CIRCLE THE CITY - TOHONO OODHAM 2017.PDF

Last updated: 01/13/2017
Page 1
General information
Organization Circle the City
Contact First name Kimberly
Contact Last name O'Leary
Contact e-mail koleary@circlethecity.org
Contact phone number 602-357-4257
Address
Street 300 W. Clarendon Ave., Suite 200
City Phoenix
State AZ
ZIP Code 85013
From what tribe is the organization requesting the grant?
Tohono O’odham Nation
Total grant amount request
50000
1 of 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)

Form 1023 (Rev. 6-2006) Name: Circle the City EIN: 26 _ 2420730 Page 11
IimII3 Public Charity Status (Continued)
e 509(a)(4}-an organization organized and operated exclusively for testing for public safety. oo
f 509(a)(1) and 170(b)(1)(A)(iv)--an organization operated for the benefit of a college or university that is owned or
operated by a governmental unit.
g 509(a}(1} and 170(b}(1}(A)(vi}-an organization that receives a substantial part of its financial support in the form
of contributions from publicly supported organizations, from a govemmental unit, or from the general public.
h 509(a}(2}-an organization that normally receives not more than one-third of its financial support from gross o
investment income and receives more than one-third of its financial support from contributions, membership
fees, and gross receipts from activities related to its exempt functions (subject to certain exceptions).
A publicly supported organization, but unsure if it is described in 5g or 5h. The organization would like the IRS to o
decide the correct status. .
6 If you checked box g, h, or i in question 5 above, you must request either an advance or a definitive ruling by
selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive.
a Request for Advance Ruling: By checking this box and signing the consent, pursuant to section 6501(c)(4)of
the Code you request an advance ruling and agree to extend the statute of-limitations on the assessment-of-
excise tax under section 4940 of the Code. The tax will apply only if you do not establish public support status
at the end of the 5-year advance ruling period. The assessment period will be extended for the 5 advance ruling
years to 8 years, 4 months, and 15 days beyond the end of the first year. You have the right to refuse or limit
the extension to a mutually agreed-upon period of time or issue(s). Publication 1035, Extending the Tax
Assessment Period, provides a more detailed explanation of your rights and the consequences of the choices
you make. You may obtain Publication 1035 free of charge from the IRS web site at www.irs.govor by calling
toll-free 1-800-829-3676. Signing this consent will not deprive you of any appeal rights to which you would
otherwise be entitled. If you decide not to extend the statute of limitations, you are not eligible for an advance
ruling.
Consent Fixing Period of Limitations Upon Assessment of Tax Underc;Section4940 of the Intemal'RevenueCode
For Organization
~~~?:~r_.~_.·_~:.~.i.~~0_~_?~~!.j.~.~ ....7/3/c2
~'h:~~: ~ffi':~t' ~Di.~~~~..__ . .__ ...._...
Director, Trustee, or other (Date)
(Type or print title or authority of signer)
For IRS Use Only
SEP - 9 2008
IRS Director, Exempt Organizations (Date)
b Request for Definitive Ruling: Check this box if you have completed one tax year of at least 8 full months and 0
you are requesting a definitive ruling. To confirm your public support status, answer line 6b(i) if you checked box
g in line 5 above. Answer line 6b(ii) if you checked box h in line 5 above. If you checked box i in line 5 above,
answer both lines 6b(i) and (ii).
(i) (a) Enter 2% of line 8, column (e) on Part IX-A. Statement of Revenues and Expenses.
(b) Attach a list showing the name and amount contributed by each person, company, or organization whose 0
gifts totaled more than the 2% amount. If the answer is "None," check this box.
(ii) (a) For each year amounts are included on lines 1, 2, and 9 of Part IX-A. Statement of Revenues and
Expenses, attach a list showing the name of and amount received from each disqualified person. If the
answer is "None," check this box. 0
(b) For each year amounts are included on line 9 of Part IX-A. Statement of Revenues and Expenses, attach
a list showing the name of and amount received from each payer, other than a disqualified person, whose
payments were more than the larger of (1) 1% of line 10, Part IX-A. Statement of Revenues and
Expenses, or (2) $5,000. If the answer is "None," check this box. o
7 Did you receive any unusual grants during any of the years shown on Part IX-A. Statement of DYes 121 No
Revenues and Expenses? If "Yes," attach a fist including the name of the contributor, the date and
amount of the grant, a brief description of the grant, and explain why it is unusual.
Form 1023 (Rev.6-2006)

Circle the City
Tohono O’odham Nation Proposal
Proposal
a) Explain the perceived need and explain how the proposal will address that need.
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.
Circle the City is a rapidly growing non-profit community health organization dedicated
to creating and delivering innovative healthcare solutions that compassionately address the
needs of men, women, and children facing homelessness in Maricopa County. Incorporated
in 2008 by Sister Adele O’Sullivan, CSJ, MD, Circle the City offers a continuum of homeless
healthcare that is one-of-a-kind in the state and one of the only models of its type in the
nation. In 2012, Circle the City launched the state’s first and only medical respite center for
men and women experiencing homelessness while ill or injured. Always looking for
opportunities to fill critical gaps in the homeless healthcare system, in September 2015,
Circle the City opened The Parsons Family Health Center, a homeless-specialty primary care
facility that provides comprehensive medical care as well as on-site wrap-around services
including case management. Furthering its community outreach, Circle the City also
launched a two-room mobile medical clinic that visits parks, supportive housing complexes,
and other homeless community service agencies in order to provide healthcare to those
who cannot access the fixed primary care site. Collectively, Circle the City expects to serve
more than 4,000 individuals in FY2017. Ultimately, Circle the City is committed to ending
homelessness by providing high quality medical care and social services that give patients
the tools and resources to lead healthy, independent lives.
