FORM 1023-EZ for BRIDGING THE GAP BEHAVIORAL HEALTHSERVICES

Field	Data
EIN	83-2042005
Case Number	EO-2019161-000182
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	BRIDGING THE GAP BEHAVIORAL HEALTHSERVICES
Organization’s Mailing Address	1325 MURPHY LANE
City	WINSTON-SALEM
State	NC
ZIP	27104
Accounting period End	12
Primary contact name	GEVONNA GRAVES-WORNEY
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00

Officer/Director/Trustee One

GEVONNA GRAVES-WORNEY
CHIEF EXECUTIVE OFFICER
1325 MURPHY LANE
WINSTON-SALEM NC 27104

Officer/Director/Trustee Two

JOHN WORNEY
CHAIRPERSON
1325 MURPHY LANE
WINSTON-SALEM NC 27104

Officer/Director/Trustee Three

ARCOLA LEWIS
TREASURER
1325 MURPHY LANE
WINSTON-SALEM NC 27104

Officer/Director/Trustee Four

LEIGH WARE
SECRETARY
1325 MURPHY LANE
WINSTON-SALEM NC 27104

Organization’s website
Organization’s email
Organization Incorporated	Yes
Organization trust	No
Necessary Organizing Documents	Yes
Organization Incorporation Date	9/5/18
Organization Incorporation State	NC
Contains Limitation	Yes
Does not expressly empower	Yes
Contains dissolution	Yes
National Taxonomy of Exempt Entities (NTEE) code	F21 - Alcohol, Drug Abuse, Prevention Only
Organization’s purpose	Charitable: Yes Religious: No Educational: Yes Scientific: No Literary: No Public Safety: No Amateur Sports: No Cruelty Prevention: Yes
Qualify For Exemption	No
Legislation influence	No
Compensation of Officer director trustee	No
Donation of funds	No
Conducting Activities Outside of United States	No
Financial transactions with officers	No
Unrelated Gross Income $1,000 or More	No
Gaming Activity	No
Disaster relief assistance	No
One Third Support Public	Yes
One Third Support Gifts	No
Benefit of College	No
Private Foundation 508(e)	No
Seeking Retroactive Reinstatement	No
Seeking Section 7 Reinstatement	No
Correctness Declaration	Yes
Signature Name	GEVONNA GRAVES-WORNEY
Signature Title	CHIEF EXECUTIVE OFFICER
Signature Date	6/6/19
EIN	83-2042005
Case Number	EO-2019161-000182
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	BRIDGING THE GAP BEHAVIORAL HEALTH SERVICES
Organization’s Mailing Address	1325 MURPHY LANE
City	WINSTON-SALEM
State	NC
ZIP	27104
Accounting period End	12
Primary contact name	GEVONNA GRAVES-WORNEY
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00