MEDICAL-RESPITE-CARE-FOR-THE-HOMELESS-IN-MARICOPA-COUNTY.PDF

Last updated: 03/09/2018
General information
Organization Circle the City
Contact First name Kimberly
Contact Last name O'Leary
Contact e-mail koleary@circlethecity.org
Contact phone number 6023574257
Address
Street 300 W. Clarendon Ave., Suite 200
City Phoenix
State AZ
ZIP Code 85013
From what tribe is the Fort McDowell Yavapai Nation
organization requesting the
grant?
Total grant amount request 50,000.00
1 / 1

INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
P. O. BOX 2508
CINCINNATI, OH 45201
Employer Identification Number:
Date: SEP -9 Z006 26-2420730
DLN:
17053191342048
CIRCLE THE CITY Contact Person:
C/O ADELE OSULLIVAN NANCY L HEAGNEY ID# 31306
220 S 12TH AVE Contact Telephone Number:
PHOENIX, AZ 85007 (877) 829-5500
Accounting Period Ending:
June 30
Public Charity Status:
l70(b) (1) (M (vi)
Form 990 Required:
Yes
Effective Date of Exemption:
March 6, 2008
Contribution Deductibility:
Yes
Advance Ruling Ending Date:
June 30, 2012
Addendum Applies:
No
Dear Applicant:
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c) (3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
regarding your exempt status, you should keep it in your permanent records.
Organizations exempt under section 50l(c) (3) of the Code are further classified
as either public charities or private foundations. During your advance ruling
period, you will be treated as a public charity. Your advance ruling period
begins with the effective date of your exemption and ends with advance ruling
ending date shown 'in the heading of the letter.
Shortly before the end of your advance ruling period, we will send you Form
8734, Support Schedule for Advance Ruling Period. You will have 90 days after
the end of your advance ruling period to return the completed form. We will
then notify you, in writing, about your public charity status.
Please see enclosed Publication 4221-PC, Compliance Guide for SOl(c) (3) Public
Charities, for some helpful information about your responsibilities as an
exempt organization,
Letter 1045 (DO/CG)

-2-
CIRCLE THE CITY
Sincerely,
Robert Choi
Director, Exempt Organizations
Rulings and Agreements
Enclosures: Publication 4221-PC
Statute Extension
Letter 1045 (DO/CG)

Circle the City
Fort McDowell Yavapai Nation
2018 Arizona Benefits Fund Grant Application
Applicant Info: Name and contact information for government entity/organization applying for grant
funds.
Steve Chucri Circle the City
Maricopa County Government Relations Brandon Clark, CEO
301 W. Jefferson, 10th Floor 300 W. Clarendon Ave., Suite 200
Phoenix, AZ 85003 Phoenix, AZ 85013
602-506-2798 602-776-9000
Primary Contact: Name, address, e-mail and telephone numbers for the primary point of contact.
Kimberly O’Leary, Grants Specialist
300 W. Clarendon Ave., Suite 200
Phoenix, AZ 85013
koleary@circlethecity.org
602-357-4257
Acknowledgement of Submission by Authorized Municipality Representative
Zachary Wolfe, Finance Department_ ______________________________
Typed Name/Title Signature

