Facility record report · CMS certification number 146035
NORTH ADAMS HOME
MENDON, Illinois
This certification number is not in CMS’s current Care Compare Provider Information file, processed on 1 August 2026. Its Medicare enrollment, NORTH ADAMS HOME INC (enrollment ID O20111111000127), is not listed in the CMS enrollment file dated 1 August 2026.
Finances, as filed
From this facility’s Medicare cost reports on form CMS-2540, each figure with the worksheet, line and column it was read from.
Cost report for 1 November 2017 to 31 October 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 26 June 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,195,240 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $4,351 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,190,889 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,526,845 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$335,956 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $162,149 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$173,807 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$173,807 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Bed days available, all components | 33,580 | CMS-2540-10 worksheet S300001 line 800 column 200 |
| Medicare (Title XVIII) patient days | 1,170 | CMS-2540-10 worksheet S300001 line 800 column 400 |
| Medicaid (Title XIX) patient days | 11,828 | CMS-2540-10 worksheet S300001 line 800 column 500 |
| Other-payer patient days | 6,819 | CMS-2540-10 worksheet S300001 line 800 column 600 |
| Total patient days, all components | 19,817 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Medicare discharges | 69 | CMS-2540-10 worksheet S300001 line 800 column 900 |
| Medicaid discharges | 14 | CMS-2540-10 worksheet S300001 line 800 column 1000 |
| Other-payer discharges | 46 | CMS-2540-10 worksheet S300001 line 800 column 1100 |
| Total discharges, all components | 129 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 16.96 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 844.86 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 153.62 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1232336, read from the public cost report file SNF10FY2018.zip.
Cost report for 1 November 2016 to 31 October 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 24 January 2019.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,576,301 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | $16,875 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,559,426 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,103,642 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$544,216 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $185,691 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$358,525 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$358,525 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 20,496 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 105 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 23.99 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 704.88 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 195.2 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1218103, read from the public cost report file SNF10FY2017.zip.
Cost report for 1 November 2015 to 31 October 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 8 June 2017.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,693,940 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $3,693,940 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,967,173 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$273,233 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $101,490 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$171,743 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$171,743 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 20,519 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 121 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 25.89 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 665.06 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 169.58 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1160131, read from the public cost report file SNF10FY2016.zip.
Cost report for 1 November 2014 to 31 October 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 20 May 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,460,709 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $3,460,709 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,531,813 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$71,104 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $87,436 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $16,332 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $16,332 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 19,970 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 111 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 28.87 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 485.35 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 179.91 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1124333, read from the public cost report file SNF10FY2015.zip.
Cost report for 1 November 2013 to 31 October 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 1 February 2016.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,633,871 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $3,633,871 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,567,007 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | $66,864 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $149,918 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $216,782 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $216,782 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 21,717 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 97 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 31.52 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 962.69 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 223.89 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1118385, read from the public cost report file SNF10FY2014.zip.
Cost report for 1 November 2012 to 31 October 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 15 August 2015.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,264,936 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Contractual allowances and discounts | −$60,693 | CMS-2540-10 worksheet G300000 line 200 column 100 |
| Net patient revenue | $3,325,629 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,454,729 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$129,100 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $119,687 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | −$9,413 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: −$9,413 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 22,045 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 88 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.96 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 735.89 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 250.51 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1108023, read from the public cost report file SNF10FY2013.zip.
Cost report for 1 November 2011 to 31 October 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 23 September 2014.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total patient revenue | $3,396,687 | CMS-2540-10 worksheet G300000 line 100 column 100 |
| Net patient revenue | $3,396,687 | CMS-2540-10 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,398,815 | CMS-2540-10 worksheet G300000 line 400 column 100 |
| Net income from service to patients | −$2,128 | CMS-2540-10 worksheet G300000 line 500 column 100 |
| Total other income | $131,570 | CMS-2540-10 worksheet G300000 line 2500 column 100 |
| Net income after other income | $129,442 | CMS-2540-10 worksheet G300000 line 2600 column 100 |
Net income: $129,442 (CMS-2540-10 worksheet G300000 line 3100 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 26 less 27 through 30) on 204,018 of the 204,018 reports filed on Form CMS-2540-10 in publication years 2011-2025 that file every line it is computed from (100%).
