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Who's up and who's down upUPCity of Hope National Medical Center, Duarte, Calif.Rating: A3Outlook: StableAffected debt: $173 million Agency: Moody's Investors ServiceRemarks: Several years of strong operating margins, including 2005 and 2006 margins of more than 6 percent, led to the upgrade from Baa1. Fundraising has been strong and should get stronger with new development head.DownMemorial Health University Medical Center, Savannah, Ga.Rating: BBB+Outlook: NegativeAffected debt: $94 million Agency: Standard & Poor'sRemarks: Unexpected significant operating loss led to downgrade from A-. Cost-saving plan complete but not yet implemented.UpPrinceton Community Hospital, Princeton, W.VaRating: BOutlook: PositiveAffected debt: $42 millionAgency: Standard & Poor'sRemarks: Strong improvement in operating income and increasing liquidity. Further rating improvement could come from a permanent solution to ongoing losses at its smaller facility, St. Luke's Hospital.DownCommunity General Hospital of Greater, Syracuse, Syracuse, N.Y. Rating: Ba3Outlook: NegativeAffected debt: $13.5 millionAgency: Moody's Investors Service Remarks: Significant decline in interim 2006 operating performance coupled with expectation of considerable decline in liquidity in 2007 as hospital funds $9.4 million in pension obligations. -Philip Betbeze