The following hospital and health system rating and outlook changes or affirmations took place in October, starting with the most recent.
1. S&P assigns 'BBB' rating to Beebe Medical Center's outstanding bonds
S&P Global Ratings assigned a "BBB" rating to Lewes, Del.-based Beebe Medical Center's outstanding bonds.
2. S&P revises Virginia Mason Medical Center rating outlook to negative
S&P Global Ratings revised its rating outlook for Seattle-based Virginia Mason Medical Center from stable to negative.
3. S&P downgrades NorthShore University HealthSystem's rating to 'AA-'
S&P Global Ratings lowered its rating for Evanston, Ill.-based NorthShore University HealthSystem's revenue refunding bonds to "AA-" from "AA."
4. Moody's assigns 'A2' rating to Jackson-Madison County General Hospital's proposed bonds
Moody's Investors Service assigned an "A2" rating to Jackson, Tenn.-based Jackson-Madison County General Hospital's proposed revenue bonds, affecting $265.7 million of debt.
5. Moody's withdraws ratings on Montefiore Medical Center's prior bond
Moody's Investors Service has withdrawn its ratings on Bronx, N.Y.-based Montefiore Medical Center's prior bonds because their full outstanding balances have been legally defeased or redeemed.
6. S&P upgrades Aspirus' rating to 'AA-'
S&P Global Ratings upgraded its long-term rating on Wausau, Wis.-based Aspirus from "A+" to "AA-."
7. Fitch assigns 'AA+' issuer rating to Ascension Health Alliance
Fitch Ratings assigned an "AA+" issuer default rating to St. Louis-based Ascension Health Alliance and affirmed its "F1+" short-term rating to the system's variable rate demand bonds.
8. Moody's downgrades Capital Region Medical Center's rating to 'Baa2'
Moody's Investors Service downgraded the bond rating for Jefferson City, Mo.-based Capital Region Medical Center from "Baa1" to "Baa2."
9. Moody's affirms North Memorial Health's and Maple Grove Hospital's 'Baa1' rating
Moody's Investors Services affirmed the "Baa1" ratings for Robbinsdale, Minn.-based North Memorial Health Care and Maple Grove (Minn.) Hospital's outstanding revenue bonds, affecting a combined $162 million of debt.
10. Moody's downgrades Fairfield Medical Center's rating to 'Baa3'
Moody's Investors Service downgraded Lancaster, Ohio-based Fairfield Medical Center's revenue bond rating from "Baa2" to "Baa3," affecting $90 million of debt.
11. Moody's downgrades Gwinnett Hospital System revenue certificates to 'Baa1'
Moody's Investors Service downgraded Lawrenceville, Ga.-based Gwinnett Hospital System's revenue certificates from "A3" to "Baa," affecting $132 million of rated debt.
12. Fitch assigns 'BBB+' rating to various series of ProMedica Health System debt
Fitch Ratings assigned a long-term "BBB+" rating to various series of debt for Toledo, Ohio-based ProMedica Health System.
13. Fitch downgrades Erlanger Health System's rating to 'BBB'
Fitch Ratings assigned a "BBB" issuer default rating to Chattanooga, Tenn.-based Erlanger Health System and downgraded its rating on a series 2014A bond from "BBB+" to "BBB."
14. Fitch affirms Regional West Health Services' 'BBB+' rating
Fitch Ratings assigned Scottsbluff, Neb.-based Regional West Health Services a "BBB+" issuer default rating and affirmed its "BBB+" rating for a series 2016A bond.
15. Fitch affirms Carson Tahoe Health System's 'BBB+' rating
Fitch Ratings assigned Carson City, Nev.-based Carson Tahoe Health System an issuer default rating of "BBB+" and affirmed its "BBB+" ratings for outstanding bonds issued by Carson City.
16. Moody's affirms Temple University Health System's 'Ba1' rating
Moody's Investors Service affirmed Philadelphia-based Temple University Health System's "Ba1" bond rating, affecting $478 million of debt.
17. Moody's affirms Forrest County General Hospital's 'A2' rating
Moody's Investors Service affirmed Hattiesburg, Ms.-based Forrest County General Hospital's "A2" bond rating, affecting $104 million of outstanding bonds.
18. Moody's affirms Holland Community Hospital's 'A2' rating
Moody's Investors Service affirmed Holland (Mich.) Community Hospital's "A2" bond rating, affecting $36.5 million of debt.
19. S&P lowers Integris Health's bond rating to 'A+'
S&P Global Ratings lowered its long-term rating for Oklahoma City-based Integris Health's series 2015A bonds from "A+" to "AA-" and its series 2015B bonds from "AA-/A-1+" to "A+/A-1."
20. Fitch assigns PeaceHealth 'F1+' short-term rating
Fitch Ratings assigned an "F1+" short-term rating to the state of Oregon, Oregon Facilities Authority refunding revenue bonds for Vancouver, Wash.-based PeaceHealth and revised the bonds' long-term rating to "AA-."
