Concord Hospital, NH

Transcription

1 CREDIT OPINION New Issue Concord Hospital, NH New Issue - Moody's assigns A2 to Concord Hospital's (NH) Ser. 2017; outlook stable Summary Rating Rationale Contacts Safat Hannan Analyst safat.hannan@moodys.com Lisa Goldstein Associate Managing Director lisa.goldstein@moodys.com Moody s Investors Service has assigned an A2 rating to Concord Hospital's proposed $55 million Revenue Bonds, Concord Hospital Issue, Series Bonds are to be issued through the New Hampshire Health and Education Facilities Authority and have a final maturity in At this time we are affirming the A2 ratings on Concord Hospital s revenue bonds affecting $83 million of debt outstanding. The outlook is stable. The A2 reflects Concord s stable and leading market position as the only inpatient provider in an economically stable primary service area, favorable operating performance, and strong absolute and relative balance sheet metrics. Concord has maintained a very low debt burden in recent years, which partially mitigates the material increase in leverage with the proposed financing and supports the A2 rating. Other challenges include Concord s small scope of operations compared to A2 medians, expectations of more modest performance in fiscal 2018 driven by increased costs with a large information technology installation and risks of financial and operational disruptions from the installation. Credit Strengths» Distinctly leading market share of 69% as the only acute care hospital in the demographically favorable service area of the state capital and 28 surrounding towns» Multi-year trend of favorable financial operating performance above the A2 medians» Strong liquidity (254 days cash) and manageable debt (220% pro forma cash to debt) relative to A2 medians» A large and tenured employed physician group which includes 280 physicians and advanced providers Credit Challenges» Material increase in leverage by nearly 60% associated with this financing» Potential disruptions to financial performance relating to the IT installation» Low growth service area with an aging population» Heavy reliance on a single managed care contract that represents 17% of gross revenues

2 Rating Outlook The stable outlook reflects our expectation that Concord Hospital will meet its 2018 budget, implement its IT installation and construction project without material disruption to operations given significant advanced planning. Factors that Could Lead to an Upgrade» Material enterprise growth» Improved and sustained operating performance and liquidity measures that are favorable to the A1 medians Factors that Could Lead to a Downgrade» Cost overruns or disruption in operations related to construction project» Challenges related to the IT installation» Sustained decline in operating performance leading to materially weaker debt coverage ratios» Marked increase in leverage» Material decline in liquidity Key Indicators Exhibit 1 Concord Hospital, NH , , , , , Operating Cash Flow Margin (%) PM: Medicare (%) PM: Medicaid (%) Operating Revenue ($'000) 3 Year Operating Revenue CAGR (%) Days Cash on Hand Unrestricted Cash and Investments to Total Debt (%) Total Debt to Cash Flow (x) 2017 Pro Forma 479, Based on audited financial statements for Concord Hospital, Inc. and Subsidiaries for the year ended September 30; Pro forma column incorporates proposed $55 million par amount; Investment returns normalized at 6% prior to 2015 and at 5% in 2015 and beyond Source: Moody's Investors Service Detailed Rating Considerations Market Position: Distinctly leading market share in demographically favorable service area expected to continue Concord Hospital (CH) has a leading market share in a demographically favorable service area. CH is the only acute care hospital located in the capital city of Concord, which is characterized by a high level of federal, state, and local government employment, low unemployment and median household incomes above the state and national medians. The system faces little competition in Concord and the 28-town service area where it maintains a distinctly leading market share of 69% (88% in the City of Concord). The hospital has a Level III Trauma center designation, a small open heart surgical program and a large employed physician group. The Elliot Hospital (Baa1/stable) and Catholic Medical Center (Baa1/stable) are located 18 miles south in Manchester. When combined, the Manchester hospitals account for less than 10% of CH's primary market share. This publication does not announce a credit rating action. For any credit ratings referenced in this publication, please see the ratings tab on the issuer/entity page on for the most updated credit rating action information and rating history. 2

