S&P Global Ratings lowered its long-term rating to 'BB' from 'BB+' on the Montgomery County Higher Education&Health Authority, Pa.'s revenue bonds, issued for Holy Redeemer Health System (d/b/a Redeemer Health [RH]). The outlook is negative. The downgrade reflects Holy Redeemer's rapidly declining operating margins, particularly in the first nine months of fiscal 2023, coupled with a trend of diminishing reserves that we believe no longer offsets the magnitude of the losses. Securing the bonds is a gross receipts pledge from the obligated group and a mortgage on Holy Redeemer Hospital. The obligated group consists of RH (Holy Redeemer Hospital, St. Joseph Manor, Redeemer Lafayette, Redeemer Health Home Care&Hospice--Pennsylvania, and Holy Redeemer Support at Home) and Holy