xt7rbn9x2183 https://exploreuk.uky.edu/dips/xt7rbn9x2183/data/mets.xml The Frontier Nursing Service, Inc. 2003 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. 79, No. 1, Summer/Septeber 2003 text Frontier Nursing Service, Vol. 79, No. 1, Summer/Septeber 2003 2003 2014 true xt7rbn9x2183 section xt7rbn9x2183 FRONTIER NURSING SERVICE
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US ISSN 0016-2116
TABLE OF CONTENTS
Courier Program News - Barb Gibson 1 •
Wendover News - Barb Gibson 2
Mary Breckinridge Healthcare News - Mallie Noble 3
Frontier Nursing Clinics update - Dr Julie Modell 5
Frontier School of Midwifery & Family Nursing News -
- Dr Susan Stone 7
Website Information 8
Annual Teen Pregnancy Lock-in - Debi Karsriitz 9
Urgent Need - Renovation of old Beech Fork Nursing Center 10
Seventy-Eighth Annual Report - Potter & Company 11
In Memoriam 36
Urgent Needs 41
Cover: Beautiful Wendover! Januaiy 2003. Barn in background.
Photo by Kate Fox, C ouriet:
Frontier Nursing Service Quarterly Bulletin
Published at the end of each quarter by the Frontier Nursing Service
Subscription Price $5.00 a year for Donors/$15.00 for Institutions
Volume 79 Number l Summer/September 2003
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 I
Courier Program News
by Barb Gibson, Assistant t0 CEO
‘ We haven’t had any Couriers this summer but are looking
forward to the arrival of Anna Carey, Webster, New York, on Sep-
tember 2. Anna is a school teacher who wants to broaden her ex-
' periences in rural settings to more than the school aspect.
Totty Lawson, Tour Guide, and AnnDraia Bales, Devel-
opment Secretary, plan to attend job fairs during October in New
Hampshire and Maine in an effort to encourage Couriers to apply
to our Program. We are trying to get the word out that we provide
opportunties to observe providers.
Former Courier News
Mike Thompson (‘02), wrote during May from Costa Rica where
he was visiting his sister. Mike is transferring to Brown University
in the fall.
Susan Mathew (‘98), Washington, DC, wrote during August that
she recently got a job with Family Health International which does
public health work in HIV/AIDS and reproductive health.
Karen T homisee, (‘96) Asheville, North Carolina, and her dog,
Ruby, visited during Memorial Day weekend. They were our first
guests to stay in the newly renovated Upper Shelf.

l
2 FRONTIER NURSING SERVICE
{
Wendover News
by Barb Gibson, Assistant t0 CEO I
It has been a very wet summer with · l
more rain than we normally have. Between
the rain we have continued the upkeep of . (
Wendover with no major problems/projects. H I
We continue in our efforts to make Wen- A - » ‘ ‘i
dover more beautiful. Our Bed & Breakfast _ _ y g I
Inn staff do a wonderful job of making our K S i ·‘.»
guests feel welcome. We continue to accommodate ovemight guests
and to host guests through luncheons, dinners and tour groups. We l
have had several journalists visit recently while touring eastern
Kentucky. Some of them wrote about Wendover’s Bed & Break-
fast Inn.
Upper Shey”Hist0ry l
In the last Wendover News I wrote an update about the j
renovations of the Upper Shelf. The following is a note from
Michele Bouche, nurse midwife, who lived at the Upper Shelf in
1980. Her husband remodeled the Upper Shelf during that time:
l
"In the latest Quarterly Bulletin I was fascinated to see a
picture ofthe Upper Shelf and to read that it was still standing and
in use. It was an abandoned building with four separate entrances 3
and only outside access to the bathroom when my husband and my j
seven—month-old son and I moved to Wendover so I could attend
the Frontier School of Midwifery in l978."
"Dr. Beasley arranged for us to live there rent free in ex-
change for remodeling the place into a single family dwelling. My
husband is a building contractor and he did all the work. We put in
insulation, made a hallway, made a kitchen and lived there for
three plus years. In fact, our second son was born there on Novem- E
ber l l, 1980, the day of the fire at the little Post Office. We have
pictures and lots of fond memories of hauling coal buckets up the K ·
l05 stone steps to the Upper SheltY" -MicheIe Bouche