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-10 worksheet S300001 line 800 column 100 |
| Total patient days, all components | 21,347 | CMS-2540-10 worksheet S300001 line 800 column 700 |
| Total discharges, all components | 93 | CMS-2540-10 worksheet S300001 line 800 column 1200 |
| Average length of stay, Medicare, in days | 22.75 | CMS-2540-10 worksheet S300001 line 800 column 1400 |
| Average length of stay, Medicaid, in days | 857.2 | CMS-2540-10 worksheet S300001 line 800 column 1500 |
| Average length of stay, all patients, in days | 229.54 | CMS-2540-10 worksheet S300001 line 800 column 1600 |
CMS report record 1078302, read from the public cost report file SNF10FY2012.zip.
Cost report for 1 November 2010 to 31 October 2011 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 21 March 2013.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,989,935 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,790,975 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $198,960 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $124,233 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $323,193 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 25,676 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 132 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 22.27 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 699.38 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 194.52 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 434325, read from the public cost report file SNFFY2011.zip.
Cost report for 1 November 2009 to 31 October 2010 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 17 April 2012.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,720,474 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $3,596,003 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | $124,471 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $48,395 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: $172,866 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 92 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 25,422 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 103 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 33.74 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 780.1 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 246.82 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 427226, read from the public cost report file SNFFY2010.zip.
Cost report for 1 November 2008 to 31 October 2009 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 25 May 2011.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,766,290 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,047,525 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$281,235 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $544,011 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
| Total other expenses | $298 | CMS-2540-96 worksheet G300000 line 3100 column 100 |
Net income, stated at moderate confidence: $262,478 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 99 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 26,629 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 110 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 38.93 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 1,423.25 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 242.08 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 400363, read from the public cost report file SNFFY2009.zip.
Cost report for 1 November 2007 to 31 October 2008 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 12 April 2010.
None of these figures is carried on this report.
CMS report record 367150, read from the public cost report file SNFFY2008.zip.
Cost report for 1 November 2006 to 31 October 2007 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 19 March 2009.
None of these figures is carried on this report.
CMS report record 335682, read from the public cost report file SNFFY2007.zip.
Cost report for 1 November 2005 to 31 October 2006 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 17 March 2008.
| Figure | As filed | Where it comes from |
|---|---|---|
| Net patient revenue | $3,660,159 | CMS-2540-96 worksheet G300000 line 300 column 100 |
| Total operating expenses | $4,176,717 | CMS-2540-96 worksheet G200002 line 1500 column 200 |
| Net income from service to patients | −$516,558 | CMS-2540-96 worksheet G300000 line 500 column 100 |
| Total other income | $154,137 | CMS-2540-96 worksheet G300000 line 2600 column 100 |
Net income, stated at moderate confidence: −$362,421 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
| Figure | As filed | Where it comes from |
|---|---|---|
| Total facility beds, all components | 99 | CMS-2540-96 worksheet S300001 line 900 column 100 |
| Total patient days, all components | 32,916 | CMS-2540-96 worksheet S300001 line 900 column 700 |
| Total discharges, all components | 121 | CMS-2540-96 worksheet S300001 line 900 column 1200 |
| Average length of stay, Medicare, in days | 39.02 | CMS-2540-96 worksheet S300001 line 900 column 1400 |
| Average length of stay, Medicaid, in days | 610.97 | CMS-2540-96 worksheet S300001 line 900 column 1500 |
| Average length of stay, all patients, in days | 272.03 | CMS-2540-96 worksheet S300001 line 900 column 1600 |
CMS report record 304713, read from the public cost report file SNFFY2006.zip.
