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Who's up and who's down 

Yale-New Haven (CT) Hospital
Outlook: Stable
Affected debt: $386 million
Agency: Moody's Investors Service
Remarks: Moody's upgraded Yale-New Haven Hospital's underlying bond ratings to Aa3 from A1. This action affects approximately $104 million of Series K variable-rate demand obligation revenue bonds, $107 million of Series L VRDO revenue bonds, and $174 million of Series J fixed-rate revenue bonds issued through the Connecticut Health and Educational Facilities Authority. The upgrade reflects improved operating performance in FY 2008 and 2009, continued volume gains, and maintenance of adequate liquidity ratios despite facing a challenging economic environment and dealing with a significant construction effort. The outlook is revised to stable from positive at the higher rating level.

Mayo Clinic, Rochester, MN
Outlook: Positive
Affected debt: $1.7 billion
Agency: Standard & Poor's Ratings Services
Remarks: S&P revised its rating outlook to positive from stable and affirmed its AA- rating on various issuers' debt issued for Mayo Clinic. At the same time, S&P affirmed its various other ratings on numerous bonds issued on behalf of Mayo Clinic. Offsetting credit factors include liquidity levels that are still below similarly rated organizations. S&P also considers Mayo Clinic's asset allocation aggressive, with approximately 50% of Mayo's long-term fund in alternative assets. S&P also cites its potential exposure to future Medicare and Medicare physician reimbursement reductions.

Chester County Hospital, West Chester, PA
Outlook: Negative
Affected debt: $42 million
Agency: Moody's Investors Service
Remarks: Moody's has affirmed Chester County Hospital's Baa2 rating on the Series 1996 and 2001 fixed-rate bonds that were issued through the Chester County Health and Education Facilities Authority. The rating outlook has been revised to negative from stable reflecting weakening of cash-to-debt and days-cash-on-hand measures, thin operating performance of the entire consolidated entity, and capital needs that could require borrowing over the next two years. An ability to strengthen consolidated operating performance and grow cash and investments could help stabilize the hospital's rating outlook.

Karen Minich-Pourshadi

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