Standard & Poor's Ratings Services said it revised its outlook to negative from stable and affirmed its AA-minus rating on North Carolina Medical Care Commission's health facilities revenue bonds, issued for the Wake Forest Baptist Obligated Group.

"The outlook revision is due to thin operating results that did not improve in accordance with our expectations following the approval of a new provider tax in North Carolina in fiscal 2012, and the effect of additional debt, which leaves WFB with less flexibility at the current rating," said Standard & Poor's credit analyst Liz Sweeney.

Standard & Poor's also assigned its AA-minus long-term rating and negative outlook to the commission's health facilities revenue bonds, to be issued for WFB, as follows: $114.175 million series 2012A, expected to be issued as fixed-rate bonds; $114.445 million series 2012B, expected to be issued as fixed-rate bonds; and $58.08 million series 2012C, expected to be issued in an index floating-rate mode.

Also factored into the ratings is the expected issuance of $80 million series 2012D to be directly purchased by a bank within the next 60 days. Standard & Poor's has not been requested to rate the series 2012D; however, it will factor its terms into our ratings when they are available.

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