Providers registered in any registration category must use this form to notify the Commission of a significant change in circumstance relating to their organisation arrangements.

Providers registered in any registration category must also use this form to notify the Commission of any change in circumstances relating to their governance arrangements. Providers are not required to notify the Commission of any change in circumstances relating to their governance arrangements if they are:

  • a government entity or local government authority
  • exempt from governing body membership requirements to have a majority of independent non-executive members, and at least one member with experience in providing clinical care.

The guidance for this smart form does not cover questions, such as those relating to identification or contact details, which are self-explanatory.

Consider if this change to your organisation structure or governance arrangements affects your responsible persons and associated providers.

If there are changes to responsible persons and associated providers, you need to also complete the other relevant forms.

If you are a provider operating through a trust, the Commission must be notified if you no longer hold the ABN related to the trust, because you are no longer the trustee of that trust.

The Commission would like to be notified in advance if you are planning to no longer be the trustee of the trust, as this has flow on effects for the registration of the incoming trustee as a provider. 

Section 2: Change details

These questions are about requirements detailed in section 167(3)(d) of the Aged Care Act 2024

Questions 2.2 and 2.3

  • Detail the reason and circumstances for the change, including any internal or external factors

  • Detail the impact of this change on your delivery of care and services

  • Your change may relate to an insolvency event, which may involve:

    • a CGT event G3 in respect of your shares or financial instrument

    • the making of an order that you will be wound up in insolvency

    • the passing of a special resolution that you will be wound up voluntarily

    • the passing of a resolution by your creditors that you will be wound up

    • the making of a sequestration order against your estate

    • the acceptance of a debtor’s petition against you by an Official Receiver

    • the making of an insolvency event declaration in relation to you

  • New organisational chart

  • New Executive Membership structure

  • Documentation of ASIC registration of Directors

  • New governance structure or composition

  • Meeting minutes for board meetings 

  • Related policies and procedures

  • Any other documents to support your response

Section 4: Agreement with another entity

These questions are about requirements detailed in sections 11(6) and 167(3)(d) of the Aged Care Act 2024

Questions 4.2.7, 4.3.4, 4.3.6, 4.3.8 and 4.3.9

  • Outline what services the new entity will be providing, to support your management or governance function (e.g. clinical support, financial advice) 

  • Detail the reason and circumstances for the change, including any internal or external factors

  • Detail the impact of this change on your delivery of care and services

  • New organisational structure

  • New Executive Membership structure

  • New governance structure or composition 

  • Related policies and procedures

  • Any other documents to support your response

Section 5: Compliance with the membership of governing body condition of registration

These questions are about requirements detailed in sections 157 and 167(3)(d) of the Aged Care Act 2024

Questions 5.3 and 5.4

  • Detail the reason and circumstances for the change, including any internal or external factors

  • List each incoming and outgoing member, and the impact of this change on the organisational structure 

  • Outline the steps that you are going to take as a registered provider, to ensure ongoing compliance with the governing body membership requirements outlined in section 157 of the Aged Care Act 2024

  • For question 5.4, ‘obligations’ refers to all key obligations that a registered provider must comply with, including conditions on their registration. For further information, see section 103 of the Aged Care Act 2024

  • If you are no longer in compliance with the governing body membership requirements outlined in section 157 of the Aged Care Act 2024, please apply for a Governing Body Determination. For further information, please see the Determinations webpage

  • New organisational structure

  • New Executive Membership structure

  • New governance structure or composition

  • Documentation of ASIC registration of Directors

  • Related policies and procedures, including internal and external reporting obligations 

  • Any other documents to support your response

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Acknowledgement of Country

In the spirit of reconciliation, the Aged Care Quality and Safety Commission acknowledges the Traditional Custodians of Country throughout Australia and their connections to land, water and community. We pay our respect to their Elders, past, present and emerging and extend that respect to all Aboriginal and Torres Strait Islander peoples. 

Aboriginal and Torres Strait Islander readers are advised that content on this website may contain images of deceased persons.