In March 2025, S&P Global Ratings maintained 22 ratings, took four negative rating actions, and did not upgrade any U.S. not-for-profit health care providers. In addition, we revised two outlooks unfavorably and one outlook favorably.
Included in the month's activity were ratings assigned to seven new debt issuances for currently rated organizations (all affirmed but one outlook revised to stable from negative). We also assigned a rating to a new issuer, CharterCARE Health of Rhode Island.
The seven rating actions and outlook revision consisted of the following:
- Four downgrades on three stand-alone hospitals and one system in the 'A' and 'BBB' rating categories;
- Two outlook revisions to negative from stable on one health system in the 'AA' category and one stand-alone hospital in the 'A' category; and
- One outlook revision to stable from negative on a stand-alone hospital in the 'BBB' category.
Chart 1
Chart 2
Table 1
U.S. not-for-profit health care rating action summary, year to date 2025 | ||||
---|---|---|---|---|
January | February | March | First quarter | |
Maintained | 16 | 20 | 22 | 58 |
Downgrades | 3 | 3 | 4 | 10 |
Upgrades | 1 | 1 | 0 | 2 |
Unfavorable outlook revisions | 2 | 2 | 2 | 6 |
Favorable outlook revisions | 2 | 2 | 1 | 5 |
Table 2
March 2025, U.S. not-for-profit health care rating actions | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
State | Rating | Outlook | Entity type | Action | Description | |||||||||
Baptist Health | AR | A | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
BJC Healthcare | MO | AA | Stable | System | Maintained; New sale* | Credit quality consistent with existing rating | ||||||||
Blue Ridge Healthcare System | NC | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Bon Secours Mercy Health | MD | A+ | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Bowling Green-Warren County Community Hospital Corporation | KY | AA- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
CharterCare Health of Rhode Island | RI | BB- | Negative | Stand-alone | Rating assigned; New sale | Rating assigned based on future operational uncertainty, partly offset by unrestricted reserves cushion | ||||||||
Dallas County Hospital District | TX | AA | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Fort Healthcare | WI | A- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Good Shepherd Group | PA | BBB | Stable | Stand-alone | Downgrade | Trend of substantial operating losses that are expected to persist over the outlook period | ||||||||
Greater Baltimore Medical Center | MD | A- | Stable | Stand-alone | Downgrade | Persistent negative operating performance and weakened cash flow expected to continue for years | ||||||||
Hannibal Regional Hospital | MO | BBB- | Stable | Stand-alone | Downgrade | Material deterioration in DCOH and strained operating performance | ||||||||
Infirmary Health System | AL | A- | Negative | System | Maintained | Credit quality consistent with existing rating | ||||||||
INTEGRIS Health | OK | A- | Stable | System | Downgrade | Weakened balance-sheet profile with a notable drop in unrestricted reserves and DCOH | ||||||||
Mass General Brigham | MA | AA- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Mayo Clinic | MN | AA | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Memorial Health System | IL | A+ | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Midland County Hospital District | TX | A- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
North Mississippi Health Services | MS | A+ | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
North Oaks Health System | LA | A- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Northbay Healthcare System | CA | BBB- | Stable | Stand-alone | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
Presbyterian Healthcare Services | NM | AA- | Negative | System | Unfavorable outlook revision | Ongoing negative operating margins and unexpected deterioration in key balance-sheet metrics | ||||||||
Rogers Memorial Hospital | WI | A | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
Sharp Healthcare | CA | AA | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
Southwest Louisiana Hospital Association | LA | BB | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
St. Francis Regional Medical Center | MN | A- | Stable | Stand-alone | Maintained | Credit quality consistent with existing rating | ||||||||
St. Tammany Parish Hospital Service District #2 | LA | A | Negative | Stand-alone | Unfavorable outlook revision | Possible debt issuance could further strain already pressured balance-sheet metrics | ||||||||
Tampa General Hospital | FL | A- | Stable | System | Maintained | Credit quality consistent with existing rating | ||||||||
UC Health | OH | BBB- | Stable | Stand-alone | Favorable outlook revision; New sale | Considerable operational improvement and a stabilizing pro forma balance sheet | ||||||||
University of Colorado Health | CO | AA | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
University of Pittsburgh Medical Center | PA | A | Stable | System | Maintained; New sale | Credit quality consistent with existing rating | ||||||||
*New sale issuance for tax-exempt commercial paper with the assignment of an 'A-1+' short-term rating following a review completed in February. DCOH--Days' cash on hand. |
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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