U.S. Income Tax Return for an S Corporation

Transcription

1 - D E D U C T 0 N S Form 1120S Department of the Treasury Internal Revenue Servie U.S. Inome Tax Return for an S Corporation Do not file this form unless the orporation has filed or is attahing Form 2553 to elet to e an S orporation. See separate instrutions. For alendar year 2009 or tax year eginning, 2009, ending, 20 A S eletion effetive date Use IRS B Business ativity ode numer (see instrutions) C Chek if Sh. M-3 attahed lael. Otherwise, print or type. Name Numer, street, room/suite no. City/town, state, & Zip ode Commission On Health Care Certifiation In Village Mill Drive Midlothian VA H Chek if: (1) Final return (2) 0 Name hange (3) 0 Address hange _ (4) _ Amended return (5) 0 S eletion termination or revoation I Enter the numer of shareholders who were shareholders during any part of the tax year Caution. Inlude only trade or usiness inome and expenses on lines la through 21. See the instrutions for more information. -z.)0 2w E-. I 1-ax azo o_< >-2Luz i-u) 1a Gross reeipts or sales Cost of goods sold (Shedule A, line 8) Gross profit. Sutrat line 2 from line 1 OMB No D Employer ID no E Date inorporated F Total assets (see inst.) $ 824 G Is the orporation to e an S orporation eginning with this tax year? J Yes IN No If "Yes," attah Form 2553 if not already filed 172 r 297 Less retums and allowanes CBal C 172,297 Net gain (loss) from Form 4797, Part II, line 17 (attah Form 4797) Other inome (loss) (see instrutions -- attah statement) Total inome (loss). Add lines 3 through 5 7 Compensation of offiers 7 8 Salaries and wages (less employment redits) , ,297 9 Repairs and maintenane 9 10 Bad dets Rents 11 6, Taxes and lienses Interest Depreiation not laimed on Shedule A or elsewhere on return (attah Form 4562) Depletion (Do not dedut oil and gas depletion.) Advertising 16 6, Pension, profit-sharing, et., plans Employee enefit programs Other dedutions (attah statement) 19 71, Total dedutions. Add lines 7 through , Ordinary usiness inome (loss).sutrat line 20 from line , a Sign Here Exess net passive inome or LIFO reapture tax (see instrutions)... Tax from Shedule D (Form 1120S) Add lines 22a and 22 (see instrutions for additional taxes) a 2009 estimated tax payments and 2008 overpayment redited to a Tax deposited with Form 7004 Credit for federal tax paid on fuels (attah Form 4136) d Add lines 23a through 23 23d 0 24 Estimated tax penalty (see instrutions). Chek if Form 2220 is attahed I Amount owed. If line 23d is smaller than the total of lines 22 and 24, enter amount owed Overpayment. If line 23d is larger than the total of lines 22 and 24, enter amount overpaid Enter amount from line 26 Credited to 2010 estimated tax 0 Refunded 27 0 Under penalties of perjury, I deelerelfret have examined this return, inluding aompanying shedules and statements, and to the est of my knowledge and elief, it is true, orret, and omplete. Delaration of preparer (other than taxpayer) is ased on all information of whih preparer has any knowledge. Preparer's Date 22a 22 President Paid signature Preparer's Firm's name (or Kevin J Perlowski CPA Use Only yours if self-employed), r 9409 Hull Street Rd address, and ZIP ode Rihmond, VA For Privay At and Paperwork Redution At Notie, see separate instrutions. JVA S12 TWF Copyright Forms (Software Only) TW Date Title Chek if selfemployed n May the IRS disuss this return with the preparer shown elow (see inst.)? g Yes n No EIN Phone no. Preparer's SSN or PTIN P Form 1120S (2009) #1 #2

