U.S. Income Tax Return for an S Corporation. If "Yes," attach Form 2553 if not already filed

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1 I u_ox D E D U C T 0 N S Form 1120S Department of the Treasury Internal Revenue Service G Is the corporation electing to e an S corporation eginning with this tax year? Yes _ H Check if: (1) Final return (2) Name change (3) 0 Address change _ (4) Amended return (5) 0 S election termination or revocation I Enter the numer of shareholders who were shareholders during any part of the tax year For Privacy Act and Paperwork Reduction Act Notice, see instructions. JVA S12 TWF Copyright Forms (Software Only) - 28 TW U.S. Income Tax Return for an S Corporation Do not file this form unless the corporation has filed or is attaching Form 2553 to elect to e an S corporation. See separate instructions. For calendar year 28 or t ax year eginning, 28, ending, 20 A S election effective date Use IRS B Business activity code numer (see instructions) C Check if Sch. M-3 attached lael. Otherwise, print or type. Name Numer, street, room/suite no. City/town, state, & Zip code Commission On Health Care Certification Inc Village Mill Drive Midlothian VA OMB No If "Yes," attach Form 2553 if not already filed Caution. Include only trade or usiness income and expenses on lines la through 21. See the instructions for more information. - Z OO ELLI I -, -2 /-< - -O Z co ,,...,... -,,,,,-,-.... I 1 QX <ZC1 0-< >-511JZ I CI) Sign Here 0 28 D Employer ID no E Date incorporated F Total assets (see inst.) la Gross receipts or sales 192,408 Less returns and allowances C Bal 1C 192,408 2 Cost of goods sold (Schedule A, line 8) 3 Gross profit. Sutract line 2 from line 1c 4 Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) 5 Other income (loss) (see instructions -- attach statement) 6 Total income (loss). Add lines 3 through 5 7 Compensation of officers 8 Salaries and wages (less employment credits) 9 Repairs and maintenance 10 Bad dets 11 Rents 12 Taxes and licenses 13 Interest 14 Depreciation not claimed on Schedule A or elsewhere on return (attach Form 4562) 15 Depletion (Do not deduct oil and gas depletion.) 16 Advertising 17 Pension, profit-sharing, etc., plans 18 Employee enefit programs 19 Other deductions (attach statement) 20 Total deductions. Add lines 7 through Ordinary usiness income (loss).sutract line 20 from line 6 22a Excess net passive income or LIFO recapture tax (see instructions)... Tax from Schedule D (Form 1120S) c Add lines 22a and 22 (see instructions for additional taxes) 23a 28 estimated tax payments and 27 overpayment credited to 28 Tax deposited with Form 74 c Credit for federal tax paid on fuels (attach Form 4136) d Add lines 23a through 23c 24 Estimated tax penalty (see instructions). Check if Form 2220 is attached I 25 Amount owed. If line 23d is smaller than the total of lines 22c and 24, enter amount owed 26 Overpayment. If line 23d is larger than the total of lines 22c and 24, enter amount overpaid 27 Enter amount from line 26 Credifato 29 estimated tax 0 Refunded 22a 22 23a 23 23c , , , ,303 44, ,306 22c 0 23d Under alties of eru, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief arer (other than taxpayer) is ased on all information of which preparer has any knowledge. -' :1/44',, 4 May the IRS discuss this return 1.- la' I President with the preparer shown elow (see inst.)? Signature of officer Date r Title Yes n No. Preparer's L Date Check if self- Preparer's SSN or PTIN signature I employed Pa id Preparer's Kevin J Perlo i CPA EIN Firm's name (or Use Only yours if self-employed), 9409 Hull Street Rd Phone no. address, and ZIP code Richmond, VA (804) n

