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SAN FRANCISCO--(BUSINESS WIRE)--As part of its ongoing surveillance efforts, Fitch Ratings has affirmed the 'AA-' rating on the following bonds issued through the Kentucky Economic Development Authority for the benefit of Saint Elizabeth Medical Center (SEMC), KY:

--$101,850,000 revenue refunding and improvement bonds, series 2009A;

--$38,150,000 adjustable-rate hospital facilities revenue refunding bonds, series 2009B.

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For the series 2009B bonds, this is an underlying rating.

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The Rating Outlook is Stable.

SECURITY

The bonds are secured by a revenue pledge of the hospital and a negative mortgage pledge. Additional security is provided by a rate covenant of 1.25 times (x) maximum annual debt service.

KEY RATING DRIVERS

Excellent Market Position: SEMC is the sole acute care provider in its primary service area of Northern Kentucky following the acquisition of its only competitor in the service area.

Strong Operating Performance: SEMC's operating performance is strong relative to Fitch's 'AA' rating category medians: St. Elizabeth had a 7.2% operating margin and 13.5% operating EBITDA margin through the first six months of FY2011 (ending June 30) which exceeds the medians for the rating category of 4.3% and 10.6%, respectively.

Strong Coverage and Light Debt Burden: St. Elizabeth's maximum annual debt service (MADS) as a percentage of revenues was light at 0.9% compared to the median for the rating category of 2.6% through the six-month period ending June 30, 2011. MADS coverage by operating EBITDA is strong at 14.2x versus the median of 4.1x.

Strong Liquidity Ratios: At June 30, 2011, St. Elizabeth had $453 million in unrestricted cash and investments which calculates to 202.4 days of cash, a 47.1x cushion ratio and a cash to debt ratio of 345.5%, which is favorable to the medians for the 'AA' category of 240 days, 22.4x cushion ratio and 159% cash to debt ratio.

CREDIT PROFILE

The 'AA-' rating reflects SEMC's dominant market share in its service area, strong operating margins, low debt burden and excellent coverage. Saint Elizabeth acquired its main competitor in 2008 and since that time, senior management has consolidated operations to enhance overall efficiency at the system's facilities. For example, the hospital has merged three obstetrical units into one unit at its flagship facility in Covington and completed the merger of its two medical staffs with 645 active staff members physicians and 49 offices located throughout the service area. The hospital's historical operating results are strong and compare favorably to Fitch's rating medians for the 'AA' category.

Excellent Market Position

Saint Elizabeth Medical Center is the dominant regional provider of acute care services in Northern Kentucky with a market share of 81% on an overall inpatient basis and a 90% market share for cardiology services. SEMC employs more than 90% of the primary care physicians in its service area and has an excellent reputation for quality. The hospital is well positioned to compete in the greater Cincinnati market which includes a number of strong hospital systems.

Strong Operating Performance

For the first six months ending June 30, 2011, SEMC had a 7.2% operating margin and 13.5% operating EBITDA margin which compares favorably to the medians for the 'AA' rating category. SEMC's strong profitability is a result of solid growth in utilization trends fueled by continued population growth in the area, an increase in patient acuity levels from its expansion into cardiology and orthopedics and the reduction in the level of out-migration to the Cincinnati service area.

Strong Coverage and Light Debt Burden

SEMC's capital ratios are also strong compared to the medians for the rating category as a result of the hospital's solid profitability trends and light debt burden. Through June 30, 2011, MADS as a percentage of revenue was less than 1% compared to the median of 2.6%. MADS coverage by operating EBITDA was 14.2x compared to the median of 4.1. Debt to capitalization ratios are low at 21% versus the median for the 'AA' rating category of 34.4.

Strong Liquidity Metrics

At June 30, 2011, SEMC had $453 million in unrestricted cash and investments (compared to $427 million at FY2010) which calculates to 202.4 days of cash, 34.0x cushion ratio and a cash to debt ratio of 345.5%, which compares favorably to the respective medians for the 'AA' rating category of 240, 22.4x, and 159%.

