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MARRIOTTSVILLE, Md. (AP) — Bon Secours Health System has announced plans to merge with Cincinnati-based Mercy Health to create the fifth-largest Catholic health system in the country.

If approved, the merged company would serve patients across seven states, including Maryland, Virginia, Ohio, Kentucky, New York, South Carolina and Florida.

Executives at Mercy Health and Bon Secours, based in Maryland, said Wednesday that they expect to complete the merger by the end of the year.

The Richmond-Times Dispatch reports that it is unclear how the merger would impact Bon Secours’ operations in Virginia, where it has four hospitals in the Richmond area and three in Hampton Roads.

Bon Secours owns, manages or has joint ventures in 20 hospitals.

Mercy Health is the largest health system in Ohio, with 23 hospitals and 26 post-acute care facilities.