Fitch Downgrades Vidant Credit Rating

A press release from Fitch Ratings says it has downgraded the credit rating of Vidant Health from AA- to A+.

A ratings downgrade typically means that it would cost more for Vidant to borrow money, because it's deemed less likely to be able to pay back its debt.

The press release lists $508 million in debt that led to the ratings downgrade. Despite this Fitch does list Vidant as having a "stable" outlook.

Vidant ended the 2011 fiscal year with a strong 4.3% operating margin, according to Fitch ratings.

We will ask Vidant Health for their reaction today.

Press Release

Fitch Ratings has downgraded the rating to 'A+' from 'AA-' on Vidant Health, NC's (fka University Health Systems of Eastern Carolina) outstanding debt. A full list of affected bonds follows at the end of this release.

The Rating Outlook is Stable.


The bonds are a general and unsecured obligation of the obligated group, which includes the parent company and the flagship facility, Vidant Medical Center fka Pitt County Memorial Hospital


LOW LIQUIDITY: The downgrade reflects Vidant Health's (Vidant) continued low liquidity position even for the 'A' category and the expectation that there will be slow balance sheet improvement given fairly sizeable ongoing capital needs.

IMPROVED OPERATING PERFORMANCE: Vidant ended fiscal 2011 with a strong 4.3% operating margin compared to 2.5% in fiscal 2010 and 2.2% in fiscal 2009. The performance was driven by the increased capacity at the flagship facility, which resulted in improved volume in addition to ongoing cost containment initiatives.

EXPANDING MARKET FOOTPRINT: Vidant continues to grow its regional system within its 29 county service area by adding community hospitals. This assists in providing care in the most cost effective setting as primary care is kept local while tertiary services are referred to its flagship academic medical center, Vidant Medical Center.

ROBUST CAPITAL SPENDING: In addition to its acquisition activity, Vidant's capital spending plans include adding capacity to its flagship facility, reinvesting in its regional facilities and implementing a systemwide electronic medical record.


The rating downgrade reflects Vidant's continued low liquidity position, which could no longer be justified at the 'AA-' rating level despite its strong operational performance. Although unrestricted cash and investments have increased, the liquidity ratios are weak even compared to the 'A' category median ratios. At Sept. 30, 2011 (audited), Vidant had $474 million of unrestricted cash and investments, which translated to 148.5 days cash on hand and 88.9% cash to debt compared to the 'A' category median ratios of 194.1 and 113.8%, respectively.

Fitch believes significant liquidity growth is unlikely due to ongoing capital needs. Vidant's capital spending plan is fairly robust and totals $139 million in fiscal 2012, $143 million in fiscal 2013, and $113 million in fiscal 2014. This will be funded from operating cash flow, which averaged $141 million over the last three years.

Credit strengths include Vidant's strong market position and geographic coverage and solid operating performance. Vidant continues to expand its regional network and acquired two community hospitals in fiscal 2011 and has so far added one additional facility in fiscal 2012. The system is anchored by the academic medical center with nine regional hospitals that serve as feeders to the tertiary facility. Management indicated that it continues to evaluate growth opportunities for the system.

The tertiary facility has experienced strong volume growth with a 4.2% growth in admissions (same store basis) in fiscal 2011. Market share in Vidant's 29-county service area increased to 29.6% in fiscal 2010 from 28.6% in 2009 and is expected to continue to grow due to its recent acquisitions. The closest competitor is CarolinaEast Health System with 8.8% in 2010, and their market share has dropped from the prior year. Fitch views Vidant's growth strategy favorably, which should enhance overall operational efficiency as the newer facilities are integrated into the system and as the organization implements its systemwide electronic medical record platform.

Vidant had a strong operational year in fiscal 2011 due to the added capacity at its tertiary facility, which drove volume growth, in addition to ongoing cost initiatives. Operating income was $62.8 million (4.3% margin) in fiscal 2011 compared to $32.7 million (2.5% margin) in fiscal 2010. Management has a 3% operating margin budget for fiscal 2012.

Although Vidant's payor mix is challenging with over 20% of revenue from Medicaid, under state legislation, Vidant Medical Center receives full cost reimbursement for Medicaid. Vidant also receives disproportionate share hospital (DSH) payments from the state, which equaled $19.3 million in 2011.

Vidant has $567 million of debt outstanding which is approximately 50% fixed rate and 50% variable rate. Total debt has increased since Fitch's last review with the issuance of $50 million series 2011 direct bank loan (Bank of America). Fitch believes Vidant's debt profile is somewhat aggressive given its liquidity position. Vidant has exposure to the risks related to its variable rate demand bonds (VRDBs), its put bonds (due in 2013 and 2014) and the series 2011 direct bank loan (due in 2018) in addition to swap collateral requirements. The exposure to VRDBs is mitigated by Vidant's solid cash to VRDBs of 2.1x in fiscal 2011. As of Sept. 30, 2011, Vidant was posting $20 million in collateral related to its swaps.

