On July 1, 2006, the Medical University of Ohio officially merged with the University of Toledo and became the third largest public institution of higher education in the state of Ohio. The combination of the two neighboring institutions occurred through the efforts of a number of individuals who recognized the potential advantages of a merger and worked quickly through challenges by early engagement of stakeholders in the merger process. The advantages of a larger, more diverse institution with increased budget and research funding outweighed the challenges of bringing two different cultures together. Changing the culture and leadership was necessary to allow the process to move forward. In addition, statewide political support was mobilized to carry forward the legislative actions that permitted the formation of the new institution. The transformation of a free standing medical campus to a part of a larger university required a fusion of the existing boards of trustees, a new organizational structure and a unified strategic plan, all of which occurred in the first 12 months after the merger. The college of medicine of the former Medical University of Ohio has been strengthened by the merger process, and the new University of Toledo has emerged as a much more diverse and complete institution.