S&P Global Ratings maintained 20 ratings without revising the outlooks, took four rating actions, and revised three outlooks without changing the ratings in the U.S. not-for-profit health care sector in February 2023. In addition, two ratings were placed on CreditWatch, one with negative implications, and one developing, and we revised one outlook to positive from developing. One of the two CreditWatch placements as well as the outlook revision to positive from developing were related to mergers and acquisitions. There was one new sale in the month, for which the rating and outlook were unchanged.
The seven rating actions consist of the following:
- Four downgrades on three health care systems and one stand-alone hospital, all now in the 'BBB' and 'Speculative Grade' categories; and
- Three unfavorable outlook revisions to negative from stable on two stand-alone hospitals and one health care system, all in the 'BBB' and 'Speculative Grade' categories.
|February 2023, U.S. Not-For-Profit Health Care Rating Actions|
|Antelope Valley Healthcare District||CA||BBB||Negative||Stand-alone||Unfavorable outlook revision||Weak performance with negative operating margins along with modest debt service coverage|
|Bibb County Health Care Authority||AL||BB||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Care New England||RI||B+||Negative||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Carson Tahoe Regional Healthcare||NV||BBB+||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Concordia Lutheran Ministries||PA||AA-||Stable||Long-term care||Maintained||Credit quality consistent with existing rating|
|Cook Children's Medical Center||TX||AA||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Eastern Maine Healthcare Systems||ME||BBB||Negative||System||Unfavorable outlook revision||Weak operating results that are expected to continue|
|Fairview Health Services||MN||BBB+||Stable||System||Downgrade||Operating losses leading to significantly lower unrestricted reserves and weak debt service coverage|
|H. Lee Moffitt Cancer Center & Research Institute||FL||A-||Positive||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Lee Memorial Health System||FL||A+||Stable||System||Maintained||Credit quality consistent with existing rating|
|Marshfield Clinic Health System||WI||BBB+||Stable||System||Downgrade||Uneven performance with sizable operating losses|
|Masonic Villages of the Grand Lodge of Pennsylvania||PA||A||Stable||Long-term care||Maintained||Credit quality consistent with existing rating|
|Northern Inyo County Local Hospital District||CA||B+||Negative||Stand-alone||Unfavorable outlook revision||Weakened financial performance with negative debt service coverage and decreasing unrestricted reserves|
|Penn Highlands Healthcare||PA||A-||Negative||System||Maintained||Credit quality consistent with existing rating|
|Princeton Community Hospital||WV||BBB||Positive||Stand-alone||Outlook revised from developing||Affiliation agreement with West Virginia University Health System finalized|
|RUSH Obligated Group||IL||A+||Stable||System||Maintained||Credit quality consistent with existing rating|
|RWJ Barnabas Health||NJ||AA-||Stable||System||Maintained||Credit quality consistent with existing rating|
|Saint Francis Health System||OK||AA+||Stable||System||Maintained||Credit quality consistent with existing rating|
|Saratoga Hospital||NY||A||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Seven Hills Foundation||MA||BBB-||Stable||Long-term care||Maintained||Credit quality consistent with existing rating|
|Sparrow Obligated Group||MI||A-||Not meaningful||System||Placed on CreditWatch developing||
Pending the outcome of a possible merger with University of Michigan Health
|St. Francis Regional Medical Center||MN||A-||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
|Stamford Hospital||CT||BBB+||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
|The Health Care Authority for Baptist Health||AL||BBB+||Stable||Stand-alone||Maintained; new sale||Credit quality consistent with existing rating|
|Tower Health||PA||B||Negative||System||Downgrade||Ongoing operating losses and a steep decline in unrestricted reserves|
|UC Health||OH||BBB+||Negative||Stand-alone||Downgrade||Escalating losses primarily as a result of elevated labor costs|
|UNC Southeastern Regional Medical Center||NC||BBB+||Not meaningful||Stand-alone||Placed on CreditWatch negative||Insufficient financial information and some evidence of weakened unrestricted reserves and negative operating performance|
|University of Colorado Hospital Authority||CO||AA||Stable||System||Maintained||Credit quality consistent with existing rating|
|University of Kansas Hospital Authority||KS||AA-||Stable||System||Maintained||Credit quality consistent with existing rating|
|White River Health System Inc.||AR||BBB-||Stable||Stand-alone||Maintained||Credit quality consistent with existing rating|
This report does not constitute a rating action.
|Primary Credit Analyst:||Blake C Fundingsland, Englewood + 1 (303) 721 4703;|
|Secondary Contacts:||Cynthia S Keller, Augusta + 1 (212) 438 2035;|
|Suzie R Desai, Chicago + 1 (312) 233 7046;|
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