The imperatives of health care economics encourages Catholic health care ministry leaders to consider new collaborations. Such business arrangements are being made by lay leaders, many of whom do not come from the Catholic tradition. The issues associated with merging entities when one represents Catholic health care include due diligence regarding business, economic, legal, ecclesial, mission, personnel, tradition, heritage and community needs. The most successful integrations occur when the process flows from and is informed by the heritage, mission and charism of the Catholic entity. When this is done well, the ministry answers community need, responds to the signs of the time and is rooted in tradition.