S&P Global Ratings revised Montgomery, Ala.-based Jackson Hospital & Clinic's outlook to negative from stable.
The ratings agency also affirmed the "BBB" long-term rating on the organization's series 2015 bonds.
"The outlook revision reflects our view of Jackson's weak financial performance over the past three fiscal years, generating lighter debt service coverage in fiscal [year] 2016 and weakening liquidity metrics," said S&P analyst James Neville.