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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, Suite 200 City Phoenix State AZ ZIP Code 85013 From what tribe is the organization requesting the grant? Fort McDowell Yavapai 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) Circle the City Fort McDowell Yavapai Nation 2017 Arizona Benefits Fund Grant Application Applicant Info: Name and contact information for government entity/organization applying for grant funds. Melody Henderson 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 Melody Henderson, Maricopa County Government Relations_ ______________________________ Typed Name/Title Signature Circle the City Fort McDowell Yavapai Nation 2017 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 990 patients and has quickly become one of the nation’s leading models for holistic, homeless-focused integrated healthcare. 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 FY2017, 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 2017 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 340 patients in FY2017. 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: July 1, 2017 to June 30, 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 Ft. McD. 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 Project Budget Detail Please provide a narrative description for each of the project budget items listed on the previous page. Include the dollar figure and how it was derived. 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. Following major legislative changes in 2014, CTC's business strategy shifted to a revenue model that leverages the resources of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid administration. During the past year, CTC has secured contracts with eight Medicaid managed care organizations, resulting in a projected incremental revenue of nearly $4 million across all programs for FY2017. The Medical Respite Center, in particular, has now achieved a new level of independent stability in which roughly 75% of its operating expenses are financed by operating income. In CTC’s new earned income-centric environment, the organization effectively matches every dollar granted or donated to CTC with an additional $2-$3 of health services revenue, ensuring that each philanthropic dollar is leveraged as fully as possible. Additionally, CTC holds three annual fundraisers: a spring Garden Tea Party; a Community Breakfast in April; and a fall Top Golf event, with proceeds from all three events benefitting patient programs. try 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