Key Takeaways
- Almost all system rating levels experienced a decline in margins and maximum annual debt service (MADS) coverage, though all median operating margins remained positive outside the smaller 'BBB' category.
- Though the magnitude of operating pressure varied across rating levels and categories and operating earnings are weaker than prior year, the strength of profitability measures remained directly correlated with rating level.
- Balance sheets remain robust and at the strongest levels on record with growth in unrestricted reserves and a reduction in contingent debt, although systems continued to issue debt to support liquidity and to fund strategic investments, with taxable issuances particularly notable.
- The system outlook distribution has materially improved over the past year, though negative outlooks remain well above pre-COVID-19 levels indicating further downgrades could be considered.
Rating And Outlook Overview
Health care systems generally followed median trends exhibited across the entire acute care sector, however with benefits from increased scale and economic, business, and geographic dispersion, systems can have lower volatility and more stable overall credit profiles. This has led to a very stable rating distribution for the group when compared with both summer 2020 and 2019 (see chart 1).
As of June 30, 2021, the outlook distribution has seen some recovery from last year, when 17% of system outlooks carried a negative outlook (see chart 2). This rebound has been supported by receipt of CARES Act grants and other stimulus funds, the return of patient volumes following state-mandated shutdowns, albeit not necessarily to pre pandemic levels, and growing confidence in management to adequately manage COVID-19 surges. Though improved from last year, 12% of systems remain on negative outlook as of June 30, 2021, compared with just 5% prior to COVID-19.
Statement Of Operations
State-mandated care shutdowns in spring 2020 and the ensuing volume rebound created mixed results across rating levels when comparing median net patient revenue (NPR) to prior years, halting a steady trend of top-line growth. Much of this was offset with CARES Act grants, as total operating revenue grew across all ratings. Systems in the 'AA' and 'A' categories (89% of the sample), continued to post positive operating earnings though we believe this would not be the case for many providers absent the immense support under the CARES Act, namely provider relief funds, but also add-on payments for Medicare and uninsured COVID-19 patients.
When compared to the stand-alone hospital portfolio, we generally believe that systems enjoy greater revenue diversity, such as expansive service lines and locations across multiple geographic regions, as well as health plans and other non-acute care components or joint ventures. This has been a critical supporting factor throughout the pandemic, further enabled by strong management teams with deep financial resources and sector expertise. Median salaries and benefits as a percentage of net patient revenue rose for all ratings, but the magnitude of the increase was more pronounced in lower rating levels. This reflects the stress on NPR as well as the increased costs associated with staffing requirements, including significantly elevated nurse agency costs during the height of the pandemic.
Financial performance trends were moderately better for systems with fiscal year ends falling in the latter half of calendar 2020, and this recovery has generally continued into 2021 as volumes return and additional CARES Act grants are recognized.
Balance Sheet
While system financial performance metrics weakened in fiscal 2020, balance sheet metrics continued to improve, in line with trends observed across the acute care sector over the past several years. Unrestricted reserves have increased throughout the sector and across the entire systems portfolio, and correspondingly, unrestricted days' cash on hand and reserves to long-term debt improved across almost all rating levels. This is a primarily a result of the recovery in financial performance and operating cash flow seen in the latter half of the year, along with the ongoing strong performance of investment portfolios, in line with market trends. We also consider the improvement in the days' cash on hand to also be a result of prudent strategies developed by management teams in response to the pandemic, which kept expenses in check.
Despite many systems pausing capital projects, particularly early in the pandemic, capital spending remained well above 100% of depreciation expense at all rating levels except 'BBB+', albeit at the lowest level in many years. That said, and not surprisingly, almost all the individual rating levels showed a decline in capital spending as a percentage of depreciation compared with the prior year.
With respect to debt metrics, the sector and the portfolio has seen the continued de-risking of debt structures with a near 10% decline in contingent debt to long-term debt since 2014. There was a modest uptick in leverage this past year, as measured by long-term debt-to-capitalization. Systems have continued to take advantage of the low interest rate environment, issuing debt to support capital strategies and liquidity, including extending out line of credit borrowings. The funded status of the defined-benefit plans declined slightly from fiscal 2019, in part due to low discount rates, but we note that credits with fiscal year ends in the latter half of the year reported improved funding levels due to the recovery in the investment markets.
