AUSTIN, Texas--(BUSINESS WIRE)--Fitch Ratings assigns an 'AA' rating to the following El Paso County Hospital District dba University Medical Center (the district, or UMC) debt:
--Approximately $140 million combination tax and revenue certificates of obligation (CO), series 2013
--Approximately $116 million refunding bonds, series 2013
The bonds will be sold via negotiation as early as the week of April 22. The CO proceeds will be used to fund the acquisition, construction, and equipment of three outpatient medical clinics, a satellite emergency center, renovations to some existing facilities, and to pay issuance costs. The refunding bonds will be used to advance refund the series 2005 bonds for savings and to pay related issuance costs.
In addition, Fitch affirms the following ratings:
--$120 million outstanding combination tax and revenue COs, series 2005 at 'AA' (pre-refunding);
--$120.1 million outstanding general obligation bonds, series 2008A at 'AA';
--$11 million outstanding refunding bonds, series 2009 at 'AA';
The Rating Outlook is Stable.
SECURITY
The bonds are direct obligations of the district and are payable from an annual ad valorem tax, levied within the limits described by law. Overall, the property tax rate cannot exceed 75 cents per $100 taxable assessed valuation (TAV) for both operations and maintenance (O&M) and debt service.
KEY RATING DRIVERS
ECONOMIC EXPANSION AND DIVERSIFICATION: Economic activity within the county is largely derived from its position in a key NAFTA trade corridor near Mexico's maquiladora assembly plants as well as the presence of Fort Bliss. Recent expansion at Fort Bliss and an emerging healthcare sector somewhat offset credit concerns as to historically below-average income levels, high unemployment rates and some contraction in the manufacturing base.
HIGH OVERALL DEBT LOAD: Overall debt levels are high and likely to grow due to large capital needs of overlapping debt issuers. Debt payout is slow but in line with the expected life of the financed assets.
AMPLE TAXING MARGIN AND SUPPORT: The district maintains 75% margin under the tax limitation which should remain ample despite projected increases to support additional debt. Community support is evidenced by voter support for 2007 general obligation bonds and city-dedicated revenue support for capital investment.
ESSENTIALITY OF SERVICE: UMC provides an essential service to the district's growing population. The recent capital improvements and current capital plan are poised to maximize Medicaid waiver payments. There are two competing for-profit hospital systems in the service area.
ADEQUATE FINANCIAL PROFILE: Hospital profitability is modest, relying heavily on property taxes and the Texas Medicaid Waiver Program, which replaces what was previously uncompensated care (UC) and upper payment limit (UPL) program revenues, typical of a large county hospital district that serves as the primary safety net provider.
RATING SENSITIVITIES
FUNDING CHANGES: UMC's operations and profitability are heavily reliant on receipt of annual UC/UPL and property taxes annually appropriated by the county commissioner's court. Adverse changes to federal, state, or local funding would pose operational challenges that could negatively pressure the rating.
CREDIT PROFILE
The El Paso County Hospital District covers a very large service area, totaling 1,058 square miles, and operates the only public hospital located in its service area.
GROWING TAX BASE/BROAD TAXING MARGIN
The county's $38 billion TAV has slowed after double-digit annual TAV growth between fiscals 2005 and 2008. Growth began to slow in fiscal 2009 in line with weaker economic conditions throughout the nation. In fiscal 2011, taxable value growth was flat, but resumed 3% and 4% growth in fiscal years 2012 and 2013, respectively. The tax base is diverse and the top 10 taxpayers comprise less than 5% of total values.
The district's current total tax rate equals just over 19 cents per $100 TAV, well below the tax cap of 75 cents per $100 TAV. A tax rate increase of two cents is projected for fiscal 2014 to support the current debt issuance assuming no growth.
