The downgrade on Northern Hospital District of Surry County, N.C's bonds is based on the hospital increased leverage to $31 million from $14 million, and subsequent reduction in coverage. Other factors include: Competition from large tertiary providers located about 40 miles away in Winston-Salem, Small complement of active physicians, and Reimbursement pressures from governmental agencies. These credit concerns are tempered by the hospital's: Strong market position as the leading provider in Surry County, Growing patient volumes, and Profitable operations with sufficient liquidity to offset near-term risks associated with the project. The 1999 issuance of $18 million more than doubles leverage, and lowers solid historical coverage of 4.4 times (x), to a low of 2.4x, rendering a financial profile consistent with
