DALLAS -- Fort Wayne, Indiana based Parkview Health System's improved operating performance earned it a one notch upgrade into the double-A category.

Moody's Investors Service on Tuesday upgraded the system to Aa3 from A1. The action impacts $471 million of debt outstanding.

"The upgrade reflects Parkview's very strong financial performance and debt service coverage, growth in absolute liquidity measures, manageable capital spending and the system's expansive tertiary and quaternary service array as a sizable $1.5 billion system in northeastern Indiana," Moody's said in a credit report.

The system's operating performance has been very strong, particularly over the last two years, exceeding levels seen by peer-rated organizations, Moody's said. Operating cash-flow margins in fiscal 2014 and fiscal 2015 were at 22.1% and 19.2%, respectively. "Through six months of FY 2016 margins have tempered, but remain well above similarly rated entities, with operating cash-flow margin of 15.0%," according to Moody's.

But analysts also noted that Parkview Health's higher-than-average debt load requires it maintain an above average operating performance in order to adequately support debt, capital plans, and grow balance sheet resources.

Parkview's debt structure includes variable-rate paper that comprises 47% of its total debt load. The variable-rate bonds are supported by letters of credit from a diversity of banks with expirations that range between 2019 and 2021. The system issued floating-rate bonds this year that were privately placed with term dates between 2023 and 2026.

Gross revenue of the obligated group secure the bonds and the group includes Parkview Health and Parkview Hospital.

The Fort Wayne based Health System operates 10 acute and specialty service hospital campuses, several ambulatory sites, and numerous physician offices throughout its market in northeastern Indiana and northwestern Ohio.

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