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        <PersonNm>Saxon Kathleen</PersonNm>
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        <PersonNm>Seufert Regina</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Newmyer Joyce</PersonNm>
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        <PersonNm>Welch Donald</PersonNm>
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        <PersonNm>Lafleur Brett</PersonNm>
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        <PersonNm>Kaba David</PersonNm>
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        <PersonNm>Mitchell Brandon</PersonNm>
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        <PersonNm>Foss Jr Frederick</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Carmen Robert</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Rebok Douglas</PersonNm>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
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        <ContractorAddress>
          <USAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
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          <USAddress>
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      <ContractorCompensationGrp>
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          <USAddress>
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        <ContractorName>
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          <USAddress>
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      <ProgramServiceRevenueGrp>
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      <ProgramServiceRevenueGrp>
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        <FormAndLineReferenceDesc>Part V, Line 5 - Account Input from Persons Who Represent the Community</FormAndLineReferenceDesc>
        <ExplanationTxt>The data collection process of the CHNA included compilation and analysis of quantitative and qualitative data, which helped to identify information gaps and areas of need for priority focus.Tillamook Regional Medical Center is working hard to listen to our community and collectively identify needs and assets in our region. Traditional, publicly available data were included in the assessment, along with qualitative data collected from a broad representation of the community.Quantitative Data: Morbidity and Mortality collected from the County Health Profiles. Social Determinants of Health collected from the U.S. Census Bureau,American Community Survey. Health Indicator Data Collected from a variety of publicly available data.Qualitative Data: Community Health Needs Survey conducted by the Columbia Pacific CCO Community agencies serving our primary service area, to assess their needs and to identify areas in which Tillamook Regional Medical Center can be a strategic partner. Focused group meetings with key community leaders, to engage them in the development of our interventions and solicit their input to improving the health of our region. Focused group meetings with Medical Staff members to identify areas inwhich we can support the health of their patients in our community initiatives. Focused group meetings with our internal leaders and staff.The Columbia Pacific Coordinated Care Organization (CCO)conducted a community health survey of Tillamook County September 15 through October 15 of 2013 that garnered around 200 responses. This data was reviewed by the Tillamook Community Advisory Council in November-December 2013. Community feedback was sought about the top 3-5 priorities identified through this survey, after which a plan of action was created and adopted by the CCO. The preliminary results of that survey have been included in Tillamook Regional Medical Centers 2013 CHNA. TRMCs 2013 CHNA was also shared with the Columbia Pacific CCO Community Advisory Council, key community health stakeholders and community leaders, with feedback being used to shape action plans and strategies to improve the health of our community.</ExplanationTxt>
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            <CityNm>Tillamook</CityNm>
            <StateAbbreviationCd>OR</StateAbbreviationCd>
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            <CityNm>Lincoln City</CityNm>
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            <CityNm>Tillamook</CityNm>
            <StateAbbreviationCd>OR</StateAbbreviationCd>
            <ZIPCd>97141</ZIPCd>
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          <FacilityTxt>Outpatient Clinic</FacilityTxt>
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            <CityNm>Pacific City</CityNm>
            <StateAbbreviationCd>OR</StateAbbreviationCd>
            <ZIPCd>97135</ZIPCd>
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          <FacilityTxt>Rural Health Clinic</FacilityTxt>
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            <CityNm>Manzanita</CityNm>
            <StateAbbreviationCd>OR</StateAbbreviationCd>
            <ZIPCd>97130</ZIPCd>
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          <FacilityTxt>Rural Health Clinic</FacilityTxt>
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        <FormAndLineReferenceDesc>Part I, Line 7 - Explanation of Costing Methodology</FormAndLineReferenceDesc>
        <ExplanationTxt>The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:(Total expenses - (Provision for bad debts + Other revenue + Interest income)) / Gross patient charges</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense</FormAndLineReferenceDesc>
        <ExplanationTxt>Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense as reported in the system-wide audited combined financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3 - Methodology of Estimated Amount &amp; Rationale for Including in Community Benefit</FormAndLineReferenceDesc>
        <ExplanationTxt>The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4 - Bad Debt Expense</FormAndLineReferenceDesc>
        <ExplanationTxt>The system-wide audited combined financial statements do not contain a footnote describing bad debt expense.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8 - Explanation Of Shortfall As Community Benefit</FormAndLineReferenceDesc>
        <ExplanationTxt>The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments too many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL*Medicare Cost Report Revenue $22,088,835Prior Year Settlements (15,259)Cost Report Reimbursable Bad Debts 419,177Estimates and Accrual Variances 960,789Other (1,877,718)Subtotal - Amount reported in Pt. III, line 5 21,575,824Amounts included in Part 1, lines g and f -Total Medicare Revenue $21,575,824*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b - Provisions On Collection Practices For Qualified Patients</FormAndLineReferenceDesc>