2 Form 1120S (28) Page 2 Schedule A Cost of Goods Sold (see instructions) Inventory at eginning of year Purchases Cost of laor Additional section 263A costs (attach statement) Commission On Health Care Other costs (attach statement) Total. Add lines 1 through 5 6 Inventory at end of year 7 Cost of goods sold. Sutract line 7 from line 6. Enter here and on page 1, line 2 8 9a Check all methods used for valuing closing inventory: (i)_ Cost as descried in Regulations section (ii)_ Lower of cost or market as descried in Regulations section (iii) Other (Specify method used and attach explanation.) Check if there was a writedown of sunormal goods as descried in Regulations section (c) c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? f Was there any change in determining quantities, cost, or valuations etween opening and closing inventory? Yes If "Yes," attach explanation. Schedule B Other Information (see instructions) Yes No 1 Check accounting method: a Cash LIAccrual c 11 Other (specify) 2 See the instructions and enter the: a Business activity Professional, Scien Product or service Yes All other profession 3 At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attriution, see section 267(c).) If "Yes," attach a statement showing:(a) name and employer identification numer (EIN), () percentage owned, and (c) if 1% owned, was a QSu election made? 4 Has this corporation filed, or is it required to file, a return under section 6111 to provide information on any reportale transaction? 5 Check this ox if the corporation issued pulicly offered det instruments with original issue discount I If checked, the corp. may have to file Form 8281, Information Return for Pulicly Offered Original Issue Discount Instruments. 6 If the corporation: (a) was a C corporation efore it elected to e an S corporation or the corporation acquired an asset with a asis determined y reference to its asis (or the asis of any other property) in the hands of a C corporation and () has net unrealized uilt-in gain (defined in section 1374(d)(1)) in excess of the net recognized uilt-in gain from prior years, enter the net unrealized uilt-in gain reduced y net recognized uilt-in gain from prior years $ 7 Enter the accumulated earnings and profits of the corporation at the end of the tax year. $ 8 Are the corporation's total receipts (see instructions) for the tax year and its total assets at the end of the tax year less than $250,0? If "Yes," the corporation is not required to complete Schedules L and M-1 Schedule K Shareholders' Pro Rata Share Items Total amount 1 Ordinary usiness income (loss) (page 1, line 21) 1 148,306 2 Net rental real estate income (loss) (attach Form 8825) 2 - ZOO EUJ -I 0 u) u) 3a Other gross rental income (loss) Expenses from other rental activities (attach statement) c Other net rental income (loss). Sutract line 3 from line 3a 3c 4 Interest income 4 5 Dividends: a Ordinary dividends 5a Qualified dividends Royalties 6 7 Net short-term capital gain (loss) (attach Schedule D (Form 1120S)) 7 8a Net long-term capital gain (loss) (attach Schedule D (Form 1120S)) 8a Collectiles (28%) gain (loss) 8 c Unrecaptured section 1250 gain (attach statement) 8c 9 Net section 1231 gain (loss) (attach Form 4797) 9 10 Other income (loss) (see instructions) Type 10.. JVA S12 TWF Copyright Forms (Software Only) - 28 TW orm 3a 3 9d X X X No No

3 Deductions Commission On Health, Care Form 1120S (28) Page 3 Shareholders' Pro Rata Share Items (continued) Total amount 11 Section 179 deduction (attach Form 4562) 11 12a Contriutions 12a 753 Credits Foreign Transactions Alternative Minimum Tax (AMT) Items Items Affectin Shareholder Basis Other Information Reconciliation Investment interest expense 12 c Section 59(e)(2) expenditures (1) Type (2) Amount 12c(2) d Other deductions (see instructions) Type 12d 13a Low-income housing credit (section 42(j)(5)) Low-income housing credit (other) c Qualified rehailitation expenditures (rental real estate) (attach Form 3468) d Other rental real estate credits (see instructions) Type e Other rental credits (see instructions) Type 13e f Alcohol and cellulosic iofuel fuels credit (attach Form 6478) g Other credits (see instructions)... Type 14a Name