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Who's up and who's downDownLewistown Hospital, Lewistown, Pa.Rating: Baa1Outlook: StableAffected debt: $22.1 million Agency: Moody's Investors ServiceRemarks: Outlook revised to stable from positive thanks to weakened operating performance that is attributed to physician departures. With 123 staffed beds, Lewistown holds strong market share in a 25-mile radius but is vulnerable to physician departures. UpHighland Hospital, Rochester, N.Y.Rating: BBB+Outlook: PositiveAffected debt: $42.3 million Agency: Standard & Poor'sRemarks: Growth in operating profitability, increasingly sound business position. Highland should use increased business volumes and cash flow to fortify the balance sheet, which is light for this rating.DownWheaton Franciscan Services Inc., Wheaton, Ill.Rating: A3-Outlook: NegativeAffected debt: $536.33 millionAgency: Moody's Investors ServiceRemarks: Downgrade from A2 to A3 in addition to outlook revision from stable resulting from the closure of its St. Michael's campus in Milwaukee, as well as a 2006 $30 million operating loss. UpDenver Health and Hospital AuthorityRating: Baa3Outlook: PositiveAffected debt: $132 millionAgency: Moody's Investors Service Remarks: Outlook revision due to improved performance over the past three years, despite the system's reliance on medically indigent and Medicaid patients who make up 67 percent of its patient mix. The outlook change includes the system's plans to issue new debt in the 2007 fiscal year. -Philip Betbeze