Moody's Investors Service has downgraded the rating on Sonoma (Calif.) Valley Health Care District's general obligation bonds to "Baa3" from "Baa1," affecting $34.2 million in outstanding obligations.
The downgrade is based on a number of factors, including the facility's low liquidity levels, challenging payer mix, difficult operating environment and weak operating cash flow margins.
The outlook is negative, reflecting the challenges presented by the District's rural location, competitive environment and demographic trends.