With the increase in health system Mergers and Acquisitions (MandA’s) since the Affordable Care Act [Brown TC, Werling KA, Walker BC, et al. Current trends in hospital mergers and acquisitions. Healthc Financ Manage. March, 2012], health systems must carefully weigh and measure the current organizational culture prior to the consummation of the merger, seeking to understand differentiation within and between the merging organizations, and requires that the organization be analyzed by employee levels or tiers. This study seeks to understand the organizational culture of two merging partners before the merger is consummated, identifying levels of differentiation among employee tiers. Cultural domination from an acquiring organization is also considered. The cultures are analyzed utilizing the Competing Values Framework (CVF). The population included all employees of both health systems with the survey respondent sample stratified by the following employee types: (Tier 1), entry-level employee; (Tier 2), supervisory level, and, (Tier 3), executive level. Statistical procedures included independent t tests and indicated a statistically significant difference between the current cultures of the health systems prior to the merger with significant differences in the cultural perceptions of Tier 1 employees and Tier 2 employees.