I
QUARTERLY BULLETIN 3
I Mary Breckinridge Healthcare, Inc. News
A by Mollie Noble, Administrator
I Critical Access Licensure
The Office of Inspector General con-
( ducted Mary Breckinridge Hospital’s survey
as a Critical Access Hospital on July 22. I am ·
very pleased to announce that no deficiencies I ii
were found and the OIG Office recommended 4
p that our facility be licensed and certified as a
l Critical Access Hospital on September l. A
i special thank you to the employees for their
5 hard work in achieving this.
i Hospital Receives New Paint Job
I Mary Breckinridge Hospital is in thc process of getting a
new face-lift, thanks to the Ladies Auxiliary Committee. The Hos-
I pital currently is about two-thirds painted with plans to finish by
J the end of August. Local contractors are doing the painting and
the hospital looks great. I have had numerous calls from local com-
munity members commenting on how well the hospital looks. The
local contractors have done an excellent job.
SHIP Gram
~ Mary Breckinridge Healthcare has applied for a Small
Rural Hospital Improvement Grant (SHIP) through the Kentucky
Hospital Association.
Heaizh Fair
Mary Breckimidge Hospital Quality Improvement Depart-
ment conducted their 8th Annual Health Fair at the Nixon Center
1, on July 25th. F orty-five vendors were present and set up booths
f with healthcare information, free blood pressure checks, free glu-
cose checks and gave out a variety of nutritional information. Rep-
· resentatives from Centers for Medicare and Medicaid (CMS) were
= present with information conceming Medicare benefits. Approxi-
mately 300 community members attended the Health Fair. Thanks

4 FRONTIER NURSING SERVICE
to the Quality Improvement Department and all employees who r
participated in this year’s Health Fair. This is a very good educa-
tional and outreach resource for community members. _
Mary Breckinridge Festival Plans
Since the Mary Breckinridge Festival last October the _
Mary Breckinridge Festival Committee Members have been meet- I
ing monthly to help ensure that this Festival is bigger and better
each year. The theme this year is "Celebrating l25 years of His·
tory of Leslie County, Past, Present and Future". I would like to
express a special thank you to all the Committee members for
doing such a wonderfirl job, especially Rhonda Brashear, Chair- `
man.
I
Regional Bioterrorism Meetings
Some MBHC staff members and I have been meeting with |
representatives from the Kentucky Hospital Association and from
Kentucky Region l0, to develop a federally mandated plan to ad-
dress bioterrorism. This region includes the counties of Leslie, l
Knott, Letcher, Perry, Wolfe, Lee and Owsley. The development
of this plan has been a six-month process and will address an in-
flux of 500 patients to be handled within this regional structure.
The Federal Government, along with the Kentucky Hos-
pital Association, will be issuing grants to assist in supplies and ·
upgrades of radio equipment and personal protective equipment l
needed by the region. We have completed all the necessary grant
applications and are awaiting confirmation of the funding we will
receive. The amount we are expecting is around $l0,000. Our
plans are to prepare our facility and to educate the community
concerning bioterrorism
This process will include networking with all the district l
clinics, private physicians and the County Health Department. This l _
preparation is a goal which we will continue to upgrade and change g
as the government mandates and as we see the need arise. I

