10 health systems with strong finances

Here are 10 health systems with strong operational metrics and solid financial positions based on recent reports from Moody's Investors Service, Fitch Ratings and Standard & Poor's Ratings Services.

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+" and stable outlook with S&P. Ascension has a broad operating platform, strong management practices and consistent profitability, according to Fitch.

2. 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.

3. Duke University Health System has an "Aa2" rating and stable outlook with Moody's. The Durham, N.C.-based system has favorable operating margins, and Moody's expects the system to generate sound operating cash flow margins over time.

4. Inova Health System has an "Aa2" rating and stable outlook with Moody's. The Falls Church, Va.-based system has a leading market position, excellent liquidity and robust financial performance.

5. 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 credit rating agencies.

6. 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.

7. 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.

8. 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's balance sheet measures have been maintained.

9. 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.

10. Yale New Haven (Conn.) Health System has an "AA-" rating and stable outlook with Fitch. The system has a renowned clinical reputation, low debt burden and strong historical operating results.

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