S&P Global Ratings revised the outlook to negative from stable and affirmed its 'AA-' long-term rating on the Chester County Health and Education Facilities Authority, Pa.'s debt issued for Main Line Health System (MLH). MLH is the parent company of Main Line Health. The outlook revision reflects our view of MLH's weakened balance sheet profile on increased operating losses, which provides less cushion in light of budgeted operating losses for fiscal 2024 and potential for continued operating pressures that could keep margins weak and debt service coverage low over the outlook period. Gross revenue from the obligated group, which consists of MLH, Main Line Health Inc., Main Line Hospitals Inc., Riddle Memorial Hospital, and Mirmont Treatment Center, secures the bonds.