SIOUX FALLS, S.D. (KELO) — Sanford Health is working to create a new health system with Fairview Health Services out of the twin cities.

This isn’t the first time Sanford has made plans to merge with another organization. The process usually takes several months and it doesn’t always end with a deal.

At the end of June in 2018, two of South Dakota’s largest employers signed an agreement to merge — Sanford Health and the Good Samaritan Society. Together, they would create a six billion dollar company with 50,000 employees.

“We’re going to be stronger together on very practical purposes, economic purposes, financial reasons,” Krabbenhoft said.

The plan was to grow across the country with a new model to serve people of all ages.

“We will need all those people and more as we grow this mission opportunity and this vision we collectively share,” Horazdovsky said.

Six months after agreeing to merge, it was finalized at the beginning of 2019.

“We thought we would both be stronger together by combining what each organization does respectively,” Good Samaritan Society CEO David Horazdovsky said.

“No one else has put together a long-term care organization of that magnitude together with a hospital-based system of this magnitude in the country before,” Krabbenhoft said.

Serving thousands, if not millions, of people nationwide.

“It’s going to provoke us to think bigger and think more opportunistically,” Krabbenhoft said.

“Knowing what we do is going to be extremely important in the future,” Horazdovsky said.

In addition to the Good Samaritan Society, Sanford has merged with two North Dakota health systems.