The rating on the Nashville and Davidson County Metropolitan Government Health and Educational Facilities Board, Tenn.'s bonds, issued for Ascension Health, Mo., reflects: The maintenance of a solid operating profile, highlighted by improved operations in each of the past two years, which was led by sharply improved performance at three of Ascension Health's larger local health ministries (although a weak stock market has hurt overall cash flow); Considerable geographic and financial dispersion among system members, as Ascension Health remains the largest non-governmental not-for-profit health system in the country; A solid balance sheet, reflecting moderate pro forma debt levels, light debt service as a percentage of revenues, and sizable unrestricted investments, which, though very large on an absolute basis, are only
