This report card provides a transparent, timely, and geographically detailed assessment of 2010 Chesapeake Bay health. The overall health of Chesapeake Bay, assessed using water quality and biotic indicators, declined slightly in 2010. The overall grade decreased from a C in 2009 to C- in 2010. Only two reporting regions (James River and York River) had improved grades in 2010, three were unchanged, and nine declined. The highest-ranked region in previous years, the Upper Western Shore, decreased to fourth highest. The Upper Bay (C+) became the top-ranked region in 2010.