Not-for-profit healthcare

After management and physicians from both health systems worked to provide a merger recommendation, the UnityPoint Health board “failed to embrace the vision."

Ahead of the deal, Moody's revised its outlook on the hospital system's Aa3 rating to positive from stable.

ProMedica Health System was downgraded to Baa3 by Moody's Investors Service, which assigned a negative outlook.

Most of the proceeds will refinance direct placement debt with bonds sold in the public markets.

Spectrum Health System will consolidate its administrative offices into a central location.

St. Louis-based Ascension Health Alliance will price up to $856 million through the Wisconsin Health and Educational Facilities Authority.

Moody's Investors Service cut OSF Healthcare System to A3 from A2.

The rating agency upgraded the hospital system to Aa2 from Aa3.

Moody's Investors Service dropped Fairfield Medical Center to Ba2 from Baa3.

Budget pressure amid plans for capital investments drove a downgrade to a hospital affiliated with the Mount Sinai Health System.