Rating Action: Moody's downgrades Jackson Hospital and Clinic (AL) to Ba3; outlook negativeGlobal Credit Research - 11 Aug 2022New York, August 11, 2022 -- Moody's Investors Service has downgraded Jackson Hospital & Clinic's (AL) revenue bond rating to Ba3 from Baa3. The outlook has been revised to negative from stable at the lower rating. The organization has approximately $84 million of debt outstanding.RATINGS RATIONALEThe downgrade to Ba3 reflects Jackson Hospital & Clinic's material and recent deterioration of operating performance and unrestricted cash through June 2022. As a result, headroom to both the debt service coverage and days cash on hand covenants has been materially reduced increasing the risk of a covenant violation, which could lead to immediate acceleration of debt, a governance consideration under our ESG framework. Through the last measurement date (12/31/2021), Jackson was in compliance with both covenant requirements but will be challenged to remain compliant going forward. Poor operating performance has been driven by industry-wide challenges including increased labor costs resulting from staff shortages and rising expenses due to inflationary pressures. Management has a strategic plan to improve financial performance and grow cash reserves, however ongoing labor and COVID challenges will make it difficult to achieve results quickly. Factors supporting the Ba3 rating include Jackson's continued service line growth following significant investments in urgent care and ambulatory services which helps offset competitive pressures. The rating also incorporates Jackson's minimal capital spending plans which will help preserve liquidity, however the high age of plant will continue to increase and pose longer term challenges to rebuilding the balance sheet.RATING OUTLOOKThe revision of the outlook to negative from stable reflects risks to achieving margin improvement by fiscal yearend 2022, given ongoing and significant labor challenges and related costs. There is increased risk of a days' cash on hand and/or debt service coverage covenant breach at fiscal yearend 2022. Uncertainty in Jackson's ability to meet debt covenants will carry into fiscal 2023.FACTORS THAT COULD LEAD TO AN UPGRADE OF THE RATING- Material and sustained improvement in operating performance which drives sufficient headroom to financial covenants- Meaningful and sustained liquidity growth - Material enterprise growth that leads to an increase in operating revenue and volumes FACTORS THAT COULD LEAD TO A DOWNGRADE OF THE RATING- Violation of financial covenants- Inability to improve financial performance and/or a decline in liquidity or further narrowing of headroom to financial covenants- Incremental leverage or weakening of debt metricsLEGAL SECURITYThe bonds are secured by a pledge of Gross Receipts as defined in the bond documents. Additional security is provided by a mortgage on Jackson Hospital and Clinic's hospital and adjacent parking decks. Covenants includePROFILEJackson Hospital & Clinic is a 344-licensed bed acute care center located in Montgomery, Alabama. Jackson also has a controlling interest in a Surgery Center and an Imaging Center.METHODOLOGYThe principal methodology used in this rating was Not-For-Profit Healthcare published in December 2018 and available at https://ratings.moodys.com/api/rmc-documents/70886. Alternatively, please see the Rating Methodologies page on https://ratings.moodys.com for a copy of this methodology.REGULATORY DISCLOSURESFor further specification of Moody's key rating assumptions and sensitivity analysis, see the sections Methodology Assumptions and Sensitivity to Assumptions in the disclosure form. Moody's Rating Symbols and Definitions can be found on https://ratings.moodys.com/rating-definitions.For ratings issued on a program, series, category/class of debt or security this announcement provides certain regulatory disclosures in relation to each rating of a subsequently issued bond or note of the same series, category/class of debt, security or pursuant to a program for which the ratings are derived exclusively from existing ratings in accordance with Moody's rating practices. For ratings issued on a support provider, this announcement provides certain regulatory disclosures in relation to the credit rating action on the support provider and in relation to each particular credit rating action for securities that derive their credit ratings from the support provider's credit rating. For provisional ratings, this announcement provides certain regulatory disclosures in relation to the provisional rating assigned, and in relation to a definitive rating that may be assigned subsequent to the final issuance of the debt, in each case where the transaction structure and terms have not changed prior to the assignment of the definitive rating in a manner that would have affected the rating. For further information please see the issuer/deal page for the respective issuer on https://ratings.moodys.com.Regulatory disclosures contained in this press release apply to the credit rating and, if applicable, the related rating outlook or rating review.Moody's general principles for assessing environmental, social and governance (ESG) risks in our credit analysis can be found at https://ratings.moodys.com/documents/PBC_1288235.At least one ESG consideration was material to the credit rating action (s) announced and described above.Please see https://ratings.moodys.com for any updates on changes to the lead rating analyst and to the Moody's legal entity that has issued the rating.Please see the issuer/deal page on https://ratings.moodys.com for additional regulatory disclosures for each credit rating. Nansis Hayek Lead Analyst PF Healthcare Moody's Investors Service, Inc. 901 Yamato Rd. 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