S&P Global Ratings' long-term rating on the California Statewide Communities Development Authority's series 2018, 2016A, 2014A, and 2014B fixed-rate revenue bonds is 'BB-'. All bonds were issued for the Loma Linda University Medical Center (LLUMC) obligated group. LLUMC includes several entities. A subset of these organizations (outlined below) compose the LLUMC obligated group. References to LLUMC include both the obligated and nonobligated group entities unless specified differently. The outlook is negative. On April 21, 2020, S&P Global Ratings revised its outlook to negative from stable on LLUMC's debt as part of a multi-credit rating action that included several health care organizations that we rate as speculative grade or that had low unrestricted reserves due to our view of heightened risks