Ratio Analysis
We view ratio analysis as an important tool in our assessment of the credit quality of not-for-profit health care organizations in addition to other key considerations including our analysis of enterprise profile factors and forward-looking views relative to both the business and financial positions. The median ratios offer a snapshot of the financial profile and help in the comparison of credits across rating categories. Tracking median ratios over time also presents a clearer understanding of industrywide trends and provides a tool to better assess the sector's future credit quality.
The financial statements used for medians and in our analysis include both obligated and nonobligated group members. For the 2020 medians, unrestricted reserves exclude Medicare advance payments and pandemic-related short-term borrowings. All recognized CARES Act funding and other pandemic related relief is included in total operating revenue.
Chart 1
Chart 2
Table 1
| U.S. Not-For-Profit Health Care System Medians | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fiscal year | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | ||||||||||
| Sample size | 153 | 146 | 142 | 144 | 146 | 142 | 140 | 138 | ||||||||||
| Statement of operations | ||||||||||||||||||
| Net patient revenue (NPR; $000) | 2,587,620 | 2,519,213 | 2,397,747 | 2,203,429 | 2,022,277 | 1,873,321 | 1,718,626 | 1,590,127 | ||||||||||
| Total operating revenue ($000) | 3,089,200 | 2,877,252 | MNR | MNR | MNR | MNR | MNR | MNR | ||||||||||
| Salaries & benefits/NPR (%) | 62.0 | 58.3 | 57.9 | 57.9 | 57.2 | 56.4 | 57.8 | 57.7 | ||||||||||
| Maximum annual debt service coverage (x) | 4.1 | 4.4 | 4.4 | 4.5 | 4.3 | 5.0 | 4.6 | 4.2 | ||||||||||
| Operating lease-adjusted coverage (x)* | 3.1 | 3.4 | 3.2 | 3.5 | 3.1 | 3.4 | 3.4 | 3.3 | ||||||||||
| Debt burden (%) | 2.1 | 2.2 | 2.2 | 2.2 | 2.3 | 2.3 | 2.4 | 2.6 | ||||||||||
| EBIDA ($000) | 279,127 | 303,095 | 282,188 | 265,041 | 223,165 | 278,605 | 247,243 | 204,975 | ||||||||||
| Nonoperating revenue/total revenue (%) | 1.9 | 1.9 | 1.7 | 2.1 | 1.1 | 2.0 | 2.6 | 2.5 | ||||||||||
| EBIDA margin (%) | 8.6 | 9.8 | 10.0 | 10.3 | 9.9 | 11.5 | 12.0 | 11.3 | ||||||||||
| Operating EBIDA margin (%) | 6.8 | 8.4 | 8.3 | 8.3 | 9.0 | 10.2 | 9.5 | 9.1 | ||||||||||
| Operating margin (%) | 1.2 | 2.7 | 2.3 | 2.2 | 2.4 | 3.6 | 2.9 | 2.2 | ||||||||||
| Excess margin (%) | 3.2 | 4.3 | 3.9 | 4.5 | 3.7 | 5.3 | 5.1 | 4.2 | ||||||||||
| Capital expenditures/depr. & amort. exp. (%) | 120.0 | 134.4 | 133.3 | 132.3 | 125.1 | 126.0 | 123.8 | 130.0 | ||||||||||
| Balance sheet | ||||||||||||||||||
| Average age of plant (years) | 11.1 | 11.0 | 10.6 | 10.8 | 10.6 | 10.5 | 10.4 | 10.5 | ||||||||||
