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

S&P Global Ratings maintained 22 ratings without revising the outlooks, took one positive rating action, one negative rating action, and revised eight outlooks unfavorably without changing the ratings in the U.S. not-for-profit health care sector in August.

There were two new issuer credit ratings (ICRs) assigned this month to Firelands Regional Medical Center, Ohio, and Montrose Memorial Hospital, Colo. Three existing organizations issued debt with the ratings and outlooks unchanged. There was also one issuer removed from CreditWatch negative and assigned a developing outlook (SoutheastHEALTH, Mo.) while another was placed on CreditWatch negative (Tufts Medicine, Mass.).

The nine rating actions and outlook revisions consist of the following:

  • Upgrade on San Antonio Regional Hospital, Calif.;
  • Downgrade on Holy Redeemer Health System, Pa.; and
  • Eight unfavorable outlook revisions on two health care systems and six stand-alone hospitals. The revisions were on organizations in the 'A' and 'AA' categories except for one stand-alone hospital rated 'BBB'. All but one outlook revision (to stable from positive) were to negative from stable.

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Table 1

August 2023, U.S. not-for-profit health care rating actions
State Rating Outlook Entity Type Action Description

AnMed Health System and Affiliates

SC A+ Stable Stand-alone Maintained; new sale Credit quality consistent with existing rating

Appalachian Regional Healthcare

KY A Stable Stand-alone Maintained Credit quality consistent with existing rating

Asante Health System

OR A+ Negative Stand-alone Unfavorable outlook revision Weaker operations coupled with a decline in unrestricted reserves and more constrained balance sheet

Children's Hospital of Alabama

AL AA- Stable Stand-alone Maintained Credit quality consistent with existing rating

Children's Mercy Hospital

MO AA- Stable Stand-alone Maintained Credit quality consistent with existing rating

Cottage Health

CA AA- Stable Stand-alone Maintained Credit quality consistent with existing rating

Faith Regional Health Services

NE BBB Stable Stand-alone Maintained Credit quality consistent with existing rating

Firelands Regional Medical Center

OH A- Stable Stand-alone Rating initially assigned Rating initially assigned based on the healthy balance sheet and dominant market position

Genesis Healthcare System

OH BB+ Stable Stand-alone Maintained Credit quality consistent with existing rating

Glencoe Regional Health Services

MN BBB Negative Stand-alone Unfavorable outlook revision Unbudgeted operating losses and thin margins that are anticipated to continue

Health First

FL A Stable System Maintained Credit quality consistent with existing rating

Henry Ford Health System

MI A Stable System Maintained Credit quality consistent with existing rating

Holy Redeemer Health System

PA BB Negative Stand-alone Downgrade Declining operating margins coupled with a trend of diminishing reserves

Hospital For Special Surgery

NY A+ Stable Stand-alone Maintained Credit quality consistent with existing rating

Kettering Health Network

OH A+ Stable System Maintained Credit quality consistent with existing rating

Louisville Medical Center

KY A- Negative Stand-alone Unfavorable outlook revision Rating and outlook are based on that of UofL Health Inc., the lowest rated member in the pool of revenues for the bonds

Marion Health

IN A Negative Stand-alone Unfavorable outlook revision Decline in operations in the midst of a large capital project

Memorial Health Services

CA AA- Negative System Unfavorable outlook revision Increasing operating losses and a weakened balance sheet

Montrose Memorial Hospital

CO BBB+ Stable Stand-alone Rating initially assigned Rating initially assigned based on an adequate enterprise profile with robust operations and a sound pro forma balance sheet

Moorings Park Institute

FL A+ Stable Long-term care Maintained Credit quality consistent with existing rating

Mount Sinai Hospital

NY A- Stable System Maintained Credit quality consistent with existing rating

Opelousas General Hospital Authority

LA BB- Negative Stand-alone Maintained Credit quality consistent with existing rating

Parkview Health System Obligation Group

IN AA- Negative System Unfavorable outlook revision Softer operation performance that is anticipated to continue during the outlook period

Phoenix Children's Hospital

AZ A+ Stable Stand-alone Maintained Credit quality consistent with existing rating

Renown Regional Medical Center

NV A Stable Stand-alone Maintained Credit quality consistent with existing rating

Saint Francis Medical Center

MO A+ Stable Stand-alone Unfavorable outlook revision Recent trend of weaker operations as well as less balance sheet cushion

San Antonio Regional Hospital

CA BBB+ Stable Stand-alone Upgrade Consistently solid operating margins that are expected to be sustained through the outlook period

Sky Lakes Medical Center

OR A- Negative Stand-alone Unfavorable outlook revision Weaker operating trend, decline in days' cash on hand, and expectations of ongoing labor pressures

Southcoast Health System

MA BBB+ Negative System Maintained Credit quality consistent with existing rating

SouthEast Alaska Regional Health Consortium

AK A- Stable Stand-alone Maintained Credit quality consistent with existing rating

SoutheastHEALTH

MO BB- Developing Stand-alone Removed from CreditWatch negative Successful signing of a forbearance agreement in parallel with a definitive agreement to affiliate with Mercy Health, Mo (A+/Stable; Mercy)

Stanford Health Care

CA AA- Stable Stand-alone Maintained; new sale Credit quality consistent with existing rating

Tufts Medicine

MA BBB+ Not meaningful System Placed on CreditWatch negative Heightened and unexpected operating losses with thin unrestricted reserves

University of North Carolina Hospitals

NC AA Stable System Maintained Credit quality consistent with existing rating

University of North Carolina Rex Healthcare

NC AA- Stable System Maintained Credit quality consistent with existing rating; highly strategic to UNC Health

Virginia Hospital Center

VA A+ Stable Stand-alone Maintained; new sale 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
Research Assistant:Elsa Berisha, New York

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