The rating actions on Cuyahoga County, Ohio's bonds, issued for University Hospital Health System Inc. (University Hospital of Cleveland), reflect increased risk from reliance upon investment income and securities gains to produce positive financial margins and a rise in the organization's leverage to 42% debt-to-capitalization from 34% inclusive of $100 million of new debt included in the series 1999 bond financing and up to $65 million of additional debt that is expected to be issued later this year. The additional debt will be issued in conjunction with UHHS's new joint venture with The Sisters of Charity of St. Augustine Health System (CSA Health System) to acquire a number of hospitals and health related assets located in Cleveland and Canton from
