Sanford Health, North Memorial Health enter into 10-year oversight agreement with Attorney General’s Office

Merger between health systems to proceed with commitments to make $600M in investments in North Memorial Health system, including Robbinsdale Hospital, and to maintain the Level 1 trauma center and extensive core services at Robbinsdale for 10 years

Memorandum of Understanding also includes commitments to:

•  Honor all collective-bargaining agreements and retain employees in good standing
• Not materially reduce current service lines at Minnesota locations
• Maintain charity care and participation in Medicare and Medicaid
• Maintain existing levels of air and ground emergency transportation service in Minnesota
• Maintain and enhance existing behavioral and mental-health services
• Not reduce scope of existing reproductive and gender-affirming care

Sanford North Memorial further publicly commits to:

• Investing $15 million in new initiative to support small and independent healthcare providers in Greater Minnesota
• Working to enhance Level 1 trauma care and safety-net care in metro area
•  Maintaining corporate presence in Minnesota, drawing on Minnesota talent, and continuing commitment to Minnesota’s world-class healthcare community

Merged entity to meet quarterly with Attorney General and report annually to Attorney General’s Office for 10 years

August 28, 2026 (SAINT PAUL) — Minnesota Attorney General Keith Ellison announced today that his Office has entered into a 10-year oversight agreement with health systems Sanford Health and North Memorial Health that ensures a commitment to maintain core services at the Robbinsdale Hospital, including the Level 1 trauma center, for 10 years and to invest $600 million into both Robbinsdale and Maple Grove Hospitals, among many other commitments. Sanford Health additionally commits to maintaining a significant corporate office in Minnesota and drawing on Minnesota-based talent. It also underscores its intent to make significant investments in the health and sustainability of both rural and urban hospitals and healthcare providers, including a $15 million anchor contribution to a new initiative that is dedicated to supporting small and independent rural health care providers in Minnesota.

The 10-year oversight agreement, memorialized in a memorandum of understanding, has been reached after a review that Attorney General Ellison’s Office launched in May 2026, following the announcement of the proposed acquisition of Minnesota-based North Memorial by South Dakota-based Sanford. Attorney General Ellison’s Office is authorized under Minnesota’s healthcare entity transactions law to determine whether transactions are in the public interest and has further authority to review healthcare entity transactions under Minnesota’s nonprofit and antitrust statutes.

With the signed agreement today, the combination of Sanford Health and North Memorial Health will proceed, creating the largest integrated urban–rural health system in Minnesota. Sanford has an extensive existing network of hospitals and clinics across the western third of Minnesota stretching from Thief River Falls in the northwest to Luverne in the far southwest.

The signed memorandum of understanding, Sanford Health’s commitment letter, a review of the agreement, and frequently asked questions are all publicly available on Attorney General Ellison’s website.

“Nothing is more basic to helping Minnesotans afford their lives and live with dignity, safety, and respect than access to high-quality, affordable healthcare. In obtaining these public interest commitments for the proposed merger between Sanford Health and North Memorial Health, we have a ground-breaking agreement to protect Minnesotans," Attorney General Ellison said. “The commitments and expressions of strong intent that Sanford Health and North Memorial Health have made to make significant investments in facilities and people and maintain key services in Minnesota — and their willingness to be held accountable to those commitments in an oversight agreement for 10 years — are in the public interest. I am also gratified that during this period of damaging federal healthcare cuts, the agreement addresses the distress affecting the hospitals and clinics that serve rural Minnesota. While healthcare system mergers can all too often result in higher costs, fewer jobs, and less care, today’s agreement shows that Minnesota’s healthcare entity transactions law is a powerful tool for ensuring that major healthcare transactions in Minnesota serve Minnesotans’ interest.”

“I thank Sanford Health and North Memorial Health for working toward a positive resolution for Minnesotans. I thank the public and community coalitions for engaging in this process, raising their concerns, and lifting up the community benefits they want Minnesotans to enjoy. I thank the staff of my Office for working so diligently and so quickly to bring about this agreement. And I thank Minnesotans for speaking up and sharing their fears and hopes with us,” Attorney General Ellison added. “I am hopeful that this combined entity of Sanford and North Memorial will be a significant new force for public health and the public good in Minnesota’s unrivaled, world-class healthcare ecosystem.”

“We appreciate the Attorney General’s Office’s thoughtful engagement and thorough review of our partnership and the opportunity to hear from patients, employees, community leaders, healthcare stakeholders and elected officials across Minnesota,” said Bill Gassen, president and chief executive officer of Sanford Health.

“The commitments we’ve made reflect the needs and priorities of the communities we serve and reinforce the shared vision that brought our organizations together. 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. Together, we will build a future where every Minnesotan, no matter where they live, their social or economic status or their ability to pay, can count on timely access to high-quality, affordable care.”

“North Memorial Health has listened closely throughout this process to our patients, team members, physicians, and communities. What we heard was clear: protect the care people depend on, support the people who provide it, and make the investments needed to keep healthcare strong in Minnesota,” said Trevor Sawallish, chief executive officer of North Memorial Health. “These commitments give us a clear path forward. We can protect what matters most today while investing in Robbinsdale, expanding Maple Grove, and building a stronger future for the communities we are here to serve.”

