The outlook downgrade was based on a number of factors, including MMHD’s weakened financial position. The district’s operating losses increased and its liquidity decreased in fiscal years 2013 and 2014.
MMHD’s narrow tax base also supported the outlook revision. The hospital district is geographically large, covering 8,000 square miles. However, the district’s area is sparsely populated, with about 14,000 people in its service area.
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