Three months after the transaction was first announced, St. Louis-based Ascension Health and Chicago’s Presence Health have signed a definitive agreement for Presence to join Ascension’s existing joint venture in Illinois, AMITA Health.

All facilities operated by Presence, the largest Catholic health system in Illinois, would join AMITA, with the exception of senior care facility Presence Life Connections in Mokena, Illinois, which would be absorbed into Ascension’s senior care subsidiary.

“Joining Ascension and AMITA Health is a natural evolution for Presence Health given our shared mission, vision and values to provide quality, faith-based care,” Presence president and CEO Michael Englehart said in a statement. “We will continue to deliver quality care for our patients and residents, as well as provide additional clinical opportunities and patient care resources to all our physicians and associates.”

Presence holds approximately 10 percent of the Chicago hospital market, though it has struggled financially over the past several years. It posted a $186 million operating loss in 2015, leading to layoffs of 250 employees. It then posted another $40 million loss in 2016, only getting back into the black with an operating gain of $12.4 million in the first quarter of 2017. It had already announced the sale of two hospitals farther away from Chicago, signing a letter of intent earlier in August to sell Presence Covenant Medical Center in Urbana, Illinois, and Presence United Samaritans Medical Center in Danville, Illinois, to OSF Healthcare.

Ascension, by contrast, has seen increases in its operating income and has been seeking other expansion opportunities. Already the largest integrated health system in the U.S. by number of facilities, it has reportedly been in merger talks with Renton, Washington-based Providence St. Joseph Health.

Both Ascension and Presence expect the transaction to be completed soon.

“Both our systems are dedicated to providing compassionate and personalized care for all, with special attention to persons living in poverty and those most vulnerable,” said Ascension president and CEO Anthony Tersigni, EdD. “We believe that by coming together, we will strengthen Catholic healthcare as we provide affordable, accessible and quality care to the community.”