S&P Global Ratings' long-term rating on Northern Hospital District of Surry County (NHDSC), N.C.'s (d.b.a. Northern Regional Hospital) revenue bonds is 'BBB'. The outlook is stable. The rating reflects our assessment of NHDSC's continued positive performance through fiscal year end 2020 and solid cash flow generation as the system navigated the early months of the COVID pandemic. Three-month interim results ended Dec. 31, 2020, were weak given a larger spike in COVID-related impacts during the second wave in late 2020, into the early months of 2021. Management has noted that volumes began to rebound in January and February, supporting improved operations. Despite the solid operations, NHDSC operates in a small, economically challenged area with a limited revenue base that relies
