Good Samaritan remains the largest non-profit provider of nursing home care in the United States.

The Sioux Falls, South Dakota-based organization ranks as the largest nonprofit multi-site senior living organization by number of nursing care beds in the annual LZ 200 report, released Wednesday. The report is compiled by specialty investment bank Ziegler and nonprofit provider association LeadingAge.

Good Samaritan’s portfolio encompassed 7,098 nursing care beds as of Dec. 31, 2024, according to the report. That put Good Samaritan well ahead of the second-largest provider, Ascension Living, which operated 3,689 nursing care beds.

The 10 largest nonprofit multi-site providers ranked by number of nursing care beds are:

• Good Samaritan (7,257 beds)
• Ascension Living (3,689 beds)
• Benedictine (2,089 beds)
• The Carmelite System (2,003 beds)
• Trinity Health Senior Communities (1,938 beds)
• ArchCare (1,723 beds)
• ACTS Retirement Life Communities and affiliates (1,663 beds)
• Presbyterian Homes & Services (1,448 beds)
• Cassia (1,386 beds)
• Otterbein SeniorLife (1,338 beds)

The list is similar to the 2024 rankings. Presbyterian Homes & Services joined the top 10 after coming in at No. 11 last year. Benedictine and The Carmelite System swapped spots year-over-year, as did Cassia and Otterbein SeniorLife.

Further down the rankings, more significant changes occurred. The combination of Eventide and Tabitha created the 18th-largest nonprofit provider of nursing home care; previously, Eventide had ranked No. 40 and Tabitha held the No. 95 spot.

Volunteers of America was another notable mover. The organization was ranked No. 16 on last year’s LZ 200 in terms of number of nursing care beds but fell to No. 27 in this edition, with 744 nursing care beds.

Good Samaritan perennially has held the top spot on the list, even as the organization has shed more than 1,000 nursing care beds since the start of 2023. That has occurred in part due to a strategic decision to exit 15 states and consolidate the portfolio in stronghold markets. At the end of 2022, Good Samaritan operated 8,423 nursing care beds, according to a past edition of the LZ 200.

Good Samaritan is not alone in reducing its nursing home portfolio. Many nonprofit providers are shifting away from nursing care while expanding in other areas.

“In the last 10 years, the average annual growth rate in total units is 2.3%, with independent living and assisted living growth each year, but decline in the number of nursing care beds,” the latest LZ 200 report states.

A notable feature of Good Samaritan is that 70% of the 10,000 older adults served by the provider reside in rural areas. CEO Nate Schema has been outspoken about the challenges facing rural providers and the need for public policies that support continued access to care, including in nursing homes. He is focused at the moment on advocating for sustainable Medicaid rates, particularly in light of funding cuts enacted as part of the One Big Beautiful Bill Act (OBBBA).

“Now is the time for state and rural health care leaders to come together — with urgency and focus — to strengthen sustainable access to care,” Schema recently told SNN.