| Cushion ratio (x) | 27.9 | 25.1 | 24.0 | 22.9 | 21.4 | 21.4 | 19.6 | 18.2 | ||||||||||
| Days' cash on hand | 236.7 | 218.3 | 213.3 | 205.5 | 197.6 | 205.5 | 203.1 | 204.6 | ||||||||||
| Days in accounts receivable | 44.6 | 46.5 | 45.8 | 47.8 | 48.2 | 48.0 | 48.1 | 50.2 | ||||||||||
| Cash flow/total liabilities (%) | 10.1 | 14.9 | 14.3 | 15.3 | 13.9 | 16.2 | 16.9 | 15.0 | ||||||||||
| Unrestricted reserves ($000) | 1,961,547 | 1,604,728 | 1,484,081 | 1,402,672 | 1,213,897 | 1,191,485 | 1,086,026 | 901,350 | ||||||||||
| Unrestricted reserves/long-term debt (%) | 189.3 | 175.6 | 175.1 | 173.3 | 169.5 | 161.0 | 153.4 | 141.5 | ||||||||||
| Unrestricted reserves/contingent liabilities (%)* | 794.1 | 645.8 | 594.1 | 546.3 | 507.6 | 462.6 | 451.2 | MNR | ||||||||||
| Contingent liabilities/long-term debt (%)* | 27.0 | 28.7 | 31.8 | 33.2 | 31.9 | 34.4 | 36.7 | MNR | ||||||||||
| Long-term debt/capitalization (%) | 31.9 | 31.6 | 31.7 | 32.3 | 34.0 | 33.7 | 34.6 | 35.1 | ||||||||||
| DB pension funded status (%)* | 79.9 | 81.8 | 84.8 | 81.0 | 74.0 | 78.2 | 82.0 | 83.6 | ||||||||||
| Pension-adjusted long-term debt/capitalization (%)* | 34.6 | 34.5 | 33.9 | 34.9 | 37.3 | 38.2 | 38.2 | 37.8 | ||||||||||
| MNR--median not reported. *These five ratios are only for organizations that have defined-benefit (DB) pension plans, operating leases, or contingent liabilities. | ||||||||||||||||||
Table 2
| U.S. Not-For-Profit Health Care System Medians By Rating Category--2020 vs. 2019 | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AA | A | BBB | ||||||||||||
| Fiscal year | 2020 | 2019 | 2020 | 2019 | 2020 | 2019 | ||||||||
| Sample size | 68 | 65 | 68 | 66 | 14 | 13 | ||||||||
| Statement of operations | ||||||||||||||
| Net patient revenue (NPR; $000) | 3,656,374 | 3,603,041 | 2,355,251 | 2,345,110 | 1,848,873 | 1,767,828 | ||||||||
| Total operating revenue ($000) | 4,246,373 | 4,190,784 | 2,777,093 | 2,605,688 | 2,274,580 | 2,034,197 | ||||||||
| Salaries & benefits/NPR (%) | 60.8 | 57.1 | 62.3 | 58.5 | 69.0 | 62.6 | ||||||||
| Maximum annual debt service coverage (x) | 5.2 | 5.9 | 3.6 | 3.7 | 2.4 | 2.5 | ||||||||
| Operating lease-adjusted coverage (x)* | 3.8 | 4.2 | 2.8 | 3.0 | 1.8 | 2.1 | ||||||||
| Debt burden (%) | 1.9 | 1.9 | 2.3 | 2.3 | 2.0 | 2.0 | ||||||||
| EBIDA ($000) | 389,264 | 454,459 | 242,866 | 247,851 | 115,755 | 114,960 | ||||||||
| Nonoperating revenue/total revenue (%) | 2.3 | 2.3 | 1.5 | 1.7 | 1.0 | 1.5 | ||||||||
| EBIDA margin (%) | 10.2 | 11.6 | 8.3 | 9.1 | 5.4 | 5.5 | ||||||||
| Operating EBIDA margin (%) | 7.8 | 9.6 | 6.8 | 7.6 | 4.5 | 4.2 | ||||||||
| Operating margin (%) | 2.3 | 3.8 | 1.1 | 1.9 | (0.9) | (1.1) | ||||||||
| Excess margin (%) | 5.1 | 6.0 | 2.6 | 3.6 | 0.1 | 0.6 | ||||||||
