MINNEAPOLIMEDIA NEWS | Sanford Health and North Memorial Health Merger Moves Forward Under 10-Year State Oversight Agreement

The agreement requires $600 million in hospital investments, preserves core services at Robbinsdale Hospital and establishes a decade of monitoring by the Minnesota Attorney General’s Office. 

SAINT PAUL, MN (August 29, 2026) Sanford Health’s proposed acquisition of North Memorial Health will move forward under a legally enforceable 10-year agreement intended to protect hospital services, workers and patients while bringing Minnesota’s largest rural health system into the Twin Cities metropolitan area.

Minnesota Attorney General Keith Ellison announced the agreement Friday after nearly four months of review, public meetings and discussions with health-care workers, patients, labor organizations, insurers and community groups.

The agreement requires Sanford and North Memorial to invest $600 million in North Memorial’s hospital system, preserve the Level 1 trauma center and other essential services at Robbinsdale Hospital for at least 10 years, honor existing collective bargaining agreements and submit to continuing oversight by the Attorney General’s Office.

The merger will create what the Attorney General’s Office describes as Minnesota’s largest integrated urban-rural health system and the first fully integrated provider serving both the Minneapolis-Saint Paul metropolitan area and Greater Minnesota.

“While health-care system mergers can all too often result in higher costs, fewer jobs, and less care, today’s agreement shows that Minnesota’s health-care entity transactions law is a powerful tool for ensuring that major health-care transactions in Minnesota serve Minnesotans’ interest,” Ellison said.

$600 Million for Maple Grove and Robbinsdale

Under the agreement, Sanford must commit $500 million to North Memorial’s long-planned expansion of Maple Grove Hospital.

The remaining $100 million will be invested in Robbinsdale Hospital.

Maple Grove Hospital has experienced sustained demand as the northwestern metropolitan area continues to grow. According to the Attorney General’s Office, more children are born at Maple Grove Hospital annually than at any other hospital in Minnesota.

The Robbinsdale investment is particularly significant because of longstanding questions about the hospital’s financial condition and future. North Memorial announced service reductions and layoffs in recent years as it struggled with operating losses, rising labor expenses and the cost of providing uncompensated and publicly reimbursed care.

The new agreement does not merely promise capital investment. It restricts the merged organization from materially reducing the health-care services currently offered by Sanford and North Memorial at their Minnesota locations during the oversight period.

Level 1 Trauma Center and Core Services Protected

Sanford must maintain Robbinsdale Hospital’s Level 1 trauma center and cancer center for at least 10 years.

The services protected by the agreement include:

• The emergency department
• Level 1 trauma coverage and supporting services
• Cardiac and catheterization laboratory services
• Labor and delivery
• Intensive care
• Stroke care
• Acute rehabilitation
• Mental-health services

The Level 1 designation means Robbinsdale Hospital is equipped to provide comprehensive treatment for patients with the most serious and complex injuries. Its continued operation is important not only to residents of Robbinsdale and surrounding communities, but also to emergency systems across the Twin Cities.

Sanford and North Memorial also agreed to maintain existing air and ground emergency transportation services in Minnesota.

North Memorial operates what the Attorney General’s Office describes as the nation’s largest hospital-based air and ground medical transportation system. Its ambulances and medical helicopters serve communities across Minnesota and parts of neighboring states.

The agreement further calls on Sanford to work toward strengthening Level 1 trauma and safety-net services across the metropolitan area. That includes possible discussions with Hennepin Healthcare about the long-term sustainability of trauma and safety-net care.

Protections for North Memorial Employees

The memorandum contains several commitments affecting North Memorial’s approximately 6,500 employees.

Sanford must honor existing collective bargaining agreements and retain employees who are in good standing and satisfy the organization’s standard hiring requirements.

North Memorial workers must be offered health-insurance options comparable to those currently available to them.

Sanford also agreed not to include noncompete provisions in new employment agreements and not to enforce existing noncompete provisions against North Memorial employees.

The employee provisions respond to concerns raised by labor unions and health-care professionals during the Attorney General’s review. Large health-system mergers can produce uncertainty about staffing, compensation, benefits and whether administrative or clinical positions will be consolidated.

Although the agreement provides significant employment protections, it does not guarantee that every position or workplace arrangement will remain unchanged indefinitely. Its principal protections cover collective bargaining obligations, retention standards, comparable health benefits and restrictions on noncompete agreements.

Charity Care and Government Programs Must Continue

The combined organization must continue participating in Medicare, Medicaid and other government health programs in which the two systems presently participate.

Sanford must also retain North Memorial’s policies governing charity care for uninsured, underserved and financially disadvantaged patients.

Funding for the community-benefit and financial-assistance programs currently supported by North Memorial must continue under the agreement.

