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

The Wall Street Journal reports the non-profits Ascension and Providence St. Joseph Health are talking about combining, according to people familiar with the discussions.

A deal would create a new operation of unprecedented reach, with 191 hospitals in 27 states and annual revenue of $44.8 billion, based on the most recent fiscal year. That would dethrone the nation’s largest pure hospital operator, HCA Healthcare Inc., which owns 177 hospitals and ended 2016 with $41.5 billion in revenue.

Ascension Living already ranks as the nation’s second largest non-profit senior living system, with some 10,000 residents in 11 states. Providence St. Joseph provides a range of senior living and skilled nursing facilities across its eight affiliated brands, including 90 non-acute services and 12 supportive housing units.

Some sources told the Wall Street Journal that a merger is far from certain and that talks “have included a variety of arrangements short of a merger.”