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

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U.S. State Ratings And Outlooks: Current List

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Private Markets Monthly, April 2024: Private Credit Is A Growing Segment Of Nonbank Finance


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

S&P Global Ratings maintained 18 ratings without revising the outlooks, took two positive rating actions, and three negative rating actions in January. In addition, we revised five outlooks favorably, and revised one outlook unfavorably, all without changing the ratings in the U.S. not-for-profit health care sector. Two of the favorable outlook revisions (to positive from stable) are related to the pending consolidation of two hospitals under a common parent company.

There were seven new debt issuances in the month, four of which were joint criteria ratings on variable-rate demand bonds.

The 11 rating actions and outlook revisions consisted of the following:

  • Two upgrades, one of which was related to a merger;
  • Three downgrades on stand-alone hospitals, one each in the 'A', 'BB', and 'B' rating categories;
  • Five favorable outlook revisions on two systems and three stand-alone hospitals, with one outlook revised to stable from negative and four revised to positive from stable; and
  • One unfavorable outlook revision on a system with the outlook revised to negative from stable.

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January 2024, U.S. not-for-profit health care rating actions
State Rating Outlook Entity type Action Description

BJC HealthCare

MO AA Stable System Maintained Credit quality consistent with existing rating

Bowling Green-Warren County Community Hospital

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

Cedars-Sinai Health System

CA AA- Stable System Maintained Credit quality consistent with existing rating

Chesapeake Regional Medical Center

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

Children's Hospital of Boston

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

Children's Hospital of Boston

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

Denver Health & Hospital Authority

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

Elliot Hospital

NH A- Positive Stand-alone Favorable outlook revision Continued operational improvement and reserve stability with near term consolidation expected under SolutionHealth

Hendrick Health

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

Infirmary Health System Inc.

AL A- Negative System Unfavorable outlook revision Financial profile deterioration and likely additional debt

Lifespan

RI BBB+ Stable System Maintained; new sale Credit quality consistent with existing rating

Mass General Brigham

MA AA- Stable System Maintained; new sale Credit quality consistent with existing rating

Methodist Hospital

IN BB+ Stable Stand-alone Downgrade Decline in balance sheet metrics and significant operating losses

Milford Regional Medical Center

MA B Developing Stand-alone Downgrade Weak balance sheet and persistent operating losses; higher rating dependent on affiliation with UMass

Montefiore Health System

NY BBB- Negative System Maintained Credit quality consistent with existing rating

North Oaks Health

LA A- Stable Stand-alone Upgrade Trend of positive operational performance and balance sheet strength

Ochsner LSU Health System of Northern Louisiana

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

Orlando Health

FL A+ Positive System Favorable outlook revision Consistent operating income and cash flow strength expected support multiyear capital plan and balance sheet growth

ProHealth Care

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

ProMedica Healthcare

OH BB Stable System Favorable outlook revision Successful divestment of non-core business, paydown of all private debt, and elimination of near-term covenant risk

Saint Luke's Health System

MO AA Stable System Upgrade Merger with BJC Health System

Saint Peter's University Hospital

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

Scripps Health

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

Sharp HealthCare

CA AA Stable System Maintained; new sale Credit quality consistent with existing rating

Southern New Hampshire Medical Center

NH A- Positive Stand-alone Favorable outlook revision Continued operational improvement and reserve stability with near term consolidation expected under SolutionHealth

St. Tammany Parish Hospital Service District No. 2

LA A Stable Stand-alone Downgrade Weakening operations with significant finance lease, declined days' cash on hand, increase in payables

Tarrant County Hospital District

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

TriHealth

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

Winkler County Hospital District

TX BB+ Positive Stand-alone Favorable outlook revision Strong cash, debt service coverage, and operating performance with low debt levels compared to peers

This report does not constitute a rating action.

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

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