Sanford Health and North Memorial Health Transaction Frequently Asked Questions (FAQs)

• Who are the parties?

  Sanford Health is a nonprofit health system headquartered in Sioux Falls, South Dakota, with approximately 55,000 employees. It serves over 2 million patients and nearly 415,000 health plan members across the upper Midwest. Minnesota locations include Bemidji, Canby, Jackson, Luverne, Thief River Falls, and Worthington.

  North Memorial Health is a Minnesota nonprofit with two hospitals, North Maple Grove and North Robbinsdale, and over 20 associated clinics. It employs more than 6,500 people and serves over 55,000 patients monthly.

• What is the transaction?

  On May 8, 2026, Sanford Health and North Memorial Health announced they had signed an affiliation agreement for North Memorial Health to join Sanford Health. Under the terms of the transaction, North Memorial Health will remain a corporate entity but become a subsidiary of Sanford Health. Sanford Health will become the sole corporate member of North Memorial Health.

• Why did the Attorney General review this transaction?

  Minnesota law requires the Attorney General’s Office (AGO) to review certain health care transactions under Minn. Stat. § 145D.01. The AGO also enforces nonprofit laws and state and federal antitrust laws. The AGO reviewed the transaction to ensure compliance with these laws and to protect Minnesota communities, patients, employees, charitable assets, and the public interest.

• Has the Attorney General approved the transaction?

  No. The AGO does not “approve” health care transactions. Instead, after its investigation, the AGO entered into a 10-year oversight agreement with Sanford Health and North Memorial Health detailed in a Memorandum of Understanding (MOU). The AGO agreed not to take legal action at this time so long as Sanford and North Memorial continue to comply with the MOU designed to protect Minnesota patients, providers, and communities. The AGO retains full authority to take action if the parties fail to meet their obligations or if the transaction violates state or federal law.

• How long will the oversight agreement remain in effect?

  The terms of the agreement remain in effect for 10 years.

• Will patients continue to receive care regardless of ability to pay?

  Yes. Under the MOU, Sanford Health will maintain and, where possible, enhance North Memorial Health’s charity care policies. This includes:

  • Continued care for disadvantaged, uninsured, underinsured, and underserved populations and populations enrolled in public health programs; and
  • Implementing presumptive eligibility for financial assistance and reasonable payment plans.

  The organization must report annually on charity care levels and explain any reductions of 10% or more.

• Will patients enrolled in Medicare or Medicaid still be able to receive care at North Memorial Health?

  Yes, Sanford Health will maintain participation in Medicare, Medicaid and any other means-tested government health care programs at North Memorial Health.

• Are community benefit programs protected?

  Yes. Sanford Health must maintain or enhance all community benefit programs in place on the closing date. If any category of community benefit decreases by 10% or more, the organization must report the reduction to the AGO and explain the change.

• Will donations to the North Memorial Health Foundation or other donations or gifts to North Memorial Health remain committed to North Memorial Health?

  Yes. The Affiliation Agreement and the MOU both include commitments to maintain and use the charitable assets of each respective organization in accordance with the terms, conditions, restrictions and charitable intent of the original gifts. This includes supporting the mission of each applicable organization within which a charitable gift originated.

• What commitments exist for medical education and training?

  Sanford Health will:

  • Maintain all existing medical education and residency programs;
  • Continue participation in statewide medical training collaborations;
  • Support the University of Minnesota’s Masonic Cancer Center’s NCI designation;
  • Participate in the Metro Minnesota Council on Graduate Medical Education (MMCGME); and
  • Explore opportunities to expand health professions training.

• What investments has Sanford Health committed to making?

  Sanford Health will invest $600M in North Memorial Health over the next 10 years. Specifically, $100M for maintenance, infrastructure and technology upgrades, modernization, equipment, and Emergency Medical Services support for Robbinsdale Hospital with $25M being invested within the next three years. $500M to expand Maple Grove Hospital, home to the highest volume Family Birth Center in the state, delivering 5,000+ babies a year, with construction beginning no later than Q1 2027.

  Sanford will report annually on how these investments are being made until the full commitment is complete.

• Will Level 1 Trauma and other core services remain in Robbinsdale?

  Yes. Sanford Health will:

  • Maintain Level I trauma center status and core services including emergency department, cardiac and cath lab services, labor and delivery, ICU services, stroke care, acute rehab services, and mental health services; and
  • Maintain current oncology services at North Memorial Cancer Center Robbinsdale.

  These protections last at least 10 years.

• Will behavioral and mental health services provided by North Memorial Health be preserved?

  Yes. Sanford Health will maintain and, when possible, enhance behavioral and mental health services at all Minnesota locations. Any reduction of more than 10% at any location must be reported with an explanation and documentation of efforts to avoid the reduction.

• Will service lines be reduced by Sanford Health in Minnesota after the acquisition?

