The following hospital and health system ratings, outlook changes and affirmations took place in July, starting with the most recent.
1. S&P assigns 'BBB+' rating to CHI's bonds
S&P Global Ratings assigned its "BBB+" long-term rating on Englewood, Colo.-based Catholic Health Initiatives' proposed $275 million series 2018A bonds.
2. S&P places Essentia Health on credit watch negative
S&P Global Ratings placed its "A" underlying rating on Duluth, Minn.-based Essentia Health on credit watch with negative implications.
3. S&P revises Halifax Hospital Medical Center's outlook to negative over litigation risks
S&P Global Ratings affirmed its "A-" long-term rating on Daytona Beach, Fla.-based Halifax Hospital Medical Center's revenue bonds and revised the outlook to negative from stable.
4. Fitch assigns 'AA' IDR to Advocate Aurora Health
Fitch Ratings assigned an issuer default rating of "AA" to Advocate Aurora Health — the entity formed by the recent merger of Downers Grove, Ill.-based Advocate Health Care and Milwaukee-based Aurora Health.
5. Fitch affirms Nebraska Medicine's 'AA-' rating
Fitch Ratings affirmed its "AA-" rating on Omaha-based Nebraska Medicine's outstanding bonds. Concurrently, Fitch assigned its "AA-" issuer default rating to the academic healthcare provider.
6. Fitch affirms 'AA' rating on Presbyterian Healthcare
Fitch Ratings affirmed its "AA" rating of Albuquerque, N.M.-based Presbyterian Healthcare Services' outstanding bonds, affecting $850 billion of debt. At the same time, Fitch assigned its "AA" issuer default rating to the health system.
7. Moody's affirms 'Aa3' rating on Main Line Health
Moody's Investors Service affirmed its "Aa3" rating on Philadelphia-based Main Line Health's outstanding bonds, affecting $219.5 million of debt.
8. Moody's downgrades Lafayette General Medical Center
Moody's Investors Service downgraded its rating on Lafayette (La.) General Medical Center to "Baa2" from "Baa1," affecting $147 million of rated debt.
9. Moody's affirms SCL Health's 'Aa3' rating
Moody's Investors Service affirmed its "Aa3" long-term rating on Sisters of Charity of Leavenworth (Kan.) Health System, which does business as SCL Health. The rating affects about $1.2 billion of debt.
10. S&P ratings on ProMedica debt unchanged after HCR ManorCare acquisition
ProMedica's acquisition of Toledo-based nursing home chain HCR ManorCare will not immediately affect its 'A+' long-term ratings on the Ohio-based health system's debt, according to S&P Global Ratings.
11. Fitch places LifePoint Health on rating watch negative after acquisition announcement
Fitch Ratings placed Brentwood, Tenn.-based LifePoint Health's outstanding bond ratings on rating watch negative after the hospital operator announced it would be acquired by private equity firm Apollo Global Management.
12. Moody's affirms 'Ba3' long-term rating on McCamey County Hospital
Moody's Investors Service affirmed its "Ba3" long-term issuer rating on McCamey (Texas) County Hospital District.
13. Fitch downgrades Loma Linda University Health System's rating to 'BB'
Fitch Ratings downgraded Loma Linda (Calif.) University Health System's issuer default and outstanding series 2014A, 2014B and 2016A revenue bond ratings to "BB" from "BB+."
14. S&P revises Pullman Regional Hospital's outlook to stable
S&P Global Ratings revised Pullman (Wash.) Regional Hospital's outlook to stable from positive and affirmed its "BBB-" long-term rating on its bonds.
15. Fitch assigns 'AA-' rating to Willis-Knighton Medical Center, revises outlook to stable
Fitch Ratings assigned its "AA-" issuer default rating to Shreveport, La.-based Willis-Knighton Medical Center.
16. Moody's affirms 'Baa1' rating on Central Washington Hospital
Moody's Investors Service affirmed its "Baa1" rating on Wenatchee-based Central Washington Hospital's revenue bonds, affecting $113 million of debt.
17. Moody's affirms 'Baa2' rating on Westchester County Health Care Corp.
Moody's Investors Service affirmed its "Baa2" rating on two members of the Westchester Medical Center Health Care Corp. network — Valhalla, N.Y.-based Westchester Medical Center and Suffern, N.Y.-based Charity Health System. The actions affect a combined $772 million of debt.
18. 9-notch downgrade: S&P lowers Nacogdoches County Hospital District's rating to 'B-'
S&P Global Ratings lowered its long-term rating on Nacogdoches (Texas) County Hospital District nine notches to "B-" from "A-."
19. Fitch assigns 'BBB' IDR rating to Tufts Medical Center
Fitch Ratings assigned its "BBB" issuer default rating to Boston-based Tufts Medical Center.
