S&P Global Ratings revised its outlook to negative from stable and affirmed its 'A+' long long-term rating on the Salem Hospital Facility Authority, Ore.'s series 2016A and 2019A revenue bonds, issued for Salem Health. The outlook revision reflects our view of Salem Health's deteriorated financial position, underlined by meaningful operating losses through the first four months of fiscal 2023 along with the onboarding of a new patient tower and a weakening, though still healthy, balance sheet. Salem Health's bonds are secured by a gross receivable pledge of the obligated group. The rating and reflects our view of Salem's still healthy unrestricted reserves and average debt metrics that despite modest weakening remain strong enough to support Salem's credit profile for a