2 ' Commission On Health Care Form 1120S (2009) Page 2 Shedule A Cost of Goods Sold (see instrutions) 1 Inventory at eginning of year Purhases 2 Cost of laor 3 Additional setion 263A osts (attah statement) 4 Other osts (attah statement) 5 Total. Add lines 1 through 5 6 Inventory at end of year 7 Cost of goods sold. Sutrat line 7 from line 6. Enter here and on page 1, line 2 8 9a Chek all methods useor used f valuing l i losing l i inventory: i t W 0 Cost as desried in Regulations setion (ii)_ Lower of ost or market as desried in Regulations setion (iii) Other (Speify method used and attah explanation.) Chek if there was a writedown of sunormal goods as desried in Regulations setion () Chek if the LIFO inventory method was adopted this tax year for any goods (if heked, attah Form 970) d e If the LIFO inventory method was used for this tax year, enter perentage (or amounts) of losing inventory omputed under LIFO If property is produed or aquired for resale, do the rules of setion 263A apply to the orporation? f Was there any hange in determining quantities, ost, or valuations etween opening and losing inventory? If "Yes," attah explanation. Shedule B Other Information (see instrutions) Yes No 1 Chek aounting method: a Cash 11 Arual 11 Other (speify) 2 See the instrutions and enter the: a Business ativity Professional, Sien Produt or servie All other profession 3 At the end of the tax year, did the orporation own, diretly or indiretly, 50% or more of the voting stok of a domesti orporation? (For rules of attriution, see setion 267().) If "Yes," attah a statement showing:(a) name and employer identifiation numer (EIN), () perentage owned, and () if 100% owned, was a QSu eletion made? 4 Has this orporation filed, or is it required to file, a return under setion 6111 to provide information on any reportale transation? 5 Chek this ox if the orporation issued pulily offered det instruments with original issue disount 1 If heked, the orp. may have to file Form 8281, Information Return for Pulily Offered Original Issue Disount Instruments. 6 If the orporation: (a) was a C orporation efore it eleted to e an S orporation or the orporation aquired an asset with a asis determined y referene to its asis (or the asis of any other property) in the hands of a C orporation net unrealized uilt-in gain (defined in setion 1374(d)(1)) in exess of the net reognized uilt-in gain from prior years, enter the net unrealized uilt-in gain redued y net reognized uilt-in gain from prior years $ 7 Enter the aumulated earnings and profits of the orporation at the end of the tax year. $ 9d and () has 8 Are the orporation's total reeipts (see instrutions) for the tax year and its total assets at the end of the tax year less than $250,000? If "Yes," the orporation is not required to omplete Shedules L and M-1 X 'Shedule K] Shareholders' Pro Rata Share Items Total amount 1 Ordinary usiness inome (loss) (page 1, line 21) 1 87,693 2 Net rental real estate inome (loss) (attah Form 8825) 2 Z OO SLLI 1 0 o in 3a Other gross rental inome (loss) Expenses from other rental ativities (attah statement) Other net rental inome (loss). Sutrat line 3 from line 3a 3 4 Interest inome 4 5 Dividends: a Ordinary dividends Qualified dividends Royalties 6 7 Net short-term apital gain (loss) (attah Shedule D (Form 1120S)) 7 8a Net long-term apital gain (loss) (attah Shedule D (Form 1120S)) Colletiles (28%) gain (loss) Unreaptured setion 1250 gain (attah statement) 9 Net setion 1231 gain (loss) (attah Form 4797) 9 10 Other inome (loss) (see instrutions) Type 10 JVA S12 TWF Copyright Forms (Software Only) TW Form 1120S (2009) 3a a 8a Yes Yes X X No No

