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U.S. Not-For-Profit Health Care Rating Actions, January 2025

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

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U.S. Public Finance Rating Activity Brief: January 2025


U.S. Not-For-Profit Health Care Rating Actions, January 2025

S&P Global Ratings maintained 16 ratings in the U.S. not-for-profit health care sector without revising the outlooks and took one positive rating action and three negative rating actions in January. In addition, we revised two outlooks favorably and two outlooks unfavorably without changing the ratings during that month.

Additionally, we took three rating actions related to mergers and acquisitions. We placed Marshfield Clinic in Wisconsin on CreditWatch with positive implications related to its merger with Sanford Health and assigned developing outlooks to two stand-alone hospitals: Grand View Hospital in Pa. due to a definitive agreement with St. Luke's University Health Network, and Catholic Medical Center, N.H. given its proposed acquisition by for-profit Healthcare Corp. of America, which has since closed.

Four existing organizations issued debt with three of the ratings and outlooks unchanged, and one outlook revised unfavorably.

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

  • One upgrade on Scotland Memorial Hospital, N.C.;
  • Three downgrades on one system and two stand-alone hospitals in the 'A' and 'B' categories;
  • Two favorable outlook revisions on one system and one stand-alone hospital, with both outlooks revised to positive from stable; and
  • Two unfavorable outlook revisions, both on systems, with the outlooks revised to stable from positive.

Chart 1

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Chart 2

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January 2025, U.S. not-for-profit health care rating actions
State Rating Outlook Entity type Action Description
Catholic Medical Center NH BB+ Developing Stand-alone Placed on developing outlook Approved asset purchase agreement signed with for-profit Healthcare Corp. of America
CHRISTUS Health TX A Stable System Downgrade Weak unrestricted reserves relative to peers, further strained by growth plans
Cook Children's Medical Center TX AA Stable Stand-alone Maintained; New sale Credit quality consistent with existing rating
Deaconess Health System IN A+ Positive System Favorable outlook revision Trend of positive operations with balance sheet cushion and unrestricted reserves growth
Grand View Hospital PA B+ Developing Stand-alone Placed on developing outlook Signed definitive agreement to merge with St. Luke's University Health Network
H. Lee Moffitt Cancer Center & Research Institute FL A Stable Stand-alone Maintained Credit quality consistent with existing rating
Hendrick Health TX A Stable Stand-alone Maintained Credit quality consistent with existing rating
Henry Ford Health System MI A Stable System Maintained Credit quality consistent with existing rating
Henry Mayo Newhall Hospital CA BBB- Positive Stand-alone Favorable outlook revision Improved operating performance bolstered by strong DCOH, and unrestricted reserves
Lake Regional Health System MO BBB+ Stable Stand-alone Maintained Credit quality consistent with existing rating
Lifescape SD A+ Stable Human service provider Maintained Credit quality consistent with existing rating
Marion Health IN A Negative Stand-alone Maintained Credit quality consistent with existing rating
Marshfield Clinic WI BBB CreditWatch Positive System Placed on CreditWatch positive Potential rating impact related to its merger with the higher-rated Sanford Health
Montage Health CA AA- Stable Stand-alone Maintained Credit quality consistent with existing rating
National Jewish Health CO BB+ Stable Stand-alone Maintained Credit quality consistent with existing rating
Norman Regional Hospital Authority OK B Negative Stand-alone Downgrade Significant decline in liquidity profile from unexpected increases in operating losses and transformation project cost overruns
Orlando Health FL A+ Stable System Unfavorable outlook revision; New sale Elevated integration risk and reduced liquidity and financial flexibility from recent sizable acquisitions
Palomar Health CA B Negative Stand-alone Downgrade Accelerating operating losses and rapidly deteriorating unrestricted reserves resulting in DSC and DCOH covenant violations
Phoebe Putney Memorial Hospital GA A+ Stable Stand-alone Maintained Credit quality consistent with existing rating
Scotland Memorial Hospital NC A Stable Stand-alone Upgrade Robust operations, exceptional MADS coverage, and favorable balance-sheet metrics aided by Health Access Stabilization Program
Scripps Health CA AA- Stable System Maintained Credit quality consistent with existing rating
Self Regional Healthcare SC A+ Stable Stand-alone Maintained Credit quality consistent with existing rating
St Elizabeth Medical Center KY AA Stable System Maintained Credit quality consistent with existing rating
St. Luke's Health System* ID A Stable System Maintained; New sale Credit quality consistent with existing rating
Trinity Health ND BB- Negative Stand-alone Maintained Credit quality consistent with existing rating
UMass Memorial Health Care MA BBB+ Stable System Maintained; New sale Credit quality consistent with existing rating
Vandalia Health WV BBB+ Stable System Unfavorable outlook revision Balance sheet deterioration and less favorable operating performance reduced upside ratings potential over the outlook period
*This action relates to a new sale issuance for variable-rate demand bonds following a review completed in December. DSC--Debt service coverage. 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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