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Who's up and who's down

Up
St. Tammany Parish Hospital, Service District No. 2, LA
Rating: A+
Outlook: Stable
Affected debt: $18.7 million
Agency: Fitch Inc.
Remarks: Upgraded rating from A- due to improved operations, a strong tax base, and continued economic growth in an area recovering from Hurricane Katrina.

Down
Resurrection Health Care, Chicago
Rating: BBB+
Outlook: Negative
Affected debt: $592.8 million
Agency: Standard & Poor's
Remarks: Outlook revised from stable due to continued operating losses, negative margins of 5.2%, and weak maximum annual debt service coverage.

Down
Silver Cross Health System, Joliet, IL
Rating: BBB
Outlook: Stable
Affected debt: $376 million
Agency: Standard & Poor's
Remarks: Downgraded rating from A due to the system taking on increased debt when profits are expected to be below average.

Down
Temple University Health System, Philadelphia
Rating: BBB
Outlook: Negative
Affected debt: $349.2 million
Agency: Standard & Poor's
Remarks: Outlook revised from stable based on large operating losses in fiscal 2008 and through the first nine months of fiscal 2009, as well as a continued decrease in liquidity.

—Michelle Ponte