.
July 15, 2006, Jeff and Jennifer Wilson were married at The Liv-
ery. Jeff is a twin brother to Chris Wilson, Wendover Mainte-
nance/Security Guard. Over 100 people attended the wedding.
July 22, 2006, Jim and Lillian Hayes, Camp Creek residents, cel-
ebrated their 50th wedding anniversary at The Big House with
about 60 people in attendance. Jim and Lillian were married in
The Big House Living Room 50 years ago. They were close friends
to Mrs. Breckinridge. Several of Lillian’s family members were
former employees of FNS.
A Play by Jeff Barker ·
Friday, August 5, Denise Barrett, Development Officer, Michael
Claussen, Tour Guide, Julie Marfell, Chairperson of Family Prac-
tice and Jean Fee, former FNS FNP, attended a play by Jeff Barker '

 QUARTERLY BULLETIN 5
which tells the true story of FNS graduate Arlene Schuiteman, an
. Iowa school teacher tumed African missionary nurse. The play
was performed in McKee, Kentucky, and was part of the North-
westem College’s Drama Ministries Ensemble’s summer tour.
Since the 1980’s Northwestern College’s touring theatre company
has traveled across the United States performing original worship
dramas and bringing true stories and biblical characters to life on
stage. Their compelling plays explore AIDS, drug abuse, Septem-
ber 11, and now the effects of civil war in Africa — through the
light of the gospel and its message of compassion and grace. A
schedule of performances can be found at www.nwciowa.edu[
theatreftouring.
K Candy Striper Program
A Candy Striper Program began this year at the Mary Breckinridge
Hospital where students from the Leslie County Vocational School
spend time with patients playing cards, reading or talking. They
also greet families and visitors making them feel welcome during
their visit to the Hospital.
Plea for Lap Quilts
Lap Quilts are distributed to Family Nurse
Practitioner Students to give to chair bound
or wheelchair bound patients, young or old.
Colors may be of your choosing. Quilts can
be knitted or quilted. Size needed is 40"x42".
Send finished quilts to Christine Collins,
132 FNS Drive, Wendover, Kentucky 41775.

 ' 6 FRONTIER NURSING SERVICE -
Beyond the Mountains
Global Volunteers Assignment
Pamela King, a Faculty member of the Frontier School of Mid-
wifery & Family Nursing (FSMFN), just retumed from a volun- _
teer assignment with Global Volunteers International who has as I
its mission "Peace Through Understanding; Understanding Through
Service". Pamela was involved in a teaching program for children
of immigrant and refugee workers in Pelican Rapids, MN. Peli- I
can Rapids is a town of 2,000 people, 25% of whom are immi-
grants from Vietnam, Russia, the Ukraine, Mexico and Somali.
The goal was to help the children improve their English speaking,
reading and writing.
FSMFN Faculty Member Recognized
Mary R. Nichols, Faculty member of the FSMFN, presented the I
following papers during June and July, 2006:
Prenatal Maternal Role Transition: Primigravidae and Multi-
gravidae Women — presented at the 17th Intemational Nursing
Research Congress on Evidence—Based Practice, Sigma Theta
Tau International, Montreal, Canada.
Primigravidae and Multigravidae Women: Innovations in Prena-
tal Achustment to Motherhood and Assessing Supportive Care for
the Laboring Woman: The Therapeutic Labor Support Inventory -
presented at the 2006 AWHONN Convention, Baltimore, Mary-
land.
American Academy of Nurse Practitioner Conference
During June, Dr. Julie Marfell, FNP Chair of the Department of
Family Nursing, Angela Mitchell, FNP, Director of Faculty Prac-
tice and Kathy Wheeler, FNP, FSMFN Faculty Member, attended
the annual American Academy of Nurse Practitioners (AANP) l
Conference held in Texas. Kathy Wheeler was elected the Re-
gional Representative for Region 4 of the AANP. A FSMFN re- .
ception was held during the Conference. .
I
l