21. Fitch revises Edward-Elmhurst's long-term rating to short term
Fitch Ratings revised its "A" long-term rating for Naperville, Ill.-based Edward-Elmhurst Healthcare's series 2018 bonds and assigned the bonds an "F1" short-term rating.
22. Fitch assigns 'AA-' issuer default rating to Johns Hopkins Health System
Fitch Ratings assigned an "AA-" issuer default rating to Baltimore-based Johns Hopkins Health System.
23. Moody's assigns 'A1' rating to UnityPoint Health's proposed bonds
Moody's Investors Service assigned an "A1" rating to West Des Moines, Iowa-based UnityPoint Health's proposed revenue bonds, affecting $929 million.
24. S&P revises TJ Samson Community Hospital outlook to positive
S&P Global Ratings revised its outlook on Glasgow, Ky.-based T.J. Samson Community Hospital from stable to positive.
25. Fitch Ratings upgrades Benefis Health System rating to 'A+'
Fitch Ratings upgraded its rating for Great Falls, Mont.-based Benefis Health System's outstanding revenue bonds from "A" to "A+."
26. Moody's affirms 'A3' rating for Calvert Health System
Moody's Investor Service affirmed its"A3" rating for Prince Frederick, Md.-based Calvert Health System's Series 2013 bonds, affecting $30.43 million of outstanding debt.
27. Moody's affirms Trinitas Regional Medical Center's 'Baa2' rating
Moody's Investor Service affirmed its "Baa2" rating for Elizabeth, N.J.-based Trinitas Regional Medical Center's outstanding revenue bonds, worth $89.6 million.
28. Moody's assigns 'Aa3' rating to University of Wisconsin Hospital and Clinics bonds
Moody's Investor Service has assigned an "Aa3" rating to Madison-based University of Wisconsin Hospital and Clinics' proposed revenue bonds, affecting $450 million of debt.
29. Moody's assigns 'A1' rating to Christus Health bonds
Moody's Investor Service assigned an "A1" rating to Irving, Texas-based Christus Health's proposed bonds and affirmed an "A1" rating on the system's parity debt.
30. Moody's assigns 'A1' rating to Phoenix Children's Hospital
Moody's Investor Service has assigned an "A1" rating to Phoenix Children's Hospital's outstanding bonds, affecting $552 million of debt.
31. S&P downgrades St. Charles Parish Hospital District long-term rating to 'B'
S&P Global Ratings downgraded St. Charles Parish Hospital District No. 1's long-term rating from "A" to "B."
32. Moody's affirms 'Ba3' rating on MaineGeneral Medical Center
Moody's Investors Service affirmed its "Ba3" rating on Augusta-based MaineGeneral Medical Center's outstanding bonds, affecting $280 million of debt.
33. Moody's affirms 'A1' rating on Vidant Health
Moody's Investors Service affirmed its "A1" rating on Greenville, N.C.-based Vidant Health's bonds, affecting $430 million of debt.
34. S&P revises Holy Name Medical Center's outlook to stable from negative
S&P Global Ratings affirmed its "BBB" long-term rating on Teaneck, N.J.-based Holy Name Medical Center, affecting $55.3 million of debt. Concurrently, S&P revised the medical center's outlook to stable from negative.
35. Moody's affirms 'Ba1' rating on Oaklawn Hospital
Moody's Investors Service affirmed its "Ba1" rating on Marshall, Mich.-based Oaklawn Hospital, affecting $63.5 million of outstanding debt.
36. Moody's assigns 'Aa3' to Mercy Health
Moody's Investors Service assigned its "Aa3" rating to St. Louis-based Mercy Health's proposed $230 million series 2018A-B. Concurrently, Moody's affirmed its "Aa3" rating on the health system.
37. Moody's downgrades East Jefferson General Health to 'Caa1,' maintains negative outlook
Moody's Investors Service downgraded Metairie, La.-based East Jefferson General Health's rating to "Caa1" from "B3," affecting $142 million of rated debt.
38. Moody's affirms 'A2' rating on Bellin Memorial Health System
Moody's Investors Service affirmed its "A2" rating on Green Bay, Wis.-based Bellin Memorial Health System's outstanding bonds, affecting $53 million of debt.
39. Moody's affirms 'A1' rating on Memorial Hermann Health System
Moody's Investors Service affirmed its "A1" rating on Houston-based Memorial Hermann Health System, affecting $1.1 billion of debt.
40. Fitch assigns 'A+' rating to Baystate Medical Center
Fitch Ratings assigned its "A+" issuer default rating to Springfield, Mass.-based Baystate Medical Center.
41. Moody's upgrades Johns Hopkins Health System's rating to 'Aa2'
Moody's Investors Service upgraded Baltimore-based Johns Hopkins Health System's outstanding bond ratings to "Aa2" from "Aa3."
42. S&P upgrades Renown Regional Medical Centers' rating to 'A+'
S&P Global Ratings upgraded its long-term and underlying rating on Reno, Nev.-based Renown Regional Medical Center to "A+" from "A."
