The independent hospital is becoming increasingly rare.
Squeezed by thin or negative operating margins, rising labor and drug costs, and mounting payer denials, standalone community hospitals and small nonprofit systems are increasingly determining they can no longer go it alone.
The result is a steady shift from independence to scale. Over the past year, dozens of independent hospitals and health systems have joined, or agreed to join, larger regional and academic health systems, from 25-bed critical access hospitals in New Hampshire and North Carolina to multihospital systems in Minnesota and Oregon.
Here are 49 independent hospitals — that are either standalone facilities or part of a health system — that have joined or plan to join a larger health system, listed by the most recent development.
Editor’s note: This list covers independent hospitals and independent systems joining a larger health system. It excludes divestitures between systems (for example, hospitals changing hands between larger health systems.
1-2. Beaver, Pa.-based Heritage Valley Health System joined Pittsburgh-based Allegheny Health Network — a subsidiary of Highmark Health — effective July 1. Heritage Valley’s two hospitals, Heritage Valley Beaver and Heritage Valley Sewickley, will be rebranded to AHN Beaver Hospital-Heritage Valley and AHN Sewickley Hospital-Heritage Valley.
3. Flemington, N.J.-based Hunterdon Health signed a June 22 letter of intent to be acquired by Edison, N.J.-based Hackensack Meridian Health. The independent system includes its flagship, Hunterdon Medical Center, and a network of more than 30 medical practices across central New Jersey. Hackensack Meridian operates 18 hospitals, more than 500 care sites and 40,000 employees.
4. Jacksonville, N.C.-based Onslow Memorial Hospital, 162-bed facility , will affiliate with Chapel Hill, N.C.-based UNC Health under an agreement the Onslow County Board of Commissioners approved June 15. UNC Health gained a 30% membership interest and an expanded operational role effective July 1, with a second phase raising its stake to 49% and a third phase in 2029 making the 16-hospital system the sole member.
5-9. Greensburg, Pa.-based Independence Health System, which includes five hospitals, signed a definitive agreement in June to be acquired by Morgantown, W.Va.-based WVU Health System. The deal is projected to close this fall and would grow WVU Health’s footprint to 30 hospitals, expanding its presence in Pennsylvania from one hospital to six.
10-11. Little Rock, Ark.-based Baptist Health acquired South Arkansas Regional Hospital in El Dorado in June. Baptist Health separately signed a definitive agreement in April to acquire Magnolia Regional Medical Center, a deal expected to close July 12.
12. Goshen (Ind.) Health on June 3 signed a formal affiliation agreement with Fort Wayne, Ind.-based Parkview Health, a 15-hospital system. Goshen Health includes a 105-bed hospital, a cancer center, a heart and vascular center, a physician group and 40 care locations.
13. Community Hospital of Stokes, a 53-bed critical access hospital in Danbury, N.C., was acquired by Winston-Salem, N.C.-based Novant Health, effective June 1. The deal increased Novant’s hospital footprint to 20.
14-16. Raleigh, N.C.-based WakeMed Health & Hospitals, plans to combine with Charlotte, N.C.-based Atrium Health, part of Advocate Health. WakeMed comprises a 973-bed network of facilities, including three full-service hospitals. It would come under Atrium Health in a transaction subject to regulatory review expected to take several months.
17. Anniston, Ala.-based RMC Health System —which includes a 375-bed medical center, about 200 physicians and nearly 2,000 employees — plans to be acquired by Orlando (Fla.) Health. The transaction is expected to close this fall, with RMC joining Orlando Health’s Alabama Region alongside Baptist Health.
18-19. North Memorial Health, a two-hospital system in Robbinsdale, Minn., signed a definitive agreement in May to combine with Sioux Falls, S.D.-based Sanford Health, a 58-hospital nonprofit. North Memorial Health would anchor a new care-delivery region for Sanford Health in the Twin Cities.
12-23. Minneapolis-based Allina Health, a 12-hospital system, signed a definitive agreement in May to combine with Sacramento, Calif.-based Sutter Health, creating a nonprofit spanning California, Minnesota and Wisconsin. The proposed $26 billion organization would include 39 hospitals, more than 400 care sites and 88,000 employees, with a close expected by the end of 2026, pending regulatory approval.