St. Elizabeth has a conservative debt structure, with 73% in fixed-rate bonds and in 27% variable-rate bonds. At June 30, 2011, St. Elizabeth had $134.6 million in total long-term debt outstanding consisting of $97.9 million of fixed-rate bonds and $36 million of variable-rate bonds. The variable-rate debt is further secured by a letter of credit from JP Morgan with an expiration date of December 2014.

St. Elizabeth has several floating-to-fixed-rate swaps in place with a total notional value of $54.2 million. The counterparty is Merrill Lynch Capital Services. The current mark to market for the swaps is negative $2.8 million as of Sept. 30, 2011. SEMC is not required to post collateral at its current rating level.

At June 30, 2011, the funded status of St. Elizabeth's defined benefit plan had fallen to 54.8% of its pension obligation from 63.7% in 2008. St. Elizabeth has made a $15.4 million contribution to the plan through June 2011 and expects to contribute $24 million in total to its defined benefit pension plan in 2011. Fitch does not view St. Elizabeth's pension liability as a major credit concern, as its strong cash flow, solid balance sheet, and status as a non-ERISA plan, mitigates any concerns.

Stable Rating Outlook

The Rating Outlook is Stable based on SEMC's strong operating profile which Fitch views favorably. The potential for positive rating action based on the hospital's improved profitability and strong liquidity metrics is precluded at this time. Management reports that it is reviewing its future strategic initiatives and the possibility of additional capital spending which may be funded by the issuance of additional debt. Fitch will take rating action as appropriate as management provides additional detail over the near term.

Saint Elizabeth Medical Center, Inc. consists of Saint Elizabeth Hospitals, St. Elizabeth Physicians and other health care related corporations. The organization has facilities in Covington, Edgewood, Florence, Fort Thomas, Falmouth and Williamstown, KY, with additional outpatient and ancillary services throughout Northern Kentucky. Saint Elizabeth has approximately 1,200 licensed beds, 6,000 employees and more than 600 physicians on staff. Total operating revenue in fiscal 2010 was $902.6 million. The hospital has covenanted to disclose annual and quarterly results to bondholders through the Municipal Securities Rulemaking Board EMMA system. Quarterly disclosure includes a balance sheet, income statement, and a statement of cash flows; however, the hospital does not provide utilization statistics nor management's discussion and analysis as part of its disclosure process.

Additional information is available at 'www.fitchratings.com'. The ratings above were solicited by, or on behalf of, the issuer, and therefore, Fitch has been compensated for the provision of the ratings.

Related Research:

'Revenue-Supported Rating Criteria' dated August 12, 2011

'Nonprofit Hospitals and Health Systems Rating Criteria', dated June 20, 2011

For information on Build America Bonds, visit www.fitchratings.com/BABs'

Applicable Criteria and Related Research:

Revenue-Supported Rating Criteria

Nonprofit Hospitals and Health Systems Rating Criteria

ALL FITCH CREDIT RATINGS ARE SUBJECT TO CERTAIN LIMITATIONS AND DISCLAIMERS. PLEASE READ THESE LIMITATIONS AND DISCLAIMERS BY FOLLOWING THIS LINK: HTTP://FITCHRATINGS.COM/UNDERSTANDINGCREDITRATINGS. IN ADDITION, RATING DEFINITIONS AND THE TERMS OF USE OF SUCH RATINGS ARE AVAILABLE ON THE AGENCY'S PUBLIC WEBSITE 'WWW.FITCHRATINGS.COM'. PUBLISHED RATINGS, CRITERIA AND METHODOLOGIES ARE AVAILABLE FROM THIS SITE AT ALL TIMES. FITCH'S CODE OF CONDUCT, CONFIDENTIALITY, CONFLICTS OF INTEREST, AFFILIATE FIREWALL, COMPLIANCE AND OTHER RELEVANT POLICIES AND PROCEDURES ARE ALSO AVAILABLE FROM THE 'CODE OF CONDUCT' SECTION OF THIS SITE.

NEW YORK--(BUSINESS WIRE)--Fitch Ratings has upgraded to 'AA' from 'AA-' the rating on the following bonds issued by the Kentucky Economic Development Finance Authority on behalf of St. Elizabeth Medical Center (SEMC):

--$93,575,000 fixed rate bonds, series 2009A;

--$33,700,000 variable rate bonds, series 2009B.

For the series 2009B bonds, this is an underlying rating.