The Stable Outlook reflects the expectation of continued solid operating performance driven by its excellent and growing market position, which should fund its robust capital plans.

Vidant Health is a 1,309 bed hospital system operating 10 hospitals and several other related health care entities throughout Eastern North Carolina. Vidant includes Vidant Medical Center, an academic medical center affiliated with the Brody School of Medicine at East Carolina University. Vidant had total operating revenue of $1.45 billion in fiscal 2011. Vidant covenants to provide annual audited financials and quarterly disclosure (which includes balance sheet, income statement, cash flow statement and utilization statistics) to the NRMSIRs.

Fitch has downgraded the following outstanding debt issued by the North Carolina Medical Care Commission on behalf of Vidant to 'A+' from 'AA-':

--$7,850,000 Pitt County Memorial Hospital hospital revenue bonds series 1998A;

--$109,125,000 University Health Systems of Eastern Carolina variable-rate health care facilities revenue bonds series 2008A-1 and A-2; underlying rating (variable-rate demand bonds supported by letter of credit from Bank of America);

--$119,970,000 University Health Systems of Eastern Carolina variable-rate health care facilities revenue bonds series 2008B-1 and B-2; underlying rating (variable rate demand bonds supported by letter of credit from Branch Banking & Trust Company);

--$73,740,000 University Health Systems of Eastern Carolina health care facilities revenue refunding bonds series 2008C;

--$119,715,000 University Health Systems of Eastern Carolina health care facilities revenue refunding bonds series 2008D;

--$22,325,000 University Health Systems of Eastern Carolina health care facilities revenue refunding bonds series 2008E-1 (put bond due on Dec. 1, 2013);

--$55,200,000 University Health Systems of Eastern Carolina health care facilities revenue refunding bonds series 2008E-2 (put bond due on Dec. 1, 2014).

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

Applicable Criteria and Related Research:

--'Revenue-Supported Rating Criteria', dated June 20, 2011;

--'Nonprofit Hospitals and Health Systems Rating Criteria', dated Aug. 12, 2011.

For information on Build America Bonds, visit ''.

Applicable Criteria and Related Research:

Revenue-Supported Rating Criteria

Nonprofit Hospitals and Health Systems Rating Criteria


Fitch Ratings
Primary Analyst
Emily Wong, +1-212-908-0651
Senior Director
Fitch, Inc.
One State Street Plaza
New York, NY 10004
Secondary Analyst
Emily Wadhwani, +1-312-368-3347
Associate Director
Committee Chairperson
Jim LeBuhn, +1-312-368-2059
Senior Director
Media Relations:
Sandro Scenga, +1-212-908-0278