 QUARTERLY BULLETIN 7
Staff attend Dairyland Healthcare Conference
· June 24-28, Kevin Couch, Assistant Controller, Pam Smith, Busi-
ness Office Manager, Frank Baker and John Hoskins, Informa-
tion Techs, Linda Craft, Director of Nursing and Kevin Cook, OR
‘ Manager, attended a conference sponsored by Dairyland
Healthcare in Alexandria, Minnesota. Computerized order entry
and bedside charting were the topics discussed.
Kentucky Organization of Nurse Leaders Meeting
June 29th Linda Craft attended a meeting of the Kentucky Orga-
nization of Nurse Leaders sponsored by St. Clare’s Regional
Medical Center in Morehead, Kentucky.
Emergency Preparedness Meeting
July 26th, Kevin Cook attended a meeting addressing Emergency
Preparedness in Frankfort, Kentucky.
Former Staff, Courier and Alumni News
Myra Adamson (‘54) is now living in Peoria, Arizona and work-
ing as an evening staff nurse in a nursing home on the Alzheimer’s
unit. She spent her life as a missionary nurse in Africa, mainly
Rwanda and Zaire (now Congo) and continues to make volunteer
trips.
l

 ` 8 FRONTIER NURSING SERVICE V I
The Courier Program
by Michael Claussen _
Wendover/Development C00rdinat0r
Our latest Courier, Laura Carr, arrived   · __ I _  V ,, _ .
June 25 from Northem Virginia (near     ,
Washington D.C.) and plans to stay at        W e _ ,
Wendover through September. Laura  · `     i\'£·y_=. "`i`   ,
graduated from Whitman College in 1     W @2....;. *1,.%  
Walla Walla, Washington. This is the * "”'       ,
same school that our spring Courier,    i    
Jennifer, graduated from. Word of 1
mouth continues to be an excellent resource for attracting candi-
dates to the Program.
Several recent Couriers have applied their experiences in the Pro- l
gram as a vital milestone toward medical school enrollment. It is ,
in this vein that I plan to target part of my recruitment for the l
Courier Program. On June 19-21, I traveled to five colleges and
universities in Tennessee and North Carolina to meet with key (
members of Career Services staff. All of these meetings resulted 1
in positive discussions on ways to recruit excellent applicants,
methods to promote the Program to reach targeted students that
are looking for intemships and ideas to create a greater aware-
ness of the Courier Program. While in North Carolina, I met with I
former Mary Breckinridge Hospital Intemist, Tim Carey, and his I
wife, Kathleen (Dalton). Dr. Carey is a Professor of Medicine at I
the University of North Carolina at Chapel Hill (UNC) and is ,
committed to assisting us in recruiting UNC students for the Cou-
rier Program. I plan to visit several colleges and universities in
Ohio and Kentucky in the coming months to continue this drive to
attract high caliber candidates for the Program.
My goal of utilizing the services of Couriers on a year round basis
is coming to fruition. I have Couriers scheduled to come during
the fall of 2006 and for the winter of 2007.   ~
l
I

 QUARTERLY BULLETIN 9
Frontier School 0f Midwifery & Family Nursing
_ by Dr Susan Stone, President
50th Frontier Bound
. Greetings from the Frontier School of Mid-
wifery & Family Nursing (FSMFN)! I am lj ,  - `
just back from Frontier Bound where 56 U    
students were admitted on August 22, 2006,     j
into FSMFN’s 50th class of distance leam— S t i
. ing. This included six men and 50 women.   ,‘5i Q 
21 were nurse—midwifery students, 29 were   i5'S
family nurse practitioner students and six
were enrolled in the women’s healthcare nurse practitioner pro-
gram. They came from far and wide including 30 states plus Ghana.
There were two from the state of Kentucky.
One student, Jeremiah N oggle, lives in Leslie County. Jeremiah is
married to our very own Sarah Noggle FNP, CNM, who is cur-
rently the nurse practitioner caring for clients at the Beech Fork
Clinic. Jeremiah is a nurse who is planning to join his wife in a
career as a family nurse practitioner. We are very happy to have
both Sarah and Jeremiah as pan of the Frontier family.
We celebrated the occasion of 50 distance leaming classes with a
cake and much singing and laughter in Aunt Hattie’s Bam on the
last night of Frontier Bound.
We honored Kitty Ernst, the Mary Breckinridge Chair of Mid-
wifery. Her vision, formed in the early1980’s, was to bring edu-
cation to nurses who could not leave home to attend a traditional
university. That vision led to the development of this very suc-
cessful distance learning program. Since the first Frontier Bound
( occurred in 1989, Kitty has attended every single one. We are
grateful to her for her vision and ongoing support and guidance.

