Moody’s said the planned merger of Chicago-based Rush University System for Health and Evanston, Ill.-based Endeavor Health has credit positive aspects for both organizations.
The two systems signed a definitive agreement Oct. 14 for Endeavor to join Rush. The transaction, pending regulatory approval, is targeted to close in early 2027. The combined organization would operate under the Rush name, with 12 hospitals and more than 400 care sites across northern Illinois and northwest Indiana.
Endeavor President and CEO Gerald “J.P.” Gallagher would be president and CEO of the unified system. The board would include equal representation from Rush and Endeavor and would initially be chaired by a Rush representative.
Moody’s pointed to complementary strengths in its Oct. 21 report. Rush would benefit from Endeavor’s stronger liquidity and debt profile, while Endeavor would gain Rush’s academic medical center, research enterprise and tertiary and quaternary clinical capabilities. Endeavor brings a broad geographic footprint, an extensive physician network and an ambulatory platform.
Based on fiscal 2025 results, the systems generated about $10.2 billion in combined operating revenue and held about $6.8 billion in unrestricted cash and investments. On a simple combined basis, that equals roughly 252 days cash on hand, unrestricted cash and investments at 254% of adjusted debt, and adjusted debt-to-adjusted cash flow of about 2.7 times.
Moody’s flagged execution and integration risk, planned investment spending, and the final organizational and debt structure as key credit considerations. The parties have committed to fund an incremental $1 billion investment in community impact, academics and research, and quality and care innovation. They have not yet decided whether to refinance or restructure outstanding debt or consolidate their obligated groups.
If completed, the deal would create a larger, more diversified enterprise with broader service-line depth and stronger competitive positioning across the Chicago region.
Moody’s said the proposed merger does not change either system’s rating or outlook for now. Rush has an “A1” rating and Endeavor has an “Aa3” rating with the agency. Both have stable outlooks.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