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  • by Sam Location: Kitty Hawk on Feb 1, 2012 at 04:43 PM
    You can blame the ambulance chasing scumbag injury attorneys for their outrageous lawsuits against not just this hospital, but several hospitals as well as insurance companies. About 30% of them deserve to lose their law license due to the lack of integrity and the corruption that has helped add to this deficit just to help their bank account.
  • by gettin' out of dodge on Feb 1, 2012 at 02:35 PM
    watch vidant slowly go broke like all the rest of the hospitals they have bought up in ENC. Then what? hurricanes,floods,tornado outbreaks,crime way out of control? hmmm I think I will do like the police chiefs and city admin. folks seem to be doing and get my tail out of enc! I think that would be the smart thing to do.Good luck good people of ENC looks like you are going to need it!
    • reply
      by Anonymous on Feb 1, 2012 at 11:58 PM in reply to gettin' out of dodge
      I agree that good ole ENC will be down and out in the next few years, but what do you expect from people who spend money they don't have.
  • by ever wonder on Feb 1, 2012 at 01:17 PM
    why University Health Systems (now Vidant) is buying up every hospital they can get their hands on in Eastern NC? It's called a monopoly folks. When they own every medical facility in this part of the state, they can change the rates/rules/pay standard to whatever suits their best interests. They can continually pay their employees less while they line the pockets of their administrators with extravagant bonuses. They will do all this in the name of building a better medical system to serve the people of Eastern NC. But make no mistake, all this greedy purchasing is to make $$$ first not to do great and wonderous things for the communities. If they were only concerned with service, some of these extravagant bonuses and free luxury vehicles for admins would be cut out so that money could go towards patient care.
  • by JAWS Location: Greenville on Feb 1, 2012 at 12:12 PM
    In reply to "Stupid" who thinks I'm an idiot.I didn't mention not paying money actually owed. Sometimes a bill is issued for services that have already been payed. Even the hospital makes mistakes. All they have to say is the bill wasn't payed. Even with receipts to prove your point, you still have to go to court. When you go to court sometimes you win & sometimes you lose. When it happens to you, you'll understand what I mean. By the way, I'm not an idiot.
  • by john Location: farm on Feb 1, 2012 at 11:32 AM
    you left out the 1.2 million it cost to change the name
    • reply
      by Anonymous on Feb 1, 2012 at 12:53 PM in reply to john
      That's probably part of the listed debt
  • by HAHA on Feb 1, 2012 at 10:45 AM
    This comment has been deleted.
    • reply
      by curious on Feb 1, 2012 at 11:14 AM in reply to HAHA
      Why did the police department take a pay cut???? I haven't heard of any other departments having to take a pay cut. How much did you lose?
      • reply
        by to curious on Feb 1, 2012 at 01:12 PM in reply to curious
        They lost hours while nursing staff gained mandatory overtime. Taking into account the hourly wage difference between police officers and nurses, you figure which department's overtime costs Vidant more money. Also, housekeeping is short staffed and the hospital refuses to hire any additional employees for that department. I wonder how many positive reviews patients will give them when the place gets nastier than it already is? Vidant continually cuts the non medical staff off at the knees while adding administrators. You can't cut out your support system and expect to keep functioning at the same level. It's only a matter of time until a place that top heavy topples.
        • reply
          by Anonymous on Feb 2, 2012 at 12:00 AM in reply to to curious
          Preach honey preach. Amen to that.
        • reply
          by Anonymous on Feb 2, 2012 at 04:54 AM in reply to to curious
          Usually the patient area are still ok.Housekeeping gets pulled from cleaning the employee areas.Can't remember the last time I saw someone cleaning the bathrooms or breakrooms in my area.
    • reply
      by T Jones on Feb 1, 2012 at 12:31 PM in reply to HAHA
      I agree brother
  • by It's still an A! on Feb 1, 2012 at 08:01 AM
    They've bought a lot of floundering community hospitals and have begun to turn them around. That debt to income ratio isn't bad, and it will get better as they acquire more resources and improve the hospitals they've purchased. I don't like the name very much, but the company seems to be serving our region very well right now. The downgrade doesn't mean they are doing anything wrong. It's still an A, people!
  • by REALLY????? Location: Chowan on Feb 1, 2012 at 07:53 AM
    To all you people who are bad mouthing PCMH, Vidant, whatever you want to call it... Next time you are in eastern NC and you are sick and injured why don't you just refuse to be taken to Vidant Health and see where you end up then! I am pretty sure I would feel safer at a Vidant Health facility then any other facility in NC or the neighboring states!
    • reply
      by HA on Feb 1, 2012 at 10:50 AM in reply to REALLY?????
      You obviously have never worked there.
      • reply
        by REALLY??? on Feb 1, 2012 at 11:32 AM in reply to HA
        Yes I do work at one of the facilities and I have worked at about 7 other facilities throughout my long career and I can promise from behind the scenes and from personal experiences Vidant Health would be my preference... BUT LIKE I SAID - Next time you are sick or injured just refuse to be taken there since you are so unhappy with them!
    • reply
      by Audra - SoCal on Feb 1, 2012 at 12:58 PM in reply to REALLY?????
      I've been treated at PCMH and I can honestly say it's good care. I've seen bad, I've seen good - there's a pretty broad spectrum in CA - so I do know the difference. I'm always appalled when I see anyone badmouthing the school and facilities you have there. From everything I've seen and read, you are BLESSED with great technology and physicians and could do a heck of a lot worse any day of the week. Teaching hospitals are innovative and amazing anyway. The name thing was a lateral move and tactical error, it's true. If the care stays the same however, you're golden.
  • by SBI on Feb 1, 2012 at 07:27 AM
    How in the world did this happen? You would think that one of the 82 VP's out there would have been on top of something like that.....oh wait a minute maybe that's why they have a bad income to debt ratio. If the average of the VP's is $500,000 that comes to $41M per year. Not hard to see where the fat needs to be trimmed from.
    • reply
      by T Jones on Feb 1, 2012 at 12:33 PM in reply to SBI
      You are correct but they will take more out on the worker bees at Vidant not the VP's.
  • by The Original ENC Location: enc on Feb 1, 2012 at 06:36 AM
    I'd downgrade them too with such a dumb name change and a ripped off ( read: Belks ) logo.
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