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QUARTERLY BULLETIN 5
Frontier Nursing Clinics Update
by Dr Julie Mmjell, Executive Director
We continue to grow and change at
the Frontier Nursing Healthcare, Inc (FNH).
I · As we plan and move forward, we re-visited . —
the mission statement for the clinics. A new u p y, ’»< _
, statement was drafted from the previous one I
I and is as follows: "The mission of FNH is ~ A ·
} to provide effective, comprehensive and l
' affordable primary healthcare to rural families in partnership with
the community. This includes maternity care, childbirth, the care
of infants, children, adolescents, adults and the elderly, within the
{ context of the entire family. FNH is committed to advancing the
} education of health professionals by providing an educational site
V for clinical practice with primary consideration given to FSMFN
i students." The Board of Directors approved the statement at the
I July meeting. Per the Board of Director ’s request, we will be add-
[ ing additional language to the statement that speaks to research.
Also, at the July meeting I was named the Executive Di-
rector of FNH. This will be part of my appointment as the Chair-
person ofthe Department of Family Nursing at the Frontier School
of Midwifery and Family Nursing (F SMFN) and is an administra-
tive position. This organization’s structural change will continue
to strengthen the ties between FSMFN and the clinics and our
concept of faculty practice. Heidi Froemke, MSN, F NP, and Debi
Karsnitz, MSN, CNM, will remain Directors ofthe Family Nurse
Practitioner and Midwifery Services and will continue to oversee
the daily operations of the clinics. The Kate Ireland Health Center
in Manchester passed the state inspection for rural clinic licensure
I with flying colors.
'» The nurse—midwives and nurse practitioners from all four
clinics participated in a health fair held in Hyden in July. The staff
gave away health education literature and a raffle for a sports physi-
_‘ cal, a women’s exam, a gift certificate for athletic shoes, baby
T gear and sports equipment was held as part of the promotional
activities.

6 FRONTIER NURSING SERVICE
FNH also participated in a Women’s Day at the Leslie
County Health Department. Debi Karsnitz gave an educational
presentation and we sponsored lunch for the participants. ,
Plans are underway for participation in Clay County Days l
and the Mary Breckinridge Festival. We are very excited because
FSMFN students will be in for a Level III during the Mary Breck— L .
inridge Festival and will participate in the festivities including the ;
parade.
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Hyden Clinic/Dr: Anne Wasson Building F
I

I
QUARTERLY BULLETIN 7
E
l Frontier School of Midwifery and Family Nursing News
by Dt: Susan Stone, President & Dean
T The Frontier School of Midwifery ·—~r
and Family Nursing is proud to announce
_· that we have achieved Candidacy status
with the Southern Association of Colleges je., .
1 and Schools (SACS). This is a major step _ `P _ P _. M
l forward toward achieving full accredita- vi J A ·
E tion. The next steps include a full assess- ‘
ment of our school, submission of the com-
l pleted SACS compliance document, applications and a self-study
Q for nursing accreditation and preparation for re-accreditation with
the American College of Nurse-Midwives for our CNEP program.
E Our work has only just begun but we embrace the challenge be-
cause we know that we will be meeting the needs of our students
E and producing wonderfully competent clinicians who will care for
j underserved populations around the world. Students admitted in
{ the F all of 2003 will be offered the full Master of Science in Nurs-
‘ ing program with the option of completing the nurse-midwifery
track or the family nurse practitioner track. Our goal is to achieve
Z full accreditation by December 2004.
Graduation plans for this Fall are progressing. As part of
{ our transition to a fully accredited graduate school, we will be
i wearing caps and gowns for the very first time. Students and fac-
l ulty voted on the choice of color for the gowns and the vote was
overwhelmingly to wear the school color of royal blue. Our cer-
emony this year will celebrate the achievement of l000 graduates
from the Conm1unity—Based Nurse Midwifery Education Program.
, Most appropriately, the speaker for this ceremony will be the
l founder of the CNEP, Kitty Ernst, CNM, MPH, DPS. We are
E, looking forward to this ceremony with great excitement.

