1. Altru Health System (Grand Forks, N.D.) — from “A-” to “BBB” (Fitch Ratings); from “Baa1” to “Baa2” (Moody’s Investors Service)
2. Augusta (Ga.) University Health System — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB” to “BBB-” (S&P Global Ratings)
3. Bibb County Medical Center (Centreville, Ala.) — from “BBB+” to “BB” (S&P Global Ratings)
4. Boone Hospital Center (Columbia, Mo.) — from “Baa2” to “Ba1” (Moody’s Investors Service); from “A-” to “BBB” (Fitch Ratings)
5. Covenant Health (Tewksbury, Mass.) — from “BBB+” to “BBB” (Fitch Ratings)
6. Delta (Colo.) County Memorial Hospital — from “BB+” to “BB” (S&P Global Ratings)
7. Erlanger Health System (Chattanooga, Tenn.) — from “Baa2” to “Baa3” (Moody’s Investors Service)
8. Excela Health (Greensburg, Pa.) — from “A3” to “Baa1” (Moody’s Investors Service)
9. Fairfield Medical Center (Lancaster, Ohio) — from “Baa3” to “Ba2” (Moody’s Investors Service)
10. Hospital Sisters Health System (Springfield, Ill.) — from “AA-” to “A+” (S&P Global Ratings)
11. Indiana (Pa.) Regional Medical Center — from “Ba1” to “Ba2” (Moody’s Investors Service)
12. Integris (Oklahoma City) — from “A1” to “A2” (Moody’s Investors Service)
13. Mercy Medical Center (Des Moines, Iowa) — from “A” to “A-” (S&P Global Ratings)
14. Methodist Hospitals (Gary, Ind.) — from “BBB” to “BBB-” (S&P Global Ratings)
15. Murray (Ky.) Calloway County Hospital — from “Baa3” to “Ba2” (Moody’s Investors Service)
16. Nicklaus Children’s Hospital (Miami) — from “A+” to “A” (S&P Global Ratings)
17. OSF HealthCare (Peoria, Ill.) — from “A2” to “A3” (Moody’s Investors Service)
18. Parmer County (Texas) Hospital District — from “Baa1” to “Baa2” (Moody’s Investors Service)
19. Princeton (W.Va.) Community Hospital — from “BBB+” to “BBB” (S&P Global Ratings)
20. ProMedica Health System (Toledo, Ohio) — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB+” to “BBB” (Fitch Ratings)
21. Regional West Health Services (Scottsbluff, Neb.) — from “BBB” to “BB+” (Fitch Ratings)
22. Sanford Health (Sioux Fall, S.D.) — from “A1” to “A2” (Moody’s Investors Service)
23. South Nassau Communities Hospital (Oceanside, N.Y.) — from “Baa1” to “Baa2” (Moody’s Investors Service)
24. Southeastern Regional Medical Center (Lumberton, N.C.) — from “A-” to “BBB+” (Fitch Ratings)
25. Sparrow Health System (Lansing, Mich.) — from “A1” to “A2” (Moody’s Investors Service)
26. St. John’s Riverside Hospital (Yonkers, N.Y.) — from “B-” to “CCC+” (S&P Global Ratings)
27. St. Luke’s Hospital (Chesterfield, Mo.) — from “A+” to “A” (S&P Global Ratings)
28. Tower Health (West Reading, Pa.) — from “A” to “BBB” (Fitch Ratings); from “A3” to “Baa2” (Moody’s Investors Service)
29. University of Chicago Medical Center — from “A1” to “Aa3” (Moody’s Investors Service)
30. Winkler County Memorial Hospital (Kermit, Texas) — from “AA” to “BB+” (S&P Global Ratings)
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