        <ExplanationTxt>When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Needs Assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>In addition to our triennial Community Health Needs Assessment (CHNA) process, we actively listen to and incorporate community feedback through a robust performance improvement program, annual strategic planning meetings with community leaders and primary care providers, and ongoing participation in many community agencies and groups working to improve our coastal communities. Although, the most recent assessment was conducted in 2013, we are continually assessing our communities for growing trends or environmental conditions that need to be addressed before our next assessment in 2016. In 2014, expanding healthcare insurance coverage through the Affordable Care Act positively impacted access to health services for lower income Oregonians.Copies of the hospital's 2013 CHNA study and the 2015 Community Health Plan Update are posted on the hospital's website, https://www.adventisthealth.org/trmc/Pages/About-Us.aspx, as well as on the Adventist Health Corporate website, https://www.adventisthealth.org/Pages/About-Us/Community-Health-Needs-Assessments.aspx</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Patient Education of Eligibility for Assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>In addition to initial information and education provided to patients and their guarantors through conversations, brochures and flyers, there are 2 financial counselors and 4 certified health plan application assistors on staff who are available to further explain and assist anyone with financial need in accessing program or financial assistance. A copy of our financial assistance policies are maintained on our website and easily accessible throughout the hospital in both English and Spanish. Tillamook Regional Medical Center informs patients of the Charity Care/Discount Policy through 1-1 conversations, brochures, and flyers. There are financial counselors and certified health plan application assistors on staff who provide further assistance. The Financial Assistance Policy (FAP) is being posted and summarized and the FAP Application is made widely available on the hospital's website, at:https://www.adventisthealth.org/trmc/pages/patients-and-visitors/financial-services/assistance-policy.aspx</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Community Information</FormAndLineReferenceDesc>
        <ExplanationTxt>Tillamook Regional Medical Center is located along the rugged North Oregon Coast. Primary, specialty and urgent care services are provided through 5 rural health clinics spanning 71 miles from Manzanita in North Tillamook County to Lincoln City in North Lincoln County. The population served in this rural area includes a significant percentage of retirees, a growing Hispanic population, and 1 in 4 children under age 18 living in poverty.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Community Building Activities</FormAndLineReferenceDesc>
        <ExplanationTxt>Our hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. And, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Explanation Of How Organization Furthers Its Exempt Purpose</FormAndLineReferenceDesc>
        <ExplanationTxt>Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given todays state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy.Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population;2) Factors that cause the present outcomes distribution; and3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to:1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors,2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum.Our mission as a health system is to share God's love by providing physical, mental, and spiritual healing. We believe the best way to re-imagine our future business model with a major emphasis of community health is by working together with our community.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Affilated Health Care System Roles and Promotion</FormAndLineReferenceDesc>
        <ExplanationTxt>Tillamook Regional Medical Center is part of the the Adventist Health System. of Adventist Health, a faith-based, not-for-profit, integrated health care delivery system headquartered in Roseville, California. We provide compassionate care in communities throughout California, Hawaii, Oregon and Washington.Adventist Health entities include:19 hospitals with more than 2,700 bedsMore than 235 clinics and outpatient centers14 home care agencies and 7 hospice agenciesFour joint-venture retirement centers Workforce of 28,600 includes more than 20,500 employees; 4,500 medical staff physicians; and 3,600 volunteers</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents</FormAndLineReferenceDesc>
        <ExplanationTxt>New Bylaws adopted 11/02/2015.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder</FormAndLineReferenceDesc>
        <ExplanationTxt>The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders</FormAndLineReferenceDesc>
        <ExplanationTxt>The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b: Form 990 Review Process</FormAndLineReferenceDesc>
        <ExplanationTxt>The completed Form 990 is shared with members of the hospital's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board after their review but prior to filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts</FormAndLineReferenceDesc>
        <ExplanationTxt>During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The corporate internal audit staff review these questionnaires and disclosures each year during the audit process.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a: Compensation Review &amp; Approval Process - CEO, Top Management</FormAndLineReferenceDesc>
        <ExplanationTxt>See explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees</FormAndLineReferenceDesc>
        <ExplanationTxt>The hospital board of directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19: Other Organization Documents Publicly Available</FormAndLineReferenceDesc>
        <ExplanationTxt>The hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency.</ExplanationTxt>
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        <ExplanationTxt>Transfers to related organizations = -$545822</ExplanationTxt>
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          <AddressLine1Txt>10123 SE Market St</AddressLine1Txt>
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          <BusinessNameLine1Txt>San Joaquin Community Hospital</BusinessNameLine1Txt>
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        <EIN>680357690</EIN>
        <PrimaryActivitiesTxt>Medical Foundation</PrimaryActivitiesTxt>
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</Return>