Sanford Health’s acquisition of Robbinsdale, Minn.-based North Memorial Health is set to close Sept. 1, after the two systems signed a 10-year oversight agreement with the Minnesota Attorney General’s Office Aug. 28 — five times longer than Sanford’s original two-year commitment.
The $11.7 billion, Sioux Falls, S.D.-based system agreed to keep Robbinsdale’s level 1 trauma center, ER, cardiac, obstetrics, ICU, stroke, mental health and oncology services running for a decade, plus $100 million in Robbinsdale upgrades and $500 million for North Memorial’s Maple Grove hospital.
By August 2024, Robbinsdale was on pace to lose $124 million that year. At the time, a spokesperson for the system attributed the loss to a financial crisis brought on by the payer mix in its service area, with 74% of patients on Medicaid or Medicare, programs that reimburse at roughly 70 cents per dollar cost of care. The system had already cut 103 jobs.
The state of Minnesota, meanwhile, funded a $705 million rescue for Hennepin County Medical Center this year, but a parallel ask for North Memorial was dropped from the final bill, leaving acquisition as the remaining option.
This is Sanford’s third run at the Twin Cities. It tried to buy Fairview Health in 2013 and again in 2022, when a proposed 58-hospital combination collapsed in 2023 under opposition from the University of Minnesota and two major unions. That fight produced the 2023 state law now governing hospital deals, which gives the attorney general power to sue to block any merger found against the public interest. North Memorial carries no University of Minnesota affiliation, which narrowed the politics, but Sanford still had to buy a decade of guarantees to get a signature.
The same office is separately reviewing a bigger test case: a proposed $26 billion combination of Allina Health and California-based Sutter Health, announced in March. Sutter has paid more than $800 million in California anticompetitive-practices settlements since 2021. The coalition that shaped North Memorial’s terms has already contrasted Sanford’s willingness to negotiate with Sutter and Allina’s refusal to meet with them.
Nationally, hospital deal-making has accelerated sharply. Kaufman Hall counted 18 transactions in the second quarter of 2026, more than double the second quarter of 2025, with $7.7 billion in transacted revenue versus $1.4 billion a year earlier. Nearly all of the buyers were nonprofits, and Kaufman Hall expects 2026 to bring more distress-driven deals as regulators take a softer line on systems at risk of closing. That’s landing on an already-concentrated market: KFF found that one or two systems controlled the entire inpatient market in 47% of U.S. metro areas in 2024, and links that concentration to higher prices.
The service guarantees also double as workforce guarantees. The Health Resources and Services Administration projects a shortage of 141,160 physicians by 2038, and this year’s residency Match left family medicine 16.4% unfilled — the same specialties Robbinsdale’s obstetric and trauma units depend on.
The deal also feeds a broader shift in how physicians work. AMA’s 2024 survey found only 42.2% of physicians remain in private practice, down from 60.1% in 2012, as hospital employment has climbed.
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