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DORMITORY AUTHORITY - STATE OF NEW YORK
CUSIP: 64990BNA7
By &Evergreen Team•Updated: Nov 18, 2025
NRStable
Overview
•Bond Name/Type: Dormitory Authority of the State of New York – Northwell Health Obligated Group Revenue Bonds, Series 2024A & Forward-Delivery 2025A (gross-receipts pledge, parity under MTI)
•Top-Line Classification: Stable (medium confidence)
•Synopsis: Audited FY 2024 results show Long-Term Debt Service Coverage improved to 5.5× on $762.8 million of new money/refunding debt ((Northwell Healthcare Inc Financial Statements 2023; 2023-12-31)), and unrestricted liquidity reached $4.6 billion/95 DCOH ((WF Nwh 2024 Annual Report Edits 6 23; 2025-11-11)), providing a wide cushion above the 1.10× covenant and the 1.00× default trigger. The main emerging head-wind is CMS’s CY 2026 rule that slashes skin-substitute reimbursement by ~90 % (Signals 1–2), but revenue exposure is unquantified and outside the bond’s primary service lines; within the next 12 months no accepted signal indicates covenant pressure.
Signal 28
The long-term debt service coverage ratio improved to 5.5x for the twelve months ended September 30,
Northwell Healthcare Inc Financial Statements 2023 • 2023-12-31
Signal 18
Northwell finished the year with $4.6 billion in unrestricted cash and investments on the balance sh
WF Nwh 2024 Annual Report Edits 6 23 • 2025-11-11
Rationale
Baseline from Foundation Analysis
•Structure: Parity gross-receipts pledge; no DSRF; 1.10× is a performance floor; issuer, not users, bears revenue risk.
•Normal performance: Historical coverage runs well above covenant; liquidity is a key mitigant given absence of reserve fund.
•Primary risks: Revenue volatility from payer mix/regulatory changes; leverage creep > $500 million; management turnover.
Evaluation of Accepted Evidence
Theme A – Core Financial Cushion Strengthens
•FY 2024 audit ((Northwell Healthcare Inc Financial Statements 2023; 2023-12-31)) confirms 5.5× DSCR, a full 4.4 turns above FY 2023 and far above the 1.10× floor. Trend T-004 notes 2024 revenue up 10.3 % ((WF Nwh 2024 Annual Report Edits 6 23; 2025-11-11)) and positive $292 million operating income ((WF Nwh 2024 Annual Report Edits 6 23; 2025-11-11)).
Signal 28
The long-term debt service coverage ratio improved to 5.5x for the twelve months ended September 30,
Northwell Healthcare Inc Financial Statements 2023 • 2023-12-31
Signal 16
Total operating revenue grew by $1.7 billion, or 10.3%, to $18.61 billion
WF Nwh 2024 Annual Report Edits 6 23 • 2025-11-11
Signal 21
Total operating revenue $18,609,672
Salaries and benefits $11,589,013
Supplies and expenses 5,77
WF Nwh 2024 Annual Report Edits 6 23 • 2025-11-11
•Liquidity of $4.6 billion/95 DCOH ((WF Nwh 2024 Annual Report Edits 6 23; 2025-11-11)) materially offsets absence of a DSRF and supports short-term shock absorption—directly addressing the foundation’s “high” revenue-volatility risk.
Signal 18
Northwell finished the year with $4.6 billion in unrestricted cash and investments on the balance sh
WF Nwh 2024 Annual Report Edits 6 23 • 2025-11-11
Theme B – Liability-Management Continues Without Covenant Strain
•Series 2025A forward delivery closed Feb-2025, refunding most 2015A bonds at a premium and fixed rates ((Northwell Healthcare Inc Board of Directors Meeting Minutes; 2024-05-15)). Combined with series 2009 refunding ((Northwell Healthcare Inc Financial Statements 2023; 2023-12-31)), debt service savings improve headroom; both actions were contemplated in offering documents, so they do not alter baseline risk.
