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Who's up and who's down

Down
St. Joseph Health Services of Rhode Island, North Providence, RI
Rating: BB-
Outlook: Negative
Affected debt: $19.1 million
Agency: Standard & Poor's
Remarks: Rating lowered from BB due to lower-than-budgeted financial results over a two-year period.

Up
Sarasota (FL) County Public Hospital
Rating: A1
Outlook: Stable
Affected debt: $472 million
Agency: Moody's Investors Service
Remarks: Rating upgraded from A2 following continued improvement in financial performance, including a return to profitability and increased liquidity.

Up
Yampa Valley Medical Center Steamboat Springs, CO
Rating: BBB
Outlook: Stable
Affected debt: $41.7 million
Agency: Standard & Poor's
Remarks: Rating raised from BBB- based on balance sheet improvements, along with strong operating margins and strong liquidity.

Down
Firelands Regional Medical Center Sandusky, OH
Rating: Baa2
Outlook: Stable
Affected debt: $152 million
Agency: Moody's Investors Service
Remarks: Rating downgraded from Baa1 because of a 31% decline in unrestricted cash, a weak cash-to-debt ratio, and weakened operating performance between 2007 and 2008.

—Michelle Ponte