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

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History Of U.S. State Ratings

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U.S. State Ratings And Outlooks: Current List

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Table Of Contents: S&P Global Ratings Credit Rating Models

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U.S. Not-For-Profit Health Care Outstanding Ratings And Outlooks As Of June 30, 2024


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

S&P Global Ratings maintained 22 ratings without revising the outlooks, took one positive rating action, three negative rating actions, and revised two outlooks favorably without changing the ratings in the U.S. not-for-profit health care sector in April. In addition, we placed two issuers on CreditWatch--one positive and one negative--with the positive listing reflecting potential rating uplift due to a merger.

There were four new debt issuances in the month, one of which was accompanied by a downgrade on a system in the 'A' category.

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

  • One upgrade on a stand-alone hospital in the 'A' category due to positive operations and improved balance-sheet metrics;
  • Three downgrades on two systems and one stand-alone hospital, with the stand-alone being speculative grade; and
  • Two outlook revisions on stand-alone hospitals; one to stable from negative and the other to positive from stable.

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Chart 2

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

Cabell Huntington Hospital

WV BBB Stable System Downgrade Operating losses leading to degradation of the balance sheet

CaroMont Health

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

Cone Health

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

East Tennessee Children's Hospital

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

Eskaton Properties

CA BBB- Negative Long-term care Maintained Credit quality consistent with existing rating

Essentia Health

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

Fairview Health Services

MN BBB+ Stable System Maintained Credit quality consistent with existing rating

Greater Fairbanks Community Hospital Foundation

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

Hoag Memorial Hospital Presbyterian

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

Marin General Hospital

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

Mercy Health Services

MD A- Stable Stand-alone Upgrade Positive operations and solid cash flows increased cushion in balance sheet metrics and unrestricted reserves

Novant Health Inc.

NC A+ Stable System Downgrade; New sale Substantial increase in leverage following acquisition of three hospitals

OSF Healthcare System

IL A Stable System Maintained Credit quality consistent with existing rating

Palomar Health

CA BB+ Negative Stand-alone Downgrade Operating losses resulting in significantly weakened balance sheets; at risk of breaching bond covenants

Penn Highlands Healthcare

PA A- CreditWatch Negative System Placed on CreditWatch negative Persistent negative operating performance and continually weakening unrestricted reserves

Providence St. Joseph Health

WA A Negative System Maintained Credit quality consistent with existing rating

RWJ Barnabas Health

NJ AA- Stable System Maintained; New sale Credit quality consistent with existing rating

RWJ Barnabas Health*

NJ AA- Stable System Maintained; New sale Credit quality consistent with existing rating

Salem Health

OR A+ Stable Stand-alone Favorable outlook revision Improvement in operating performance and reserves with solid balance sheet metrics in FY24

Samaritan Health Services

OR BBB+ Stable System Maintained Credit quality consistent with existing rating

Seven Hills Foundation

MA BBB- Stable Human service provider  Maintained Credit quality consistent with existing rating

South Shore Hospital

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

St. Lukes Hospital of Duluth

MN BB+ CreditWatch Positive Stand-alone Placed on CreditWatch positive St. Luke's joining Aspirus' obligated group and Aspirus now being responsible for all of St. Luke's Debt

Stanford Health Care

CA AA- Positive Stand-alone Favorable outlook revision Sustained strong financials metrics and consistent operating performance

Temple University Health System

PA BBB Stable System Maintained Credit quality consistent with existing rating

UAB Health System

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

United Health Services Hospitals

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

University of Vermont Medical Center

VT A Stable System Maintained Credit quality consistent with existing rating

Vernon Memorial Hospital

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

Virginia Commonwealth University Health System Authority

VA AA- Stable System Maintained; New sale Credit quality consistent with existing rating
*The second action relates to a new sale rating later in the month for a commercial paper program.

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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