The economic recession has brought on incredible uncertainly and stress for most Americans of all walks of life. Our Nations hospitals are no exception. In addition to the common elements of rising bad debt and inadequate reimbursement, hospital finance staffs have been busting at the seems over the past two years dealing with a number of crises related to their debt portfolios. The failed auction rate security market, the failed insured variable rate demand market, the downgrade of bank credit enhancers, the contraction of credit, the increased cost of credit and negative mark to markets on derivative instruments have been just some of the issues being dealt with by hospital finance staffs across the country for the past 24 months. Since the end of 2007 every 2 to 3 months has brought upon a new reality for hospitals accessing the capital markets. Some trust worthy financing vehicles of the past are now extinct and are being replaced by financing products that are currently more reliable such as fixed rate bonds, self-liquidity on variable rate bonds, direct bank loans and equipment leases. Three hospital provider panelists will detail their recent experiences in dealing with problems presented by the capital markets. Panelists will detail the multitude of challenges encountered in the financing process and the successful practices employed to weigh the costs and benefits of various financing alternatives available to them. The panel will include a broad array of hospital credit profiles. Steve Gilmore of Ascension Health will detail the challenges faced and solutions created from the view point of a AA rated national healthcare system; Ed Mann of Kettering Health Network in Ohio will talk about his perspectives as a A rated regional healthcare provider; and Kerry Vermillion of Baptist Hospital in Pensacola, FL will discuss the challenges of a BBB+ rated health system in raising new money and restructuring an entire debt portfolio, which was heavily weighted with bank enhanced variable rate demand bonds. These case studies will be co-moderated with additional commentary from Jeff Graff, a Senior Credit Products Officer with Bank of America Merrill Lynchs Healthcare and Institutions Group and Ken Vallrugo, a managing director with Bank of America Merrill Lynchs Healthcare Public Finance Group.