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Who's up and who's down DownUniversity of Alabama Hospital; Birmingham, Ala.Rating: A1Outlook: NegativeAffected debt: $250 million Agency: Moody's Investors ServiceRemarks: Outlook revised from stable. Strong reputation for clinical excellence at 908-bed tertiary medical center offset by concerns about increase in debt load. Should projected cash flow levels not be attained, a rating downgrade could be considered. UpNew Hanover Regional Medical Center; Wilmington, N.C.Rating: A+Outlook: StableAffected debt: $305 millionAgency: Standard & Poor'sRemarks: Change in outlook from negative reflects relatively new senior management and a track record of financial improvement. UpBurdette Tomlin Memorial Hospital; Cape May Court House, N.J.Rating: A2Outlook: StableAffected debt: $27 millionAgency: Moody's Investors ServiceRemarks: New senior management and a cultivation of medical staff relations contributed to improved financial performance in the 2005 fiscal year. Low debt to cash flow. DownUniversity Community Hospital; Tampa, Fla.Rating: Baa2Outlook: NegativeAffected debt: $135.9 millionAgency: Standard & Poor's Remarks: Outlook revised from stable primarily because of a decline in operating performance and uncertainty following the termination of an affiliation with Sun Coast Hospital in Largo, Fla. -Philip Betbeze