20. Moody's assigns 'A3' rating to St. Luke's Health System, maintains negative outlook
Moody's Investors Service assigned its "A3" rating to Boise, Idaho-based St. Luke's Health System's proposed $387 million series 2018A, 2018B and 2018C revenue bonds.
21. S&P upgrades Saratoga Hospital to 'A'
S&P Global Ratings upgraded Saratoga Springs, N.Y.-based Saratoga Hospital's long-term and underlying rating to "A" from "A-."
22. Fitch affirms 'BBB-' on Wright Memorial Hospital
Fitch Ratings affirmed its "BBB-" rating on Trenton, Mo.-based Wright Memorial Hospital's series 2009 revenue bonds, affecting $26 million of debt.
23. Moody's affirms 'A2' rating on Southwest General Health Center
Moody's Investors Service affirmed its "A2" rating on Middleburg Heights, Ohio-based Southwest General Health Center, affecting about $153 million of debt.
24. Moody's affirms New York-Presbyterian Hospital's issuer, bond ratings
Moody's Investors Service affirmed its "Aa2" issuer rating and its "Aa3" bond rating on New York City-based NewYork-Presbyterian Hospital.
25. Moody's affirms 'A2' rating on WakeMed
Moody's Investors Service affirmed its "A2" long-term rating on Raleigh, N.C.-based WakeMed, affecting about $390 million of debt.
26. Moody's affirms 'Aa2' rating on Cleveland Clinic
Moody's Investors Service affirmed its "Aa2" long-term rating on Cleveland Clinic, affecting about $2.8 billion of outstanding debt.
27. Fitch affirms 'BBB' rating on The Methodist Hospitals, revises outlook to negative
Fitch Ratings affirmed its "BBB" rating on Gary, Ind.-based The Methodist Hospitals' series 2014A revenue refunding bonds and assigned its "BBB" issuer default rating to the health system.
28. S&P changes Valley Medical Center's rating to 'A-'
S&P Global Ratings upgraded the rating on Renton, Wash.-based Valley Medical Center's series 2010A and 2010B revenue bonds to "A-" from "BBB+." At the same time, S&P downgraded Valley Medical Center's series 2016 and 2008B general obligation bonds to "A-" from "A."
29. S&P assigns 'BBB' rating to Montefiore Health System
S&P Global Ratings assigned its "BBB" long-term rating to New York City-based Montefiore Health System's series 2018A, 2018B and 2018C bonds
30. Moody's affirms 'A3' rating on Torrance Memorial Medical Center
Moody's Investors Service affirmed its "A3" rating on Torrance (Calif.) Memorial Medical Center, affecting about $230 million of debt.
31. Moody's assigns 'A1' rating to Valley Children's Healthcare
Moody's Investors Service assigned its "A1" rating to Madera, Calif.-based Valley Children's Healthcare's proposed $202.5 million series 2018A bonds.
32. Fitch downgrades Lexington Medical Center to 'BB+'
Fitch Ratings downgraded West Columbia, S.C.-based Lexington Medical Center's rating to "BB+" from "A+."
33. Fitch downgrades University Hospital's rating to 'BB-'
Fitch Ratings downgraded the rating on Newark, N.J.-based University Hospital's series 2015A revenue and refunding bonds to "BB-" from "BBB," affecting about $255 million of debt.
34. Fitch downgrades Dignity Health to 'A-'
Fitch Ratings downgraded San Francisco-based Dignity Health's bond ratings to "A-" from "A."
35. S&P assigns 'AA+' rating to Inova Health System Foundation
S&P Global Ratings assigned its "AA+" long-term rating to Falls Church, Va.-based Inova Health System Foundation's $500 million series 2018A and 2018B revenue bonds.
36. Fitch affirms 'BBB+' rating on Lifespan's bonds
Fitch Ratings affirmed its "BBB+" rating on Providence, R.I.-based Lifespan's revenue refunding bonds. In addition, Fitch assigned Lifespan an issuer default rating of "BBB+."
37. Fitch downgrades MedStar Health's rating to 'A-'
Fitch Ratings downgraded Columbia, Md.-based MedStar Health's bond ratings to "A-" from "A."
38. Fitch downgrades King's Daughters Medical Center to 'BBB-'
Fitch Ratings downgraded Ashland, Ky.-based King's Daughters Medical Center's bonds to "BBB-" from "A-."
39. Fitch upgrades Calvert Health System's rating to 'AA-'
Fitch Ratings upgraded the rating on Prince Frederick, Md.-based Calvert Health System's revenue bonds to "AA-" from "A."
40. Moody's affirms 'Aa3' rating on Methodist Health System
Moody's Investors Service affirmed its "Aa3" rating on Dallas-based Methodist Health System, affecting about $348 million of outstanding debt.
41. Moody's assigns 'A2' rating to Centra Health, maintains negative outlook
Moody's Investors Service assigned its "A2" rating to Lynchburg, Va.-based Centra Health's proposed $126.6 million series 2018 bonds.