3 ' Commission On Health Care Form 1120S (2009) Page 3 Shareholders' Pro Rata Share Items (ontinued) Total amount Dedutions Credits Foreign Transations Alternative Minimum Tax (AMT) Items Items Affetmg Shareholder Basis Other Information Reon- :illation 11 Setion 179 dedution (attah Form 4562) 11 12a Contriutions 12a 560 Investment interest expense 12 Setion 59(e)(2) expenditures (1) Type (2) Amount 12(2) d Other dedutions (see instrutions) Type 12d 13a Low-inome housing redit (setion 42(j)(5)) Low-inome housing redit (other) Qualified rehailitation expenditures (rental real estate) (attah Form 3468) d Other rental real estate redits (see instrutions) Type e Other rental redits (see instrutions) Type 13e f Alohol and ellulosi iofuel fuels redit (attah Form 6478) g Other redits (see instrutions)... Type 14a Name of ountry or U.S. possession d e f g h i j k Gross inome from all soures Gross inome soured at shareholder level Foreign gross inome soured at orporate level Passive ategory General ategory Other (attah statement) Dedutions alloated and apportioned at shareholder level Interest expense Other Dedutions alloated and apportioned at orporate level to foreign soure inome Passive ategory General ategory Other (attah statement) Other information I Total foreign taxes (hek one): I Paid I Arued m n 15a d e f 16a d e 17a d Redution in taxes availale for redit (attah statement) Other foreign tax information (attah statement) Post-1986 depreiation adjustment Adjusted gain or loss Depletion (other than oil and gas) Oil, gas, and geothermal properties--gross inome Oil, gas, and geothermal properties--dedutions Other AMT items (attah statement) Tax-exempt interest inome Other tax-exempt inome Nondedutile expenses Property distriutions Repayment of loans from shareholders Investment inome Investment expenses Dividend distriutions paid from aumulated earnings and profits Other items and amounts (attah statement) 13a d 13f 13g d 14e 14f 14g 14h 14i 14j 14k m 15a d 15e 15f 16a d 86, Inome/loss reoniliation. Comine the amounts on lines 1 through 10 in the far right olumn. From the result, sutrat the sum of the amounts on lines 11 through 12d and , 133 JVA S34 TWF Copyright Forms (Software Only) TVV Form 11 ZUS (2009) 16e 17a 17 17

4 Commission On Health Care Form 1120S (2009) Page 4 Shedule L I Balane Sheets per Books Beginning of tax year End of tax year 1 2a a 11a 12 13a Cash Assets Trade notes and aounts reeivale. Less allowane for ad dets Inventories U.S. government oligations Tax-exempt seurities (see instrutions) Other urrent assets (attah statement) Loans to shareholders Mortgage and real estate loans Other investments (attah statement).... Buildings and other depreiale assets Less aumulated depreiation Depletale assets Less aumulated depletion Land (net of any amortization) Intangile assets (amortizale only) Less aumulated amortization Other assets (attah statement) Total assets Liailities and Shareholders' Equity Aounts payale Mortgages, notes, onds payale in less than 1 yr Other urrent liailities (attah statement) Loans from shareholders Mortgages, notes, onds payale in 1 year or more Other liailities (attah statement) Capital stok Additional paid-in apital Retained earnings Adjustments to shareholders' equity (attah stmt.) (a) () () (d) ) ( ) 20,838 20,838 ( 20,838 ) ( 20,838 ) ( ) ( ) ( ) ( ) Less ost of treasury stok ( ) ( ) 27 Total liailities and shareholders' equity Shedule M-1 Reoniliation of Inome (Loss) per Books With Inome (Loss) per Return Note: Shedule M-3 required instead of Shedule M-1 if total assets are $10 million or more -- see instrutions 1 Net inome (loss) per ooks 2 Inome inluded on Shedule K, lines 1, 2, 3, 4, 5a, 6, 7, 8a, 9, and 10, not reorded on ooks this year (itemize): 3 Expenses reorded on ooks this year not inluded on Shedule K, lines 1 through 12 and 141 (itemize): a