Cost report for 1 November 2004 to 31 October 2005 — a reporting period of 364 days, on form CMS-2540-96, settled, processed by CMS on 27 November 2006.
None of these figures is carried on this report.
CMS report record 267119, read from the public cost report file SNFFY2005.zip.
Cost report for 1 November 2003 to 31 October 2004 — a reporting period of 365 days, on form CMS-2540-96, settled, processed by CMS on 10 November 2005.
None of these figures is carried on this report.
CMS report record 236541, read from the public cost report file SNFFY2004.zip.
Cost report for 1 October 2002 to 31 October 2003 — a reporting period of 395 days, on form CMS-2540-96, settled, processed by CMS on 1 March 2005.
Net income, stated at moderate confidence: −$155,700 (CMS-2540-96 worksheet G300000 line 3200 column 100). As filed, net income for the period equals net income from service to patients plus total other income, less total other expenses (Worksheet G-3 lines 5 plus 26 less 31) on 192,460 of the 192,462 reports filed on Form CMS-2540-96 in publication years 1995-2012 that file every line it is computed from (99.99%); on 2 of them the filed figure and that arithmetic differ, by a median of $46,907, and those figures are not shown. A further 2,252 reports file net income without filing net income from service to patients (Worksheet G-3 line 5), so the arithmetic cannot be applied to them and their figure is shown as filed.
CMS report record 209242, read from the public cost report file SNFFY2003.zip.
Five facilities of a similar size in Illinois, fiscal year 2018
Chosen for having certified bed counts closest to this facility’s, listed by name. Every one filed for the same fiscal year; the day each year ends differs and is shown. Each figure is that facility’s own filing.
| Facility | Total facility beds | Total patient days | Net patient revenue | Total operating expenses | Net income from service to patients | Period ended |
|---|---|---|---|---|---|---|
| ALDEN - NORTH SHORE | 93 | 23,110 | $9,781,740 | $10,079,536 | −$297,796 | 31 December 2018 |
| FARMINGTON COUNTRY MANOR | 92 | 27,313 | $6,262,334 | $5,917,051 | $345,283 | 31 December 2018 |
| HERITAGE MANOR LITCHFIELD LLC | 92 | 22,840 | $5,034,008 | $4,956,409 | $77,599 | 31 December 2018 |
| NORTH ADAMS HOME | 92 | 19,817 | $3,190,889 | $3,526,845 | −$335,956 | 31 October 2018 |
| ST JOSEPH NURSING HOME | 93 | 26,936 | $5,200,287 | $5,535,873 | −$335,586 | 30 June 2018 |
| THE LOFT REHABILITATION & NURSING LL | 92 | 22,951 | $4,426,524 | $4,780,543 | −$354,019 | 31 December 2018 |
Where each column comes from, on every filing in this table: Total facility beds: CMS-2540-10 worksheet S300001 line 800 column 100 · Total patient days: CMS-2540-10 worksheet S300001 line 800 column 700 · Net patient revenue: CMS-2540-10 worksheet G300000 line 300 column 100 · Total operating expenses: CMS-2540-10 worksheet G300000 line 400 column 100 · Net income from service to patients: CMS-2540-10 worksheet G300000 line 500 column 100.
Ownership, as filed with CMS
Care Compare
Not yet extracted for this facility.
Medicare enrollment
Not yet extracted for this facility.
Changes in ownership
- 14 April 2023: RICHARD MARTIN no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: DARON DUKE no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: DEBORAH HULL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: JAMES TOTSCH no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: PAUL TERWELP no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: GERRI BUSS no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: CAROL ANDERSON no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: SUSAN YORK no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: TONIA HEMMING no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: NANCY CROW no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
Inspections
Not yet extracted for this facility.
Deficiencies cited
Not yet extracted for this facility.
Penalties
Not yet extracted for this facility.
Care Compare provider information
Not yet extracted for this facility.
