Moody’s Investors Service has affirmed its A2 rating on Kettering Health Network’s $41 million of bonds but revised its outlook to negative from stable, warning that planned debt sales could pressure the system’s balance sheet.

The negative outlook reflects Moody’s expectation that Kettering will either issue debt or use cash to finance capital projects, which could pressure its rating if the system fails to meet management’s cash-flow projections, analyst Mark Pascaris wrote in a recent report.

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