Sanford Health, the largest rural health system in the U.S., headquartered in Sioux Falls, South Dakota, and Marshfield Clinic Health System, a physician-led integrated health system serving rural Wisconsin and the Upper Peninsula, announced Wednesday a nonbinding Memorandum of Understanding (MOU) to combine.

In January, Marshfield Clinic Health System and Essentia Health called off their two-year plans to integrate. Sanford also called off plans to merge with Fairview Health Services last year.

Marshfield completed a purchase of Dickinson County Healthcare in 2022. The Wisconsin-based healthcare provider also bought the Marquette Internal Medicine and Pediatric Associates Center in 2023.

There are no immediate changes for Marshfield or Sanford employees or those each system serves.

The combination will create an integrated health system dedicated to advancing world-class care in the rural Midwest.

“We are excited to combine our common purpose to lead the way for the future, drive innovation and solve the most pressing challenges facing rural health care,” said Bill Gassen, president and CEO of Sanford Health. “We are who we are today because of combinations with care delivery organizations in rural communities across America s heartland. These opportunities have allowed us to follow through on our promise to deliver world-class health care to every patient we serve no matter their ZIP code, and we are eager to continue building on this track record with Marshfield Clinic Health System.”

Sanford Health says the partnership will bring together two strong physician-driven organizations, each with a reputation for excellence in quality, safety and patient experience. Together, the combined organization will advance national leadership in physician-led integrated care, lead the way in research with an emphasis on underrepresented populations, foster a healthy operating performance, and put patients, people and communities at the forefront.

According to MCHS, Sanford Health is committed to take on MCHS s debt and liabilities.