3 Operating Performance, Balance Sheet and Capital Plans: Strong financial performance expected to temper in fiscal 2018; balance sheet should be able to absorb the MOB project CH has a track record of favorable operating performance which continued in fiscal CH recorded a 10.2% operating cash flow margin and 4.5% operating margin compared to A2 medians of 10% and 3.2%, respectively. Top line growth of 7.6% year-over-year was attributed to strong volume growth and an increase in DSH revenues. Management is forecasting modest fiscal 2018 performance primarily attributed to the launch of its EMR platform which includes revenue cycle. Management estimates one-time unfavorable impacts to revenue and expense of $9.7 million resulting in an operating margin and operating cashflow margin of 2.4% and 8.1%, respectively, for the system. After fiscal 2018, performance is expected to return to levels closer to fiscal LIQUIDITY We expect liquidity to continue to grow even when including the construction project and IT installation. As of fiscal 2017, CH's unrestricted liquidity increased to $302 million equating to days cash on hand of 253 days compared the A2 median days cash on hand of 210 days. Days cash would have been 280 days if CH did not make the extra contribution to its pension plan in fiscal 2017 (discussed below). CH's liquidity position provides a cushion to adverse events, but the investment allocation carries some risks should the market decline. Investment allocation includes 51% equities, 28% hedge funds and 21% in cash and fixed income. Capital spending was elevated across the past two years due to an EMR installation which recently went live on December 1. CH had a capital spend ratio of 1.4 times depreciation in fiscal 2017 and projects it to rise to 1.7 time in fiscal 2018 ($42 million), reflecting some IT installation cost carry-over and the beginning of the MOB construction project. Debt Structure and Legal Covenants: All fixed rate debt, good headroom to covenants A low debt burden allows CH to absorb the nearly 62% increase in leverage. Pro forma debt and liquidity metrics compare favorably to the A2 medians. At fiscal 2017, cash to pro forma debt of 220% compares favorably to the A2 median of 151%. Pro forma total debt to operating revenue and debt to cash flow at fiscal 2017 was 28.7% and 2.05 times, respectively, compared to A2 medians of 34% and 2.8 times. DEBT STRUCTURE Debt structure risk is limited with all fixed rate debt. Series 2013B is a fixed rate bond privately held by Citizens Bank which makes up a small 12% of pro forma direct debt. The series is amortizing over the next nine years and matures in The bank covenants are the same as in the MTI and include 75 days cash on hand and 1.1 times coverage. The system has good headroom to covenants with 253 days cash and 4.54 times pro forma debt service coverage. DEBT-RELATED DERIVATIVES CH is not party to any interest rate swaps or derivative agreements. PENSIONS AND OPEB CH has high indirect debt of approximately 50% of pro forma direct debt though down from previous years. CH has a cash balance noncontributory defined benefit plan that is underfunded by $44 million (84% funded) as of fiscal CH made a one-time contribution to the pension plan of $27 million in fiscal 2017 in addition to its normal contribution of $16 million for a total of $43 million due to available cash flow. CH expects to contribute $16 million to the pension in fiscal Management and Governance Stable and tenured management team with a proven track record of meeting operating budgets and strong planning around the IT installation. Ultimate reserve powers for the organization rest with the hospital Board of Directors. The hospital is the sole corporate member of Concord Hospital Trust, whose main role is fundraising and philanthropic activities. Legal Security The bonds are secured by a gross revenue pledge of the Hospital and Trust and a mortgage on the institution's main campus and a security interest in its equipment. Upon the redemption of the Series 2011 Bonds, the outstanding bonds will no longer be secured by a mortgage. 3

4 Use of Proceeds Bond proceeds will be used to build a medical office building on its main campus and reimburse the hospital for previous capital expenditures. Obligor Profile The obligated group includes the 242-staffed bed acute care hospital in Concord, New Hampshire which provides a broad array of inpatient and outpatient services as well as the Concord Hospital Trust. The Trust retains its own Board of Trustees but ultimate reserve powers rest with the Hospital Board. The financial statistics above incorporate other subsidiaries, including a large employed physician group. Methodology The principal methodology used in this rating was Not-For-Profit Healthcare published in November Please see the Rating Methodologies page on for a copy of this methodology. Ratings Exhibit 2 Concord Hospital, NH Issue Revenue Bonds, Issue, Series 2017 Rating Type Sale Amount Expected Sale Date Rating Description Rating A2 Underlying LT $54,600,000 12/15/2017 Revenue: Other Source: Moody's Investors Service 4