Every change on this record
- 14 April 2023: RICHARD MARTIN no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: DARON DUKE no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: DEBORAH HULL no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: JAMES TOTSCH no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: PAUL TERWELP no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: GERRI BUSS no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: CAROL ANDERSON no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: SUSAN YORK no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: TONIA HEMMING no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 14 April 2023: NANCY CROW no longer appears as OTHER in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2023-04-14.csv
- 26 June 2019: A cost report was filed for fiscal year 2018, on form CMS-2540-10. SNF10FY2018.zip
- 24 January 2019: A cost report was filed for fiscal year 2017, on form CMS-2540-10. SNF10FY2017.zip
- 8 June 2017: A cost report was filed for fiscal year 2016, on form CMS-2540-10. SNF10FY2016.zip
- 20 May 2016: A cost report was filed for fiscal year 2015, on form CMS-2540-10. SNF10FY2015.zip
- 1 February 2016: A cost report was filed for fiscal year 2014, on form CMS-2540-10. SNF10FY2014.zip
- 15 August 2015: A cost report was filed for fiscal year 2013, on form CMS-2540-10. SNF10FY2013.zip
- 23 September 2014: A cost report was filed for fiscal year 2012, on form CMS-2540-10. SNF10FY2012.zip
- 21 March 2013: A cost report was filed for fiscal year 2011, on form CMS-2540-96. SNFFY2011.zip
- 17 April 2012: A cost report was filed for fiscal year 2010, on form CMS-2540-96. SNFFY2010.zip
- 25 May 2011: A cost report was filed for fiscal year 2009, on form CMS-2540-96. SNFFY2009.zip
- 12 April 2010: A cost report was filed for fiscal year 2008, on form CMS-2540-96. SNFFY2008.zip
- 19 March 2009: A cost report was filed for fiscal year 2007, on form CMS-2540-96. SNFFY2007.zip
- 17 March 2008: A cost report was filed for fiscal year 2006, on form CMS-2540-96. SNFFY2006.zip
- 27 November 2006: A cost report was filed for fiscal year 2005, on form CMS-2540-96. SNFFY2005.zip
- 10 November 2005: A cost report was filed for fiscal year 2004, on form CMS-2540-96. SNFFY2004.zip
- 1 March 2005: A cost report was filed for fiscal year 2003, on form CMS-2540-96. SNFFY2003.zip
How to read this report
Every figure is printed as the CMS file it came from printed it. Each cost-report figure carries the worksheet, line and column of form CMS-2540 it was read from, so a reader holding the same public file can go to that cell; each Care Compare and Medicare enrollment section names its file and the date CMS stamped on it.
A figure the filing does not carry is left out, and so is a figure whose value the filing’s own arithmetic contradicts. Net income is printed with what the form’s own arithmetic shows about it — plainly where it follows from the lines above it, and, where it does not, beside what the form’s own lines leave unaccounted for. An ownership field left empty carries the dated sentence on CMS’s pause of the expanded Form CMS-855A disclosure. A source that holds nothing for this facility says so in its section.
This report carries no percentile and no score, and it does not place this facility above or below another. The five facilities above are the one comparison it draws: the nearest certified bed counts in the same state at the same fiscal year, listed by name. Nurse staffing is printed in its own section, on its own page, apart from the cost-report figures.
How to cite this report
Velarion Records, NORTH ADAMS HOME — facility record report, CMS certification number 146035. https://velarionrecords.com/facility/146035/report.
- Cost report figures: CMS Healthcare Cost Report Information System, form CMS-2540-10, publication year 2018, file
SNF10FY2018.zip. - Provider information, inspections, deficiencies and penalties: CMS Care Compare, file dated 1 August 2026.
- Care Compare ownership: CMS file dated 1 August 2026.
- Medicare enrollment ownership: CMS file dated 1 August 2026.
- Nurse staffing: CMS Payroll-Based Journal, quarters 2017Q1 to 2018Q4.
Published by VELARIONAI LLC · Andrew Richardson, founder. Corrections: hello@velarionrecords.com, quoting certification number 146035. Velarion Records publishes these records as filed.
