Skilled nursing facility · CMS certification number 245138

BOUNDARY WATERS CARE CENTER

ELY, Minnesota · Medicare and Medicaid

Certified beds, as filed in Care Compare: 38

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 January 2024 to 31 December 2024 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 29 August 2025.

Revenue and expenses, fiscal year 2024
Figure	As filed	Where it comes from
Total patient revenue	$4,991,405	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$33,302	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$4,958,103	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$5,329,297	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$371,194	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$564,935	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$193,741	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $193,741 (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%).

Beds, days and discharges, fiscal year 2024
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Bed days available, all components	15,372	CMS-2540-10 worksheet S300001 line 800 column 200
Medicare (Title XVIII) patient days	309	CMS-2540-10 worksheet S300001 line 800 column 400
Medicaid (Title XIX) patient days	7,253	CMS-2540-10 worksheet S300001 line 800 column 500
Other-payer patient days	4,395	CMS-2540-10 worksheet S300001 line 800 column 600
Total patient days, all components	11,957	CMS-2540-10 worksheet S300001 line 800 column 700
Medicare discharges	4	CMS-2540-10 worksheet S300001 line 800 column 900
Medicaid discharges	6	CMS-2540-10 worksheet S300001 line 800 column 1000
Other-payer discharges	35	CMS-2540-10 worksheet S300001 line 800 column 1100
Total discharges, all components	45	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	77.25	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	1,208.83	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	265.71	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1437177, read from the public cost report file SNF10FY2024.zip.

Fiscal year 2023, ended 31 December 2023

Cost report for 1 January 2023 to 31 December 2023 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 1 August 2024.

Revenue and expenses, fiscal year 2023
Figure	As filed	Where it comes from
Total patient revenue	$4,231,781	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$36,497	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$4,195,284	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$5,053,195	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$857,911	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$634,142	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	−$223,769	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$223,769 (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%).

Beds, days and discharges, fiscal year 2023
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	11,807	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	45	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	28.39	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	647	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	262.38	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1390823, read from the public cost report file SNF10FY2023.zip.

Fiscal year 2022, ended 31 December 2022

Cost report for 1 January 2022 to 31 December 2022 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 9 August 2023.

Revenue and expenses, fiscal year 2022
Figure	As filed	Where it comes from
Total patient revenue	$3,721,654	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$40,493	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,681,161	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$4,839,132	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$1,157,971	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$423,163	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	−$734,808	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$734,808 (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%).

Beds, days and discharges, fiscal year 2022
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	11,320	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	61	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	58.17	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	684.57	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	185.57	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1361542, read from the public cost report file SNF10FY2022.zip.

Fiscal year 2021, ended 31 December 2021

Cost report for 1 January 2021 to 31 December 2021 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 2 August 2022.

Revenue and expenses, fiscal year 2021
Figure	As filed	Where it comes from
Total patient revenue	$3,364,850	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$6,493	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,358,357	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,901,211	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$542,854	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$815,918	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$273,064	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $273,064 (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%).

Beds, days and discharges, fiscal year 2021
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	10,814	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	59	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	65.29	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	751.63	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	183.29	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1328591, read from the public cost report file SNF10FY2021.zip.

Fiscal year 2020, ended 31 December 2020

Cost report for 1 January 2020 to 31 December 2020 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 28 October 2021.

Revenue and expenses, fiscal year 2020
Figure	As filed	Where it comes from
Total patient revenue	$3,534,497	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$28,762	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,505,735	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,900,360	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$394,625	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$415,245	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$20,620	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $20,620 (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%).

Beds, days and discharges, fiscal year 2020
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	12,329	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	72	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	42.72	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	453.33	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	171.24	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1303343, read from the public cost report file SNF10FY2020.zip.

Fiscal year 2019, ended 31 December 2019

Cost report for 1 January 2019 to 31 December 2019 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 10 November 2020.

Revenue and expenses, fiscal year 2019
Figure	As filed	Where it comes from
Total patient revenue	$3,588,079	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$99,310	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,488,769	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,574,114	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$85,345	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$189,487	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$104,142	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $102,463 (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%).

Beds, days and discharges, fiscal year 2019
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	13,065	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	100	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	33.48	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	675.33	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	130.65	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1273267, read from the public cost report file SNF10FY2019.zip.

Fiscal year 2018, ended 31 December 2018

Cost report for 1 January 2018 to 31 December 2018 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 11 July 2019.

Revenue and expenses, fiscal year 2018
Figure	As filed	Where it comes from
Total patient revenue	$3,455,238	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$61,823	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,393,415	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,457,294	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$63,879	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$208,614	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$144,735	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $144,735 (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%).

