The following hospital and health system rating, outlook changes and affirmations took place in April, starting with the most recent.
1. S&P assigns 'A+' rating to Saint Luke's Health System
S&P Global Ratings assigned its "A+" rating to Kansas City, Mo.-based Saint Luke's Health System's proposed $93.1 million series 2018A revenue bonds.
2. S&P downgrades Coalinga Regional Medical Center's rating to 'CCC'
S&P Global Ratings downgraded Coalinga (Calif.) Regional Medical Center's rating to "CCC" from "B-."
3. S&P places ProMedica's bonds on rating watch negative following HCR ManorCare acquisition
S&P Global Ratings placed its Toledo, Ohio-based ProMedica's "A+" rated debt on CreditWatch with negative implications after the hospital operator announced it would acquire a nursing home chain.
4. S&P revises Catholic Health Initiatives outlook to positive
S&P Global Ratings affirmed its "BBB+" long-term rating and underlying rating on Englewood, Colo.-based Catholic Health Initiative's outstanding debt.
5. S&P affirms 'A' rating on Dignity Health, outlook remains negative pending CHI merger
S&P Global Ratings affirmed its "A" long-term rating and underlying rating on San Francisco-based Dignity Health.
6. S&P assigns 'AA' rating to Sentara Healthcare's bonds
S&P Global Ratings assigned its "AA" long-term rating to Norfolk, Va.-based Sentara Healthcare's series 2018 revenue refunding bonds.
7. S&P assigns 'A-' rating to Marin General Hospital
S&P Global Ratings assigned its "A-" rating to Kentfield, Calif.-based Marin General Hospital's proposed $91.9 million series 2018A revenue bonds and $64.8 million series 2018B bonds.
8. S&P assigns 'A-' rating to Ballad Health's bonds
S&P Global Ratings assigned its "A-" rating to Johnson City, Tenn.-based Ballad Health's $514 million series 2018A bonds.
9. Fitch assigns 'A-' rating to Penn Highlands Healthcare
Fitch Ratings assigned its "A-" rating to DuBois, Pa.-based Penn Highlands Healthcare's proposed $158.4 million series 2018 revenue bonds.
10. Fitch downgrades Stamford Health to 'BBB+'
Fitch Ratings downgraded Stamford (Conn.) Health's outstanding debt rating to "BBB+" from "A."
11. Moody's affirms 'A2' on Riverside Healthcare
Moody's Investors Service affirmed its "A2" rating on Kankakee, Ill.-based Riverside Healthcare's bonds, affecting $131 million of debt.
12. Fitch affirms 'A+' rating on North Colorado Medical Center
Fitch Ratings affirmed its "A+" rating on Greeley-based North Colorado Medical Center.
13. Fitch upgrades Sky Lakes Medical Center to 'A'
Fitch Ratings upgraded Klamath Falls, Ore.-based Sky Lakes Medical Center's series 2012 and series 2016 revenue bonds to "A" from "A-."
14. Fitch downgrades MetroHealth's rating to 'BB'
Fitch Ratings downgraded Cleveland-based MetroHealth's series 2009B and series 2017 revenue bonds to "BB" from "BBB-," affecting more than $1 billion of debt.
15. Fitch affirms 'AA-' rating on St. Clair Hospital
Fitch Ratings affirmed its "AA-" rating on Pittsburgh-based St. Clair Hospital's series 2012 revenue bonds, affecting $17.9 million of debt.
16. Moody's revises University of Chicago Medical Center's outlook to negative
Moody's Investors Service affirmed its "Aa3" rating on University of Chicago Medical Center, and also revised its outlook to negative from stable.
17. Moody's affirms Oregon Health & Science University's 'Aa3' rating
Moody's Investors Service affirmed its "Aa3" rating on Portland-based Oregon Health & Science University's revenue bonds, affecting $708 million of rated debt.
18. Moody's downgrades Lincoln County Public Hospital District to 'A3'
Moody's Investors Service downgraded the issuer rating on Davenport, Wash.-based Lincoln County Public Hospital District No. 3 to "A3" from "A2."
19. Moody's affirms 'Baa1' on Palmetto Health
Moody's Investors Service affirmed its "Baa1" rating on Columbia, S.C.-based Palmetto Health's series 2005 bonds, affecting $180 million of debt.
20. Moody's revises Greenville Health System's outlook to negative
Moody's Investors Service affirmed its "A1" rating on Greenville (S.C.) Health System's bond ratings, affecting $490 million of debt.
21. Moody's affirms 'A2' rating on Kettering Health Network
Moody's Investors Service affirmed its "A2" rating on Dayton, Ohio-based Kettering Health Network's revenue bond rating, affecting $644 million of debt.
22. Fitch assigns 'AA-' rating to Hackensack Meridian Health
Fitch Ratings assigned its "AA-" rating to Edison, N.J.-based Hackensack Meridian Health's proposed $300 million series 2018 bonds.
23. Moody's affirms 'A1' on Christus Health
Moody's Investors Service affirmed its "A1" rating on Irving, Texas-based Christus Health.