I 8 FRONTIER NURSING SERVICE
I
WEBSITES
Frontier Nursing Service - www.frontiernursing.org
FSMFN Community Based Nurse Midwifery Education Program
(CNEP) — www.midwives.org
FSMFN Community Based Nurse Practitioner Program (CFNP)
— www.frontierfnp.org
Special Thanks for Urgent Needs i
Thanks to Joy Phonix, Elenor C. Hoague, S. i
Marc Cohen, Robert and Ceclia Morris, for I
the purchase of l) pulse oximetry probes for
the Emergency Room; and 2) Otoscope, 02 p
Sat Machine and blood pressure cuffs for g
Home Health.
Thanks to Charles Nickolaus for the purchase
of Littman stethescope and sensory mani- l
pulatives for Medical/Surgical. I
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QUARTERLY BULLETIN 9
I
Annual Teen Pregnancy Prevention Lock-In
by Deborah Karsnitz, Director of Midw@ry
This May, the Frontier Nursing Midwives sponsored their
5"' Annual Teen Pregnancy Prevention Lock—in. Like years before,
the night was a huge success. The event started on a Friday evening
at 7:00 pm and ended the next morning at 7:00 am.Volunteers for
the Lock-In consisted of staff from Frontier School of Midwifery
and Family Nursing, Frontier Nursing Healthcare, Inc., and Mary
Breckinridge Hospital, as well as many community members and,
l of course, our local City Police department, Sheriff ’s department,
‘ and State Police. I want to say a special thank-you to our local
L seniors from Leslie County High School. They were a wonderful
addition to our staff this year. They patrolled constantly, kept in
communication with the rest ofthe staff and greatly helped control
I the crowd. They also had fun dancing and singing with other stu-
dents in our talent competition.
l We had 300 student participants this year, ages I3-15.
We started the evening with live music from the band, Ambush,
followed by a dance with local DJ, Michael Dwayne. Michael has
participated in this event for the past five years and has become a
¥ fixture in our planning. The co-chairs for the lock-in were Deborah
I Karsnitz, CNM, and Karen Sallee, LCSW, former Social Worker
Q for Mary Breckinridge Hospital. We raised over $1 ,500.00 mostly
i due to Karen Sallee’s expertise in fund raising. The students en-
i joyed a night of music, fun, games, karaoke, and sports, all the
I free food they could eat and drink, and prizes at the end of the
i night.
t During the night we held mandatory teaching sessions
, where groups were divided by age and sex. The discussions ranged
from pregnancy prevention, date rape, and protection from dis-
F, ease and how to deal with peer pressure. The discussions were
very frank, lively and interesting. We encouraged very open dis-
cussions and often discovered that our teens have many miscon-
l . ceptions in these areas. We plan to continue this yearly event each
l May, and hope for continued support from the community and
friends of Frontier Nursing Service.

I 10 FRONTIER NURSING SERVICE
_ I
Beech Fork Nursing Center
Renovations Update
·
In the last Quarterly Bulletin, we wrote about the Beech
Fork Nursing Center renovations project, the first out—post clinic 2
built by Mrs. Breckinridge. f
Since the last update, the roof has been replaced and trees `
have been cut to prevent further roof damage. Many hours have
been spent burning brush, etc. The outside of the Center has been
painted and work has begun on the inside - replacing ceilings, res-
toration of wooden floors and much more. We are making progress
but still have a lotto do. We encourage your support! I
Special thanks to the following people who have contrib- x
uted to this project: Mr. & Mrs. James V Tartala, Dr. Zondra
Linblade, Mrs. Charles S. Potter, Betty Ann Bradbury, Jane Leigh `
Powell, Eunice "Kitty" Emst, Kathy Kaufman, Karen Clark,
Harriet Palmer and Carolyn Godfrey. »
C r li y .
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· I i J Z I- 3 V .‘‘· i - °' il
` V · ' - ` Ur" -[FT`;-L ll NAI" ‘;:';;4}·»>¤;:" V
e Fork Center — August 2003 I .

