SIOUX FALLS, SD-As Sanford Health continues to grow rapidly from its roots in Sioux Falls, the health system is not holding back whatsoever on new construction projects.

Haven't heard of Sanford yet? You will. After starting from one hospital in Sioux Falls in 2004, the health system is now the country's largest rural, not-for-profit provider, with locations in 126 communities throughout eight states, most of which are in North and South Dakota, Minnesota and other the Midwest states. Credit card mogul T. Denny Sanford has fueled the growth with nearly $700 million in gifts, and the system now boasts 35 medical centers and 140 clinics.

Sanford does not look to be stopping the growth anytime soon, as it currently has two hospital projects, several outpatient clinics and a sports complex under way. The largest of its projects is the future $500 million Sanford Fargo Medical Center in Fargo, ND According to Sanford, the one-million-square-foot campus opening in 2016 will be a “world-class medical facility equipped with the best technology and the brightest medical experts in the country.”

Another $60 million hospital is under construction in Thief River Falls, MN, as is a $13-million, 49,000-square-foot clinic in Moorhead, MN. The latter will be the first facility on what will eventually be a 28-acre campus.

Perhaps the most interesting endeavor for the health system is its building of the Sanford Sports Complex in Sioux Falls. At a 162-acre site, Sanford is building a variety of indoor and outdoor athletic fields. The soon-to-be-finished Sanford Pentagon, a 160,000-square-foot facility that includes an NBA/college sized basketball court, indoor training facilities and equipment for a variety of sports, will anchor the complex. Included will be offices and areas for Sanford's trainers and doctors involved with its athletic training, physical therapy and sports medicine outreach programs, among others.

What's been most curious about Sanford's growth is that it has yet to penetrate the largest market in the Dakotas and Minnesota: The Twin Cities of Minneapolis and St. Paul.

In recent months, it looked as if Sanford might actually make a leap into the Twin Cities, as officials acknowledged they had been in “preliminary” merger discussions with one of the region's largest providers, Fairview Health Services. But those talks fell through after criticism from several high-ranking Minnesota officials including the attorney general.

In announcing that the merger talks had ended, Sanford's CEO Kelby Krabbenhoft stated that the system has a philosophical policy of “only going where we are invited.”

Even so, many observers believe that Sanford seeks to eventually become a prestigious national player like the Mayo Clinic, the Cleveland Clinic and Johns Hopkins. If that is the case, it might be only a matter of time before it expands into major metro areas, including the Twin Cities.

Murray W. Wolf is Publisher and Founder of Healthcare Real Estate Insights™, the nation's first and only publication totally dedicated to covering news and trends in healthcare real estate development, financing and investment. For more information, please visit www.HREInsights.com.