5 2017 Moody s Corporation, Moody s Investors Service, Inc., Moody s Analytics, Inc. and/or their licensors and affiliates (collectively, MOODY S ). All rights reserved. CREDIT RATINGS ISSUED BY, INC. AND ITS RATINGS AFFILIATES ( MIS ) ARE MOODY S CURRENT OPINIONS OF THE RELATIVE FUTURE CREDIT RISK OF ENTITIES, CREDIT COMMITMENTS, OR DEBT OR DEBT-LIKE SECURITIES, AND MOODY S PUBLICATIONS MAY INCLUDE MOODY S CURRENT OPINIONS OF THE RELATIVE FUTURE CREDIT RISK OF ENTITIES, CREDIT COMMITMENTS, OR DEBT OR DEBT-LIKE SECURITIES. MOODY S DEFINES CREDIT RISK AS THE RISK THAT AN ENTITY MAY NOT MEET ITS CONTRACTUAL, FINANCIAL OBLIGATIONS AS THEY COME DUE AND ANY ESTIMATED FINANCIAL LOSS IN THE EVENT OF DEFAULT. CREDIT RATINGS DO NOT ADDRESS ANY OTHER RISK, INCLUDING BUT NOT LIMITED TO: LIQUIDITY RISK, MARKET VALUE RISK, OR PRICE VOLATILITY. CREDIT RATINGS AND MOODY S OPINIONS INCLUDED IN MOODY S PUBLICATIONS ARE NOT STATEMENTS OF CURRENT OR HISTORICAL FACT. MOODY S PUBLICATIONS MAY ALSO INCLUDE QUANTITATIVE MODEL-BASED ESTIMATES OF CREDIT RISK AND RELATED OPINIONS OR COMMENTARY PUBLISHED BY MOODY S ANALYTICS, INC. CREDIT RATINGS AND MOODY S PUBLICATIONS DO NOT CONSTITUTE OR PROVIDE INVESTMENT OR FINANCIAL ADVICE, AND CREDIT RATINGS AND MOODY S PUBLICATIONS ARE NOT AND DO NOT PROVIDE RECOMMENDATIONS TO PURCHASE, SELL, OR HOLD PARTICULAR SECURITIES. NEITHER CREDIT RATINGS NOR MOODY S PUBLICATIONS COMMENT ON THE SUITABILITY OF AN INVESTMENT FOR ANY PARTICULAR INVESTOR. MOODY S ISSUES ITS CREDIT RATINGS AND PUBLISHES MOODY S PUBLICATIONS WITH THE EXPECTATION AND UNDERSTANDING THAT EACH INVESTOR WILL, WITH DUE CARE, MAKE ITS OWN STUDY AND EVALUATION OF EACH SECURITY THAT IS UNDER CONSIDERATION FOR PURCHASE, HOLDING, OR SALE. MOODY S CREDIT RATINGS AND MOODY S PUBLICATIONS ARE NOT INTENDED FOR USE BY RETAIL INVESTORS AND IT WOULD BE RECKLESS AND INAPPROPRIATE FOR RETAIL INVESTORS TO USE MOODY S CREDIT RATINGS OR MOODY S PUBLICATIONS WHEN MAKING AN INVESTMENT DECISION. IF IN DOUBT YOU SHOULD CONTACT YOUR FINANCIAL OR OTHER PROFESSIONAL ADVISER. ALL INFORMATION CONTAINED HEREIN IS PROTECTED BY LAW, INCLUDING BUT NOT LIMITED TO, COPYRIGHT LAW, AND NONE OF SUCH INFORMATION MAY BE COPIED OR OTHERWISE REPRODUCED, REPACKAGED, FURTHER TRANSMITTED, TRANSFERRED, DISSEMINATED, REDISTRIBUTED OR RESOLD, OR STORED FOR SUBSEQUENT USE FOR ANY SUCH PURPOSE, IN WHOLE OR IN PART, IN ANY FORM OR MANNER OR BY ANY MEANS WHATSOEVER, BY ANY PERSON WITHOUT MOODY S PRIOR WRITTEN CONSENT. All information contained herein is obtained by MOODY S from sources believed by it to be accurate and reliable. Because of the possibility of human or mechanical error as well as other factors, however, all information contained herein is provided AS IS without warranty of any kind. MOODY'S adopts all necessary measures so that the information it uses in assigning a credit rating is of sufficient quality and from sources MOODY'S considers to be reliable including, when appropriate, independent third-party sources. However, MOODY S is not an auditor and cannot in every instance independently verify or validate information received in the rating process or in preparing the Moody s publications. To the extent permitted by law, MOODY S and its directors, officers, employees, agents, representatives, licensors and suppliers disclaim liability to any person or entity for any indirect, special, consequential, or incidental losses or damages whatsoever arising from or in connection with the information contained herein or the use of or inability to use any such information, even if MOODY S or any of its directors, officers, employees, agents, representatives, licensors or suppliers is advised in advance of the possibility of such losses or damages, including but not limited to: (a) any loss of present or prospective profits or (b) any loss or damage arising where the relevant financial instrument is not the subject of a particular credit rating assigned by MOODY S. To the extent permitted by law, MOODY S and its directors, officers, employees, agents, representatives, licensors and suppliers disclaim liability for any direct or compensatory losses or damages caused to any person or entity, including but not limited to by any negligence (but excluding