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 950 patients and has quickly become one of the nation’s leading models for
holistic, homeless-focused integrated healthcare. Approximately 30% of the patient

Circle the City
Tohono O’odham Nation Proposal
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, Circle the City expects to provide
more than $1.2 million in charitable care to these patients. 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.
Goals:
1. Provide more than 15,300 bed days of acute medical services and case management
to ill or injured homeless individuals. Of the approximately 340 total patients who will be
cared for, upwards of 125 are expected to be uninsured or under-insured;
2. Establish integrated, holistic plans of care for 100% of these uninsured or under-
insured patients;
3. Maintain the necessary engagement to ensure that at least 75% of these patients
successfully complete all goals established in their respective care plans;
4. Successfully connect at least 90% of these patients with relevant benefits or
entitlements, including nutritional assistance, health insurance, income, and housing;
5. Successfully transition at least 75% of these patients into living situations other than
the streets or emergency shelter system.
Activities:
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.
b) Describe the population who will benefit from the proposal if approved.
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.
c) Include a budget of the requested funds, with the total amount requested clearly
notated.
Circle the City is requesting $50,000. Please see attached Budget.
d) List any other funding requests that have been made for this or substantially related
proposals and provide the status of those requests.

Circle the City
Tohono O’odham Nation Proposal
Pending: Gila River Indian Community, $50,000; Fort McDowell Yavapai Nation,
$50,000; Ford Motor Company Fund, $25,000; Freeport McMoRan Copper & Gold,
$100,000; First Baptist Church of Phoenix, $20,000; The Max and Victoria Dreyfus
Foundation, $20,000; Ameriprise Financial, $20,000.
Awarded: APS, $10,000; Season for Sharing, $7,500; SRP, $5,000; Gila River Indian
Community, $25,000; Board of Visitors, $50,000; BHHS Legacy, $100,000; Kieckhefer
Foundation, $30,000; Margaret T. Morris Foundation, $15,000.
e) Indicate whether the entity has already received a 12% distribution from the Tohono
O’odham Nation or other Arizona tribes, along with the amount and date awarded.
Circle the City has not received a 12% distribution from the Tohono O’odham
Nation. We did receive a 12% distribution from the Gila River Indian Community for
$25,000 on September 19, 2016.
f) Designated Contact Person: Alternate Contact Person:
Kimberly O’Leary, Grants Specialist Brandon Clark, CEO
koleary@circlethecity.org bclark@circlethecity.org
602-357-4257 623-900-2203
300 W. Clarendon Ave., Suite 200 300 W. Clarendon Ave., Suite 200
Phoenix, AZ 85013 Phoenix, AZ 85013
FAX: 602-705-0567 FAX: 602-705-0567
g) Indicate which priority area the proposal falls under.
Health Care priority area.
h) If the proposal is from a non-profit organization, include the name of the city, town, or
county an agreement will be made with if funds are granted.
In the event that the funds are granted, Circle the City will enter into an agreement
with Maricopa County.

Project Budget
Budget Period: Nov. 17, 2017 to Nov. 16, 2018
For each budget item listed here please provide a narrative description on the following Project Budget Detail page.
Proposed Budget Expense Amount Amount In Kind Total Budget
(list each budget item) requested requested or contributions
from T.O.N. secured from
other funders
1. Salaries & Wages $25,904 $1,687,709 $0 $1,713,613
2. Consultants & Professional Fees $1,432 $80,724 $0 $82,156
3. Insurance & Benefits $5,870 $377,730 $0 $383,600
4. Supplies $3,179 $128,821 $0 $132,000
5. Direct Program Expenses $3,994 $124,406 $0 $128,400
6. Occupancy $9,621 $631,779 $31,199 $672,599
7. Professional Services & Admin. $0 $206,600 $0 $206,600
8. Click here to enter text. $0 $0 $0 $0
9. Click here to enter text. $0 $0 $0 $0
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 $3,237,769 $31,199 $3,318,968
Budget Narrative
1. Salaries & Wages ($25,904 grant; $1,713,613 total) includes salaries for medical staff, behavioral health staff, case
managers, and other program direct staff.
2. Consultants & Professional Fees ($1,432 grant; $82,156 total) includes payment for services provided by contract labor,
including physical therapists and contract physicians.
3. Insurance and Benefits ($5,870 grant; $383,600 total) includes benefits for program staff.
4. Supplies ($3,179 grant; $132,000 total) includes medical supplies, linen and laundry, etc.
5. Direct Program Expenses ($3,994 grant; $128,400 total) includes patient dental services, food & beverage,
transportation, vision care, shoes & clothing, etc.
6. Occupancy Expenses ($9,621 grant; $672,599 total) include telephone, internet, IT & maintenance, property & building
maintenance, kitchen equipment, medical equipment, utilities, etc.
7. Professional Services & Admin ($0 grant; $206,600 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.

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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