S&P Global Ratings downgraded Rocky Mount, N.C.-based Nash Health Care Systems series 2012 bonds to "BBB+" from "A-," affecting $68 million of debt.
The downgrade is a result of several factors, including the health system's mounting operating losses and shaky financial performance in recent years.
The outlook is stable, reflecting S&P's view that Nash's current operating margins are indicative of the "BBB+" rating.