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Sanford Health and Marshfield Clinic are moving on from failed mergers with Minnesota health systems and announced Wednesday plans to combine their operations by year's end.

The tentative deal comes nearly a year after South Dakota-based Sanford Health and Minneapolis-based Fairview Health Services withdrew plans for a megamerger.

Duluth-based Essentia Health, meanwhile, announced in January that it was pulling out of a deal to merge with Wisconsin-based Marshfield, citing the clinic's financial challenges.

Under the agreement announced Wednesday, the newly combined system would be based at Sanford's headquarters in Sioux Falls.

It would employ nearly 56,000 people across 56 hospitals, more than 250 clinics and two health plans, with operations spanning the Upper Midwest.

"We are excited to combine our common purpose to lead the way for the future, drive innovation and solve the most pressing challenges facing rural health care," said Bill Gassen, president and CEO of Sanford Health, in a statement.

Last July, Sanford Health and Fairview announced they were halting merger plans following opposition from the University of Minnesota.

Earlier this year, the U and Fairview announced plans for the university to acquire from the health system its teaching hospital in Minneapolis. In 1997, Fairview acquired University of Minnesota Medical Center in a financial bailout.

Sanford Health currently operates a number of hospitals and clinics in western Minnesota in addition to locations in the Dakotas and Iowa. Marshfield runs dozens of clinics and hospitals in northern and western Wisconsin and in Michigan's Upper Peninsula.