Beds, days and discharges, fiscal year 2018
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	14,059	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	76	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	51.56	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	377.7	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	184.99	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1236467, read from the public cost report file SNF10FY2018.zip.

Fiscal year 2017, ended 31 December 2017

Cost report for 1 January 2017 to 31 December 2017 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 22 August 2018.

Revenue and expenses, fiscal year 2017
Figure	As filed	Where it comes from
Total patient revenue	$3,403,083	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$75,260	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,327,823	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,419,934	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$92,111	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$198,766	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$106,655	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $106,655 (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%).

Beds, days and discharges, fiscal year 2017
Figure	As filed	Where it comes from
Total facility beds, all components	42	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	14,319	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	67	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	42.88	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	381.92	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	213.72	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1210040, read from the public cost report file SNF10FY2017.zip.

Fiscal year 2016, ended 31 December 2016

Cost report for 1 January 2016 to 31 December 2016 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 23 August 2017.

Revenue and expenses, fiscal year 2016
Figure	As filed	Where it comes from
Total patient revenue	$3,590,565	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$150,788	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$3,439,777	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,381,227	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$58,550	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$217,018	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$275,568	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $274,733 (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%).

Beds, days and discharges, fiscal year 2016
Figure	As filed	Where it comes from
Total facility beds, all components	40	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	14,375	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	49	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	52.15	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	1,057.89	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	293.37	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1174597, read from the public cost report file SNF10FY2016.zip.

Fiscal year 2015, ended 31 December 2015

Cost report for 1 January 2015 to 31 December 2015 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 30 August 2016.

Revenue and expenses, fiscal year 2015
Figure	As filed	Where it comes from
Total patient revenue	$3,099,524	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$214,800	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$2,884,724	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$2,871,895	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	$12,829	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$218,947	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	$231,776	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: $231,776 (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%).

Beds, days and discharges, fiscal year 2015
Figure	As filed	Where it comes from
Total facility beds, all components	40	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	11,977	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	56	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	44.34	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	1,129.17	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	213.88	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1142954, read from the public cost report file SNF10FY2015.zip.

Fiscal year 2014, ended 31 December 2014

Cost report for 1 January 2014 to 31 December 2014 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 15 August 2015.

None of these figures is carried on this report.

CMS report record 1108018, read from the public cost report file SNF10FY2014.zip.

Fiscal year 2013, ended 31 December 2013

Cost report for 1 January 2013 to 31 December 2013 — a reporting period of 364 days, on form CMS-2540-10, settled, processed by CMS on 31 July 2014.

None of these figures is carried on this report.

CMS report record 1074321, read from the public cost report file SNF10FY2013.zip.

Fiscal year 2012, ended 31 December 2012

Cost report for 1 January 2012 to 31 December 2012 — a reporting period of 365 days, on form CMS-2540-10, settled, processed by CMS on 20 November 2014.

Revenue and expenses, fiscal year 2012
Figure	As filed	Where it comes from
Total patient revenue	$2,859,737	CMS-2540-10 worksheet G300000 line 100 column 100
Contractual allowances and discounts	$82,724	CMS-2540-10 worksheet G300000 line 200 column 100
Net patient revenue	$2,777,013	CMS-2540-10 worksheet G300000 line 300 column 100
Total operating expenses	$3,836,702	CMS-2540-10 worksheet G300000 line 400 column 100
Net income from service to patients	−$1,059,689	CMS-2540-10 worksheet G300000 line 500 column 100
Total other income	$511,421	CMS-2540-10 worksheet G300000 line 2500 column 100
Net income after other income	−$548,268	CMS-2540-10 worksheet G300000 line 2600 column 100

Net income: −$548,268 (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%).

Beds, days and discharges, fiscal year 2012
Figure	As filed	Where it comes from
Total facility beds, all components	58	CMS-2540-10 worksheet S300001 line 800 column 100
Total patient days, all components	15,333	CMS-2540-10 worksheet S300001 line 800 column 700
Total discharges, all components	86	CMS-2540-10 worksheet S300001 line 800 column 1200
Average length of stay, Medicare, in days	30.79	CMS-2540-10 worksheet S300001 line 800 column 1400
Average length of stay, Medicaid, in days	736	CMS-2540-10 worksheet S300001 line 800 column 1500
Average length of stay, all patients, in days	178.29	CMS-2540-10 worksheet S300001 line 800 column 1600

CMS report record 1080628, read from the public cost report file SNF10FY2012.zip.

