Standard&Poor's Ratings Services affirmed its 'BBB+' long-term rating and underlying rating (SPUR) on Palomar Pomerado Health District (Palomar Health), Calif.'s general obligation (GO) bonds outstanding. The outlook is stable. The affirmation reflects our view of the stabilization in Palomar Health's financial profile since the time of our previous review. In our opinion, Palomar Health's financial profile remains vulnerable, with a high debt load, modest unrestricted reserves, and pressured operations, but operations and unrestricted reserves have improved since a low point in fiscal 2013. Volumes rose in fiscal 2014 and through the year-to-date period, but have not grown sufficiently to offset the substantial increase in costs following the opening of Palomar Medical Center (PMC) in fiscal 2013. We anticipate
