The following hospital and health system credit rating and outlook changes and affirmations took place in October, beginning with the most recent.
1. S&P places Puerto Rico's Ryder Memorial Hospital on credit watch-negative
S&P Global Ratings placed Puerto Rico-based Ryder Memorial Hospital's series 1994A bonds, which are rated "B+," on credit watch with negative implications.
2. Moody's downgrades Southcoast Health System to 'Baa1'
Moody's Investors Service downgraded New Bedford, Mass.-based Southcoast Health System's bonds to "Baa1" from "A3," affecting $148 million of rated debt.
3. Fitch revises Regional West Health Services' outlook to negative
Fitch Ratings affirmed its "BBB+" rating on Scottsbluff, Neb.-based Regional West Health Services' series 2016A bonds, affecting $73.3 million of debt.
4. Fitch assigns 'AA-' rating to Bayhealth Medical Center's bonds
Fitch Ratings assigned its "AA-" rating to Dover, Del.-based Bayhealth Medical Center's proposed $107 million series 2017A bonds.
5. Fitch affirms 'BBB+' on Erlanger Health System's bonds
Fitch Ratings affirmed its "BBB+" rating on Chattanooga, Tenn.-based Erlanger Health System's series 2014A bonds, affecting $149.9 million of debt.
6. S&P downgrades East Jefferson General Hospital's rating to 'B+'
S&P Global Ratings downgraded Metairie, La.-based East Jefferson General Hospital's series 2011 hospital revenue bonds to "B+" from "BB."
7. Moody's revises Southern Ohio Medical Center's outlook to negative
Moody's Investors Service affirmed its "A2" rating on Portsmouth-based Southern Ohio Medical Center's series 2016 bonds.
8. Moody's assigns 'A1' to Jackson-Madison County General Hospital
Moody's Investors Service assigned its "A1" rating to Jackson, Tenn.-based Jackson-Madison County General Hospital's proposed $65 million series 2018A revenue bonds.
9. Fitch assigns 'BBB+' on Carson Tahoe Health System
Fitch Ratings assigned its "BBB+" rating on Carson City, Nev.-based Carson Tahoe Health System's proposed $57.7 million series 2017A.
10. Moody's affirms 'A2' rating on Mary Greeley Medical Center
Moody's Investors Service affirmed its "A2" rating on Ames, Iowa-based Mary Greeley Medical Center, affecting $65 million of outstanding debt.
11. S&P revises Yuma Regional Medical Center's outlook to positive
S&P Global Ratings affirmed its "A-" rating on Yuma (Ariz.) Regional Medical Center's series 2014 revenue bonds, affecting $73 million of debt.
12. S&P downgrades Care New England Health System's rating to 'BB-'
S&P Global Ratings downgraded Providence, R.I.-based Care New England Health System's rating to "BB-" from "BB."
13. Moody's revises outlook on Children's Health System of Texas to negative
Moody's Investors Service affirmed its "Aa2" rating on Dallas-based Children's Health System of Texas, affecting $352 million of debt.
14. Fitch affirms 'BBB+' on Peterson Regional Medical Center
Fitch Ratings affirmed its "BBB+" rating on Kerrville, Texas-based Peterson Regional Medical Center's series 2015 revenue bonds, affecting $51.2 million of debt.
15. Fitch assigns 'BB+' to Lawrence General Hospital's bonds
Fitch assigned its "BB+" rating to Lawrence (Mass.) General Hospital's proposed $69 million series 2017 revenue bonds.
16. Fitch downgrades Great Plains Regional Medical Center to 'B+'
Fitch Ratings downgraded Elk City, Okla.-based Great Plains Regional Medical Center's series 2007 revenue bonds to "B+" from "BB-," affecting $32.8 million of debt.
17. Fitch affirms 'BB' rating on LifePoint Health
Fitch Ratings affirmed its "BB" issuer default rating on Brentwood, Tenn.-based LifePoint Health.
18. Fitch revises Swedish Covenant Hospital's outlook to negative
Fitch Ratings affirmed its "BBB+" rating on Chicago-based Swedish Covenant Hospital's series 2016A revenue bonds.
19. S&P upgrades Lawrence + Memorial Hospital's bond rating to 'A+'
S&P Global Ratings upgraded the rating to "A+" from "BBB+" on New London, Conn.-based Lawrence + Memorial Hospital's bonds.
20. S&P downgrades Lawrence General Hospital's rating to 'BB+'
S&P Global Ratings downgraded Lawrence (Mass.) General Hospital's revenue debt to "BB+" from "BBB-."
21. S&P revises Mercy Health's outlook to stable, affirms 'AA-' rating
S&P Global Ratings affirmed its "AA-" issuer credit rating and long-term revenue bond rating on Springfield, Mo.-based Mercy Health.
22. Fitch keeps Rating Watch Negative on Western Connecticut Health Network's bonds
Fitch Ratings maintained the Rating Watch Negative on Danbury-based Western Connecticut Health Network's series M and series N revenue bonds, affecting a total of $81.5 million of debt.
23. Moody's downgrades Albert Einstein Health Network to 'Baa3'
Moody's Investors Service downgraded Philadelphia- based Albert Einstein Health Network's bond and issuer rating to "Baa3" from "Baa2," affecting $447 million of outstanding debt.