Depreiation $ Travel and entertainment $ ,430 5 Inome reorded on ooks this year not inluded on Shedule K, lines 1 through 10 (itemize): a Tax-exempt interest $ 6 Dedutions inluded on Shedule K, lines 1 through 12 and 141, not harged against ook inome this year (itemize): a Depreiation $ Add lines 5 and 6 4 Add lines 1 through 3 87,133 8 Inome (loss) (Shedule K, line 18). Line 4 less line Shedule M-2 Analysis of Aumulated Adjustments Aount, Other Adjustments Aou nt, and Shareholders' Undistriuted Taxale Inome Previously axed (see instrutions) () Shareholders' (a) Aumulated () Other adjustments undistriuted taxale adjustments aount aount inome previously taxed 1 Balane at eginning of tax year 2 Ordinary inome from page 1, line 21 3 Other additions 4 Loss from page 1, line 21 5 Other redutions 6 Comine lines 1 through 5 7 Distriutions other than dividend distriutions 8 Balane at end of tax year. Sutrat line 7 from line ,693 JVA TWF Copyright Forms (Software Only) TW 1,263#5 ) 87,254 86, Form 1120S (2009)

5 Commission On Health Care SCHEDULE M-1 EXPLANATION ATTACHMENT Computation of Net Inome (Loss) Per Books Form 1120, Shedule M-1, Line 1 Inome (loss) (Shedule M-1, line 8) arries from Form 1120S, page 3, line 18 87,133 Inreases: Dedutions on return not harged against ook inome (Shedule M-1, line 6) Inome reorded on ooks not inluded on return (Shedule M-1, line 5) Dereases: Expenses reorded on ooks not inluded on return (Shedule M-1, line 3) Inome sujet to tax not reorded on ooks (Shedule M-1, line 2) 703 Computed net inome (loss) per ooks (Shedule M-1, line 1) 86,430 JVA Copyright Forms (Software Only) VV M0709A 09_CSM1

6 2009 DETAIL STATEMENTS Commission On Health Care Page 1 STATEMENT #1 - Rent On Business Property (1120S PG1 - DED LINE 11) Rent On Business Property: Rent - Real Property 6,232 TOTAL Rent On Business Property 6,232 TOTAL CARRIED TO 1120S PG1 - DED LINE 11 6,232 STATEMENT #2 - Other Dedutions (1120S PG1 LINE 19) Other Dedutions: Bank Charges 3,404 Legal & Professional 1,000 Lienses & Permits 339 Meals & Entertainment 50% 703 Offie Supplies 14,485 Postage 1,795 Telephone 2,861 Travel 20,378 Utilities 3,260 Misellaneous 6,920 Computer/IT Expenses 9,095 Card Fees 1,979 C/L 1,500 Training/Edutaion 4,200 TOTAL Other Dedutions 71,919 TOTAL CARRIED TO 1120S PG1 LINE 19 71,919 STATEMENT #3 - CONTRIBUTIONS (1120S PG 3 LINE 12a) Code A - Cash Contriutions (50%) 560 TOTAL CARRIED TO 1120S PG 3 LINE 12a 560 STATEMENT #4 - NONDEDUCTIBLE EXPENSES (1120S PG 3 LINE 16) Code C - Disallowed Meals/Entertainment 703 TOTAL CARRIED TO 1120S PG 3 LINE STATEMENT #5 - Other Redutions (1120S PG 4 M-2 LINE 5(a)) Charitale Contriutions 560 Disallowed Meals & Entertainment 703 TOTAL CARRIED TO 1120S PG 4 M-2 LINE 5(a) 1,263 JVA Copyright Forms (Software Only) TW C1005D 09LSSTMT

7 # 1 Shedule K-1 (Form 1120S) 2009 Department of the Treasury For alendar year 2009, or tax Internal Revenue Servie year eginning, 2009 ending, 20 Shareholder's Share of Inome, Dedutions, Credits, et. See page 2 and separate instrutions. Part I Information Aout the Corporation A Corporation's employer identifiation numer B Corporation's name, address, ity, state, and ZIP ode Commission On Health Care Certifiation In Village Mill Drive Midlothian VA n Final K-1 n Amended K-1 OMB No Part III Shareholder's Share of Current Year In., Dedutions, Credits, and Other Items 1 Ordinary usiness in. (toss) 13 Credits 87,693 2 Net rental real estate in (loss) 3 Other net rental inome (loss) 4 Interest inome 5a Ordinary dividends 5 Qualified dividends 6 Royalties 7 Net short-term ap. gain (loss) 14 Foreign transations C IRS Center where orporation filed return CINCINNATI