Marshall, Mo.-based John Fitzgibbon Memorial Hospital has seen its ratings downgraded to "CCC" from "B-," according to a June 22 Fitch Ratings note.
The health system, which operates a 60-bed hospital about 80 miles east of Kansas City, as well as a 99-bed skilled nursing facility and several rural clinics, had only 32 days of cash on hand on record.
"The reliance on funding operations through cash could result in further downgrades if it continues at the current level," Fitch said.
Both Fitch and John Fitzgibbon management had expected more operational improvement in fiscal 2023.
Fitch does not typically rate outlooks on "CCC" level credit.