Details of the oversight agreement 

In the memorandum of understanding that memorializes the 10-year oversight agreement announced today, Sanford Health and North Memorial Health agree to:

• Commit $500 million to North Memorial Health’s long-standing plan to expand the Maple Grove Hospital — where more children are born each year than any other hospital in Minnesota — and commit $100 million to Robbinsdale Hospital.
• Maintain core services at Robbinsdale Hospital and cancer center for a period of 10 years. Core services are defined as: Level 1 trauma center status and derivative required coverages and services, including emergency department, cardiac and cath lab services; labor and delivery; ICU services; stroke care; acute rehab services; and mental health services.
• Honor North Memorial Health’s existing collective-bargaining agreements; retain North Memorial Health employees in good standing and who meet Sanford’s standard hiring criteria; offer North Memorial Health employees health insurance benefit options that are comparable to those currently available; not include noncompete provisions in new employment agreements and not enforce any existing noncompete provisions.
• Not make material reductions to the service lines Sanford Health or North Memorial Health currently offer in Minnesota locations, including maintaining existing levels of air and ground emergency transportation service in Minnesota. North Memorial Health has operated the largest hospital-based air- and ground emergency transportation service in America.
• Maintain its commitment to charity care and government health programs: continue to participate in Medicare, Medicaid, and other government programs in which it currently participates; retain policies around the provision of charity care to disadvantaged, uninsured, and underserved populations; and continue funding all community-benefit and financial-assistance offerings that North Memorial Health currently supports.
• Maintain existing behavioral and mental-health care services and explore ways to expand those services in areas of Minnesota that lack access to them. 
• Not reduce the scope of existing reproductive healthcare and gender-affirming care services currently offered in Minnesota as of the closing date of the merger, to the extent consistent with applicable law and regulations, and make best efforts to maintain existing services.
• Hold quarterly meetings between Sanford Health leadership and the Attorney General to discuss integration, operations, and adherence to the terms of the oversight agreement, as well as submit annual reports to the Attorney General’s Office, both for a period of 10 years. The Attorney General will also meet annually with the Sanford Health Board of Trustees.

In a letter to Attorney General Ellison accompanying the memorandum of agreement, Sanford Health and North Memorial Health leaders further express their strong intention to:  

• Make an anchor contribution of $15 million total over three years to a new initiative that Attorney General Ellison will convene that is dedicated to supporting small and independent rural health care providers in Minnesota.
• Enhance safety-net and Level 1 trauma care in the metro area. This includes expanding Sanford’s model of integrating behavioral health care into primary care in its clinics to North Memorial Health’s primary care clinics, and requesting Attorney General Ellison facilitate discussions between Sanford Health and HCMC on their shared interest in the sustainability of Level 1 trauma and safety-net capacity in the metro area.
• Maintain a meaningful presence in Minnesota, including an office in the Twin Cities metropolitan area. The company will also commit to recruiting actively from Minnesota’s network of educational and professional institutions, and strengthening partnerships with Minnesota healthcare systems, non-profit organizations, and government agencies. 

Authority for and scope of Attorney General’s review 

The Minnesota Attorney General reviews healthcare transactions under Minn. Stat. § 145D.01, which authorizes the Attorney General to consider whether a healthcare transaction is in the public interest and seek court intervention if the Attorney General finds that it is not. The Attorney General also has authority over these matters as the primary regulator of Minnesota charities and nonprofits, as an enforcer of federal and state antitrust laws on behalf of the people and State of Minnesota.

The Attorney General’s review of the merger between Sanford and North Memorial Health began on May 1, 2026, when the Office received formal notice of the proposed merger as required by law. In the course of the review, Attorney General Ellison’s Office:

• Reviewed all materials the parties are required by law to provide, including supplemental information the Office sought after reviewing the parties’ initial submission.
• Received around 100 comments at public meetings in Robbinsdale that the Office hosted on June 8 and July 7.
• Reviewed requests from a coalition of labor unions, medical professionals, and community-based organizations for community benefits related to the proposed merger.
• Reviewed more than 300 written comments submitted to the Office about the proposed merger.
• Toured Robbinsdale and Maple Grove hospitals and North’s Ambulance Services Headquarters in Brooklyn Center.
• Interviewed dozens of third parties, including employers, insurers, unions, and agencies.

Should the Attorney General determine at any point that the merger of Sanford Health and North Memorial Health is no longer in the public interest, he has authority under the law to seek relief in district court.

Facts about the parties and the merged entity 

Sanford Health, the largest rural health system in the United States, is an integrated nonprofit with headquarters in Sioux Falls, South Dakota with approximately 55,000 employees. It serves more than 2 million patients a year and nearly 415,000 health plan members across the upper Midwest, including significant presence in Western Minnesota. Minnesota locations include Bemidji, Canby, Jackson, Luverne, Thief River Falls, Tracy, and Worthington.

North Memorial Health is a Minnesota nonprofit with two hospitals — Maple Grove Hospital and Robbinsdale Hospital— and more than 20 associated clinics. It employs more than 6,500 people and serves over 55,000 patients monthly. North Memorial Health operates the largest hospital-based air and ground emergency transportation system in the United States.

The merged entity of Sanford and North Memorial will be the first fully integrated provider of health care to both the Minneapolis–Saint Paul metro area and Greater Minnesota.

Individuals interested in providing comments to the Attorney General’s Office regarding Health Care Transactions can complete the Health Care Entity Transaction Community Input Form or call (651) 296-3353 (Metro area) or (800) 657-3787 (Greater Minnesota).