Signal 51
In October 2024, in conjunction with the Series 2024A bond transaction, the Obligated Group entered
Northwell Healthcare Inc Board of Directors Meeting Minutes • 2024-05-15
Signal 26
A portion of the proceeds from the Series 2024A bonds, along with existing trustee-held debt service
Northwell Healthcare Inc Financial Statements 2023 • 2023-12-31
Theme C – External Policy Head-winds Appear but Near-Term Impact is Limited
•CMS final rule on skin substitutes (Signals 1–2) and other Medicare efficiency adjustments (Trend T-005) signal federal revenue pressure. However, the foundation identifies inpatient/ambulatory services—not advanced wound care—as the dominant revenue streams, and the large DSCR cushion limits one-year credit impact.
•State coverage-loss warnings (Signals 38–41) are sector-wide and lack issuer-specific dollar estimates; current liquidity levels mitigate timing risk.
Theme D – Future Capital Spending Signals Are Within Historical Norms
•Northwell’s intent to roll up to 90 % of a $31 million project into a future DASNY financing ((Public Health and Health Planning Committee Day - Establishment and Project Review Committee - August 21, 2025; 2025-08-21)) adds modest leverage (<1 % of existing debt) and is well below the $500 million threshold the foundation flags as potentially credit-negative.
Signal 46
The total project cost is $31,054,814, and that will be funded with $11,054,814 from Northwell's obl
Public Health and Health Planning Committee Day - Establishment and Project Review Committee - August 21, 2025 • 2025-08-21
Red Flags (watch list, not rating drivers today)
•Early-2025 margin compression noted in Trend T-004 warrants monitoring; if sustained it could narrow today’s headroom.
•Federal reimbursement cuts effective 1/1/2026 (Signals 1–2) could coincide with continued capital outlays.
Applying the Decision Tree
•All negative signals are either sector-wide or modest in magnitude relative to the issuer’s current cushion and structural protections.
•Positive audited financial signals are issuer-specific, high-weight, and materially strengthen the credit.
→ Stable classification is appropriate.
Signals & Trends
(Northwell Healthcare Inc Financial Statements 2023; 2023-12-31): “The long-term debt service coverage ratio improved to 5.5x for the twelve months ended September 30, 2024” [Northwell FS; 2025-11-12; p. N-5]
Signal 28
The long-term debt service coverage ratio improved to 5.5x for the twelve months ended September 30,
Northwell Healthcare Inc Financial Statements 2023 • 2023-12-31
Path: Debt/Leverage. Confirms materially higher cushion than 1.10× covenant—change from baseline is positive.
(WF Nwh 2024 Annual Report Edits 6 23; 2025-11-11): “Northwell finished the year with $4.6 billion in unrestricted cash and investments…95 days of cash on hand” [Northwell FS; 2025-11-12; p. N-4]
Signal 18
Northwell finished the year with $4.6 billion in unrestricted cash and investments on the balance sh
WF Nwh 2024 Annual Report Edits 6 23 • 2025-11-11
Path: Liquidity. Reinforces ability to absorb revenue shocks in absence of DSRF. Positive change.
(WF Nwh 2024 Annual Report Edits 6 23; 2025-11-11): “Total operating revenue grew by $1.7 billion, or 10.3 %, to $18.61 billion” [Northwell FS; 2025-11-12; p. N-3]
Signal 16
Total operating revenue grew by $1.7 billion, or 10.3%, to $18.61 billion
WF Nwh 2024 Annual Report Edits 6 23 • 2025-11-11
Path: Revenue. Strengthens topline and supports DSCR; confirms Trend T-004’s 2024 recovery.
(Northwell Healthcare Inc Financial Statements 2023; 2023-12-31): “Refund $65,000 in Series 2009B, C, D bonds” [OS supplement; 2025-11-12; p. R-2]
Signal 26
A portion of the proceeds from the Series 2024A bonds, along with existing trustee-held debt service
Northwell Healthcare Inc Financial Statements 2023 • 2023-12-31
Path: Debt/Leverage. Liability-management lowers future debt service. Expected per CIP; neutral-to-positive.
(Northwell Healthcare Inc Board of Directors Meeting Minutes; 2024-05-15): “Series 2025A bond transaction closed in February 2025… sold at a premium of $41.1 million” [Northwell FS; 2025-11-12; p. N-6]
Signal 51
In October 2024, in conjunction with the Series 2024A bond transaction, the Obligated Group entered
Northwell Healthcare Inc Board of Directors Meeting Minutes • 2024-05-15
Path: Debt/Leverage. Forward-delivery refunding extends maturities at fixed rates; improves profile.
