...The 'A+' IDR and revenue bond rating reflect NCMC's good net-adjusted capital ratios and leading inpatient market share in a growing, but highly competitive service area. The ratings also incorporate a strong operating risk assessment supported by Fitch's expectation for operating EBITDA margins above 10% combined with limited routine capital needs. Also reflected in the ratings is NCMC's cash to adjusted debt net leverage profile through the cycle, which is stable through the rating case despite revenue and margin pressures in the near term as the result of the opening of a competitive inpatient hospital in its primary service area. The assessment of NCMC's unique combination of key rating drivers, described in detail below, does not directly place NCMC on the Rating Positioning Table in Fitch's 'Rating Criteria for U.S. Not-For-Profit Hospitals and Health Systems,' which were updated in January, and therefore no rating category is suggested. It is Fitch's practice in these cases to assess...