43. Fitch affirms 'AA' rating on Children's Hospitals and Clinics of Minnesota
Fitch Ratings affirmed its "AA" rating on Minneapolis-based Children's Hospitals and Clinics of Minnesota's outstanding bonds. Concurrently, Fitch assigned its "AA" issuer default rating to the children's hospital.
44. 9-notch upgrade: S&P gives Centegra Healthcare 'AA+' rating after acquisition by Northwestern Medicine
S&P Global Ratings upgraded its rating on Crystal Lake, Ill.-based Centegra Healthcare's series 2012 and 2014 bonds to "AA+" from "BB+."
45. Fitch upgrades PeaceHealth's bonds to 'AA-'
Fitch Ratings upgraded Vancouver, Wash.-based PeaceHealth's outstanding debt rating to "AA-" from "A+." Concurrently, Fitch assigned its "AA-" rating to PeaceHealth's series 2018A&B bonds and gave the health system an issuer default rating of "AA-."
46. Fitch assigns 'AA-' rating to Willis-Knighton Medical Center
Fitch Ratings assigned its "AA-" rating to Shreveport, La.-based Willis-Knighton Medical Center's $300 million series 2018 bonds. Concurrently, Fitch affirmed its "AA-" issuer default rating and "AA-" rating on the medical center's outstanding debt.
47. S&P assigns 'AA+' rating to OhioHealth's bonds
S&P Global Ratings assigned its "AA+" long-term rating to Columbus-based OhioHealth's $125 million series 2018A and $50 million series 2018B. Concurrently, S&P assigned its "AA+/A-1+" dual rating to the health system's $37.5 million series 2018C and $37.5 million series 2018D.
48. S&P assigns 'AA-' long-term rating to Atrium Health's bonds
S&P Global Ratings assigned its "AA-" long-term rating to Charlotte, N.C.-based Atrium Health's series 2018A-E bonds. Concurrently, S&P affirmed its "AA-" underlying rating on the health system's existing bonds.
49. S&P revises Mercy Health Services' outlook to positive
S&P Global Ratings revised Baltimore-based Mercy Health Services outlook to positive from stable.
50. Fitch assigns 'BBB+' issuer rating to ProMedica
Fitch Ratings assigned its "BBB+" issuer default rating to Toledo, Ohio-based ProMedica. Concurrently, Fitch assigned its "BBB+" long-term rating to ProMedica's $300 million series 2018A bonds and $1.15 billion series 2018B taxable bonds
51. Fitch assigns 'BBB+' issuer rating to ProMedica
Fitch Ratings assigned its "BBB+" issuer default rating to Toledo, Ohio-based ProMedica. Concurrently, Fitch assigned its "BBB+" long-term rating to ProMedica's $300 million series 2018A bonds and $1.15 billion series 2018B taxable bonds.
52. Fitch upgrades St. Francis Healthcare System to 'AA'
Fitch Ratings upgraded Cape Girardeau, Mo.-based St. Francis Healthcare System's rating to "AA" from "AA-," affecting $139.3 million of debt. Concurrently, Fitch assigned the health system its "AA" issuer default rating.
53. S&P downgrades South Georgia Medical Center's rating to 'BBB+,' assigns negative outlook
S&P Global Ratings downgraded its long-term rating on Valdosta, Ga.-based South Georgia Medical Center's certificates to "BBB+" from "A-."
54. Fitch assigns 'A' rating to Edward-Elmhurst Healthcare's bonds
Fitch Ratings assigned its "A" rating to Naperville, Ill.-based Edward-Elmhurst Healthcare's series 2018 bonds, affecting about $249.74 million of debt. Concurrently, Fitch affirmed its "A" issuer default and revenue bond ratings.
55. S&P revises PeaceHealth's outlook to positive for improved operations
S&P Global Ratings affirmed its "A" long-term and underlying rating on Vancouver, Wash.-based PeaceHealth and assigned its "A" rating to the health system's series 2018A bonds. Concurrently, the outlook was revised to positive from stable.
56. S&P revises SSM Healthcare's outlook to stable
S&P Global Ratings affirmed its "A+" long-term and underlying rating on St. Louis-based SSM Health. Concurrently, the outlook was revised to stable from negative.
57. S&P downgrades Crawford Memorial Hospital's rating to 'BBB'
S&P Global Ratings downgraded Robinson, Ill.-based Crawford Memorial Hospital's long-term and underlying rating to "BBB" from "A."
58. S&P downgrades Lexington Medical Center to 'A' after error correction
S&P Global Ratings downgraded West Columbia, S.C.-based Lexington Medical Center's series 2011, 2016 and 2017 revenue bonds to "A" from "A+."
59. S&P assigns 'AA-' rating to Parkview Regional Medical Center
S&P Global Ratings assigned its "AA-" rating to Fort Wayne, Ind.-based Parkview Regional Medical Center's series 2018 and 2019A bonds, affecting about $162 million of debt.