QUARTERLY BULLETIN ll
SEVENTY—EIGHTH ANNUAL REPORT
OF
THE
U FRONTIER NURSING SERVICE
For the Fiscal Year
2 May 1, 2002 to April 30, 2003
Preface
As has been our custom since we were one—year-old, we present
our annual report of the fiscal affairs ofthe field operations ofthe
§ Frontier Nursing Service, Incorporated.
We have, as in previous years, divided our report into two sec-
{ tions. One section is about money and one is about work.
Fiscal Report
Y
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, 2003.
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1.

1 POTTER & COMPANY. LLP
Certified Pub/ic Accountants Business Advisor: A
INDEPENDENT AUDlTOR’S REPORT
To the Board of Governors
FNS, Inc. and Affiliates
Lexington, Kentucky
We have audited the accompanying combined statements of financial position of FNS, ,
Inc. (a non-proht organization) and affiliates as of April 30, 2003 and 2002, and the ,
related combined statements of activities and changes in net assets and cash flows for T
the years then ended. These combined financial statements are the responsibility of the °
FNS, lnc.‘s management. Our responsibility is to express an opinion on these combined T
financial statements based on our audits. f
l
We conducted our audits in accordance with auditing standards generally accepted in i
the United States of America. Those standards require that we plan and perform the l
audit to obtain reasonable assurance about whether the combined Gnancial statements l
are free of material misstatement. An audit includes examining, on a test basis, ‘
evidence supporting the amounts and disclosures in the combined financial statements. 1
An audit also includes assessing the accounting principles used and significant `
estimates made by management, as well as evaluating the overall financial statement 2
presentation. We believe that our audits provide a reasonable basis for our opinion. ?
ln our opinion, the combined financial statements referred to above present fairly, in all
material respects, the hnancial position of FNS, Inc. and affiliates as of April 30, 2003 1
and 2002, and the changes in its net assets and its cash flows for the years then ended i
in conformity with accounting principles generally accepted in the United States of i
America. l
’
As discussed in Note 18 to the Hnancial statements, certain errors resulting in
understatement of previously reported temporarily restricted net assets as of April 30, ·
2001, were discovered by management of FNS, lnc. during the current year.
Accordingly, an adjustment has been made to unrestricted board designated net assets '
and temporarily restricted net assets as of April 30, 2001, to correct this error.
ci, ,.l_ 1 ;
[ w fc q, Cmefva-€ ,!/L10 I
POTTER & COMPANY, LLP
August 1, 2003 i .
E
1
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QUARTERLY BULLETIN I3

FNS, INC. AND AFFILIATES
` COMBINED STATEMENTS OF FINANCIAL POSITION
April 30, 2003 and 2002
‘ 2003 2002
A S S E T S
Current assets:
V Cash and cash equivalents $ 447,331 $ 764,789
` Cash - self insured medical 6,402 7,530
Receivables:
Patient, less allowances for uncollectible
‘ accounts of approximately $947,100 and
~ $842,000 in 2003 and 2002, respectively 2,378,592 2,685,411
~ Student tuition, less allowances for uncollectible
accounts of approximately $18,700 in
` 2003 and 2002, respectively 421,965 187,986
i Bequest receivable 0 500,000
E Other 117,378 96,383
I Investments 17,298,622 21,940,777
· Inventories 211,449 254,188
Prepaid expenses and other assets 438,956 431,463
j Total current assets 21,320,695 26,868,527
Property and equipment, net 3,186,125 2,648,925

Other assets:
[ Beneficial interest in outside trusts 1,626,457 1,772,000
I Investments held in perpetuity 3,969,022 3,969,022
I Total other assets 5,595,479 5,741,022
} Total assets $ 30 102,299 $ 35 258 474
I
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2 See accompanying notes. 2

