21 health systems with strong finances

Here are 21 health systems with strong operational metrics and solid financial positions based on recent reports from Moody's Investors Service, Fitch Ratings and S&P Global Ratings.

Note: This is not an exhaustive list. Health system names were compiled from recent credit rating reports. Systems are listed in alphabetical order.

1. St. Louis-based Ascension Health has an "Aa2" rating and stable outlook with Moody's, an "AA+" rating and stable outlook with Fitch and an "AA+" rating and stable outlook with S&P. Ascension has a broad operating platform, strong management practices and consistent profitability, according to Fitch.

2. Adventist Health has an "Aa2" rating and stable outlook with Moody's and an "AA" rating and stable outlook with Fitch. The Altamonte Springs, Fla.-based system has historically strong financial performance and ample liquidity position, which Moody's believes the system will maintain.

3. St. Louis-based BJC HealthCare has an "Aa2" rating and stable outlook with Moody's. The system has a leading market share in the St. Louis metropolitan area, track record of double-digit operating cash flow margins, and strong liquidity and debt coverage ratios. BJC also has a national reputation as a leading academic medical center, which is anchored by its long-standing affiliation with Washington University's School of Medicine, according to Moody's.

4. Children's Healthcare of Atlanta has an "Aa2" rating and stable outlook with Moody's. The system has a track record of strong margins and liquidity, according to Moody's.

5. Duke University Health System has an "AA" rating and stable outlook with S&P and an "Aa2" rating and stable outlook with Moody's. The Durham, N.C.-based system has strong balance sheet ratios and a stable leadership team, according to S&P.

6. Inova Health System has an "Aa2" rating and stable outlook with Moody's and an "AA+" rating and stable outlook with S&P. The Falls Church, Va.-based system has a leading market position, excellent liquidity and robust financial performance, according to Moody's.

7. Mayo Clinic has an "Aa2" rating and stable outlook with Moody's and an "AA" rating and stable outlook with S&P. The Rochester, Minn.-based system has an excellent enterprise profile and strong fundraising ability, according to the rating agencies.

8. Flint, Mich.-based McLaren Health Care has an "AA-" rating and stable outlook with Fitch. The system has a leading market share in its primary service area, according to Fitch.

9. Memorial Healthcare System has an "Aa3" rating and positive outlook with Moody's. The Hollywood, Fla.-based system has a dominant market position and strong balance sheet measures. Moody's expects the system's liquidity and margins to remain strong.

10. Memphis, Tenn.-based Methodist Le Bonheur Healthcare has an "AA-" rating and stable outlook with S&P. The system has a strong enterprise profile and leading market share in its service area, according to S&P.

11. Tacoma, Wash.-based MultiCare Health System has an "AA-" rating and stable outlook with Fitch and an "Aa3" rating and stable outlook with Moody's. The system has a strong presence in a competitive market area and solid financial performance, according to Fitch.

12. Nebraska Medicine has an "AA-" rating and stable outlook with Fitch and an "AA-" rating and stable outlook with S&P. The Omaha-based system has a broad operating platform and low debt burden, according to Fitch.

13. Columbus-based OhioHealth has an "Aa2" rating and stable outlook with Moody's. The system has a history of consistently strong cash flow margins, leading market position and solid unrestricted debt position, according to Moody's.

14. Providence St. Joseph Health has an "Aa3" rating and stable outlook with Moody's and an "AA-" rating and stable outlook with Fitch. The Renton, Wash.-based system has a leading market share in its service area and large consolidated pro forma revenue base of more than $20 billion, according to Moody's.

15. Norfolk, Va.-based Sentara Healthcare has an "Aa2" rating and stable outlook with Moody's and an "AA" rating and stable outlook with S&P. The system has a leading market position, strong patient demand and history of solid operating margins, according to Moody's.

16. Broomfield, Colo.-based Sisters of Charity of Leavenworth Health System has an "AA-" rating and stable outlook with S&P and an "Aa3" rating and stable outlook with Moody's. The system has consistently performed at a high level, according to Moody's. Despite high levels of capital spending, the system has maintained its balance sheet measures.

17. Sutter Health has an "AA-" rating and stable outlook with S&P. The Sacramento, Calif.-based system has a solid financial profile and a strong enterprise profile, which is highlighted by a sizable market presence, according to S&P.

18. UnityPoint Health has an "AA-" rating and stable outlook with Fitch. The Des Moines, Iowa-based system has a broad operating footprint and solid liquidity, according to Fitch.

19. Iowa City-based University of Iowa Hospitals and Clinics has an "Aa2" rating and stable outlook with Moody's. The system has broad market reach for high-end services, strong local market share and a track record of profitability. Moody's expects the system to continue to have good debt coverage.

20. Philadelphia-based University of Pennsylvania Health System has an "AA-" rating and stable outlook with S&P. The system has strong market position and broadening geographic draw, according to S&P.

21. Yale-New Haven (Conn.) Health System has an "Aa3" rating and stable outlook with Moody's and an "AA-" rating and stable outlook with Fitch. The system has a leading market position and consistently solid margins, according to Moody's.

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