Two Catholic health systems, Maryland-based Bon Secours and Cincinnati’s Mercy Health have announced plans to merge into a 43-hospital system stretching across seven states in the eastern half of the U.S.

According to a joint press release, the merger would create the fifth-largest Catholic health system in the country, with a combined $8 billion in net operating revenue, $293 million in operating income and 2,100 employed physicians and advanced practice clinicians.

“As consumers grapple with the implications of Health Care Reform in a dynamic marketplace, Mercy Health and Bon Secours share a vision to improve the health of the communities we serve as the low-cost, high-value provider,” Mercy president and CEO John Starcher Jr. said in a statement. “Working together, our strong faith-based heritage fuels our mutual focus to provide efficient and effective healthcare for each patient who comes through our doors.”

Along with the 43 hospitals, the combined system would include more than 50 home health agencies, hospice agencies, skilled nursing and assisted living facilities. Those sites of care are located in Maryland, Virginia, South Carolina, Kentucky, Florida New York and Ohio.

The only in-state overlap between Mercy and Bon Secours can be found in Kentucky. Mercy operates three primary care clinics and one hospital, Marcum & Wallace Memorial, in rural areas southeast of Lexington. Its facilities are about a two-hour drive away from the Bon Secours-owned Our Lady of Bellefonte Hospital, a 214-bed acute care hospital in Ashland, Kentucky.

The two systems haven’t finalized a definitive merger agreement and the deal will require regulatory approval. Executives at both companies expect the transaction to be completed by the end of 2018.

“The mission, vision, values and geographic service areas of Bon Secours and Mercy Health are remarkably well-aligned and highly complementary,” said Bon Secours president and CEO Richard J. Statuto. “This merger strengthens our shared commitment to improve population health, eliminate health disparities, build strength to address social determinants of health, and invest heavily in innovating our approaches to healthcare.”