fraud, willful misconduct or any other type of liability that, for the avoidance of doubt, by law cannot be excluded) on the part of, or any contingency within or beyond the control of, MOODY S or any of its directors, officers, employees, agents, representatives, licensors or suppliers, arising from or in connection with the information contained herein or the use of or inability to use any such information. NO WARRANTY, EXPRESS OR IMPLIED, AS TO THE ACCURACY, TIMELINESS, COMPLETENESS, MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE OF ANY SUCH RATING OR OTHER OPINION OR INFORMATION IS GIVEN OR MADE BY MOODY S IN ANY FORM OR MANNER WHATSOEVER. Moody s Investors Service, Inc., a wholly-owned credit rating agency subsidiary of Moody s Corporation ( MCO ), hereby discloses that most issuers of debt securities (including corporate and municipal bonds, debentures, notes and commercial paper) and preferred stock rated by Moody s Investors Service, Inc. have, prior to assignment of any rating, agreed to pay to Moody s Investors Service, Inc. for appraisal and rating services rendered by it fees ranging from $1,500 to approximately $2,500,000. MCO and MIS also maintain policies and procedures to address the independence of MIS s ratings and rating processes. Information regarding certain affiliations that may exist between directors of MCO and rated entities, and between entities who hold ratings from MIS and have also publicly reported to the SEC an ownership interest in MCO of more than 5%, is posted annually at under the heading Investor Relations Corporate Governance Director and Shareholder Affiliation Policy. Additional terms for Australia only: Any publication into Australia of this document is pursuant to the Australian Financial Services License of MOODY S affiliate, Moody s Investors Service Pty Limited ABN AFSL and/or Moody s Analytics Australia Pty Ltd ABN AFSL (as applicable). This document is intended to be provided only to wholesale clients within the meaning of section 761G of the Corporations Act By continuing to access this document from within Australia, you represent to MOODY S that you are, or are accessing the document as a representative of, a wholesale client and that neither you nor the entity you represent will directly or indirectly disseminate this document or its contents to retail clients within the meaning of section 761G of the Corporations Act MOODY S credit rating is an opinion as to the creditworthiness of a debt obligation of the issuer, not on the equity securities of the issuer or any form of security that is available to retail investors. It would be reckless and inappropriate for retail investors to use MOODY S credit ratings or publications when making an investment decision. If in doubt you should contact your financial or other professional adviser. Additional terms for Japan only: Moody's Japan K.K. ( MJKK ) is a wholly-owned credit rating agency subsidiary of Moody's Group Japan G.K., which is wholly-owned by Moody s Overseas Holdings Inc., a wholly-owned subsidiary of MCO. Moody s SF Japan K.K. ( MSFJ ) is a wholly-owned credit rating agency subsidiary of MJKK. MSFJ is not a Nationally Recognized Statistical Rating Organization ( NRSRO ). Therefore, credit ratings assigned by MSFJ are Non-NRSRO Credit Ratings. Non-NRSRO Credit Ratings are assigned by an entity that is not a NRSRO and, consequently, the rated obligation will not qualify for certain types of treatment under U.S. laws. MJKK and MSFJ are credit rating agencies registered with the Japan Financial Services Agency and their registration numbers are FSA Commissioner (Ratings) No. 2 and 3 respectively. MJKK or MSFJ (as applicable) hereby disclose that most issuers of debt securities (including corporate and municipal bonds, debentures, notes and commercial paper) and preferred stock rated by MJKK or MSFJ (as applicable) have, prior to assignment of any rating, agreed to pay to MJKK or MSFJ (as applicable) for appraisal and rating services rendered by it fees ranging from JPY200,000 to approximately JPY350,000,000. MJKK and MSFJ also maintain policies and procedures to address Japanese regulatory requirements. REPORT NUMBER

6 CLIENT SERVICES 6 Americas Asia Pacific Japan EMEA