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U.S. Not-For-Profit Health Care Rating Actions, February 2023

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.

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Chart 2

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February 2023, U.S. Not-For-Profit Health Care Rating Actions
Hospitals State Rating Outlook Entity type Action Description
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;
blake.fundingsland@spglobal.com
Secondary Contacts:Cynthia S Keller, Augusta + 1 (212) 438 2035;
cynthia.keller@spglobal.com
Suzie R Desai, Chicago + 1 (312) 233 7046;
suzie.desai@spglobal.com

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