Fiscal year 2011, ended 31 December 2011

Cost report for 1 October 2011 to 31 December 2011 — a reporting period of 91 days, not a full year, on form CMS-2540-10, settled, processed by CMS on 30 October 2012.

None of these figures is carried on this report.

CMS report record 1017577, read from the public cost report file SNF10FY2012.zip.

Nurse staffing

Nurse staffing hours from the Payroll-Based Journal, quarter by quarter, are on this facility’s staffing page, each quarter with the file it came from.

The staffing record →

Ownership, as filed with CMS

Care Compare

As filed in the CMS file dated 1 August 2026 (Care Compare ownership).

Owner or manager	Role	Type	Ownership percentage	Association
ELY-BLOOMENSON COMMUNITY HOSPITAL	ADP OF THE SNF	Organization	NOT APPLICABLE	since 09/30/2011
HEALTH DIMENSIONS CONSULTING INC	ADP OF THE SNF	Organization	NOT APPLICABLE	since 07/08/2025
MASLOSKI, ADAM	ADP OF THE SNF	Individual	NOT APPLICABLE	since 06/01/2016
SCHWINGHAMER, JOSEPH	ADP OF THE SNF	Individual	NOT APPLICABLE	since 10/01/2011
CHAMPA, KATHLEEN	CORPORATE DIRECTOR	Individual	NOT APPLICABLE	since 06/01/2022
FORSMAN, MICHAEL	CORPORATE DIRECTOR	Individual	NOT APPLICABLE	since 04/01/2015
JOHNSON, WARREN	CORPORATE DIRECTOR	Individual	NOT APPLICABLE	since 07/01/2024
LOBE, JONEENE	CORPORATE DIRECTOR	Individual	NOT APPLICABLE	since 10/01/2011
PEKURI, ROGER	CORPORATE DIRECTOR	Individual	NOT APPLICABLE	since 01/01/2015
LOBE, JONEENE	CORPORATE OFFICER	Individual	NOT APPLICABLE	since 10/01/2011
PEKURI, ROGER	CORPORATE OFFICER	Individual	NOT APPLICABLE	since 01/01/2015
CHAMPA, KATHLEEN	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 06/01/2022
FORSMAN, MICHAEL	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 04/01/2015
JOHNSON, WARREN	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 07/01/2024
LOBE, JONEENE	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 02/01/2023
PEKURI, ROGER	MANAGING CONTROL - GOVERNING BODY	Individual	NOT APPLICABLE	since 01/01/2015
BRISCOE, DAVID	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 03/07/2011
BRISCOE, PATRICIA	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 03/07/2011
ELY-BLOOMENSON COMMUNITY HOSPITAL	OPERATIONAL/MANAGERIAL CONTROL	Organization	NOT APPLICABLE	since 09/30/2011
HEALTH DIMENSIONS CONSULTING INC	OPERATIONAL/MANAGERIAL CONTROL	Organization	NOT APPLICABLE	since 03/17/2011
HENNESSEY, ERIN	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 01/01/2020
MASLOSKI, ADAM	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 06/01/2016
ROGOTZKE, AMBER	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 03/07/2011
SCHWINGHAMER, JOSEPH	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 10/01/2011
SHVETZOFF, SERGEI	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 03/07/2011
SHVETZOFF, TAMI	OPERATIONAL/MANAGERIAL CONTROL	Individual	NOT APPLICABLE	since 03/17/2011

Medicare enrollment

As filed in the CMS file dated 1 August 2026 (Medicare enrollment ownership), under the enrollment of BOUNDARY WATERS CARE CENTER (enrollment ID O20111010000335).