24. Fitch upgrades Yavapai Regional Medical Center's revenue bonds to 'A'
Fitch Ratings upgraded Prescott, Ariz.-based Yavapai Regional Medical Center's series 2016 and 2013A revenue bonds to "A" from "BBB+," affecting $73 million of debt.
25. Moody's assigns 'Aa2' rating to Nationwide Children's Hospital's bonds
Moody's Investors Service assigned its "Aa2" rating to Columbus, Ohio-based Nationwide Children's Hospitals proposed $85 million series 2017A revenue refunding bonds.
26. S&P upgrades Children's Hospital of Orange County to 'A+'
S&P Global Ratings upgraded the rating to "A+" from "A-" on Orange, Calif.-based Children's Hospital of Orange County's series 2011 and 2009A as well as its underlying rating on series 2009B-D.
27. Moody's assigns 'Aa3' rating to Mercy Health's bonds
Moody's Investors Service assigned its "Aa3" rating to Cincinnati-based Mercy Health's proposed $292 million series 2017C revenue bonds.
28. Fitch affirms 'A+' rating on PeaceHealth's revenue bonds
Fitch Ratings affirmed its "A+" rating on Vancouver, Wash.-based PeaceHealth's outstanding debt, affecting a total of $477 million of debt.
29. Moody's affirms 'A3' rating on Central Florida Health's outstanding bonds
Moody's Investors Service affirmed its "A3" rating on Winter Haven, Fla.-based Central Florida Health's outstanding bonds, affecting $84 million of debt.
30. Moody's assigns 'A1' rating to Aspirus' bonds
Moody's Investors Service assigned its "A1" rating to Wausau, Wis.-based Apirus' proposed $68 million series 2017 revenue bonds.
31. Moody's revises North Mississippi Health Services' outlook to negative
Moody's Investors Service affirmed its "Aa3" and "Aa3/VMIG 1" ratings on Tupelo-based North Mississippi Health Service's outstanding rating bonds, affecting $156 million of debt.
32. S&P assigns 'BBB+' rating to Hannibal Regional Hospital's bonds
S&P Global Ratings assigned its "BBB+" rating to Hannibal (Mo.) Regional Hospital's proposed $39.4 million series 2017 hospital revenue bonds.
33. S&P assigns 'BBB-' rating to Samaritan Medical Center's bonds
S&P Global Ratings assigned its "BBB-" rating to Watertown, N.Y.-based Samaritan Medical Center's proposed series 2017A and series 2017B hospital revenue bonds.
34. Moody's assigns 'A1' rating to LifeBridge Health's bonds
Moody's Investors Service assigned its "A1' rating to Baltimore-based LifeBridge Health's proposed $119 million series 2017 revenue bonds.
35. Moody's assigns 'Aa3' rating to MultiCare Health System's bonds
Moody's Investors Service assigned its "Aa3" rating to Tacoma, Wash.-based MultiCare Health System's proposed $318 million series 2017A and 2017B revenue bonds.
36. Fitch assigns 'A-' rating to Anne Arundel Health System's bonds
Fitch Ratings assigned the "A-" rating to Annapolis, Md.-based Anne Arundel Health System's series 2017A and 2017B, affecting $58.4 million of debt.
37. Fitch upgrades rating on Halifax Health to 'A-'
Fitch Ratings upgraded Daytona Beach, Fla.-based Halifax Health's series 2016, 2015 and 2008 revenue bonds to "A-" from "BBB+," affecting $343 million of debt total.
38. Moody's affirms 'A1' rating CentraCare Health System
Moody's Investors Service affirmed its "A1" rating on St. Cloud, Minn.–based CentraCare Health System's outstanding rated revenue bonds, affecting $284 million of debt
39. Moody's affirms 'Baa2' rating on Skagit Regional Health
Moody's Investors Service affirmed its "Baa2" rating on Mt. Vernon, Wash.-based Skagit Regional Health's revenue bonds, affecting $120 million of rated debt.
40. Moody's downgrades MaineGeneral Medical Center to 'Ba3'
Moody's Investors Service downgraded Augusta-based MaineGeneral Medical Center to "Ba3" from "Ba2," affecting $280 million of rated debt.
41. S&P affirms 'A-' rating on Norton Healthcare
S&P Global Ratings affirmed its "A-" rating on Louisville, Ky.-based Norton Healthcare
42. Moody's assigns 'A3' rating to Tower Health's bonds
Moody's Investors Service assigned its "A3" rating to West Reading, Pa.-based Tower Health's proposed $584 million series 2017 bonds.
43. S&P downgrades Baptist Memorial Health Care to 'BBB+'
S&P Global Ratings downgraded Memphis, Tenn.-based Baptist Memorial Health Care to "BBB+" from "A-."
44 Fitch affirms 'BBB+' on University Health System's bonds
Fitch Ratings affirmed the "BBB+" rating on Knoxville, Tenn.-based University Health System's series 2017 and series 2016 bonds, affecting $233.4 million of debt.
45. Moody's affirms 'A2' rating on Spartanburg Regional Healthcare System
Moody's Investors Service affirmed its "A2" rating on Spartanburg (S.C.) Regional Healthcare System's outstanding rated revenue bonds, affecting $185 million of debt.