24. Moody's upgrades Good Shepherd Health System to 'Ba3'
Moody's Investors Service upgraded Longview, Texas-based Good Shepherd Health System to "Ba3" from "Caa1," affecting $130 million of debt.
25. Fitch affirms 'AA-' on Yale New Haven Health System
Fitch Ratings affirmed its "AA-" rating on Yale New Haven (Conn.) Health System's debt issued by the Connecticut Health and Educational Facilities Authority.
26. S&P downgrades Cone Health's rating to 'AA-'
S&P Global Ratings downgraded Greensboro, N.C.-based Cone Health's series 2011A bond rating to "AA-" from "AA."
27. S&P revises Bellin Health Systems' outlook to negative
S&P Global Ratings affirmed its "A+" rating on Green Bay, Wis.-based Bellin Health Systems' series 2015 bonds.
28. S&P upgrades Hackensack Meridian Health's rating to 'AA-'
S&P Global Ratings upgraded its long term rating to "AA-" from "A+" on Edison, N.J.-based Hackensack Meridian Health.
29. Moody's assigns 'A1' rating to SSM Health's bonds
Moody's Investors Service assigned its "A1" rating to St. Louis-based SSM Health's proposed $655 million series 2018 revenue bonds.
30. Fitch affirms 'BBB' rating on Culberson County Hospital District
Fitch Ratings affirmed its "BBB" issuer default rating on Van Horn, Texas-based Culberson County Hospital District.
31. Fitch upgrades Nanticoke Health Services' rating to 'BBB+'
Fitch Ratings upgraded Seaford, Del.-based Nanticoke Health Services' series 2013 revenue bond rating to "BBB+" from "BBB-."
32. Fitch affirms 'BB+' on Loma Linda University Medical Center
Fitch Ratings affirmed its "BB+" rating on Loma Linda (Calif.) University Medical Center's series 2014A, 2014B and 2016A revenue bonds.
33. Moody's assigns 'Aa2' to BJC Health System's bonds
Moody's Investors Service assigned its "Aa2" rating to St. Louis-based BJC Health System's remarketed $75 million series 2017D bonds.
34. Fitch upgrades Summit Health's rating to 'AA-'
Fitch Ratings upgraded Chambersburg, Pa.-based Summit Health's $113 million series 2010 revenue bonds to "AA-" from "A+" and assigned the health system an issuer default rating of "AA-."
35. Fitch upgrades Heritage Valley Health System to 'AA-'
Fitch Ratings upgraded the rating on Beaver, Pa.-based Heritage Valley Health System's revenue bonds to "AA-" from "A+," affecting $51.6 million of debt.
36. S&P downgrades Bozeman Health's rating to 'A'
S&P Global Ratings downgraded the rating on Bozeman (Mont.) Health's outstanding revenue bonds to "A" from "A+."
37. S&P upgrades Freeman Health System's rating to 'A'
S&P Global Ratings upgraded the rating to "A" from "A-" on Joplin, Mo.-based Freeman Health System's series 2011 and series 2015 bonds.
38. S&P downgrades ProMedica's bond rating to 'A+'
S&P Global Ratings downgraded Toledo, Ohio-based ProMedica Healthcare's bonds to "A+" from "AA-."
39. Fitch affirms 'A-' rating on Redlands Community Hospital
Fitch Ratings affirmed its "A-" rating on Redlands (Calif.) Community Hospital's series 2016 revenue bonds.
40. Fitch downgrades Valley Medical Center to 'BBB'
Fitch Ratings downgraded Renton, Wash.-based Valley Medical Center's series 2010A bonds, series 2010B bonds and its issuer default rating to "BBB" from "BBB+.
41. Fitch assigns 'A+' issuer default rating to Orlando Health
Fitch Ratings assigned its "A+" issuer default rating to Orlando (Fla.) Health and upgraded the rating on $690 million in revenue bonds to "A+" from "A."
42. Fitch affirms 'BBB' rating on Memorial Hospital at Gulfport
Fitch Ratings assigned its "BBB" issuer default rating to Memorial Hospital at Gulfport (Miss.).
43. Moody's affirms 'Aa3' rating on Scripps Health
Moody's Investors Service affirmed its "Aa3" long-term rating on San Diego-based Scripps Health, affecting $632 million of rated debt.
44. Moody's revises Firelands Regional Medical Center's outlook to negative
Moody's Investors Service affirmed its "A3" rating on Sandusky, Ohio-based Firelands Regional Medical Center, affecting $77 million of debt.
45. Moody's assigns 'Aa2' to Indiana University Health
Moody's Investors Service assigned its "Aa2" rating to Indianapolis-based Indiana University Health's proposed $354 million series 2018A bonds.
46. Moody's upgrades Medical College of Wisconsin's rating to 'Aa3'
Moody's Investors Service upgraded Milwaukee-based Medical College of Wisconsin's revenue bonds to "Aa3" from "A1," affecting $236 million of debt.
47. Moody's affirms 'A1' rating on Huntsville Health Care
Moody's Investors Service affirmed its "A1" rating on Huntsville (Ala.) Health Care Authority, affecting approximately $205 million of rated debt.