These commitments are particularly important at Robbinsdale Hospital, which provides substantial emergency, trauma and safety-net care to patients from Minneapolis, the North Metro and surrounding communities.

Public insurance programs frequently reimburse hospitals at rates below the full cost of treatment. Uncompensated care and delayed reimbursements have contributed to financial pressure at North Memorial and other hospitals serving large numbers of low-income and medically vulnerable patients.

Mental, Reproductive and Gender-Affirming Care

Sanford and North Memorial agreed to maintain existing behavioral and mental-health services and explore opportunities to expand those services in areas of Minnesota where care is difficult to access.

Sanford also agreed not to reduce the scope of reproductive health care and gender-affirming services offered in Minnesota at the time the merger closes, to the extent permitted by applicable laws and regulations.

The organization must make its best efforts to maintain those services throughout the agreement.

The provision is notable because hospital acquisitions can lead to concerns about whether changes in ownership, institutional policy or corporate leadership will affect sensitive areas of patient care.

New Rural Health-Care Initiative

Beyond its binding obligations under the memorandum, Sanford has made a public commitment to contribute $15 million over three years to a new Minnesota rural health-care initiative.

The initiative, which Ellison is expected to convene, will support small and independent health-care providers across Greater Minnesota.

Sanford is headquartered in Sioux Falls, South Dakota, and describes itself as the largest rural health system in the United States. It operates hospitals and clinics across the Upper Midwest and already has a substantial Minnesota presence, including facilities in Bemidji, Canby, Jackson, Luverne, Thief River Falls, Tracy and Worthington.

The system employs approximately 55,000 people and serves more than two million patients annually.

North Memorial operates hospitals in Robbinsdale and Maple Grove, along with more than 20 clinics. It serves more than 55,000 patients each month.

Sanford Must Maintain a Minnesota Presence

Sanford has committed to maintaining a meaningful corporate presence in Minnesota, including an office in the Twin Cities metropolitan area.

The combined organization also intends to recruit workers through Minnesota colleges, universities and professional institutions while strengthening partnerships with Minnesota health systems, nonprofit organizations and government agencies.

The commitment responds to concerns that control of North Memorial, a Minnesota nonprofit organization, will move to an institution headquartered outside the state.

Sanford President and Chief Executive Officer Bill Gassen said the commitments reflect what the two organizations heard from patients, employees, community leaders and health-care stakeholders during the review.

“As one nonprofit health system, we will preserve essential care at Robbinsdale Hospital, expand access to specialty care, invest in our people, create a more resilient emergency and trauma network and strengthen care across rural and urban Minnesota,” Gassen said.

North Memorial Health President and Chief Executive Officer Trevor Sawallish said the public response emphasized three priorities: protecting essential care, supporting health-care workers and making the investments necessary to strengthen Minnesota’s hospital system.

A Decade of State Monitoring

The agreement establishes continuing oversight rather than ending the state’s involvement when the merger closes.

Sanford leadership must meet with the Attorney General quarterly for 10 years to discuss the integration, hospital operations and compliance with the agreement.

The combined system must also submit annual reports to the Attorney General’s Office. Ellison will meet annually with Sanford’s Board of Trustees.

If the Attorney General determines that the merger is no longer operating in the public interest, his office retains the authority to seek relief in district court.

That oversight gives the state a formal mechanism for determining whether Sanford follows through on its commitments after the acquisition is completed.

The Attorney General’s authority comes from Minnesota’s health-care entity transaction law, which permits the office to evaluate whether major transactions are in the public interest. The office also reviews such transactions through its authority over nonprofit organizations, charities and state and federal antitrust laws.

Public Concerns Shaped the Agreement

The Attorney General’s formal review began May 1 after the office received notice of the proposed acquisition.

Investigators reviewed the transaction documents, requested supplemental information and toured Robbinsdale Hospital, Maple Grove Hospital and North Memorial’s ambulance-services headquarters in Brooklyn Center.

The office also interviewed employers, insurers, unions, government agencies and other interested parties.

Approximately 100 comments were received during public meetings held in Robbinsdale on June 8 and July 7. More than 300 additional comments were submitted in writing.

Labor unions, medical professionals and community organizations also presented proposals for protections and community benefits.

Those concerns helped shape provisions addressing hospital services, employee retention, charity care, reproductive health, emergency transportation and Minnesota-based leadership.

The merger now advances with one of the most extensive state oversight agreements attached to a Minnesota health-care transaction.

Whether the combination ultimately improves financial stability, access and patient care will depend on how Sanford carries out the commitments over the coming decade. The agreement gives Minnesota officials, workers and communities a framework through which those promises can be measured and enforced.

SOURCE: Minnesota Attorney General’s Office | Read the 10-year memorandum of understanding

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