Part II Information Aout the Shareholder 8a Net long-term ap. gain (loss) 8 Colletiles (28%) gain (loss) 8 Unreaptured se 1250 gain D Shareholder's identifying numer E Shareholder's name, address, ity, state, and ZIP ode 9 Net setion 1231 gain (loss) Virgil R. May Queensgate Rd VA Midlothian Other inome (loss) 15 Alternative min tax (AMT) items F Shareholder's perentage of stok ownership for tax year % For IRS Use Only 11 Setion 179 dedution 12 Other dedutions Items affeting shareholder asis C 703 D 86, Other information * See attahed statement for additional information. For Paperwork Redution At Notie, see Instrutions for Form 1120S. Shedule K-1 (Form 1120S) 2009 JVA SK112 TWF Copyright Forms (Software Only) TW

8 2009 Virginia Pass-Through Entity Form 502 Return of Inome and Return of Department of Taxation Nonresident Withholding Tax P.O. Box 1500 Rihmond, VA Chek if: Initial return Federal Employer ID Numer Entity Name Commission On Health Care Numer and Street Village Mill Drive Address ontinued fl FISCAL or SHORT Year Filer: Beginning Date Name hange Address hange Change in fisal year Ending Date Offiial Use Only II City or Town, State and ZIP Code Midlothian VA Date of Formation Date Operations Began in Virginia Entity Type (Enter Code -- See instrutions) SC El Amended return Eleting large partnership NAICS Final return State or Country Where Inorporated or Organized VA Desription of Business Ativity Professional, Sientif Sujet to ank franhise tax Unified nonresident return filed Numers And Types Of Owners Count all owners that were issued a federal Shedule K-1 for the taxale year and enter: a. The Total Numer Of Owners (Inlude individuals and any other entity types) a. 1. The Total Numer Of Nonresident Owners (See Instrutions).. Total Amount Withheld for Nonresident Owners (Total of "line e" from all VK-1's with withholding amounts),..00 d. If entity is exempt from withholding enter exemption ode (see instrutions) d. Distriutive Or Pro Rata Inome And Dedutions See instrutions. 1. Total Of Taxale Inome Amounts 1. 87, Total Of Dedutions Tax-exempt Interest Inome Alloation And Apportionment 4. Inome Alloated To Virginia (From Shedule 502A, Part A, Line 2) Inome Alloated Outside Of Virginia (From Shedule 502A, Part A, Line 3e) Apportionale Inome (From Shedule 502A, Part A, Line 4) 6. 87, Virginia Apportionment Perentage (From Shedule 502A, Part B or Part C or 100%) % Virginia Additions -- See Shedule 502ADJ For Other Additions 8. Fixed-date Conformity -- Depreiation Fixed-date Conformity -- Other Net Inome Tax Or Other Tax Used As A Dedution In Determining Taxale Inome (See Instrutions) Interest On Muniipal Or State Oligations Other Than From Virginia Total additions from attahed Shedule 502ADJ, Setion A, line Total additions (Add lines 8-12) Virginia Sutrations -- See Shedule 502ADJ For Other Sutrations 14. Fixed-date Conformity -- Depreiation Fixed-date Conformity -- Other Va. Dept. Of Taxation (Rev 08/09) VA5021 -rwf Copyright Forms (Software Only) TVV

9 2009 Va. Name Commission On Health Care Form 502 Federal Employer ID Numer Page 2 iii 16. Inome From Oligations Of The United States 17. Total Sutrations from attahed Shedule 502ADJ, Setion B, line Total Sutrations (Add lines 14-17) Virginia Tax Credits And Related Information From Shedule 502ADJ 19. Total nonrefundale redits (From Setion C, Line 26 from attahed Shedule 502ADJ) 20. Total refundale redits (From Setion C, line 32 from attahed Shedule 502ADJ) Reoniliation of Withholding, Penalties, Interest and Overpayment/Tax Due Setion 1: Withholding Payment Reoniliation 1. Total withholding tax due for nonresident owners 2. Total withholding tax paid 