| Capital expenditures/depr. & amort. exp. (%) | 127.9 | 135.8 | 118.7 | 132.0 | 92.6 | 103.4 | ||||||||
| Balance sheet | ||||||||||||||
| Average age of plant (years) | 10.6 | 10.4 | 11.6 | 11.9 | 12.6 | 11.3 | ||||||||
| Cushion ratio (x) | 37.9 | 33.2 | 21.4 | 19.2 | 19.8 | 17.6 | ||||||||
| Days' cash on hand | 295.3 | 288.9 | 187.9 | 172.8 | 146.4 | 140.7 | ||||||||
| Days in accounts receivable | 45.7 | 46.8 | 43.7 | 45.8 | 43.0 | 43.1 | ||||||||
| Cash flow/total liabilities (%) | 14.4 | 19.0 | 9.2 | 13.1 | 4.8 | 6.6 | ||||||||
| Unrestricted reserves ($000) | 2,960,920 | 2,781,745 | 1,431,682 | 1,205,384 | 772,840 | 763,598 | ||||||||
| Unrestricted reserves/long-term debt (%) | 267.0 | 241.8 | 153.5 | 147.4 | 126.0 | 136.5 | ||||||||
| Unrestricted reserves/contingent liabilities (%)* | 861.5 | 789.4 | 611.0 | 592.4 | 1,226.5 | 792.1 | ||||||||
| Contingent liabilities/long-term debt (%)* | 30.4 | 35.5 | 25.9 | 25.6 | 11.5 | 15.8 | ||||||||
| Long-term debt/capitalization (%) | 25.4 | 24.7 | 35.5 | 35.8 | 47.2 | 40.2 | ||||||||
| DB pension funded status (%)* | 81.9 | 85.2 | 79.4 | 79.3 | 68.8 | 71.1 | ||||||||
| Pension-adjusted long-term debt/capitalization (%)* | 27.6 | 26.4 | 39.9 | 39.2 | 50.7 | 47.6 | ||||||||
| *These five ratios are only for organizations that have defined-benefit (DB) pension plans, operating leases, or contingent liabilities. **These medians exclude three speculative grade systems in 2020 and two in 2019 due to a small sample size. | ||||||||||||||
Table 3A
| U.S. Not-For-Profit Health Care System Medians By Rating Level--2020 vs. 2019 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AA+ | AA | AA- | A+ | |||||||||||||||
| Fiscal year | 2020 | 2019 | 2020 | 2019 | 2020 | 2019 | 2020 | 2019 | ||||||||||
| Sample size | 7 | 6 | 23 | 23 | 38 | 36 | 26 | 28 | ||||||||||
| Statement of operations | ||||||||||||||||||
| Net patient revenue (NPR; $000) | 4,157,684 | 3,882,221 | 3,978,564 | 4,050,320 | 3,083,160 | 3,213,282 | 2,260,420 | 2,010,024 | ||||||||||
| Total operating revenue ($000) | 4,425,375 | 4,036,916 | 4,949,023 | 4,887,899 | 3,411,439 | 3,320,191 | 2,552,547 | 2,290,450 | ||||||||||
| Salaries & benefits/NPR (%) | 55.7 | 54.8 | 61.3 | 58.0 | 60.0 | 56.9 | 58.4 | 55.3 | ||||||||||
| Maximum annual debt service coverage (x) | 8.0 | 9.3 | 5.8 | 7.6 | 4.6 | 5.0 | 3.9 | 3.9 | ||||||||||
| Operating lease-adjusted coverage (x)* | 6.3 | 7.3 | 4.8 | 4.9 | 3.3 | 3.8 | 2.8 | 3.1 | ||||||||||
| Debt burden (%) | 1.6 | 1.8 | 1.8 | 1.8 | 2.0 | 2.2 | 2.1 | 2.3 | ||||||||||
| EBIDA ($000) | 775,782 | 973,465 | 577,381 | 603,513 | 307,000 | 404,081 | 232,016 | 202,563 | ||||||||||
| Nonoperating revenue/total revenue (%) | 2.9 | 3.3 | 2.3 | 2.5 | 2.0 | 1.9 | 1.5 | 1.7 | ||||||||||
