Critical role for the French government as the largest health provider in France (and Europe) and leading university medical center. Direct and indirect state control and supervision over the group's activities. Debt build-up will continue throughout 2022-2023 as a result of large investment projects. The stable outlook on Assistance Publique - Hopitaux de Paris (AP-HP) mirrors that on France (unsolicited AA/Stable/A-1+). We would consider a negative rating action if we were to take a negative rating action on France. Although unlikely at this stage, we might also consider a negative rating action if we saw any indication of a potential weakening of AP-HP' role or link with the French government, that results in a lower likelihood of extraordinary support from
