When Charlie Martin’s hospital company Vanguard Health Systems sells to former competitor Tenet Healthcare for $4.3 billion, the deal marks the second time in six years the Dallas-based Tenet pays billions for one of Martin’s companies.

The combined company becomes the second-largest for-profit U.S. hospital operator, still behind HCA but surpassing Community Health Systems. Notably, the deal with Vanguard comes two years after Tenet CEO Trevor Fetter fends off a hostile takeover effort from CHS.

Martin goes on to form a new venture fund focused on health care innovation.