S&P Global Ratings revised its outlook to negative from stable and affirmed its 'AA-' long-term and underlying (SPUR) rating on Parkview Health System Obligated Group (Parkview), Ind.'s outstanding debt, issued by the Indiana Finance Authority. In addition, we affirmed our 'AA+/A-1' dual rating on Parkview's series 2009B, 2009C, and 2009D variable-rate demand bonds (VRDBs), issued by the authority. The negative outlook reflects Parkview's recently softer operating performance that is anticipated to continue during the outlook period due labor and inflationary expense pressure, coupled with a notable decline in unrestricted reserves. Securing the bonds is revenue from the credit. The credit group consists of the parent, Parkview Health System, and Parkview Hospital, with Parkview LaGrange Hospital and Parkview Wabash Hospital as