  Sanford Health will not materially reduce (more than 10%) any service lines currently offered at Minnesota locations without explanation. If any change triggers mandatory notice under Minn. Stat. § 144.555, Sanford must notify both the Minnesota Department of Health and the AGO at the same time and include an explanation for the change.

• Sanford Health and North Memorial Health both have broad operations of air and ground ambulance and emergency transport services across Minnesota. Will the combination of these two entities impact access to these services?

  Sanford Health will:

  • Maintain all existing North Memorial Health Air Care and Sanford AirMed bases serving Minnesota;
  • Maintain coverage areas, aircraft, and crew levels;
  • Notify the AGO of any planned base closure, relocation, or downgrade;
  • Continue serving non Sanford hospitals on non discriminatory terms; and
  • Maintain or increase in network participation with pre transaction payers.

  These commitments apply statewide.

• What protections are there for employees that currently work for North Memorial Health?

  Sanford Health will maintain North Memorial Health’s existing collective bargaining agreements and report any National Labor Relations Board findings of unfair labor practices at Minnesota locations.

  All employees in good standing who meet Sanford’s standard hiring criteria will retain their employment on the closing date. Their employment terms will not become materially less favorable than those in place immediately before closing.

  Sanford Health will provide North Memorial Health employees with health insurance options comparable to those offered at closing and may transition employees over time to Sanford’s standard benefit plans.

• Will the combined entity have noncompete clauses in employment contracts?

  No. Sanford Health may not enter into new employment agreements with noncompete clauses under Minn. Stat. § 181.988. Sanford also commits to not enforcing any noncompete clauses after the transaction closes.

• Will reproductive health and gender-affirming care remain available?

  Sanford Health will maintain the scope of reproductive and gender affirming care available at Minnesota locations as of the closing date, to the extent permitted by law. Any reduction must be reported with an explanation and documentation of best efforts to preserve services.

• How are medical staff privileges protected?

  Sanford Health will:

  • Apply medical staff bylaws and privilege policies consistently;
  • Provide annual copies of medical staff bylaws, privilege policies, referral policies, and operating room scheduling policies; and
  • Confirm consistent application across all providers regardless of employment status.
• What non-discrimination commitments has Sanford Health made?

  Sanford Health will:

  • Annually provide its non discrimination policies
  • Report on compliance with state and federal non discrimination laws
  • Address equity and inclusion efforts, including respect for tribal rights and practices

  These obligations are subject to annual review by the AGO.

• What accountability and oversight will there be on the 10-year oversight agreement?

  Sanford Health executive leaders, including the CEO when possible, will meet quarterly with the Attorney General. The Attorney General will meet annually with the Sanford Board of Trustees.

  Sanford Health will submit an Annual Compliance Report to the AGO for the duration of the 10-year oversight period. The reports will provide data and details about how Sanford is meeting its commitments. Within 30 days of submitting an Annual Compliance Report, Sanford Health will work with the AGO to issue a public version of the report.

• The mission of the Attorney General's Office is 'to help people afford their lives and live with dignity, safety and respect.' How does the agreement between the Attorney General's Office and Sanford Health and North Memorial Health further this mission?

  Sanford Health is providing investment and ongoing operational funding and support to North Memorial Health. Without this funding and support, North could not make needed investments or ensure the continued operation of the Robbinsdale campus over time. Through this transaction as modified by the oversight agreement, Robbinsdale Hospitals’s level 1 trauma center and required coverages and services (e.g., emergency department and ICU services) will continue for at least the next ten years.

  Sanford Health has committed to retain and enhance the policies for and the provision of care to the disadvantaged, underinsured populations and underserved populations, and populations enrolled in public health programs. Sanford Health has committed to continue participating in all existing public health care programs and to continue or enhance access to charity care and community benefit initiatives.

  In addition to protecting patients, the oversight agreement protects care providers and workers. Sanford has pledged to honor existing union agreements and committed to employ all North Memorial Health employees in good standing at the time of closing.

  The combination of Sanford Health and North Memorial Health establishes the first extensive integrated urban-rural health care delivery system in Minnesota given Sanford's extensive set of hospital and clinics in western Minnesota and the addition of the Robbinsdale and Maple Grove campuses. This can provide a new platform for innovation and extended service delivery for rural Minnesotans. Sanford is providing an anchor investment of $15M to further this vision of rural health care working with other systems.

  In addition to the commitments secured in the oversight agreement, Sanford Health and North Memorial Health have made additional pledges to the Attorney General and to the people of Minnesota. Sanford will work with Hennepin Country Medical Center to further the sustainability and excellence of the Level 1 trauma services they each provide.

  Sanford Health will maintain and enhance behavioral health care services at all Minnesota locations and explore ways it can expand or restore services where inadequacies exist. Sanford will conduct integration planning and community outreach and engagement to expand the integrated behavioral health and primary care model it deploys in other areas to the Minneapolis metro area.

  Sanford Health will work with the University of Minnesota on medical education, training and the high-quality cancer research and patient care enabled by the University's designation as one of the select National Cancer Institute cancer centers in the United States.

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