S&P Global Ratings lowered its long-term rating to 'BBB' from 'BBB+' on California Statewide Communities Development Authority's series 2018A tax-exempt revenue bonds and series 2018B taxable revenue bonds issued for Marin General Hospital (Marin or the Hospital).The outlook is stable. The downgrade reflects our view of financial metrics that are more in line with the lower rating and more specifically reflects cumulative operating losses, an increasingly weak liquidity position underlined by less than 100 days' cash on hand, and a vulnerable debt profile marked by Marin's very high debt burden and leverage. Recent performance improvement, strategic growth initiatives, robust economic fundamentals, and tax support for general obligation bonds of the related Marin Healthcare District (the District) support the stable outlook.