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

S&P Global Ratings affirmed 23 ratings without revising the outlooks and took two negative rating actions in the U.S. not-for-profit health care sector in November.

We assigned a new sale rating this month to Whittier Sustainable Energy Partners, Ariz. in conjunction with a thermal services agreement with PIH Health, Calif. There were four additional new debt issuances in the month, all rated 'A' and above, with ratings and outlooks unchanged. In addition, we placed two issuers on CreditWatch with negative implications. These included Palomar Health, Calif. due to losses and potential covenant violations in 2024, and Children’s Hospital Los Angeles (CHLA) that was also downgraded. There were no upgrades or outlook revisions this month.

The two rating actions consisted of the following:

  • Two downgrades on one stand-alone (CHLA) and one long-term care provider, both in the 'BBB' category.

Chart 1

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Chart 2

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

Banner Health

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

Baylor Scott & White Health

TX AA- Stable System Maintained; new sale Credit quality consistent with existing rating

Cross Keys Village

PA BBB Stable Long-term care Downgrade Significant debt issuance to finance capital projects and persistent losses

Children's Healthcare of Atlanta

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

Children's Hospital Colorado

CO A+ Stable System Maintained Credit quality consistent with existing rating

Children's Hospital Los Angeles

CA BBB- CreditWatch Negative Stand-alone Downgrade; placed on CreditWatch Negative Ongoing negative operations and delayed funding; CreditWatch pending rebuilding unrestricted reserves

Children's Hospital of Wisconsin

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

Children's Mercy Hospital

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

Cincinnati Children's Hospital Medical Center

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

Dartmouth Health

NH A Stable System Maintained Credit quality consistent with existing rating

Essentia Health

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

Firelands Regional Medical Center

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

Fisher-Titus Medical Center

OH BBB+ Negative Stand-alone Maintained Credit quality consistent with existing rating

Grand River Hospital District

CO BB+ Stable Stand-alone Maintained Credit quality consistent with existing rating

Grande Ronde Hospital

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

Luminis Health

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

Madison Memorial Hospital

ID BB+ Stable Stand-alone Maintained Credit quality consistent with existing rating

Montrose Memorial Hospital

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

Otterbein Homes

OH A Stable Long-term care Maintained; new sale Credit quality consistent with existing rating

Palomar Health

CA BB+ CreditWatch Negative Stand-alone Placed on CreditWatch Negative Accelerated losses and deteriorating unrestricted reserves have likely led to covenant violations for 2024

Phoenix Children's Hospital

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

Riverside Health System

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

Sanford Health

SD A+ Stable System Maintained; new sale Credit quality consistent with existing rating

Summa Health System

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

Thomas Jefferson University

PA A Stable System Maintained; new sale Credit quality consistent with existing rating

Virginia Commonwealth University Health System Authority

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

Whittier Sustainable Energy Partners

CA A Negative Other Rating initially assigned; new sale Rating initially assigned based on unconditional fixed payments under a thermal services agreement with PIH Health

This report does not constitute a rating action.

Primary Credit Analyst:Blake C Fundingsland, Englewood + 1 (303) 721 4703;
blake.fundingsland@spglobal.com
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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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