| EBIDA margin (%) | 12.2 | 14.6 | 10.7 | 12.7 | 9.2 | 10.9 | 8.9 | 9.5 | ||||||||||
| Operating EBIDA margin (%) | 11.3 | 11.0 | 8.3 | 9.8 | 7.1 | 9.2 | 8.1 | 7.5 | ||||||||||
| Operating margin (%) | 4.5 | 5.5 | 3.2 | 4.4 | 1.9 | 3.0 | 1.6 | 1.9 | ||||||||||
| Excess margin (%) | 5.5 | 9.4 | 5.8 | 6.6 | 4.1 | 5.5 | 3.1 | 3.3 | ||||||||||
| Capital expenditures/depr. & amort. exp. (%) | 124.6 | 134.6 | 137.6 | 153.8 | 118.3 | 132.6 | 120.0 | 122.4 | ||||||||||
| Balance sheet | ||||||||||||||||||
| Average age of plant (years) | 9.1 | 8.5 | 10.8 | 10.5 | 10.4 | 10.4 | 11.6 | 12.0 | ||||||||||
| Cushion ratio (x) | 73.9 | 61.0 | 44.5 | 41.1 | 33.5 | 29.6 | 24.4 | 21.6 | ||||||||||
| Days' cash on hand | 425.0 | 424.6 | 344.9 | 335.5 | 286.7 | 258.8 | 208.1 | 195.7 | ||||||||||
| Days in accounts receivable | 41.4 | 46.1 | 47.2 | 47.6 | 46.7 | 46.2 | 42.9 | 43.7 | ||||||||||
| Cash flow/total liabilities (%) | 18.9 | 32.9 | 16.9 | 24.6 | 11.8 | 17.5 | 10.0 | 15.5 | ||||||||||
| Unrestricted reserves ($000) | 5,550,716 | 5,454,963 | 4,447,015 | 4,057,238 | 2,654,657 | 2,257,133 | 1,323,540 | 1,138,498 | ||||||||||
| Unrestricted reserves/long-term debt (%) | 382.5 | 359.0 | 300.7 | 283.1 | 237.3 | 224.7 | 172.9 | 164.1 | ||||||||||
| Unrestricted reserves/contingent liabilities (%)* | 1,105.8 | 1,093.9 | 880.8 | 863.5 | 837.2 | 642.4 | 675.2 | 605.4 | ||||||||||
| Contingent liabilities/long-term debt (%)* | 26.5 | 35.2 | 44.7 | 43.2 | 30.4 | 31.5 | 25.5 | 26.7 | ||||||||||
| Long-term debt/capitalization (%) | 20.9 | 20.9 | 22.2 | 20.8 | 26.9 | 27.4 | 31.7 | 31.6 | ||||||||||
| DB pension funded status (%)* | 82.7 | 88.4 | 81.7 | 85.6 | 82.2 | 83.8 | 82.0 | 86.0 | ||||||||||
| Pension-adjusted long-term debt/capitalization (%)* | 23.3 | 21.4 | 23.6 | 23.2 | 28.2 | 30.0 | 34.5 | 32.7 | ||||||||||
| *These five ratios are only for organizations that have defined-benefit (DB) pension plans, operating leases, or contingent liabilities. | ||||||||||||||||||
Table 3B
| U.S. Not-For-Profit Health Care System Medians By Rating Level--2020 vs. 2019 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | A- | BBB+ | BBB | |||||||||||||||
| Fiscal year | 2020 | 2019 | 2020 | 2019 | 2020 | 2019 | 2020 | 2019 | ||||||||||
| Sample size | 32 | 30 | 10 | 8 | 10 | 9 | 4 | 4 | ||||||||||
| Statement of operations | ||||||||||||||||||
| Net patient revenue (NPR; $000) | 2,687,606 | 2,811,264 | 2,076,521 | 2,089,994 | 1,848,873 | 1,767,828 | 2,961,333 | 3,223,000 | ||||||||||
| Total operating revenue ($000) | 3,065,105 | 2,920,867 | 2,684,250 | 2,450,143 | 2,274,580 | 2,034,197 | 4,112,269 | 4,003,663 | ||||||||||
| Salaries & benefits/NPR (%) | 63.4 | 59.5 | 68.3 | 66.0 | 69.6 | 65.0 | 68.8 | 62.1 | ||||||||||
