Founded in 1897 as a 12-bed hospital and training school in Springfield, Illinois, Memorial Health System (MHS) today serves communities throughout central Illinois with five affiliated hospitals, ambulatory care services, and behavioral health programs. The system includes Memorial Medical Center in Springfield, Abraham Lincoln Memorial Hospital in Lincoln, Taylorville Memorial Hospital in Taylorville, Passavant Area Hospital in Jacksonville, Decatur Memorial Hospital in Decatur, and the Memorial Physician Services, Memorial Home Services, and Memorial Behavioral Health network across central Illinois. The evolution of MHS from a system in name only-lacking full integration of organizational functions-to its current status as an optimized health system has been marked by challenges, from the initial doubts of employees and the community to the upheaval caused by the COVID-19 pandemic. Systemness requires visionary and sure-handed leadership to identify and realize economies of scale, share best practices for operational improvements, and reduce unwanted variation to improve quality of care. As the MHS story illustrates, that all starts, grows, and endures with strategic planning.