Owner	Individual or organization	Role	Ownership percentage	Association date	Described in the filing as
ADAM MASLOSKI	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2016	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ELY-BLOOMENSON COMMUNITY HOSPITAL	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	9/30/2011	Private equity company: No Real estate investment trust: No Holding company: No
HEALTH DIMENSIONS CONSULTING INC	Organization	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	7/8/2025	Private equity company: No Real estate investment trust: No Holding company: No
JOSEPH MICHAEL SCHWINGHAMER	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	10/1/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	Individual	ADP OF THE SNF	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	5/27/2015	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
JONEENE LOBE	Individual	CORPORATE DIRECTOR	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	10/1/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
KATHLEEN CHAMPA	Individual	CORPORATE DIRECTOR	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2022	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MICHAEL FORSMAN	Individual	CORPORATE DIRECTOR	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	4/1/2015	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ROGER PEKURI	Individual	CORPORATE DIRECTOR	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2015	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
WARREN DANIEL JOHNSON	Individual	CORPORATE DIRECTOR	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	7/1/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
JONEENE LOBE	Individual	CORPORATE OFFICER	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	10/1/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ROGER PEKURI	Individual	CORPORATE OFFICER	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2015	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
JONEENE LOBE	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	2/1/2023	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
KATHLEEN CHAMPA	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2022	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
MICHAEL FORSMAN	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	4/1/2015	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ROGER PEKURI	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2015	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
WARREN DANIEL JOHNSON	Individual	MANAGING CONTROL - GOVERNING BODY	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	7/1/2024	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ADAM MASLOSKI	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	6/1/2016	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
AMBER ROGOTZKE	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/7/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
DAVID LINDSAY BRISCOE	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/7/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
ELY-BLOOMENSON COMMUNITY HOSPITAL	Organization	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	9/30/2011	Private equity company: No Real estate investment trust: No Holding company: No
ERIN LEIGH SHVETZOFF HENNESSEY	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	1/1/2020	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
HEALTH DIMENSIONS CONSULTING INC	Organization	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/17/2011	Private equity company: No Real estate investment trust: No Holding company: No
JOSEPH MICHAEL SCHWINGHAMER	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	10/1/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
PATRICIA LYNN BRISCOE	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/7/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
SERGEI NICHOLAS SHVETZOFF	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/7/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.
TAMI LYN SHVETZOFF	Individual	OPERATIONAL/MANAGERIAL CONTROL	CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.	3/17/2011	Private equity company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Real estate investment trust: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. Holding company: CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle.

Changes in ownership

1 July 2026: MICHAEL FORSMAN no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MICHAEL FORSMAN no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: SERGEI NICHOLAS SHVETZOFF no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MICHAEL FORSMAN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MICHAEL FORSMAN appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: SERGEI NICHOLAS SHVETZOFF appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 May 2026: ADAM MASLOSKI no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: HELEN P TOME no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: TAMI LYN SHVETZOFF appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: AMBER ROGOTZKE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ADAM MASLOSKI appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ADAM MASLOSKI appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: WARREN DANIEL JOHNSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: WARREN DANIEL JOHNSON appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ROGER PEKURI appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: JOSEPH MICHAEL SCHWINGHAMER appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: JOSEPH MICHAEL SCHWINGHAMER appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: DAVID LINDSAY BRISCOE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ERIN LEIGH SHVETZOFF HENNESSEY appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: KATHLEEN CHAMPA appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: KATHLEEN CHAMPA appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: PATRICIA LYNN BRISCOE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: JONEENE LOBE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: HEALTH DIMENSIONS CONSULTING INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: MICHAEL FORSMAN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: SERGEI NICHOLAS SHVETZOFF appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 September 2024: ANTHONY PECHA no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
1 September 2024: BETTY ERICKSON no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv

Recent changes on this record

1 July 2026: MICHAEL FORSMAN no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MICHAEL FORSMAN no longer appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: SERGEI NICHOLAS SHVETZOFF no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL no longer appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL no longer appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MICHAEL FORSMAN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: MICHAEL FORSMAN appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: SERGEI NICHOLAS SHVETZOFF appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 July 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-07-01.csv
1 May 2026: ADAM MASLOSKI no longer appears as CONTRACTED MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: HELEN P TOME no longer appears as W-2 MANAGING EMPLOYEE in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: TAMI LYN SHVETZOFF appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: AMBER ROGOTZKE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ADAM MASLOSKI appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ADAM MASLOSKI appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: A listing under ADP OF THE SNF appears in the Medicare enrollment ownership file, with no owner named. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: WARREN DANIEL JOHNSON appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: WARREN DANIEL JOHNSON appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ROGER PEKURI appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: JOSEPH MICHAEL SCHWINGHAMER appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: JOSEPH MICHAEL SCHWINGHAMER appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: DAVID LINDSAY BRISCOE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ERIN LEIGH SHVETZOFF HENNESSEY appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: KATHLEEN CHAMPA appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: KATHLEEN CHAMPA appears as CORPORATE DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: PATRICIA LYNN BRISCOE appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: JONEENE LOBE appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: HEALTH DIMENSIONS CONSULTING INC appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: MICHAEL FORSMAN appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: SERGEI NICHOLAS SHVETZOFF appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as ADP OF THE SNF in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
1 May 2026: ELY-BLOOMENSON COMMUNITY HOSPITAL appears as OPERATIONAL/MANAGERIAL CONTROL in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2026-05-01.csv
29 August 2025: A cost report was filed for fiscal year 2024, on form CMS-2540-10. SNF10FY2024.zip
1 September 2024: ANTHONY PECHA no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
1 September 2024: BETTY ERICKSON no longer appears as DIRECTOR in the Medicare enrollment ownership file. Skilled_Nursing_Facility_All_Owners_:_2024-09-01.csv
1 August 2024: A cost report was filed for fiscal year 2023, on form CMS-2540-10. SNF10FY2023.zip
9 August 2023: A cost report was filed for fiscal year 2022, on form CMS-2540-10. SNF10FY2022.zip
2 August 2022: A cost report was filed for fiscal year 2021, on form CMS-2540-10. SNF10FY2021.zip
28 October 2021: A cost report was filed for fiscal year 2020, on form CMS-2540-10. SNF10FY2020.zip

