S&P Global Ratings affirmed its 'BB' long-term rating on the California Statewide Communities Development Authority's $981 million series 2016A, $565.7 million series 2014A, and $121.5 million series 2014B fixed-rate revenue bonds issued for Loma Linda University Medical Center (LLUMC). The outlook is stable. LLUMC includes several other entities described below. A subset of these organizations (outlined below) make up the LLUMC obligated group. References to LLUMC include both the obligated and nonobligated group entities unless specified differently. The 'BB' rating reflects our view of LLUMC's heightened debt levels, thin but improved maximum annual debt service (MADS) coverage in 2016 of around 2x, and adequate operational liquidity (albeit at budgeted levels) given the scale and scope of LLUMC's large capital project.