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All the reports I’ve read suggests that IU Health has $9 billion in cash. It would be interesting to know more about why they are issuing bonds for these projects. I’m genuinely curious.
Simple strategic financing. You don’t want to use up all your cash balances on one project in 3-4 years. But you use that strong cash balance as back-up collateral for any failed bonds or lack of repayment and to help get a better credit rating. Financing the cost over the years will help maintain a steady cash reserve (in case anything like a pandemic comes along where all the cash is needed.
Not much different than some of us having the cash to buy a car, but would rather preserve some of that cash on hand and finance some of it monthly.