Moody's Investors Service last week affirmed its Baa1 rating on Summa Health System in Ohio.

The system has about $361 million of outstanding debt.

Summa is based in Akron where it enjoys a 57% market share. Moody's said the provider saw improved operating margins in 2010 and for the first nine months of 2011.

It has also launched an ambitious program to reduce costs and offset the impact of the new federal health care law, analysts said.

Other positives include a conservative investment allocation, manageable debt levels and a pension plan that was mostly converted to a defined contribution plan earlier this year.

But Summa's cash-flow margins remain modest and it is considering taking on additional debt over the next two years, according to Moody's.

"The stable outlook is based on our expectation that Summa will at least maintain current margins and unrestricted investment position and manage future debt issuances relative to cash flow," analyst Lisa Martin wrote in a recent report.

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