Debt Covenant Violations Tick Up Among Nonprofit Providers: Report

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Dive Brief:

• The number of nonprofit health systems violating their financial agreements with lenders or investors has increased since 2022 as providers struggle to meet debt obligations amid challenging operating conditions, according to a new report from credit agency S&P Global Ratings.
• This year, nonprofits will continue to be at heightened risk of violating covenant agreements, or conditions of debt that are put in place by lenders. Recently, the most common violations among nonprofits have been debt service coverage — the amount of days-cash-on-hand to debt ratios — as the sector continues to weather high expenses and weak revenues.
• Most nonprofits have recently received extra time to remedy finances in the form of waivers or forbearance agreements, but other systems have merged with more financially stable organizations to meet lending agreements, according to the report.

Dive Insight:

Financial covenant violations among nonprofits began to increase at the onset of the COVID-19 pandemic.

In the early stages of the pandemic, violations were often tied to one-time pressures on operating income, such as mandatory stoppages of services.

However, violations have since evolved and now reflect nonprofits’ struggles with ongoing labor shortages and inflationary pressures, according to the report.

Although some nonprofits have recovered financially after notching worst-ever operating performances in 2022, high expenses and labor challenges continue to plague hospitals, including a “labordemic” of both clinical and nonclinical staff that could persist through 2024 and beyond. 

Providers in the speculative rating category were more likely to have violated financial covenants over the past two years and accounted for 60% of violations in S&P’s rated universe.