Hospital deals can take a while, and even then, they might not reach the finish line, whether due to regulatory pushback, disagreement over merger terms, or even accusations of misconduct. It’s one of the reasons you might not see a Hospital announcement in our LevinPro HC database; we wait until merger talks are settled and the deal is complete. But we still track Letter of Intent (LOI) announcements, the first step in a Hospital merger. Here is a roundup of some recent ones that are on our radar.
CommonSpirit Health and University of Pittsburgh Medical Center
CommonSpirit Health and the University of Pittsburgh Medical Center (UPMC) have signed a non-binding LOI that could result in Trinity Health System (the Steubenville, Ohio one), a subsidiary of CommonSpirit, joining UPMC. If this deal closes, the merger would give UPMC Trinity’s three hospitals: Trinity Center West, a 200-bed acute care hospital, Twin City Medical Center, a 25-bed critical access hospital and a microhospital in St. Clairsville, Ohio. UPMC would also gain a handful of outpatient care sites in the Ohio market.
Trinity Health System was originally part of Catholic Health Initiatives, which merged with Dignity Health in 2017 to form what is now CommonSpirit Health. It appears that CommonSpirit Health has been focusing on downsizing its network and portfolio over the past few years. In 2022, Trinity Health (yes, a different Trinity Health based in Michigan), acquired CommonSpirit’s stake in MercyOne in a $613 million deal.
UPMC is a substantial health system in its own right, owning more than 40 hospitals with 8,500 licensed beds. According to UPMC’s website, the organization generated more than $30 billion in operating revenue in 2024 and holds more than $23 billion in assets.
According to the release announcing the LOI, leaders from Trinity Health System and UPMC hope to complete the affiliation as soon as possible, but no specific timeline was provided.
Garnet Health to Join Montefiore Health System
In New York state, Garnet Health and Montefiore Health System are currently working on a merger agreement, under which Garnet will merge with Montefiore. Both systems have a significant presence in the New York City MSA, and this deal would create a 13-hospital system in the area, potentially making it one of the most extensive systems based on hospital count, trailing only behind systems like Northwell Health.
Garnet Health has three hospitals with more than 550 licensed beds and a myriad of outpatient services and facilities. Although Garnet Health hasn’t published any financial results publicly since early 2024, it appears that 2025 has been a challenging year for the system. In June, the health system announced a restructuring that impacted 42 employees, subsequently shuttering two outpatient services. Several executives also departed the company.
“Without question, the healthcare climate continues to be challenging, with no immediate signs of reprieve,” said Jonathan Schiller, President & CEO of Garnet Health, in the release. “And due to shrinking federal reimbursements, as well as additional anticipated federal cuts to the Medicaid program, we are faced once again with very difficult decisions.”
Montefiore Health System is an academic health system that operates 10 hospitals and more than 200 outpatient sites.
Outside of this merger agreement, neither system has been active in the M&A market for most of the decade.
Virtua Health and ChristianaCare
Virtua Health and ChristianaCare have signed a non-binding LOI to explore the co-founding of a regional not-for-profit health system. The combined system would provide care across more than 10 contiguous counties in New Jersey, Delaware, Pennsylvania, and Maryland, with over 600 sites of care and nearly 30,000 employees.
Marlton, N.J.-based Virtua Health is a not-for-profit, academic health system with five hospitals totalling nearly 1,500 beds. ChristianaCare is based in Delaware, with three hospitals and a diverse network of outpatient care clinics. The latter has been active in the M&A market recently; in May, ChristinaCare paid $50.3 million in an auction to acquire five outpatient clinics from Prospect Medical Holdings, which is undergoing Bankruptcy proceedings.
There were no specifics on the name or governing structure of the new organization.