Circle the City
Fort McDowell Yavapai Nation
2018 Arizona Benefits Fund Grant Application
Narrative: A narrative of no more than two (2) pages describing the following:
1. The proposed program or project, and whether or not it is a new or continuing project.
Before the Medical Respite Center opened in 2012, Phoenix was the largest metropolitan area in the
country without a medical respite facility for men and women experiencing homelessness. Hospitals
provided temporary medical care for the most acutely ill and injured but there was no post-discharge
option for patients to receive recuperative care. As a result, patients were discharged back to the streets
or emergency shelters where—without a clean bed, access to medication, oversight from a physician,
and assistance from a caregiver—recovery was difficult, if not impossible. Many patients suffered
complications and, often via expensive 911 calls, returned to hospitals and emergency rooms again and
again, over utilizing an already overburdened system and costing local taxpayers untold millions of
dollars. Since launching four years ago, the 50-bed, 24/7 Medical Respite Center has cared for more than
1,400 patients and has quickly become one of the nation’s leading models for holistic, homeless-focused
integrated healthcare. Due to the fact that there has been an ongoing waiting list for the respite center,
Circle the City is opening a second 50-bed respite center in April 2018 on the Human Services Campus.
Approximately 30% of the patient population is either uninsured or under-insured but, at Circle the City,
no patient is ever turned away because of an inability to pay. In FY2018/19, Circle the City expects to
provide more than $1.2 million in charitable care to these patients. Each patient interacts daily with
compassionate doctors and nurses and receives wrap-around services on-site including psychiatric
evaluation, physical therapy, and substance abuse intervention. Patients also meet regularly with case
managers to apply for identification and other documents, benefits, and housing to ensure that they are
successfully discharged to living environments other than the streets or emergency shelter system.
Additionally, more than 150 volunteers lead activities and events for patients including art classes,
bingo, crafts sessions, and tutoring. These activities are an important component in reintegrating
patients back into the community from which homelessness has isolated them. The medical respite care
program is a continuing project that began in October 2012.
2. The purpose of the program or project and how it meets one or more of Fort McDowell’s funding
priorities (i.e., education, public safety, health, environment, and economic and community
development).
This request meets Fort McDowell’s Health priority area, specifically direct patient care. Homelessness
has devastating effects on a person’s health. In one study, the prevalence rate of chronic medical illness
in the homeless was one-half of the surveyed population compared with less than one-quarter of the
housed population (Donovan et al., 2007). Because of a lack of income, insurance, or transportation,
these health conditions are left untreated and are complicated by high incidences of mental health and
substance abuse disorders. As a result, people experiencing homelessness are some of the most
frequent and costly users of healthcare services. They visit emergency departments 9 to 12 times more
than people who are housed, have higher rates of hospitalization, and stay longer per admission (S.W.
Hwang et al., 2011). But medical respite care has proven to be a cost-effective and safe stabilization
point for men and women to land after long and complex periods of hospitalization or for individuals
living in homelessness whose complicated illnesses or injuries have begun to spiral out of control. For
the average cost of one day of hospitalization--$2,194—Circle the City provides each patient with more
than 10 days of holistic, physician-supervised medical respite care in a safe and clean environment.
3. The need that the program or project aims to fulfill, the population targeted, and the estimated number
of people who will be served by the grant.
Before the Medical Respite Center opened in 2012, Phoenix was the largest metropolitan area in the
country without a medical respite facility for men and women experiencing homelessness. Hospitals

Circle the City
Fort McDowell Yavapai Nation
2018 Arizona Benefits Fund Grant Application
provided temporary medical care for the most acutely ill and injured but there was no post-discharge
option for patients to receive recuperative care. As a result, patients were discharged back to the streets
or emergency shelters where—without a clean bed, access to medication, oversight from a physician,
and assistance from a caregiver—recovery was difficult, if not impossible. Many patients suffered
complications and, often via expensive 911 calls, returned to hospitals and emergency rooms again and
again, over-utilizing an already overburdened system and costing local taxpayers untold millions of
dollars. Men and women experiencing homelessness while ill or injured are the Medical Respite Center’s
target population. Approximately 42% of Circle the City’s patients are age 55 and older. This data aligns
directly with a national phenomenon called “The Aging of the Homeless,” which was discussed in the
October 2014 issue of The Lancet medical journal. The median age of the homeless population in the
United States has risen to nearly 50 years of age. Individuals between the ages of 50-61 have
experienced homelessness at higher rates throughout their lives than previous generations did. This is
creating a more intensive medical need for the care of chronic disease, geriatric conditions, frailty, and
end-of-life issues. Circle the City has positioned itself to meet the needs of this particularly vulnerable
and growing population. Circle the City expects to care for at least 800 patients in FY2018/19.
4. The partners in the program or project, and other entities providing funding and support (please
indicate whether the organization will be submitting applications to any other tribes).
Circle the City collaborates with numerous community partners to provide an array of services for all its
patients, including those who are uninsured and under-insured. Four major hospital systems (Abrazo
Community Health Network, Banner Health, Dignity Health, and Honor Health) maintain referral
contracts with Circle the City and send patients experiencing homelessness to the Medical Respite
Center for recuperative care to heal from serious illnesses and injuries. While these hospital contracts
pay for a portion of patient stays, Circle the City must use charitable care monies to fund the balance for
patients from hospitals or community settings who are uninsured or under-insured. Another important
partner is Hospice of the Valley, which owns Circle the City’s building and exchanges reduced rent for
end-of-life care for homeless hospice patients. Collaborating with additional local agencies is a critical
means for meeting patients’ social service needs, including post-discharge housing. These partners
include Native American Connections, Arizona Housing Inc., and Ozanam Manor. Circle the City also has
academic affiliations with medical and nursing schools that rotate students into the Medical Respite
Center to learn about homeless-specific medical care. Participating schools include A.T. Still University
(first- and second-year medical students); Creighton University (fourth-year medical elective course);
Mayo School of Graduate Medical Education (resident education in neurology and internal medicine);
and Midwestern University (resident education in podiatry). Finally, employee groups from corporations
such as Willis of Arizona and Intel provide volunteers for various projects and conduct company-wide
collections of items needed by patients. Circle the City is applying for additional state shared revenues
from the Gila River Indian Community for this project, and from the Tohono O'odham Nation for a
separate project.
5. The timetable for implementation of the program or project.
Medical respite care is an ongoing patient care program and, as such, the timeline is flexible with
patients being admitted and discharged on a continual basis. Please see the attachment for an example
of a timeline of one patient’s Medical Respite Center stay.

