Fitch Ratings downgraded Columbia, Mo.-based Boone Hospital Center to "A-" from "A," affecting $79.4 million of debt.
Concurrently, Fitch assigned its "A-" issuer default rating to Boone Hospital Center.
The downgrade and assignment are a result of several factors, including the hospital's weakened market share, lower near-term profitability and moderate leverage.
The outlook remains negative, reflecting Fitch's expectation of continued revenue declines.