A I4 FRONTIER NURSING SERVICE
hi
w @0; ‘
LIABILITIES AND NET ASSETS
Current liabilities: I
Accounts payable S 456,969 $ 837,945
Accrued salaries and withholdings 320,659 305,257 ~
Accrued vacation expense 322,997 352,409
Deferred tuition, students 619,429 518,273
Self-insured medical liability 134,911 99,798 ‘
Estimated third-party payor settlements 726,999 450,000 _
Obligations under capital leases - current portion 197,724 0
Notes payable — current portion 208,820 207,287
Bond payable - current portion 99,073 122,330
Other liabilities 493,481 593,390
Total current liabilities 3,581,062 3,486,689
Commitments and contingencies
Long term liabilities:
Obligations under capital leases, j
net of current portion 571,534 0 `
Notes payable, net of current portion 18,505 37,322
Bonds payable, net of current portion 0 89,589
Total long term liabilities 590,039 126,911
Total liabilities 4,171,101 3,613,600 “
Net assets:
Unrestricted: `
Board designated 7,711,407 10,995,664 .
Undesignated 4,262,271 4,945,294 ‘
Temporarily restricted 8,362,041 9,962,894 I
Permanently restricted 5,595,479 5,741,022 I
Total net assets 25,931,198 31,644,874 [
Total liabilities and net assets $ 30 102 299 $ 35 258 474 g
t
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QUARTERLY BULLETIN I5

FNS, INC. AND AFFILIATES
t; COMBINED STATEMENTS OF ACTIVITIES AND CHANGES IN NET ASSETS
Years ended April 30, 2003 and 2002
x W W
Change in unrestricted net assets:
Revenues and gains:
Net patient service revenue $ 11,207,253 $ 13,188,196
` Contributions 596,250 589,596
Education revenues:
` Tuition and educational fees 1,498,069 1,475,710
Federal grants 130,336 112,225
. Other grant revenue 38,665 45,836
Other revenue:
` Investment return (1,328,691) (875,919)
Other revenue 3,015,507 199,152
Net assets released from restriction due to
satisfaction of program requirements 767,301 566,771
Total revenues and gains 15,924,690 15,301,567
Expenses:
Salaries and wages 6,717,470 7,565,146
Fringe benefits 1,526,791 1,278,084
, Medical senxices, supplies, and
* other expenses 8,198,130 5,385,675
Facility costs 1,747,558 1,234,232
Provider taxes 219,230 196,619
Provision for bad debts ’ 1,482,791 1,223,435
* Total expenses 19,891,970 16,883,191
‘ Change in unrestricted net assets (3,967,280) (1,581,624)
` Change in temporarily restricted net assets:
, Contributions 136,281 593,393
‘ Investment return (965,115) (1,119,924)
Q Change in annuity payable (4,718) 66,321
1 Net assets released from restriction due to
[ satisfaction of program requirements (767,301) (566,771)
F Change in temporarily restricted net assets (1,600,853) (1,026,981)
] Change in permanently restricted net assets:
Contributions 0 50,000
Change in benehcial interest
( in outside trusts (145,543) (127,853)
Change in permanently restricted net assets (145,543) (77,853)
See accompanying notes. 4
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‘ I6 FRONTIER NURSING SERVICE
FNS, INC. AND AFFILIATES
COMBINED STATEMENTS OF ACTIVITIES AND CHANGES
IN NET ASSETS (CONTINUED)
Years ended April 30, 2003 and 2002
s
2003 2002
Change in net assets (5,713,676) (2,686,458)
Net assets, beginning 0f year 31,644,874 34,331,332
Net assets, end of year $ 25,931,198 $ 31,644,874
r,
See accompanying notes. 5

