The rating on Cuyahoga County, Ohio's--publicly owned health system--bonds, issued for Metrohealth System, reflects: A unique role as a sizable primary and tertiary provider providing essential safety net services through a comprehensive integrated delivery system, including fully salaried physician staff and high levels of service to the county's medically indigent population; A strong balance sheet highlighted by ample liquidity; A long history of county support through annual appropriations from both the county's general fund and proceeds of voted tax levies for health and human services; and A strong management team, which fully integrates senior physicians, with considerable experience at MetroHealth's major competitors. Other credit factors include: A history of operating losses combined with only breakeven excess income, typical of a
