The Evangelical Lutheran Good Samaritan Society has finalized its merger with Sanford Health, creating a combined organization that now reaches 26 states.

The entities announced Wednesday that they finalized their long-running affiliation process, which first started in late 2017. All told, the Sioux Falls, SD, combined entity will employ nearly 50,000 workers at 44 hospitals and more than 200 senior care facilities.

“We know that bringing these two organizations under one umbrella has many benefits for those we serve,” Kelby Krabbenhoft, Sanford Health president and CEO, said in a statement. “Being on the forefront of the changing healthcare landscape made this historic opportunity a reality.”

Good Sam CEO David Horazdovsky will remain as CEO of the Society, and is joining Sanford’s corporate leadership team. Members of the Society’s “overwhelmingly” voted in favor of the deal in June, and it cleared regulatory review in the fall. Leaders will now turn an eye toward improving care for seniors across their continuum of services.

“With the affiliation complete, leaders can begin the exciting work of exchanging knowledge and developing ideas to better serve our patients and residents,” Krabbenhoft said in the announcement. “Bringing the expertise together will create a national model on how to deliver exceptional care through the full spectrum of life.”