Two huge hospital operators with a significant stake in long-term care could combine to create the largest U.S. hospital owner.

Nonprofits Ascension and Providence St. Joseph Health were talking about combining, reported the Wall Street Journal in early December.

A deal would create an unprecedented 191 hospitals in 27 states with annual revenue of $44.8 billion.

Ascension Living is the second-largest nonprofit senior living system, with 10,000 residents in 11 states. Providence St. Joseph has eight affiliated eldercare brands.