ECONOMIC DIVERSIFICATION
El Paso County includes the city of El Paso (GO bonds rated 'AA' by Fitch), the sixth largest city in Texas. City income levels as measured by median household income are below average, but continue to grow at a faster clip than state and national levels. Much of the city and county economic activity has historically come from its position in a key NAFTA trade corridor near Mexico's maquiladora assembly plants as well as the presence of Fort Bliss, the Army's second largest installation.
The recent expansion of the military presence at Fort Bliss as a result of the Pentagon's 2005 base realignment and closure recommendations is expected to lead to roughly 10,000 additional troops from current levels by the end of 2013. Military family members are expected to total another 40,000. About two-thirds of the additional troops are expected to live off-base. The ongoing expansion of Ft. Bliss' troop strength and military facilities has boosted residential and commercial construction citywide, although the full economic impact of the expansion is still unfolding.
Government and educational entities comprise most of the top 10 civilian employers, which provide roughly 25% of the area's employment. Major additions to the city's retail, commercial and healthcare sectors brought unemployment rates down to record lows in 2007 and 2008, although they have risen notably along with the national unemployment rate. At 8.7% in January 2013, El Paso's unemployment rate remains above the state's 6.9% and only trails the U.S. rate of 8.5%.
HIGH OVERALL DEBT BURDEN
Overall debt levels are high at 6.5% of TAV but more moderate on a per capita basis at $3,211. Direct debt is modest due to substantial pay-as-you-go capital outlays. Principal amortization is slow at 21% in 10 years but matches the life expectancy of the financed assets.
The new money bond issuance will fund construction of three outpatient clinics, a new satellite emergency center, and to renovate four floors in the existing hospital. The outpatient clinics will serve the community to comply with targets set by the Affordable Care Act and the Texas Medicaid Waiver to ensure the district qualifies for reimbursements for uncompensated care.
ADEQUATE FINANCIAL PROFILE
The district's financial profile is typical of a large county hospital district that serves as the primary safety net provider. Profitability is modest relying heavily on county appropriations and UC/UPL revenues. The break-even profitability was negatively impacted by increased interest and depreciation expenses related to new facilities recently brought online in 2012. Liquidity is weak and declined in fiscal 2012 due to pay-go funding of capital needs, a $21 million loan to the children's hospital, and rising accounts receivables. Management reports that to date, the children's hospital has repaid about $15 million.
SAFETY NET PROVIDER PAYOR MIX
The University Medical Center is a 395-bed acute care facility owned by the district with the legal responsibility to provide medical and hospital care to all El Paso County residents regardless of their ability to pay. The hospital also serves as the primary teaching hospital for the Texas Tech University Health Sciences Center in El Paso which became a full four-year medical school in 2009.
The university's $100 million medical school is adjacent to the hospital as is the region's first children's hospital, which recently opened in February 2012 and was constructed with series 2008 bond proceeds. The district owns the facility and leases it to a separately licensed non-profit children's hospital with an independent board of governors.
UMC's Medicaid, charity, and self-pay revenue components account for a very large 65% of all payor mix resulting in heavy reliance on receipt of sizeable UC/UPL program revenues as a safety net provider. In fiscal 2012, UMC received $73.6 million in these revenues, against $43.7 million in intergovernmental transfers. This high dependence is of concern in light of looming healthcare reform changes that are likely to reduce these revenues in the coming years. Property tax support somewhat serves to offset these credit concerns due to its stability and broad margin remaining.
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.
In addition to the sources of information identified in the Tax-Supported Rating Criteria, this action was additionally informed by information from Creditscope and the Municipal Advisory Council of Texas.
Applicable Criteria and Related Research:
'Tax-Supported Rating Criteria', dated Aug. 14, 2012.
'U.S. Local Government Tax-Supported Rating Criteria', dated Aug. 14, 2012.
Applicable Criteria and Related Research
Tax-Supported Rating Criteria
http://www.fitchratings.com/creditdesk/reports/report_frame.cfm?rpt_id=686015
U.S. Local Government Tax-Supported Rating Criteria
http://www.fitchratings.com/creditdesk/reports/report_frame.cfm?rpt_id=685314
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