QUARTERLY BULLETIN 17

FNS, INC. AND AFFILIATES
COMBINED STATEMENTS OF CASH FLOWS
Years ended April 30, 2003 and 2002
, 2013 @
Cash flows from operating activities:
Change in net assets $ (5,713,676) $ (2,686,458)
Adjustments to reconcile change in net assets
to net cash used in operating activities:
Change in beneficial interest in outside trusts 145,543 127,853
. Provision for bad debts 1,482,791 1,223,435
Depreciation 592,306 293,264
= Realized losses on sales of investments 1,451,420 610,272
Unrealized losses on investments 1,416,120 2,111,435
Loss on disposition of equipment 67,646
Permanently restricted contributions 0 (50,000)
(Increase) decrease in:
Patient receivables 306,819 (884,073)
Student tuition receivables (233,979) (28,590)
Bequest receivable 500,000 (500,000)
Other receivables (20,995) (95,483)
Inventories 42,739 5,928
Other assets (7,493) (99,713)
Increase (decrease) in:
Accounts payable (380,976) (172,301)
Deferred tuition, students 101,156 4,860
SeIf—insurance reserve 35,113 (222,047)
Estimated third—party payor settlements 276,999 (8,639)
Other liabilities (113,919) (143,728)
Net cash used in operating activities (52,386) (513,985)
Cash flows from investing activities:
Proceeds from sale of equipment 58,688 0
Purchase of property and equipment (285,932) (471,680)
Proceeds from sale of investments 13,925,987 13,005,096
Purchase of investments (13,703,036) (12,517,854)
Net cash provided by (used in)
investing activities (4,293) 15,562
Cash flows from financing activities:
Borrowings from notes payable 190,000
Payments on notes payable (17,284) (15,876)
Payments on capital leases (130,649) (94,712)
,v Payments on bond payable (112,846) (106,395)
Investment subject to Iong»term restrictions 0 50,000
Net cash provided by (used in)
financing activities (260,779) 23,017
See accompanying notes. 6

· l8 FRONTIER NURSING SERVICE

FNS, INC. AND AFFILIATES I
COMBINED STATEMENTS OF CASH FLOWS (CONTINUED)
Years ended April 30, 2003 and 2002
2003 2002 `
Net decrease in cash and cash equivalents (317,458) (475,406)
Cash and cash equivalents, beginning of year 764,789 1,240,195
Cash and cash equivalents, end of year $ 447,331 S 764,789
Supplemental cash tlow information:
Cash payments for interest $ 54,791 S 37,156
Noncash investing and tinancing activities
Equipment acquired with capital lease $ 899,907 SB 0

A
See accompanying notes. 7
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QUARTERLY BULLETIN 19

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" FNS, INC. AND AFFILIATES
NOTES TO THE COMBINED FINANCIAL STATEMENTS
April 30, 2003 and 2002
` 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 financial 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 significant portion of the costs of service and programs.
During 2003 the Service formed a new company entitled Frontier Nursing Healthcare, Inc. The company
was established to account for rural health clinics. All current and future health clinics will be financially
and legally separated from the Hospital. Operation for Frontier Nursing Healthcare, Inc. commenced in
February 2003.
Principles of Combination:
The Service consists of the following nonprofit entities:
FNS Inc.- Parent holding company of the Service.
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l Mag; Breckinridge Health Care lnc. — Entity responsible for operating the hospital and home health
j agency.
5 Frontier School of Midwifegy 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.
Frontier Nursing Healthcare Inc. — Entity responsible for operating the rural health clinics.
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` 20 F RONTIER NURSING SERVICE
FNS, INC. AND AFFILIATES
NOTES TO THE COMBINED FINANCIAL STATEMENTS
April 30. 2003 and 2002
NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Principles of Combination (Continued):
The combined financial statements include the accounts and transactions of the above entities.
Interccmpany transactions and accounts have been eliminated in combination.
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 Hnancial position and activities according to three classes
of net assets: unrestricted, temporarily restricted, and permanently restricted.
Contributions, including unconditional promises to give, are recognized as revenues in the period
received and are recorded as unrestricted, temporarily restricted or permanently restricted support
depending on the existence and nature of any donor restrictions. Conditional promises to give are not
recognized until the conditions on which they depend are substantially met. Contributions of assets
other than cash are recorded at their estimated fair value. Restricted contributions whose restrictions
are satisfied in the period the contributions are received are reported as unrestricted contributions.
Restricted net assets are reclassified to unrestricted net assets upon satisfaction of the time or
purpose restriction and are reported in the statement of activities as net assets released from
restrictions.
Use of Estimates:
The preparation of consolidated Hnancial 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 prog