Nurse staffing, quarter by quarter
Hours this facility reported to CMS’s Payroll-Based Journal, one row per quarter, oldest first, each with how its figures are derived and the file it came from.
| Quarter | Quarter ended | Days reported | Resident days | Registered nurse hours | Licensed practical nurse hours | Nurse aide hours | Total nurse hours |
|---|---|---|---|---|---|---|---|
| 2017Q1 | 31 March 2017 | 90 | 4,829 | 5,223.25 | 3,240.5 | 8,806 | 17,269.75 |
| 2017Q2 | 30 June 2017 | 91 | 5,020 | 4,539.97 | 3,815.75 | 10,081.75 | 18,437.47 |
| 2017Q3 | 30 September 2017 | 92 | 5,330 | 5,047.32 | 3,422.25 | 10,250.25 | 18,719.82 |
| 2017Q4 | 31 December 2017 | 92 | 5,331 | 5,242.33 | 3,542.57 | 9,227.66 | 18,012.56 |
| 2018Q1 | 31 March 2018 | 90 | 5,383 | 3,756.25 | 3,634.67 | 8,918.6 | 16,309.52 |
| 2018Q2 | 30 June 2018 | 91 | 4,768 | 3,351.72 | 3,893.95 | 8,436.91 | 15,682.58 |
| 2018Q3 | 30 September 2018 | 92 | 4,414 | 4,135.26 | 3,403.28 | 7,104.01 | 14,642.55 |
| 2018Q4 | 31 December 2018 | 92 | 4,321 | 4,180.6 | 2,080.1 | 7,740.7 | 14,001.4 |
| Quarter | Registered nurse hours per resident day | Licensed practical nurse hours per resident day | Nurse aide hours per resident day | Total nurse hours per resident day |
|---|---|---|---|---|
| 2017Q1 | 1.081642 | 0.67105 | 1.823566 | 3.576258 |
| 2017Q2 | 0.904376 | 0.76011 | 2.008317 | 3.672803 |
| 2017Q3 | 0.946964 | 0.642073 | 1.923124 | 3.512161 |
| 2017Q4 | 0.983367 | 0.664523 | 1.730944 | 3.378833 |
| 2018Q1 | 0.697799 | 0.675213 | 1.656808 | 3.02982 |
| 2018Q2 | 0.702961 | 0.816684 | 1.769486 | 3.289132 |
| 2018Q3 | 0.936851 | 0.771019 | 1.609427 | 3.317297 |
| 2018Q4 | 0.967508 | 0.481393 | 1.791414 | 3.240315 |
How each quarter is derived, and its file
- 2017Q1: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-03-31.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. This file names the totals hrs_rn_donadmin, hrs_lpn_admin, hrs_na_trn; they are read as hrs_rndon, hrs_lpnadmin, hrs_natrn.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-03-31.csv - 2017Q2: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-06-30.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. This file names the totals hrs_lpn_admin; they are read as hrs_lpnadmin. CMS's file labels its last six hours columns hrs_medaide, hrs_medaide_emp, hrs_rn_donadmin, hrs_na_trn, hrs_natrn_emp, hrs_natrn_ctr; they are read by position as Hrs_MedAide_emp, Hrs_MedAide_ctr, Hrs_NAtrn, Hrs_NAtrn_emp, Hrs_NAtrn_ctr, Hrs_MedAide, the order in which each total equals its employee and contract parts on every row.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-06-30.csv - 2017Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-09-30.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. This file names the totals hrs_lpn_admin, hrs_na_trn; they are read as hrs_lpnadmin, hrs_natrn.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-09-30.csv - 2017Q4: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-12-31.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0. This file names the totals hrs_lpn_admin, hrs_na_trn; they are read as hrs_lpnadmin, hrs_natrn.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2017-12-31.csv - 2018Q1: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-03-31.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-03-31.csv - 2018Q2: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-06-30.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-06-30.csv - 2018Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-09-30.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-09-30.csv - 2018Q4: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-12-13.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2018-12-13.csv