Inspections

Inspection cycle	Health inspection	Fire safety inspection	Health deficiencies	Fire safety deficiencies
1	11 December 2025	11 December 2025	0	2
2	16 October 2024	16 October 2024	5	6
3	25 January 2024	25 January 2024	6	8

From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.

Deficiencies cited

11 deficiencies on file, newest inspection first

Inspection date	Inspection type	Tag	Category	What was cited	Scope and severity	Complaint	Corrected	Correction date
16 October 2024	Health	F 0580	Resident Rights Deficiencies	Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.	D	No	Deficient, Provider has date of correction	18 November 2024
16 October 2024	Health	F 0688	Quality of Life and Care Deficiencies	Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.	D	No	Deficient, Provider has date of correction	18 November 2024
16 October 2024	Health	F 0695	Quality of Life and Care Deficiencies	Provide safe and appropriate respiratory care for a resident when needed.	D	No	Deficient, Provider has date of correction	18 November 2024
16 October 2024	Health	F 0809	Nutrition and Dietary Deficiencies	Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.	F	No	Deficient, Provider has date of correction	18 November 2024
16 October 2024	Health	F 0825	Quality of Life and Care Deficiencies	Provide or get specialized rehabilitative services as required for a resident.	D	No	Deficient, Provider has date of correction	18 November 2024
25 January 2024	Health	F 0582	Resident Rights Deficiencies	Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.	D	No	Deficient, Provider has date of correction	24 February 2024
25 January 2024	Health	F 0583	Resident Rights Deficiencies	Keep residents' personal and medical records private and confidential.	F	No	Deficient, Provider has date of correction	24 February 2024
25 January 2024	Health	F 0684	Quality of Life and Care Deficiencies	Provide appropriate treatment and care according to orders, resident’s preferences and goals.	D	No	Deficient, Provider has date of correction	24 February 2024
25 January 2024	Health	F 0686	Quality of Life and Care Deficiencies	Provide appropriate pressure ulcer care and prevent new ulcers from developing.	D	No	Deficient, Provider has date of correction	24 February 2024
25 January 2024	Health	F 0689	Quality of Life and Care Deficiencies	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.	D	No	Deficient, Provider has date of correction	24 February 2024
25 January 2024	Health	F 0880	Infection Control Deficiencies	Provide and implement an infection prevention and control program.	E	No	Deficient, Provider has date of correction	24 February 2024

From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.

Penalties

Not yet extracted for this facility.

Care Compare provider information

Field	As filed
Provider Type	Medicare and Medicaid
Ownership Type	Non profit - Corporation
Legal Business Name	BOUNDARY WATERS CARE CENTER
Date First Approved to Provide Medicare and Medicaid Services	1967-07-24
Provider Resides in Hospital	N
Continuing Care Retirement Community	N
Urban	Y
County/Parish	St. Louis
Telephone Number	2183658705
Chain Name	HEALTH DIMENSIONS GROUP
Chain ID	821
Provider Changed Ownership in Last 12 Months	N
With a Resident and Family Council	Resident
Automatic Sprinkler Systems in All Required Areas	Yes
Number of Certified Beds	38
Average Number of Residents per Day	28.5
Overall Rating	5
Health Inspection Rating	5
QM Rating	5
Long-Stay QM Rating	5
Processing Date	2026-08-01

From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.

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One email a day naming what moved on BOUNDARY WATERS CARE CENTER: the field, the value before, the value after, and the date of the file that first showed it.

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On 1 July 2026: MICHAEL FORSMAN no longer appears as MANAGING CONTROL - GOVERNING BODY in the Medicare enrollment ownership file. That is one line of the alert.

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The citable document for BOUNDARY WATERS CARE CENTER

This page shows the record as it stands today. The report is the citable document: the same figures with the cell each came from, and beyond this page — five facilities of a similar size in Minnesota at the same fiscal year, listed by name; every change on the record rather than the recent ones below; the inspection and staffing history in blocks of their own; and a citation block naming every CMS file it was read from.

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