Project Budget
Budget Period: Oct. 2018 – Sept. 2019
Proposed Budget Expense Amount Amount In Kind Total Budget
(list each budget item) requested from requested or contributions
GRIC secured from
other funders
1. Wages & Benefits $31,774 $4,018,986 $0 $4,050,760
2. Contract Labor $1,432 $222,023 $0 $223,455
3. Program Supplies $2,080 $164,420 $0 $166,500
4. Other Direct Program Expenses $1,994 $246,246 $0 $248,240
5. Occupancy $9,621 $962,999 $0 $972,620
6. Professional Services $3,099 $300,341 $0 $303,440
7. In-Kind Income & Expense $0 $0 $20,805 $20,805
8. Administrative Allocation $0 $446,000 $0 $446,000
9. Depreciation & Amortization $0 $300,980 $0 $300,980
10. Click here to enter text. $0 $0 $0 $0
11. Click here to enter text. $0 $0 $0 $0
12. Click here to enter text. $0 $0 $0 $0
13. Click here to enter text. $0 $0 $0 $0
14. Click here to enter text. $0 $0 $0 $0
15. Click here to enter text. $0 $0 $0 $0
16. Click here to enter text. $0 $0 $0 $0
17. Click here to enter text. $0 $0 $0 $0
Total Budget $50,000 $6,661,995 $20,805 $6,732,800
Project Budget Detail
1. Wages & Benefits ($25,904 for wages, $5,870 for benefits = $31,774 grant; $4,050,760 total) includes wages and
benefits for medical staff, behavioral health staff, case managers, and other program direct staff.
2. Contract Labor ($1,432 grant; $223,455 total) includes payment for services provided by contract labor, including
physical therapists and contract physicians.
3. Program Supplies ($2,080 grant; $166,500 total) includes medical supplies, linen and laundry, etc.
4. Other Direct Program Expenses ($1,994 grant; $248,240 total) includes patient dental services, food & beverage,
transportation, vision care, shoes & clothing, etc.
5. Occupancy Expenses ($9,621 grant; $972,620 total) include telephone, internet, IT & maintenance, property &
building maintenance, kitchen equipment, medical equipment, utilities, etc.
6. Professional Services ($3,099 grant; $303,440 total) includes administrative direct charges and allocation.


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Circle the City (CTC) provides medical
care and social support that allows patients
to rest, heal, and eventually pursue healthy,
healing independent living.
here
#healingthecity
Prior to 2012, homeless individuals experiencing Our Facility
major illness or injury faced the nearly impossible 50 beds: 40 beds for
challenge of recovering on the streets. Hospitals men; 8 beds for
women; 2 private rooms
provided temporary relief for the most acutely ill, but
were inevitably left with no option but to discharge On-site clinic with
two exam rooms for
homeless individuals back to the street or emergency 24/7 medical and
shelters. Without a clean bed, access to medication, nursing consultation
physician oversight, and assistance from a Two dining
caregiver, recovery was virtually impossible. Patients rooms serving three
frequently had no choice but to return to hospitals and meals per day
emergency rooms, often via expensive 911 calls. Living room with a
Tragically, some even died on the street. television, games,
library, and
computer stations
Circle the City Provides: Dedicated physical
therapy space, speech
• A clean bed in a dignified environment of care. and occupational
• Round-the-clock medical and nursing services. therapy services
as needed
• Behavioral health supports including psychiatry,
Interfaith chapel
counseling, and substance abuse services.
• Case management services including assistance
with housing placement.
• An array of volunteer-led activities including
AA meetings, art classes, recreation offerings,
and pet therapy.

try
97% of patients who complete their
stays at CTC are connected with a primary care
physician before discharge.
healing
82% of patients who complete their stays at
CTC are discharged to a setting other than
the street or emergency shelter.
here
CTC Partners Led by founder Sister Adele O’Sullivan, CSJ, M.D.,
Dignity Health CTC’s robust medical team includes primary care
Banner Health providers, a psychiatrist, physical therapists, behavioral
Scottsdale Healthcare health specialists, and a team of nurses dedicated to
Mayo Clinic meeting the needs of each patient admitted to the
Arizona Cardinals Medical Respite Center. Additionally, our team of case
Phoenix Symphony managers and volunteer patient advocates work to
Arizona Diamondbacks connect our patients with healthcare, income, housing,
and many others. and other benefits after discharge.
CTC is made possible by innovative contracts with
local hospital systems and the generosity of the
surrounding community. We are deeply grateful for
this support and collaboration.
CTC is an Arizona Qualifying Charitable Organization.
As such, monetary gifts to CTC are eligible for Arizona’s charitable
tax credit. Please also consider leaving a gift to Circle the City
in your will or trust.
a time and place to heal Medical Respite Center info@circlethecity.org
333 W. Indian School Road www.circlethecity.org
Circle the City
Phoenix, AZ 85013 phone 602.776.9000