The Rating Outlook is Stable.

SECURITY

The bonds are secured by a revenue pledge of the hospital and a negative mortgage pledge.

KEY RATING DRIVERS

CONTINUED FINANCIAL STRENGTHENING DRIVES UPGRADE: The upgrade to 'AA' from 'AA-' reflects the consistent, year over year improvement in SEMC's financial profile and performance, which has resulted in financial metrics that well exceed most of Fitch's 'AA' category medians.

EXCELLENT MARKET POSITION: SEMC is the sole acute care provider in its primary service area of Northern Kentucky following the acquisition of its only competitor in 2008.

STRONG OPERATING RESULTS: SEMC's profitability in the last three fiscal years has been very good, with operating and operating EBITDA margins averaging 7.6% and 13.9%, respectively. While there was some weakening through the 2013 interim period driven by lower than expected volumes, profitability metrics remain very strong.

CONTINUED LIQUIDITY GROWTH: SEMC's unrestricted cash and investments increased to $571.3 million at June 30, 2013 from $453.9 million at June 30, 2012. SEMC's cushion and cash to debt ratios at June 30, 2013 of 60.7x and 448.9% are the strongest in Fitch's 'AA' category peer group.

OUTSTANDING DEBT SERVICE COVERAGE: Supported by a light debt burden, debt metrics far exceed Fitch's medians. Coverage of maximum annual debt service of 16.0x in 2012 and 15.2x in 2011 are considerably stronger than the median of 5.0x. MADS as a percentage of revenue is very low at 0.9% against the median of 2.9%.

HEIGHTENED BUT MANAGEABLE CAPITAL PLANS: Capital spending in the next five years is budgeted at 154% of depreciation expense, compared to the average of 110.8% in the last four fiscal years. Given SEMC's strong cash flow and balance sheet, Fitch believes there is plenty of room at this rating level to sufficiently fund the expenditures either through cash flow or debt issuance.

RATING SENSITIVITY

FINANCIAL STABILITY EXPECTED: Given SEMC's history of strong cash flow generation, projected profitability, manageable capital plans, and market position, Fitch expects the overall financial position to be maintained in the foreseeable future.

CREDIT PROFILE

Saint Elizabeth Medical Center, Inc. consists of Saint Elizabeth Hospitals, St. Elizabeth Physicians and other health care related entities. The organization has facilities in Covington, Edgewood, Florence, Fort Thomas, Falmouth and Williamstown, KY, with additional outpatient and ancillary services throughout Northern Kentucky. Saint Elizabeth has approximately 1,200 licensed beds and more than 800 physicians on staff. Total operating revenue in fiscal year ended (FYE) Dec. 31, 2012 was $977.2 million.

EXCELLENT MARKET POSITION

SEMC is the dominant regional provider of acute care services in Northern Kentucky with an inpatient market share of over 81%, which has held steadily over 80% since the acquisition of its main competitor in 2008. SEMC employs more than 95% of the primary care physicians in its service area and has an excellent reputation for quality. The hospital is well positioned to compete in the greater Cincinnati/Northern Kentucky market which includes a number of strong hospital systems.

SEMC continues to invest in a targeted growth strategy, with service lines and geographic locations carefully selected based on expected return on required investments and growth potential. Management is planning further investment in orthopedics, neurosciences, and urology to grow service lines and stem outmigration into the Cincinnati area.

CONTINUED GROWTH IN LIQUIDITY

Supported by excellent cash flow and manageable capital spending, unrestricted cash and investments grew to $571.3 million at June 30, 2013 compared to $511.9 million at FYE 2012 and $431 million at FYE 2011. Days cash on hand of 240.5, cushion ratio of 60.7x, and cash to debt of 448.9% compare very well against the 'AA' medians of 254.3 days, 23.4x, and 173.6%.

STRONG OPERATING RESULTS

Profitability in fiscal 2012 was very strong, posting operating and operating EBITDA margins of 7.9% and 13.9% compared to Fitch's 'AA' medians of 4.2% and 11.8%. Profitability in 2011 and 2010 were similarly robust, and has been supported by steady growth in utilization and rate increases. Profitability weakened somewhat through the six-month interim period ended June 30, 2013, but remains robust with 4.8% operating margin and 11.1% operating EBITDA margin. Management is working with an external consultant to review SEMC's cost structure and reduce expenses. A four-year target of $87.4 million of expense reductions has been identified, and SEMC expects to exceed its goal in 2013.