 I
“ 10 FRONTIER NURSING SERVICE -  
I
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Celebration of Frontier School of Midwfery & Family Nursing ’s I
50th Distance Learning Class I
Update 0n the ADN-MSN Program  
Plans for the ADN-MSN program are coming along well. Pamela  
Lester, DNS, FNP, joined the faculty in July. Her assignment will I
be to the Bridge Program. The Admission Committee reviewed •
files and has selected the first twenty ASN—MSN students. These I
students will start the Program in January of 2007. I
I
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I

 QUARTERLY BULLETIN ll
EIGHTY FIRST ANNUAL REPORT
OF THE
FRON TIER NURSING SERVICE
For the Fiscal Ycar
May 1, 2005 t0 April 30, 2006

 · 12 FRONTIER NURSING SERVICE .
 
B ll _,____,_,__...e .
Qt ..
Independent Accountants’ Report on Consolidated Financial
Statements and Supplementary Infomation
Board of Govemors
Frontier Nursing Service, lnc. and Affiliates
Lexington, Kentucky
We have audited the accompanying consolidated statements of financial position of Frontier Nursing
Service, lnc. and Affiliates (Service) as ofApril 30, 2006 and 2005, and the related consolidated
statements of activities and changes in net assets and cash flows for the years 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 audits.
We conducted our audits 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 audits provide 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 ofthe Service as of April 30, 2006 and 2005, and the changes in its net
assets and its cash flows for the years then ended in conformity with accounting principles generally
accepted in the United States of America.
Our audits were conducted for the purpose of forming an opinion on the consolidated financial
statements taken as a whole. The accompanying supplementary consolidating information is
presented for purposes of additional analysis and is not a required part of the consolidated financial
statements. The consolidating information is presented for purposes of additional analysis of the
consolidated financial statements rather than to present the financial position and changes in net
assets of the individual organizations. The supplementary information has been subjected to the
procedures applied in the audits ofthe basic consolidated financial statements and, in our opinion, is
fairly stated, in all material respects, in relation to the basic consolidated financial statements taken as
a whole.
gm; t ee
July 26, 2006, except for Note l5, as to r
which the date is August 15, 2006
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 QUARTERLY BULLETIN 13
 
T Frontier Nursing Service, lnc. and Affiliates
Consolidated Statements of Financial Position
April 30, 2006 and 2005
Assets
2006 2005
Current Assets
Cash S 78,759 S 109,651
Accounts receivables
Patient, less allowance for uncollectible accounts; 2006 -
$1,428,066, 2005—S651,32O 2,151,152 2,011,137
Student tuition, less allowance for uncollectible
accounts; 2006 and 2005 — $55,000 696,203 565,887
Other 10,402 15,564
lnvestments 18,773,913 17,460,359
Supply inventories 169,992 224,915
Estimated third-party payer settlements 1,048,397 634,044
Prepaid expenses and other assets 188.865 504 729
Total current assets 23,1 17.683 21,526,286
Property and Equipment, Net 3,492 121 3,374,837
Other Assets
Beneficial interest in outside trusts 1,914,612 1,787,223
investments held in perpetuity 3,956,521 3,956,521
Physician loan receivable 319,243 320,000
Other noncurrent assets 242,195 —-
Total other assets 6,432 571 6,063,744
Total assets S §§,,Q§Z,§  Q  
9
See Notes to Consolidated Financial Statements
1 ,

 ` 14 FRONTIER NURSING SERVICE ·
 
`
Liabilities and Net Assets
2006 2005
Current Liabilities
Accounts payable $ 1,216,774 S l,l44,707
Accrued expenses 2,302,426 l,856,002
Deferred tuition, students l,l28,9l0 785,268
Lines of credit — l,050,000
Current maturities of long—temt obligations 402,985 494 257
Total current liabilities 5,05l 095 5,330.234
Long-term Liabilities
Long-term obligations, net of current portion 488,220 789,857
Lines of credit 2 498,008 l,022,850
Total long-term liabilities 2,986,228 l,8l2,707
Total liabilities 8 037,323 7 142,94l
Net Assets
Unrestricted 9,072,794 8,895,263
Temporarily restricted l0,06l,l25 9,l82,9l9
Permanently restricted 5,87l,l33 5 743,744
Total net assets 25,005,052 23,821,926
Total liabilities and net assets S 33,;;,,3 Z5, S 3Q,Q§,§g;
¤
{
A