| Maximum annual debt service coverage (x) | 3.6 | 3.7 | 3.3 | 3.4 | 3.6 | 2.7 | 1.3 | 2.3 | ||||||||||
| Operating lease-adjusted coverage (x)* | 2.8 | 3.1 | 2.6 | 2.7 | 2.5 | 2.1 | 1.1 | 2.0 | ||||||||||
| Debt burden (%) | 2.4 | 2.3 | 2.4 | 2.5 | 1.8 | 1.9 | 2.1 | 2.1 | ||||||||||
| EBIDA ($000) | 253,176 | 285,841 | 209,691 | 236,171 | 115,755 | 100,739 | 150,886 | 224,670 | ||||||||||
| Nonoperating revenue/total revenue (%) | 1.7 | 1.5 | 1.5 | 1.9 | 1.5 | 1.5 | 0.7 | 1.2 | ||||||||||
| EBIDA margin (%) | 8.0 | 9.0 | 8.0 | 9.3 | 6.0 | 5.7 | 2.8 | 5.1 | ||||||||||
| Operating EBIDA margin (%) | 6.6 | 8.0 | 6.7 | 7.2 | 5.0 | 4.6 | 1.6 | 3.2 | ||||||||||
| Operating margin (%) | 0.7 | 1.8 | 0.6 | 1.7 | (0.2) | (1.1) | (3.2) | (1.4) | ||||||||||
| Excess margin (%) | 2.3 | 3.5 | 2.4 | 3.9 | 0.5 | 0.4 | (2.0) | 0.6 | ||||||||||
| Capital expenditures/depr. & amort. exp. (%) | 117.3 | 134.6 | 108.3 | 133.5 | 86.8 | 81.2 | 144.9 | 142.0 | ||||||||||
| Balance sheet | ||||||||||||||||||
| Average age of plant (years) | 11.6 | 11.8 | 12.0 | 11.5 | 12.8 | 11.3 | 11.8 | 11.1 | ||||||||||
| Cushion ratio (x) | 20.1 | 18.5 | 18.6 | 15.7 | 24.6 | 17.9 | 15.3 | 14.2 | ||||||||||
| Days' cash on hand | 177.6 | 160.6 | 205.8 | 138.3 | 158.8 | 142.9 | 116.7 | 112.5 | ||||||||||
| Days in accounts receivable | 43.9 | 47.6 | 43.2 | 41.0 | 41.6 | 43.1 | 47.6 | 42.9 | ||||||||||
| Cash flow/total liabilities (%) | 9.0 | 12.2 | 7.5 | 12.0 | 6.5 | 7.8 | 1.5 | 4.7 | ||||||||||
| Unrestricted reserves ($000) | 1,653,752 | 1,462,285 | 1,287,932 | 1,059,182 | 772,840 | 763,598 | 1,292,019 | 873,022 | ||||||||||
| Unrestricted reserves/long-term debt (%) | 143.6 | 136.1 | 112.6 | 100.9 | 167.9 | 138.0 | 107.2 | 105.9 | ||||||||||
| Unrestricted reserves/contingent liabilities (%)* | 580.2 | 531.6 | 456.2 | 444.9 | 2,102.2 | 828.9 | 816.1 | 792.1 | ||||||||||
| Contingent liabilities/long-term debt (%)* | 26.4 | 25.7 | 25.2 | 19.7 | 10.7 | 15.8 | 13.7 | 14.4 | ||||||||||
| Long-term debt/capitalization (%) | 39.5 | 38.8 | 44.7 | 46.7 | 35.2 | 35.0 | 56.2 | 53.0 | ||||||||||
| DB pension funded status (%)* | 73.1 | 75.9 | 85.1 | 74.8 | 68.8 | 71.1 | 70.6 | 71.9 | ||||||||||
| Pension-adjusted long-term debt/capitalization (%)* | 46.1 | 43.7 | 45.1 | 47.7 | 41.5 | 36.7 | 59.5 | 53.8 | ||||||||||
| *These five ratios are only for organizations that have defined-benefit (DB) pension plans, operating leases, or contingent liabilities. **These medians exclude three speculative grade systems in 2020 and two in 2019 due to a small sample size. There were no 'BBB-' systems in 2020 or 2019. | ||||||||||||||||||
Related Research
