...S&P Global Ratings revised the outlook to negative from stable and affirmed its '###' long-term rating on Northern Hospital District of Surry County (NHDSC), N.C.'s (d/b/a Northern Regional Hospital) series 2017 revenue bonds. The outlook revision reflects a material decline in NHDSC's unrestricted reserves, with days' cash on hand falling by over 100 days from its high point at the end of fiscal 2020. In addition, the negative outlook is supported by recent operating losses in fiscal 2022, coupled with our expectation that losses may continue in the near term given sector-wide pressures on expenses and temporary contract labor. Precluding a lower rating at this time is our expectation for cash to recover from current levels as accounts receivable (AR) are normalized. Days in AR have increased to an elevated 74 days as of March 31, 2022, up from 50 days in fiscal 2021 due to the October 2021 implementation of a new electronic medical record (EMR) and revenue cycle IT system that has delayed...