 QUARTERLY BULLETIN 15
 
· Frontier Nursing Service, Inc. and Affiliates
Consolidated Statements of Activities and Changes in Net Assets
Years Ended April 30, 2006 and 2005
2006 2005
Change in Unrestricted Net Assets
Revenues and gains
Net patient service revenue 8 16,115,901 S 12,264.039
Contributions 898,336 1,390,416
Education revenues
Tuition and educational fees 2,488,396 1,981.921
Federal grants 112,126 91,732
Other revenue
Investment retum 1,629,259 558,140
Other revenue 384,289 428,932
Net assets released from restriction due to
satisfaction of program requirements 818,130 482 783
Total revenues and gains 22 446 437 17,197 963
Expenses
Salaries, wages and benefits 10,199,704 8,154,638
Medical services. supplies and other expenses 8,126,351 6,459,958
Facility costs 2,379,848 2,039,142
Provider taxes 247,889 198,981
Provision for bad debts 1 315,1 14 1 027,877
Total expenses 22,268,906 17 880,596
Change in unrestricted net assets 177,531 (682,6331
Change in Temporarily Restricted Net Assets
Contributions 55,029 38,641
Investment retum 1,639,869 441,213
Change in annuity payable 1,438 25,196
Net assets released from restriction due to
satisfaction ofprogram requirements (818 130) (482,783l
Change in temporarily restricted net assets 878,206 22 267
Change in Permanently Restricted Net Assets
Change in beneficial interest in outside trusts 127 389 1 1,326
Change in permanently restricted net assets 127,389 11.326
Change in Net Assets 1,183,126 (649,040)
Net Assets, Beginning of Year    
¤
Net Assets, End ol` Year    
`
See Notes to Consolidated Financial Statements
· L ,,

 ' 16 FRONTIER NURSING SERVICE (
 
Frontier Nursing Services, Inc. and Affiliates ~
Consolidated Statements of Cash Flows ,
Years Ended April 30, 2006 and 2005
2006 2005 1
Operating Activities
Change in net assets S 1,183,126 S (649,040)
Adjustments to reconcile change in net ,
assets to net cash used in operating activities
Change in beneficial interest in outside trusts (127,389) (1 1,326)
Provision for bad debts 1,315,114 1,027,877
Depreciation and amortization 937,782 741,335
Net realized and unrealized gains on investments (2,615,123) (423,385)
Changes in
Patient and student tuition receivables (1,585,445) (1,565,844)
Other receivables 5,162 6,442
Supply inventories 54,923 (18,953)
Estimated third-party payor settlements (414,353) (375,904)
Prepaid expenses and other assets 315,864 (191,750)
Accounts payable 72,067 221,201
Accrued expenses 446,424 28,702
Deferred tuition, students 343,642 40.971
Other noncurrent assets (242 195) —
Net cash used in operating activities (310 401) (1,169 674)
Investing Activities
Purchases of property and equipment (974,832) (519,520)
Proceeds from sale of investments 1 1,464,338 6,515,452
Purchase of investments (10,162,769) (6,219,469)
Physician loan advances (20,577) (320 000)
Net cash provided by (used in) investing activities 306,160 (543 537)
Financing Activities
Net borrowings undcr line-of·credit agreements 425,158 2,072,850
Proceeds from issuance of long-temi obligations — 190,000
Principal payments on long-term obligations (451 809) (514.489)
Net cash (used in) provided by financing activities (26,651 ) 1,748,361
(Decrease) Increase in Cash (30,892) 35,150
Cash, Beginning ofYear 109,651 74,501
Cash, End of Year    
Supplemental Cash Flows information
Cash payments for interest S 257,554 $ 121,009
Noncash Investment and Financing Activities
Equipment acquired with capital leases S 58,900 S 714,622
See Notes to Consolidated Financial Statements

