September 15, 2026 Chicago, IL — LeadingAge, the association of nonprofit and mission-driven providers of aging services, and Ziegler, the nation’s leading underwriters of financings for not-for-profit senior living providers, today release the 23rd Annual LeadingAge Ziegler (LZ 200) report.
The 2026 LZ 200 report, developed annually through a partnership between LeadingAge and Ziegler, is a ranking and analysis of the nation’s 200 largest not-for-profit senior living organizations across the country as of December 31, 2025. This year’s report represents more than 300,000 market-rate units and nearly 1,650 market-rate communities across the country. It also outlines relevant business trends in the industry to showcase the variety of older adult services and offerings provided in this sector.
Consistent with the last several years, the 2026 LZ 200 listing shows that not-for-profit senior living providers have grown primarily through community expansions from existing campuses as well as affiliation and acquisition activity. Nearly 30 percent of the total number of units for all senior living systems in the LZ 200 are represented by the 10 largest providers.
The 10 largest not-for-profit multi-site senior living organizations include:
- National Senior Communities – Washington, DC
- The Evangelical Lutheran Good Samaritan Society – Sioux Falls, SD
- Presbyterian Homes and Services – Roseville, MN
- Acts Retirement-Life Communities, Inc. – Fort Washington, PA
- Ascension Living – St. Louis, MO
- HumanGood – Pleasanton, CA
- Covenant Living Communities & Services – Skokie, IL
- Trinity Health Senior Communities – Livonia, MI
- Benedictine – Duluth, MN
- Lifespace Communities – Dallas, TX
The LZ 200 also showed that in the last 10 years, the average annual growth rate in total units since 2015 is 2.7 percent, with independent living and assisted living units growing each year but declining in the number of nursing care beds.
“This rich report contains valuable insights into current trends – and also provides an intriguing glimpse into how senior living will grow in the future,” said Katie Smith Sloan, president and CEO of LeadingAge. “As innovators, problem-solvers and standard-bearers in serving older adults and families, our nonprofit and mission-driven members truly shape the sector. LeadingAge is proud to share the 2026 LZ 200.”
“This LZ 200 report is a critical annual report that captures the behaviors and characteristics of the country’s largest not-for-profit senior living organizations in the country,” stated Dan Hermann, President & Chief Executive Officer and Head of Investment Banking at Ziegler. “Readers are also able to gain insights into the fastest growing and most progressive organizations nationally, regionally and in their respective states. This information helps to pave a path forward for overall sector growth among not-for-profit providers.”
The LZ 200 report, developed annually through the LeadingAge/Ziegler partnership, includes more than 200 providers of multi-site systems, more than 200 single-site campuses, and of the largest 200 multi-site providers offering government-subsidized affordable housing. Previously known as the LZ 100 and LZ 150, the report was expanded in 2014 from LZ 100 to the LZ 150 and to the LZ 200 in 2018 in response to the growing industry and increasing interest.
