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U.S. Not-For-Profit Health Care Rating Actions, December and Fourth Quarter 2024

S&P Global Ratings maintained 21 ratings without revising the outlooks, took seven negative rating actions, and had no upgrades in December. In addition, we revised three outlooks favorably and one outlook unfavorably, all without changing the ratings in the U.S. not-for-profit health care sector.

There were seven new debt issuances in the month, with six ratings maintained. The seventh new issuance was related to a newly rated organization, Mizuho America Leasing LLC, N.Y., reflecting our view of University of Chicago Medical Center and the assessment of the lease structure in place.

The 11 rating actions and outlook revisions consisted of the following:

  • Seven downgrades on three systems and four stand-alone hospitals, with two of the systems taken off CreditWatch with negative implications and downgraded to speculative-grade;
  • Three favorable outlook revisions on one long-term care provider and two systems with two outlooks revised to stable from negative and the other revised to positive from stable; and
  • One unfavorable outlook revision on a stand-alone hospital to negative from stable.

Chart 1

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Chart 2

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Table 1

U.S. not-for-profit health care rating action summary, 2024
First quarter Second quarter Third quarter October November December Fourth quarter Full year
Maintained 63 78 68 20 23 21 64 273
Downgrades 13 8 17 4 2 7 13 51
Upgrades 3 4 2 2 0 0 2 11
Unfavorable outlook revisions 4 13 6 1 0 1 2 25
Favorable outlook revisions 8 10 15 5 0 3 8 41

Table 2

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

Appalachian Regional Healthcare

KY A Stable System Maintained Credit quality consistent with existing rating

Beebe Medical Center

DE BBB- Stable Stand-alone Downgrade Weak underlying operations and multi-year sizable operating losses when excluding one-time grants

Carleton Willard Village

MA A- Stable Long-term care Favorable outlook revision Positive operations and healthy balance-sheet metric improvements through nine-month interim

Children's Health Care

MN AA- Stable Stand-alone Maintained; New sale Credit quality consistent with existing rating

Children's Health System of Texas

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

Children's Hospital of Philadelphia*

PA AA Stable Stand-alone Maintained; New sale Credit quality consistent with existing rating

Denver Health and Hospital Authority

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

Duke University Health System

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

East Alabama Medical Center

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

Grand View Hospital

PA B+ Negative Stand-alone Downgrade Persistent operating losses and declining liquidity and financial flexibility metrics

Guthrie Clinic

PA A Negative System Maintained Credit quality consistent with existing rating

Houston Methodist

TX AA Stable System Maintained Credit quality consistent with existing rating

Loma Linda University Medical Center

CA BB Positive System Favorable outlook revision Stabilized operations with further improvement expected along with a recovering balance sheet

Main Line Health System

PA AA- Stable System Favorable outlook revision Material operational improvement, with strengthening of debt service coverage and stabilization of balance sheet expected

Masonic Villages of the Grand Lodge of Pennsylvania

PA A Stable Long-term care Maintained Credit quality consistent with existing rating

Mercy Health

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

Meritus Health

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

Methodist Le Bonheur Healthcare and Affiliates

TN A Negative System Downgrade Ongoing accelerated operating losses and diminishing unrestricted reserve metrics

Mizuho America Leasing LLC

NY A+ Negative Other Rating initially assigned; New sale Rating assigned based on our view of University of Chicago Medical Center and our assessment of the lease structure in place

Nash Health Care Systems

NC BBB Positive Stand-alone Maintained Credit quality consistent with existing rating

Ochsner Health System

LA A Stable System Maintained Credit quality consistent with existing rating

Oregon Health & Science University

OR A+ Stable Stand-alone Downgrade Continual loss and weaker MADS coverage in fiscal 2024 during a period of heavy capital spending

Penn Highlands Healthcare

PA BB+ Negative System Downgrade Unexpected material operating decline and continually weakening unrestricted reserves following years of losses

Reid Hospital

IN BBB+ Negative Stand-alone Unfavorable outlook revision Significant recurring operating losses, elevated debt levels, and weakening payor mix

Sentara Health

VA AA Stable System Maintained; New sale Credit quality consistent with existing rating

Shodair Children's Hospital

MT BB Stable Stand-alone Downgrade Weakened balance-sheet metrics providing less cushion amid staffing challenges and ongoing operating losses

St. Luke's Health System

ID A Stable System Maintained; New sale Credit quality consistent with existing rating

Summit Pacific Medical Center

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

Trinity Health Credit Group

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

University of Iowa Hospitals & Clinics

IA AA Stable Stand-alone Maintained; New sale Credit quality consistent with existing rating

University of Maryland Medical System

MD A Stable System Maintained; New sale Credit quality consistent with existing rating

Virtua Health

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

Westchester County Health Care Corporation

NY BB+ Negative System Downgrade Extremely thin unrestricted reserves and another year of operating losses beyond expectations
*This action relates to a new sale issuance for a taxable commercial paper (CP) with the assignment of an 'A-1+' short-term rating following a review completed in September.
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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