 QUARTERLY BULLETIN I 7
 
Frontier Nursing Service, lnc. and Affiliates
‘ Notes to Consolidated Financial Statements
. April 30, 2006 and 2005
Note 1: Nature of Operations and Summary of Signincant Accounting Policies
i Organization
Mary Breckinridge established the Kentucky Committee for Mothers and Babies in Leslie County,
‘ Kentucky, in l925. The name later changed to the Frontier Nursing Service, Inc. and Affiliates
(Service) in 1928. The Service’s original purpose was to provide needed health care in the
Appalachian area, introducing the first nurse—midwives in the United States. During its early years,
t.he Service was the only provider of health services in Leslie County and a portion of surrounding
counties comprising its service area. In l939, the Service established a midwifery school. Today,
FNS, Inc. (FNS) operates as a holding company for a midwifery and family nursing school, a real
estate holding company, a hospital, a home health agency, a foundation and a system of rural health
clinics which provide primary care services through the Dr. Anne Wasson Rural Health Center, the
Kate Ireland Women’s I-Iealth Care Center, Community Health Center, Beechfork Clinic, Red Bud
Family Clinic and Christian Family Healthcare. The Service has historically been dependent on
charitable contributions to fimd a significant portion ofthe costs of services and programs.
Principles of Consolidation
The Service consists ofthe following nonprofit entities:
FNS — Parent holding company of the Service.
Mary Breckinridge Health Care, Inc. (MBHC) — Entity responsible for operating the hospital
and up until April 30, 2005, the home health agency.
Frontier School of Midwifery and Family Nursing, Inc. (School) — Entity responsible for
operating the midwifery and family nursing school.
Frontier Nursing Service Foundation, Inc. (Foundation)- Entity responsible for maintaining the
investment portfolio of the Service and receiving contributions from donors.
FNS Real Estate, Inc. (FNS REI)- Entity responsible for holding and managing the real estate
and fixed assets owned by the Service.
Frontier Nursing Healthcare, Inc. (FNH) — Entity responsible for operating the nrral health
clinics.
Mary Breckinridge Home Health, Inc. (MBI-IH) — At May I, 2005, MBHH became die entity
responsible for operating the home health agency.
The consolidated financial statements include the accounts and transactions ofthe above entities.
Intercompany transaaions and accounts have been eliminated in consolidation.

 18 FRONTIER NURSING SERVICE
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Frontier Nursing Service, lnc. and Affiliates
Notes to Consolidated Financial Statements
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April 30, 2006 and 2005
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 consist of cash and highly liquid investments having an original
maturity of three months or less. The Service only has cash equivalents held in trust accounts
which are classified as investments in the consolidated statements of financial position.
Patient Accounts Receivable
MBHC, FNH and MBHH report patient accounts receivable for services rendered at net realizable
amounts from third-party payors, patients and others. MBHC, FNH and MBI-IH provide an
allowance for doubtful accounts based upon a review of outstanding receivables, historical
collection information and existing economic conditions. As a service to the patient, MBHC, FNH
and MBHH bill third-party payors directly and bill the patient when the patient’s liability is
detemiined. Patient accounts receivable are due in full when billed. Accounts are considered
delinquent and subsequently written off as bad debts based on individual credit evaluation and
specific circumstances of the account.
Student Tuition Accounts Receivable
Accounts receivable are stated at the amount billed to students. The School provides an allowance
for doubtful accounts, which is based upon a review of outstanding receivables, historical
collection infomation and existing economic conditions. Accounts receivable are ordinarily due
30 days after the issuance ofthe invoice. Accounts past due more than 120 days are considered
delinquent. Delinquent receivables are written off based on individual credit evaluation and
specific circumstances of the student.
Investments and Investment Return
Investments in equity securities having a readily determinable fair value and all debt securities are
carried at fair value. Othcr investments are valued at the lower of cost (or fair value at time of
donation, if acquired by contribution) or fair value. Investment retum includes dividend. interest
and other investment income, realized and unrealized gains and losses on investments carried at
fair value and realized gains and losses on other investments.
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 QUARTERLY BULLETIN 19
 
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Frontier Nursing Service, Inc. and Affiliates
" Notes to Consolidated Financial Statements
April 30, 2006 and 2005
Investment retum that is initially restricted by donor stipulation and for which the restriction will
be satisfied in the same year is included in unrestricted net assets. Other investment retum is
reflected in the statement of activities as unrestricted, temporarily restricted or pemianently
restricted, based upon the existence and nature of any donor or legally imposed restrictions. The
board of govemors designates unrestricted assets for special uses.
Supply Inventories
Medical supply and pharmaceutical inventories are stated at the lower of cost, determined using
first-in, first-out method, or market.
Property and Equipment
Property and equipment are stated at cost and are depreciated on a straight—line basis over the
estimated useful life of each asset. Assets under capital lease obligations and leasehold
improvements are amortized over the shorter of the lease term or their respective estimated useful
lives.
Beneficial Interest in Outside Trusts
The Service is a beneficiary of trust funds held by others. The Service has recorded as permanently
restricted assets the fair value of the trusts, which represents an estimate of the net present value of
the estimated income to be received from these trusts. income received from such funds is
included in unrestricted donations.
Deferred Tuition — Students
The Service provides graduate nurse-midwifery and family nurse practitioner education over a 24
to 36—month period (depending on full-time or part—time status) to eligible students. The School’s
policy is to recognize tuition revenue ratably over the term of the program for each student.
Estimated Malpractice Costs
An annual estimated provision is accrued for the self-insured portion of medical malpract