3. Overpayment (If line 2 is greater than line 1, sutrat line 1 from line 2) 4. Balane of tax due (If line 2 is less than line 1, sutrat line 2 from line 1) Setion 2: Penalty and Interest Charges on Withholding Tax 5. Extension penalty (may apply if the differene etween line 1 and line 2 is more than 10 perent of line 1) 6. Late filing penalty (will apply if there is a alane due on line 4 and Form 502 is eing filed more than six months after the original due date) 7. Interest (may apply if there is a alane due on line 4) 8. Total penalty and interest harges due (add lines 5, 6, and 7) Setion 3: Penalty for Late Filing of Form If Form 502 is eing filed more than six months after the original due date, or more than 30 days after the federal extended due date, enter $1,200 Setion 4: Disposition of Overpayment 10. Net overpayment. Sutrat lines 8 and 9 from line 3. If lines 8 and 9 exeed line 3, go to line 13 elow 11. Amount of overpayment to e redited to Amount of overpayment to e refunded Setion 5: Total Payment Due With Form Balane of tax due from line 4, or total of lines 8 and 9 less line 3, whihever is appliale 14. Penalty and interest harges on withholding tax from line 8 if not inluded on line Late filing penalty from line 9 if not inluded on line Total payment due (Add lines 13, 14, and 15) By heking the ox to the right, I (we) authorize the Department of Taxation to disuss this return with the undersigned preparer. I, the undersigned owner and authorized representative of the pass-through entity for whih this return is made, delare under the penalties provided y law that this return (inluding any aompanying shedules, statements and attahments) has een examined y me and is, to the est of my knowledge and elief, a true, orret, and omplete return, made in good faith, for the taxale year stated, pursuant to the tax laws of the Commonwealth of Virginia. A preparer other than the authorized representative delares the same, and suh delaration is ased on all information of whih he or she has any knowledge. President (Signature and Phone Numer of Owner or Authorized Representative) (Title) (Date) 9409 Hull Street Rd Rihmond, VA (Individual or Firm, Signature of Preparer, Phone Numer, and Address) (Date) Preparer's FEIN, PTIN or SSNPO Approved Vendor Code Attah a opy of your Federal Return and Shedule VK-1 for eah owner to the Form 502. Do Not Attah Form 765 With This Return -- Mail to Address On Form VA5022 TWF Copyright Forms (Software Only) TW

10 2009 VIRGINIA Shedule VK-1 (Form 502) Chek If - Final Amended Return Owner's Share of Inome And Virginia Modifiations And Credits Chek Here if Owner is Partiipating in an Individual Unified Nonresident Return ui Name Virgil R. May Owner Information FEIN or SSN Pass-Through Entity (PTE) Information Name Commission On Health FEIN Certifiation In Address Address Tax Year End Date Address Queensgate Rd City or Town, State And ZIP Code VA Midlothian Address Village Mill Drive City or Town, State And ZIP Code Midlothian VA Additional Owner Information a. Date Owner Aquired Interest In The Pass-Through Entity (MM/DD/YYYY). Owner's Entity Type (Enter ode; see instrutions) RES. Owner's Partiipation Type (Enter ode; see instrutions) SHR d. Owner's Partiipation Perentage (Example: 47.35% -- see instrutions.) % e. Amount Withheld y PTE for Owner f. If Owner or Entity is exempt from withholding enter exemption ode (see instrutions) Distriutive or Pro Rata Inome and Dedutions See instrutions. 1. Total of Taxale Inome Amounts 1. 87, Total of Dedutions Tax-exempt Interest Inome Alloation and Apportionment 4. Inome Alloated To Virginia (Owner's Share From PTE's Shedule 502A, Part A, Line 2) Inome Alloated Outside Of Virginia (Owner's Share From PTE's Shedule 502A, Part A, Line 3e) Apportionale Inome (Owner's Share From PTE's Shedule 502A, Part A, Line 4) 6. 