The rating assigned to North Carolina Medical Care Commission bonds, issued for Duke University Health System, reflects high expectations that the rapid changes and acquisitions occurring at Duke will ultimately benefit bondholders despite an interim weakening of financial position. All outstanding ratings are affirmed, including the 'A-1+' ratings that reflect liquidity provided by First Chicago, Ltd. and the Health System. Duke University's board of trustees recently voted to separately incorporate the hospital, and it will no longer function as a division of the University but will continue to be a subsidiary. In anticipation of this increased flexibility, the hospital has rapidly and opportunistically pursued mergers and acquisitions, which will immediately increase their scope of services and geographic draw. These include:
