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U.S. Not-For-Profit Health Care Rating Actions, August 2024

S&P Global Ratings maintained 18 ratings without revising the outlooks, took two positive rating actions, seven negative rating actions, revised four outlooks favorably, and three outlooks unfavorably without changing the ratings in the U.S. not-for-profit health care sector in August.

Included in the above, were seven new debt issuances in the month, accompanied by two downgrades, one favorable outlook revision, and one initially assigned rating to Hendricks Regional Health in Indiana. Four systems, two stand-alone hospitals, and one long-term care provider issued debt with the ratings ranging from 'BBB+' to 'AA-'.

The 16 rating actions and outlook revisions consisted of the following:

  • Two upgrades on stand-alone hospitals, both in the speculative grade rating category;
  • Seven downgrades--three systems and four stand-alone hospitals--with all but two ratings remaining investment grade;
  • Four outlooks revised favorably on two systems, one stand-alone hospital, and one long-term-care facility, with two outlooks revised to stable from negative, one revised to positive from stable, and one revised to positive from negative; and
  • Three outlooks revised unfavorably on two stand-alone hospitals and one system, with all outlooks revised to negative from stable.

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August 2024, U.S. not-for-profit health care rating actions
State Rating Outlook Entity type Action Description
Antelope Valley Medical Center CA BBB Negative Stand-alone Maintained Credit quality consistent with existing rating
Asante Health System OR A+ Negative Stand-alone Maintained Credit quality consistent with existing rating
Catholic Medical Center NH BB+ Stable Stand-alone Downgrade Multiyear trend of sizeable losses and deteriorating balance sheet with weak MADS coverage
Conway Regional Medical Center AR BBB+ Negative Stand-alone Maintained Credit quality consistent with existing rating
Covenant Health MA BBB- Stable System Maintained Credit quality consistent with existing rating
Craig Hospital CO A+ Negative Stand-alone Unfavorable outlook revision Large-scale capital plans could pressure financial profile and debt metrics depending on funding sources
Doylestown Hospital PA B+ Positive Stand-alone Upgrade Alleviation of near-term liquidity risk and narrower operating losses with positive outlook reflecting a signed definitive agreement
Emanate Health CA A Negative Stand-alone Unfavorable outlook revision Lower volumes, elevated capital spending, and a multi-year decline in DCOH limit operating flexibility
Glencoe Regional Health Serivces MN BBB- Stable Stand-alone Downgrade Ongoing negative operations, weak DCOH, and expected cash decline given elevated capital spending expected
Guadalupe Regional Medical Center TX BB Stable Stand-alone Maintained Credit quality consistent with existing rating
Hendricks Regional Health IN A- Stable Stand-alone Rating initially assigned; New sale Rating initially assigned based on positive operating margins, favorable payor mix, and a fair balance sheet metrics
Hospital For Special Surgery NY A+ Stable Stand-alone Maintained Credit quality consistent with existing rating
Hospital Sisters Services IL A+ Negative System Maintained Credit quality consistent with existing rating
Houston County Health Care Authority AL BBB+ Positive Stand-alone Favorable outlook revision Sustained strong operating performance could potentially strengthen the overall financial profile position
Jackson Hospital and Clinic AL CC Creditwatch Negative Stand-alone Downgrade Elevated risk of nonpayment to bondholders following notice of acceleration and very thin liquidity based on limited unaudited financial data
Johns Hopkins Health System MD AA- Stable System Maintained; New sale Credit quality consistent with existing rating
Mount Sinai Hospital NY BBB Negative System Downgrade Balance sheet erosion coupled with accelerated and sizable operating losses
Nebraska Medicine NE AA- Stable Stand-alone Maintained Credit quality consistent with existing rating
Northwestern Memorial HealthCare IL AA+ Stable System Maintained Credit quality consistent with existing rating
Nuvance Health CT BBB Positive System Favorable outlook revision Definitive agreement to merge with Northwell Health
OU Medicine OK BB Stable Stand-alone Upgrade Healthy operating profitability, tapering capital expenditures, and expected sustained cash flow improvement
Parkview Health System IN A+ Stable System Downgrade; New sale Continuous decline in operations and DCOH
Prisma Health SC A Stable System Favorable outlook revision Strong financial recovery that improved unrestricted reserves and rebuilt balance sheet cushion
Redlands Community Hospital CA A- Stable Stand-alone Maintained Credit quality consistent with existing rating
Rochester Regional Health NY BBB+ Stable System Maintained Credit quality consistent with existing rating
Saint Francis Healthcare System MO A+ Stable Stand-alone Maintained Credit quality consistent with existing rating
Shell Point FL BBB+ Stable Long-term care Favorable outlook revision; New sale Robust service demand and solid operating liquidity help keep pro forma metrics in line with rating expectations
Sky Lakes Medical Center OR A- Negative Stand-alone Maintained Credit quality consistent with existing rating
SouthEast Alaska Regional Health Consortium AK A- Stable Stand-alone Maintained Credit quality consistent with existing rating
Texas Children's Hospital TX AA- Stable System Downgrade; New Sale Substantial losses and pressured performance that further weakened the overall financial profile
University of Kansas Hospital Authority KS AA- Negative System Unfavorable outlook revision Recent merger operational challenges are pressuring profitability, reserves, and liquidity
Vail Health CO A- Stable Stand-alone Downgrade Deteriorating balance-sheet metrics given greater-than-expected operating losses
Valley Health System* VA A+ Stable System Maintained; New sale Credit quality consistent with existing rating
Woman's Hospital Foundation LA A Stable Stand-alone Maintained Credit quality consistent with existing rating
Yuma Regional Medical Center AZ A Stable Stand-alone Maintained; New sale Credit quality consistent with existing rating
*This action relates to a new sale issuance for variable-rate demand bonds following a review completed in July. DCOH--Days' cash on hand. MADS--Maximum annual debt service.

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
Amy He, New York +1 2124380381;
amy.he@spglobal.com

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