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U.S. Not-For-Profit Health Care Rating Actions, March And First-Quarter 2025

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U.S. Not-For-Profit Health Care Rating Actions, March And First-Quarter 2025

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

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Chart 2

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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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