INCREASE IN CAPITAL SPENDING

Capital spending is expected to rise in the next few years, as SEMC executes its expansion plans and updates its facilities. Capital spending as a percentage of depreciation is projected to be 154% for the next five years ($79-99 million), compared to 101-124% in the last four years. Up to $150 million of projects may be financed with new debt. Given historical level of debt and cash flow, and liquidity position, Fitch believes future capital plans are manageable whether SEMC chooses to spend cash or issue debt to fund projects.

CONSERVATIVE DEBT PROFILE AND SOLID DEBT METRICS

At June 30, 2013, SEMC had $127.3 million in long-term debt outstanding, consisting of $93.6 million of series 2009A fixed rate bonds and $33.7 million series 2009B variable rate bonds secured by a Letter of Credit from JPMorgan Chase. Late September 2013, the series 2009Bs will undergo a liquidity substitution to replace the LOC with a standby bond purchase agreement from US Bank. The initial term of the SBPA will run to September 2018. Debt mix of 74% fixed and 26% floating is relatively conservative and is viewed favorably.

SEMC's leverage and coverage metrics are very strong, due to the light debt burden. In fiscal 2012, MADS as a percentage of revenue was 0.9% and debt to capitalization was 18.8% compared to the medians of 2.6% and 32.7%. Due to strong cash flow and low MADS, coverage was very good at 16.0x in 2012 and 15.2x in 2011 compared to the median of 5.0x. Despite lower profitability in 2013, coverage was still well in excess of the median at 13.6x.

SEMC has a floating-to-fixed-rate swap with a total notional value of $34.9 million with Merrill Lynch as counterparty. The mark to market for the swaps was negative $3.7 million as of June 30, 2013. SEMC is not required to post collateral at the current rating level.

DISCLOSURE

The hospital has covenanted to disclose annual results within 180 days of year-end and quarterly results within 60 days of quarter-end to bondholders through the Municipal Securities Rulemaking Board EMMA system.

Additional information is available at 'www.fitchratings.com'.

Applicable Criteria and Related Research:

--'Revenue Supported Rating Criteria', June 3, 2013;

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--'Non-Profit Hospital and Health System Rating Criteria', May 20, 2013.

Applicable Criteria and Related Research:

Not-for-Profit Hospitals and Health Systems Rating Criteria Outside the United States

Revenue-Supported Rating Criteria

Additional Disclosure

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Solicitation Status

Semc Japan Driver Jobs

ALL FITCH CREDIT RATINGS ARE SUBJECT TO CERTAIN LIMITATIONS AND DISCLAIMERS. PLEASE READ THESE LIMITATIONS AND DISCLAIMERS BY FOLLOWING THIS LINK: HTTP://FITCHRATINGS.COM/UNDERSTANDINGCREDITRATINGS. IN ADDITION, RATING DEFINITIONS AND THE TERMS OF USE OF SUCH RATINGS ARE AVAILABLE ON THE AGENCY'S PUBLIC WEBSITE 'WWW.FITCHRATINGS.COM'. PUBLISHED RATINGS, CRITERIA AND METHODOLOGIES ARE AVAILABLE FROM THIS SITE AT ALL TIMES. FITCH'S CODE OF CONDUCT, CONFIDENTIALITY, CONFLICTS OF INTEREST, AFFILIATE FIREWALL, COMPLIANCE AND OTHER RELEVANT POLICIES AND PROCEDURES ARE ALSO AVAILABLE FROM THE 'CODE OF CONDUCT' SECTION OF THIS SITE. FITCH MAY HAVE PROVIDED ANOTHER PERMISSIBLE SERVICE TO THE RATED ENTITY OR ITS RELATED THIRD PARTIES. DETAILS OF THIS SERVICE FOR RATINGS FOR WHICH THE LEAD ANALYST IS BASED IN AN EU-REGISTERED ENTITY CAN BE FOUND ON THE ENTITY SUMMARY PAGE FOR THIS ISSUER ON THE FITCH WEBSITE.