The proposed merger between Sioux Falls, S.D.-based Sanford Health and Minneapolis-based Fairview Health Services has been controversial in Minnesota. As the combination is reviewed by Keith Ellison, the state's attorney general, the House has passed a bill that could shake things up. 

Sacramento, Calif.-based Sutter Health and Sansum Clinic, one of the oldest outpatient providers in the state, have signed a nonbinding letter of intent to enter into a strategic partnership.

Peoria, Ill.-based OSF HealthCare is making moves to purchase St. Margaret's Hospital, which shuttered in January, WCBU reported May 5. 

Alamogordo, N.M.-based Gerald Champion Regional Medical Center has signed a nonbinding letter of intent to join Irving, Texas-based Christus Health. 

Little Rock, Ark.-based Baptist Health has picked up five more urgent care centers in Arkansas, arkadelphian.com reported May 4. 

Here are 15 major hospital and healthcare merger and acquisition-related transactions from April:

Liberty (Mo.) Hospital's leadership team and board are reaching out to a group of more than 30 local, regional and national health systems to explore partnership opportunities for growth.

Franklin, Tenn.-based CHS, which reported a net loss of $20 million in the first quarter on revenues of $3.1 billion, is on the hunt for new acquisitions just as it is also in discussions to sell off more assets.

Marietta, Ga.-based Wellstar Health System and Augusta (Ga.) University Health System have finalized their merger agreement, The Augusta Chronicle reported May 2. 

Oklahoma City-based Integris Health will take over as operator of Woodward (Okla.) Hospital after AllianceHealth's lease expires Nov. 30.

Nashville, Tenn.-based Ardent Health has swapped one private investor for another.

The Hermann (Mo.) Area District Hospital board of directors voted unanimously to approve a management agreement with St. Louis-based Mercy Health System, emissourian.com reported May 1.

Academic Medical Centers (AMCs) are facing unique challenges and opportunities in the current environment. With healthcare systems becoming more complex and dynamic, AMCs are adapting their strategies to preserve their inherent strengths and capitalize on evolving industry dynamics. One of the main challenges facing AMCs is the shortage of physicians, which is predicted to become more acute in the coming years. At the same time, revenue from higher-margin care is eroding as new businesses are capturing market share. As AMCs play an outsized role in solving labor shortages, they have also been forced to adapt to the financial pressures. Here we examine some of the major financial and strategic opportunities available to AMCs.

CommonSpirit completed its acquisition of Steward Health Care's sites of care in Utah, which will be managed by Centennial, Colo.-based Centura Health. 

Brentwood, Tenn.-based Quorum Health is selling Waukegan, Ill.-based Vista Medical Center East to American Healthcare Systems, the Lake County News-Sun reported April 28. 

West Virginia may gain a larger academic health system through the combination of Huntington-based Mountain Health Network, Marshall Health and Marshall University, which have signed a letter of intent to combine. 

UCSF Health and Chinese Hospital, both based in San Francisco, have signed a new agreement to build upon a three-year partnership between the two parties that resulted in a new primary stroke center at Chinese Hospital..

Yale New Haven (Conn.) Health made its case to the state's certificate-of-need committee on why the system should take over Waterbury (Conn.) Hospital, Manchester (Conn.) Memorial Hospital and Vernon, Conn.-based Rockville General Hospital, Hartford Business Journal reported March 26.

Oakland, Calif.-based Kaiser Permanente has agreed to acquire Geisinger Health in a deal that will make the Danville, Pa.-based health system the first to join Risant Health, a new nonprofit organization created by the Kaiser Foundation Hospitals.

Lawmakers are reviving efforts to give the Federal Trade Commission authority to investigate nonprofit hospitals for anticompetitive behavior.