Fitch notes that SIHE refunded its series 1998A bonds for present value savings with the series 2011 bonds in a private placement transaction.
The Stable Outlook reflects Fitch's expectation that SIHE will maintain its solid operations and strong balance sheet metrics, and will successfully weather any changes to state or federal supplemental reimbursement programs.
SIHE covenants to disclose both annual and quarterly financial statements through the Municipal Securities Rulemaking Board's EMMA system.
SIHE has a considerable Medicaid and self-pay concentration, which exposes SIHE to potential reimbursement cuts at the state level.
SIHE serves a significant Medicaid and self-pay population, leaving the system somewhat vulnerable to potential cuts in rates and charity programs at the state level.