Moody's Investors Service affirmed the "A1" rating on Roanoke, Va.-based Carilion Clinic's outstanding bonds, affecting $401.5 million of rated debt.
The ratings affirmation is based on several factors, including Carilion Clinic's multiyear trend of strengthening cash flow, which has contributed to its stronger balance sheet ratios.
The outlook was upgraded to positive from stable, reflecting Moody's Investors Service's expectation Carilion Clinic will maintain its strong operating margins.