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

S&P Global Ratings maintained 22 ratings without revising the outlooks and took eight negative rating actions in March. In addition, we revised two outlooks favorably, and revised two outlooks unfavorably, both without changing the ratings in the U.S. not-for-profit health care sector.

There were five new debt issuances in the month, one of which was a new issuer with an initially assigned rating.

The 12 rating actions and outlook revisions consisted of the following:

  • Eight downgrades on four systems and four stand-alone hospitals, with all but two in the 'BBB' rating category;
  • Two outlooks revised to stable from negative on systems, one of which was accompanied by a new sale; and
  • Two unfavorable outlook revisions on one system from positive to stable and one stand-alone from stable to negative.

Table 1

U.S. not-for-profit health care rating action summary, year-to-date 2024
January February March First quarter
Maintained 18 23 22 63
Downgrades 3 2 8 13
Upgrades 2 1 0 3
Unfavorable outlook revisions 1 1 2 4
Favorable outlook revisions 5 1 2 8

Chart 1

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Chart 2

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Table 2

March 2024, U.S. not-for-profit health care rating actions
State Rating Outlook Entity Type Action Description
Allegheny Health Network PA A Stable System Maintained Credit quality consistent with existing rating based our GRM criteria for Highmark
Avera Health SD AA- Stable System Maintained; new sale Credit quality consistent with existing rating
Bellin Health WI A+ Stable System Maintained Credit quality consistent with existing rating based on the group credit profile of Bellin Gunderson Health System
Berkshire Health System MA A Stable 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
Central Florida Health FL A- Stable Stand-alone Maintained Credit quality consistent with existing rating based our GRM criteria for Shands Teaching Hospital & Clinics
City of Hope CA A Negative System Maintained; new sale Credit quality consistent with existing rating
Columbus Regional Healthcare System NC BBB Stable Stand-alone Maintained Credit quality consistent with existing rating
Eastern Maine Healthcare Systems ME BBB- Negative System Downgrade Operating performance and balance sheet metrics below expectations
El Camino Health CA AA Stable Stand-alone Maintained Credit quality consistent with existing rating
Evangelical Community Hospital PA BBB+ Developing Stand-alone Downgrade Sizeable operating losses with deterioration in balance sheet metrics
Flagler Health + FL A- Stable Stand-alone Maintained Credit quality consistent with existing rating based our GRM criteria for Shands Teaching Hospital & Clinics
Geisinger Health PA AA- Stable System Maintained Credit quality consistent with existing rating
Gundersen Lutheran WI A+ Stable System Downgrade Ratings have been harmonized based on the group credit profile of Bellin Gunderson Health System
Hannibal Regional Healthcare System MO BBB Negative Stand-alone Downgrade Operating losses that have persisted along with deterioration in the balance sheet
Hartford HealthCare CT A Stable System Maintained; new sale Credit quality consistent with existing rating
Hunt Memorial Hospital District TX BBB- Negative Stand-alone Downgrade Debt issuance during a time of persistent operating pressures, weak reserves, and covenant violation
Jackson-Madison County General Hospital TN A- Negative Stand-alone Maintained Credit quality consistent with existing rating
Kaiser Foundation Hospitals (Kaiser Permanente) CA AA- Stable System Maintained Credit quality consistent with existing rating
Marshfield Clinic WI BBB Negative System Downgrade Continuous operating challenges and balance sheet weakening with moderately higher debt levels
Memorial Health System IL A+ Stable System Maintained Credit quality consistent with existing rating
MetroHealth System OH BBB Stable Stand-alone Maintained Credit quality consistent with existing rating
Midland County Hospital District TX A- Stable Stand-alone Rating initially assigned; new sale Rating initially assigned based on dominant market position and positive operations
Mount Nittany Medical Center PA A+ Stable Stand-alone Maintained Credit quality consistent with existing rating
Northern Inyo County Local Hospital District CA B+ Negative Stand-alone Maintained Credit quality consistent with existing rating
Piedmont Healthcare, Inc. GA AA- Stable System Favorable outlook revision Healthy operating performance with further improvement in the balance sheet expected
Presbyterian Healthcare Services NM AA- Stable System Downgrade Deterioration in performance, including the health plan, as well as a decline in reserves
Shands Teaching Hospital & Clinics FL A Stable System Maintained Credit quality consistent with existing rating
Shell Point FL BBB+ Stable Long Term Care Maintained Credit quality consistent with existing rating
Spartanburg Regional Health Services District SC A Stable System Maintained Credit quality consistent with existing rating
St Luke's Episcopal-Presbyterian Hospital MO A Negative Stand-alone Unfavorable outlook revision Multiyear operating losses and decreasing DCOH
UC Health OH BBB- Negative Stand-alone Downgrade Significant deterioration in reserves with ongoing operating losses
University of Pittsburgh Medical Center PA A Stable System Unfavorable outlook revision Weaker-than-anticipated operating performance and balance sheet metrics in fiscal 2023
Virginia Commonwealth University Health System Authority VA AA- Stable System Favorable outlook revision; new sale Improved operating performance, exceeding budget expectations and stabilizing reserves
Willis-Knighton Health System LA A Stable System Maintained Credit quality consistent with existing rating
GRM--Group Rating Methodology.

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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