24. Viroqua, Wis.-based Vernon Health — a nonprofit independent system that operates a hospital, four clinics and three retail pharmacies — is exploring a potential affiliation with La Crosse, Wis.-based Emplify Health. Emplify has 11 hospitals, more than 100 clinics and 15,000 employees.
25-27. Brooklyn, N.Y.-based Maimonides Health, a three-hospital system, plans to join NYC Health + Hospitals, New York City’s public system. Under the proposed deal, Maimonides would receive up to $2.2 billion over five years through a state grant announced in October, and NYC Health + Hospitals would become a 14-hospital system.
28-32. Corvallis, Ore.-based Samaritan Health Services, a five-hospital system, plans to merge with Tacoma, Wash.-based MultiCare Health System, creating an 18-hospital system with more than 33,000 employees. The transaction is expected to close in mid-2026, bringing Samaritan under the MultiCare umbrella.
33. Titus Regional Medical Center in Mount Pleasant, Texas, was acquired by Irving, Texas-based Christus Health, effective May 1. The 174-bed hospital was renamed Christus Health-Mount Pleasant Hospital. The board voted in February to proceed with the sale of the independent hospital, part of Christus Health’s broader expansion in the area.
34. Sheridan (Wyo.) Memorial Hospital, an 88-bed facility, plans to affiliate with Billings (Mont.) Clinic after the Sheridan County Board of County Commissioners unanimously approved an agreement in March. Billings Clinic is an independent system formed through a merger with Kalispell, Mont.-based Logan Health and encompasses 25 hospitals, including 16 regional partnerships.
35. Arkansas Methodist Medical Center joined Memphis, Tenn.-based Baptist Memorial Health Care on Feb. 28, becoming Baptist’s 25th hospital and third in Arkansas. Arkansas Methodist included a 191-bed hospital, a 91-bed assisted living facility, eight medical clinics and more than 500 employees.
36-38. Central Maine Healthcare, a three-hospital system headquartered in Lewiston, joined Ontario, Calif.-based Prime Healthcare in February. The transaction included Central Maine Medical Center, Bridgton Hospital, Rumford Hospital, a cancer center, a college of health professions and more than 40 physician practices.
39. Englewood (N.J.) Health signed a definitive agreement in January to be acquired by West Orange, N.J.-based RWJBarnabas Health. RWJBarnabas would invest about $500 million in Englewood Health to support expanded outpatient services, community health programs and other strategic investments.
40. Freeport, Ill.-based FHN, a 100-bed hospital, was acquired by Rockford, Ill.-based Mercyhealth, effective Jan. 1. Mercyhealth now operates seven hospitals in Illinois and Wisconsin.
41. Estes Park (Colo.) Health, a critical access hospital, was acquired by Aurora, Colo.-based UCHealth in December. The hospital was rebranded toUCHealth Estes Valley Medical Center and grew UCHealth’s hospital footprint to 15.
42. DeSoto Memorial Hospital, a 49-bed rural hospital in Arcadia, Fla., agreed to have Tampa (Fla.) General Hospital assume its operations, in a deal the DeSoto Memorial board approved Nov. 10. Tampa General committed to invest at least $45 million in the hospital under a 49-year lease set at $10 per year, with an option to buy.
43-45. Garnet Health, a three hospital system in Middletown, N.Y., signed a letter of intent in October to join New York City-based Montefiore Health System through a strategic affiliation. Montefiore operates 10 hospitals and more than 200 outpatient sites.
46-47. Littleton (N.H.) Regional Healthcare, a 25-bed critical access hospital, signed a letter of intent Sept. 12 to become a member of Lebanon, N.H.-based Dartmouth Health. Dartmouth previously added Claremont, N.H.-based Valley Regional Hospital, another 25-bed facility, to its network.
48. Georgetown, S.C.-based Tidelands Health is moving toward having Charleston, S.C.-based MUSC Health acquire a majority membership interest, deepening integration of services, technology and clinical expertise. The proposed deal cleared several regulatory hurdles, including approvals from the Joint Bond Review Committee, the State Fiscal Accountability Authority and both systems’ boards.
49. York (Maine) Hospital, a 79-bed facility, plans to join Portland, Maine-based MaineHealth, a nine-hospital system. In addition to its main hospital campus, York Hospital also has 10 community sites throughout Southern Maine and New Hampshire.
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