- U.S. Not-For-Profit Acute Health Care 2020 Medians, Buoyed By Government Funding And Strong Investment Returns, Remain Largely Stable, Aug. 30, 2021
- U.S. Not-For-Profit Health Care Stand-Alone Hospital Median Financial Ratios--2020 vs. 2019, Aug. 30, 2021
- U.S. Not-For-Profit Health Care Small Stand-Alone Hospital Median Financial Ratios--2020 vs. 2019, Aug. 30, 2021
- U.S. Not-For-Profit Health Care Children's Hospital Median Financial Ratios--2020 vs. 2019, Aug. 30, 2021
- U.S. Not-For-Profit Health Care Speculative Grade Median Financial Ratios--2020 vs. 2019, Aug. 30, 2021
- U.S. Not-For-Profit Health Care Outstanding Ratings And Outlooks As Of June 30, 2021, July 29, 2021
- U.S. Not-For-Profit Health Care Sector View Revised To Stable From Negative, June 23, 2021
- U.S. Not-For-Profit Health Care Rating Actions, 2020 Year-End Review, Feb. 25, 2021
- Outlook for U.S. Not-For-Profit Acute Health Care: Navigating The Bumps While Getting Back On Track, Jan. 12, 2021
- Not-For-Profit Acute Care Sector Outlook Revised To Negative Reflecting Possible Prolonged COVID-19 Impact, March 25, 2020
Glossary of our ratios
- Glossary: Not-For-Profit Health Care Organization Ratios, March 19, 2018
Monthly rating changes
- U.S. Not-For-Profit Health Care Rating Actions, July 2021, Aug. 10, 2021
- U.S. Not-For-Profit Health Care Rating Actions: June 2021 And Second-Quarter 2021, July 29, 2021
- U.S. Not-For-Profit Health Care Rating Actions, May 2021, June 8, 2021
- U.S. Not-For-Profit Health Care Rating Actions, April 2021, May 18, 2021
- U.S. Not-For-Profit Health Care Rating Actions, March 2021 And First-Quarter 2021, April 15, 2021
- U.S. Not-For-Profit Health Care Rating Actions, February 2021, March 9, 2021
- U.S. Not-For-Profit Health Care Rating Actions, January 2021, Feb. 20, 2021
- U.S. Not-For-Profit Health Care Rating Actions, December 2020 And Fourth Quarter 2020, Feb. 4, 2021
- U.S. Not-For-Profit Health Care Rating Actions, November 2020, Dec. 15, 2020
- U.S. Not-For-Profit Health Care Rating Actions, October 2020, Nov. 30, 2020
- U.S. Not-For-Profit Health Care Rating Actions, Third-Quarter And September 2020, Nov. 3, 2020
This report does not constitute a rating action.
| Primary Credit Analysts: | Allison Bretz, Chicago +1 (303) 721 4119; allison.bretz@spglobal.com |
| Patrick Zagar, Farmers Branch + 1 (214) 765 5883; patrick.zagar@spglobal.com | |
| Secondary Contacts: | Suzie R Desai, Chicago + 1 (312) 233 7046; suzie.desai@spglobal.com |
| Stephen Infranco, New York + 1 (212) 438 2025; stephen.infranco@spglobal.com | |
| Research Contributors: | Adwait Chandsarkar, CRISIL Global Analytical Center, an S&P affiliate, Mumbai |
| Karan Shah, CRISIL Global Analytical Center, an S&P affiliate, Mumbai |
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