S&P Global Ratings affirmed its 'BBB+' long-term rating on the Missouri Health and Education Facilities Authority's series 2021 fixed-rate revenue bonds, issued for Lake Regional Health System (LRHS). The outlook is stable. The gross receivables of the obligated group secure the bonds. The rating reflects our view of LRHS' improving though still negative operations, tied to a smaller revenue base with a limited market reach that is offset by solid debt metrics and an improving cash position. As with many providers, LRHS experienced heightened pressures related primarily to staffing expenses, resulting in larger-than-expected losses over the past few years with fiscal 2024 losses deviating well below the break-even budget. However, results for the six-month interim ended Oct. 31, 2024, are