87, Virginia Apportionment Perentage (From PTE's Shedule 502A, Part B or Part C or 100%) % Virginia Additions -- Owner's Share 8. Fixed-date Conformity -- Depreiation Fixed-date Conformity -- Other Net Inome Tax Or Other Tax Used As A Dedution In Determining Taxale Inome (See Instrutions) Interest On Muniipal Or State Oligations Other Than From Virginia Other additions (see instrutions for addition odes) Code Amount Code Amount 12a d Total additions (add lines 8-11 and 12a-12d) Virginia Sutrations -- Owner's Share 14. Fixed-date Conformity -- Depreiation Fixed-date Conformity -- Other Inome From Oligations Of The United States Other sutrations (see instrutions for sutration odes) Code Amount Code Amount 17a d Total Sutrations (Add lines and 17a-17d) Va. Dept. Of Taxation VK-1 (Rev 10109) VAVK11 TWF Copyright Forms (Software Only) TW

11 VA Shedule VK-1 (10/09) 2009 Virginia Shedule VK-1 Page 2 Owner Federal Employer ID Numer or SSN PTE Federal Employer ID Numer in SECTION C -- Virginia Tax Credits Nonrefundale Credits 1. State Inome Tax Paid (See instrutions) Neighorhood Assistane At Credit Enterprise Zone At General Tax Credit Enterprise Zone At Zone Investment Tax Credit Reserved for future use Conservation Tillage Equipment Credit Bio-Diesel Credit Fertilizer & Pestiide Appliation Equipment Credit Reylale Materials Proessing Equipment Credit Rent Redution Program Credit Vehile Emissions Testing Equipment Credit Major Business Faility Jo Tax Credit Clean Fuel Vehile Jo Creation Tax Credit Day-are Faility Investment Tax Credit Low-inome Housing Tax Credit Agriultural Best Management Praties Tax Credit Worker Retraining Credit Waste Motor Oil Burning Equipment Credit Riparian Forest Buffer Protetion For Waterways Virginia Coal And Prodution Inentive Tax Credit Enter the amount of redit assigned to another party Virginia Coal and Prodution Inentive Tax Credit availale for use y owner (Sutrat line 21 from line 20) Histori Rehailitation Tax Credit Land Preservation Tax Credit Qualified Equity & Suordinated Det Investments Tax Credit Total Nonrefundale redits (Total lines 1-19 and 22-25) Refundale Credits % Coalfield Employment Enhanement and/or Virginia Coal Employment and Prodution Inentive Tax Credits from Line 1 of your 2009 Shedule 306B Full redit: Enter amount from 2009 Form 306, Line 12a Full redit: Enter amount from your 2009 Form 306, line % Credit: Enter amount from 2009 Form 306, line 13a % Credit: Enter amount from your 2009 Form 306, line Total Coal Related Tax Credits allowale this year: Add Lines 28, 29, 30 and Coalfield Employment Enhanement Tax Credit earned to e used when ompleting your 2012 return Enter amount from your 2009 Form 306, Line Notie You have reeived this Shedule VK-1 eause the aove named Pass-Through Entity (PTE) earned inome from Virginia soures and has passed through to you a portion of that Virginia soure inome ased on your ownership of the PTE. A opy of this shedule has een filed with the Virginia Department of Taxation. Everyone who reeives Virginia soure inome is sujet to taxation y Virginia regardless of state of resideny or domiile. You may e required to file a Virginia tax return even though you may e a nonresident individual or a usiness domiiled outside of Virginia. To determine if you are required to file a Virginia inome tax return, onsult your tax professional. Information and forms may e otained at or all the Virginia Department of Taxation at (individuals) or (usinesses) VAVK12 TWF Copyright Forms (Software Only) TW