Four of the institutions issued their debt through the Illinois Health Facilities Authority. Columbus-Cabrini Medical Center issued its debt through the Illinois Development Finance Authority, and St. Elizabeth Medical Center issued its bonds through Granite City. In a press release, Moody's said it lowered Columbus-Cabrini's debt rating partly because of a "significant decline in cash levels." The decline was caused by uncollected receivables and the cost of the center's acquisition of St. Anthony's Hospital in Chicago late last year. The debt rating for Mercy Hospital and Medical Center was downgraded because of losses stemming from "inadequate malpractice insurance reserves and uncertainties related to senior management turnover and current vacancies," Moody's said.