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DOWN
Washington Hospital (Washington Township Health Care District), Fremont, CA
Rating: A2
Outlook: Negative
Affected debt: $77 million
Agency: Moody’s Investors Service
Remarks: Revised from stable to negative because of broader market competition with large health systems in the San Francisco Bay area coupled with sizable capital expenditure plans for 2007.

UP
McKenna Memorial Hospital, New Braunfels, TX
Rating: Baa2
Outlook: Stable
Affected debt: $36 million
Agency: Moody’s Investors Service
Remarks: Upgraded from Baa3 because of good liquidity coupled with strong market share in a good demographic area.

UP
Cleveland Clinic Health System, Cleveland
Rating: AA-
Outlook: Stable
Affected debt: $1.4 billion
Agency: Standard & Poor’s
Remarks: Multi-year track record of strong financial performance and many years of balance sheet improvement. Sustainable increase in profitability.

DOWN
Capital Region Medical Center, Jefferson City, MO
Rating: BBB+
Outlook: Negative
Affected debt: $38.9 million
Agency: Standard & Poor’s
Remarks: Disappointing financial results in FY 2006 and into 2007, largely due to the dissolution of a joint venture imaging center between Capital Region and its competitor, St. Mary’s Health Center.

—Philip Betbeze