Sanford Health has established itself as one of the dominant players in North Dakota’s skilled nursing facility sector, according to the latest Centers for Medicare & Medicaid Services (CMS) data. The non-profit healthcare system shares the top position with The Evangelical Lutheran Good Samaritan Society (which it merged with more than five years ago), with each organization operating 10 skilled nursing facilities in the state.
Extensive Regional Footprint
The healthcare giant’s presence extends well beyond North Dakota. Sanford operates a total of 106 skilled nursing facilities across 15 states, with its strongest presence in Minnesota (24 facilities), Iowa (15), Nebraska (14), and South Dakota (13). This extensive network is complemented by 34 critical access hospitals, 32 rural health clinics, 26 home health agencies, 11 hospitals, and 10 hospice locations.
In North Dakota specifically, Sanford’s portfolio includes 10 skilled nursing facilities, 6 rural health clinics, 4 hospitals, 4 critical access hospitals, 3 home health agencies, and 2 hospice locations. This diversified presence positions the organization as a comprehensive healthcare provider in the state.
Ownership/Corporate Structure
Analysis of CMS data reveals that Sanford maintains full ownership (100%) of 191 of its 216 total facilities across all states. Sanford is led by President and CEO Bill Gassen, who oversees an executive team that includes Chief Financial Officer Nick Olson, Chief Operating Officer Matt Hocks, and Chief Strategy Officer Nathan Peterson. Following its January 2025 merger with Marshfield Clinic Health System, Sanford now employs nearly 56,000 people across its network.
North Dakota Skilled Nursing Environment
The skilled nursing sector in North Dakota faces significant challenges, including workforce shortages and reimbursement pressures. As of January 2025, the average nursing facility Medicaid rate in the state is $401.74 per day, with approximately 54% of licensed nursing facility beds funded through Medicaid.
North Dakota’s payment system for skilled nursing facilities has evolved from a cost-based system to a pricing model, with rate rebasing occurring every two years. This changing reimbursement landscape, combined with staffing challenges and regulatory requirements like the new minimum staffing rule, creates both obstacles and opportunities for operators like Sanford.
Investment Implications
Sanford’s strong position in the North Dakota market represents both the benefits of scale and the challenges of operating in a complex regulatory environment. The organization’s integrated approach—combining skilled nursing with acute care, rural health clinics, and home health—offers potential advantages in care coordination and referral networks.