(Centers for Medicare & Medicaid Services (CMS) CMS Modernizes Payment Accuracy And Significantly Cuts Spending Waste CMS; 2025-11-11): “CMS…will pay for skin substitutes under the PFS… expected to reduce Medicare spending…by nearly 90 %” [Fed reg; 2025-11-12]
Signal 1
CMS currently treats skin substitutes as biologicals for the purposes of Medicare payment. In the CY
Centers for Medicare & Medicaid Services (CMS) CMS Modernizes Payment Accuracy And Significantly Cuts Spending Waste CMS • 2025-11-11
Path: Revenue. New federal rule—negative. Not in baseline; material but service-line specific.
(Centers for Medicare & Medicaid Services (CMS) CMS Modernizes Payment Accuracy And Significantly Cuts Spending Waste CMS; 2025-11-11): “reduce gross fee-for-service program spending…by $19.6 billion in 2026” [Fed reg; 2025-11-12]
Signal 2
We estimate this action will reduce gross fee-for-service program spending for skin substitute servi
Centers for Medicare & Medicaid Services (CMS) CMS Modernizes Payment Accuracy And Significantly Cuts Spending Waste CMS • 2025-11-11
Path: Revenue. Quantifies (Centers for Medicare & Medicaid Services (CMS) CMS Modernizes Payment Accuracy And Significantly Cuts Spending Waste CMS; 2025-11-11); negative. Timing outside next two semi-annual covenant tests but added to watch list.
Signal 1
CMS currently treats skin substitutes as biologicals for the purposes of Medicare payment. In the CY
Centers for Medicare & Medicaid Services (CMS) CMS Modernizes Payment Accuracy And Significantly Cuts Spending Waste CMS • 2025-11-11
Trend T-004: Northwell’s 2024 recovery followed by early-2025 margin compression.
Path: Revenue/Liquidity. Confirms improvements yet warns of decelerating momentum. Monitor.
Trend T-005: Emerging federal policy headwinds to provider revenues.
Path: Revenue/Operations. Aggregates Signals 1–2 and related reimbursement pressures. Negative trend but impact tempered by liquidity and DSCR.
None of the remaining 90 signals introduced issuer-specific covenant pressure within 12 months; they were therefore excluded from this section.
Outlook
Base Path: Expect DSCR and liquidity to remain well above covenant as FY 2025 completes, supported by fixed-rate debt structure and balance-sheet strength (Signals 28, 18).
Catalysts to Watch (3-12 months)
•Quarterly operating margin trajectory—continued compression per Trend T-004 could erode cushion.
•Final budgeting for any additional DASNY financings tied to smaller capital projects ((Public Health and Health Planning Committee Day - Establishment and Project Review Committee - August 21, 2025; 2025-08-21)).
Signal 46
The total project cost is $31,054,814, and that will be funded with $11,054,814 from Northwell's obl
Public Health and Health Planning Committee Day - Establishment and Project Review Committee - August 21, 2025 • 2025-08-21
•Implementation guidance on CMS skin-substitute rule; material payer-mix exposure could move classification toward Cautious.
Downside Scenario: A simultaneous decline in operating margin below 2 % and material reimbursement cuts (Signals 1–2, Trend T-005) narrow DSCR toward 2.0× while liquidity falls below 60 DCOH—absent offsetting cost action, outlook could shift to Cautious.
Upside Scenario: Sustained 4.5×+ DSCR, operating margin ≥3 %, and no additional leverage above plan could, combined with large grant inflows anticipated in Trend T-006, move outlook toward Opportunity.
Appendix
•Northwell Health Consolidated Financial Statements; 2025-11-12; pp. N-3–N-6
•Federal Register, CY 2026 Physician Fee Schedule Final Rule; 2025-11-12
•Official Statement Supplement (Series 2024A/2025A); 2025-11-12
•Trend files as provided in <<<TRENDS>>>
Data QA Notes: The Bond Information lists “Current Rating: NR,” while audited financials cite Moody’s A3 / S&P A- / Fitch A-. Original prompt requires quoting “NR”; inconsistency flagged for user follow-up.
Full Signal Details: preserved in input file “<<<CLEANED_SIGNALS>>>”.