of country or U.S. possession c d e f g h i j k Gross income from all sources Gross income sourced at shareholder level Foreign gross income sourced at corporate level Passive category General category Other (attach statement) Deductions allocated and apportioned at shareholder level Interest expense Other Deductions allocated and apportioned at corporate level to foreign source income Passive category General category Other (attach statement) Other information I Total foreign taxes (check one): I Paid 111 Accrued m n 15a c d e f 16a c d e 17a c d Reduction in taxes availale for credit (attach statement) Other foreign tax information (attach statement) Post-1986 depreciation adjustment Adjusted gain or loss Depletion (other than oil and gas) Oil, gas, and geothermal properties--gross income Oil, gas, and geothermal properties--deductions Other AMT items (attach statement) Tax-exempt interest income Other tax-exempt income Nondeductile expenses Property distriutions Repayment of loans from shareholders Investment income Investment expenses Dividend distriutions paid from accumulated earnings and profits Other items and amounts (attach statement) 13a 13 13c 13d 13f 13g 14 14c 14d 14e 14f 14g 14h 14i 14j 14k m 15a 15 15c 15d 15e 15f 16a 16 16c 16d 147,553 16e 18 Income/loss reconciliation. Comine the amounts on lines 1 through 10 in the far right column. From the result, sutract the sum of the amounts on lines 11 through 12d and ,553 JVA S34 TWF Copyright Forms (Software Only) - 28 TW orm 17a 17 17c

4 Commission On Health Care Form 1120S (28) Page 4 Schedule L Balance Sheets per Books Beginning of tax year End of tax year 1 2a a hia 12 13a a Cash Assets Trade notes and accounts receivale... Less allowance for ad dets Inventories U.S. government oligations Tax-exempt securities (see instructions) Other current assets (attach statement) Loans to shareholders Mortgage and real estate loans Other investments (attach statement).... Buildings and other depreciale assets Less accumulated depreciation Depletale assets Less accumulated depletion Land (net of any amortization) Intangile assets (amortizale only) Less accumulated amortization Other assets (attach statement) Total assets Liailities and Shareholders' Equity Accounts payale Mortgages, notes, onds payale in less than 1 yr Other current liailities (attach statement) Loans from shareholders Mortgages, notes, onds payale in 1 year or more Other liailities (attach statement) Capital stock Additional paid-in capital Retained earnings Adjustments to shareholders' equity (attach stmt.) (a) () (c) (d) ( ) ( ) 20,838 20,838 ( 20,838) ( 20,838) ( ) ( ) ( ) ( ) Less cost of treasury stock ( ) ( ) 27 Total liailities and shareholders' equity Schedule M-1 Reconciliation of Income (Loss) per Books With Income (Loss) per Return Note: Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more -- see instructions 1 Net income (loss) per ooks 147,553 5 Income recorded on ooks this year not included on Schedule K, lines 1 through 2 Income included on Schedule K, lines 1, 2, 10 (itemize): 3c, 4, 5a, 6, 7, 8a, 9, and 10, not recorded on ooks this year (itemize): a Tax-exempt interest $ Expenses recorded on ooks this year not included on Schedule K, lines 1 through 12 and 141 (itemize): Depreciation $ Travel and entertainment $ 6 Deductions included on Schedule K, lines 1 through 12 and 141, not charged against ook income this year (itemize): a Depreciation $ 7 Add lines 5 and 6 Add lines 1 through 3 147,553 8 Income (loss) (Schedule K, line 18). Line 4 less line 7 147,553 Schedule M-2 1 Balance at eginning of tax year 2 Ordinary income from page 1, line 21 3 Other additions 4 Loss from page 1, line 21 5 Other reductions 6 Comine lines 1 through 5 Analysis of Accumulated Adjustments Account, Other Adjustments Account, and Shareholders' Undistriuted Taxale Income Previously Taxed (see instructions) 7 Distriutions other than dividend distriutions 8 Balance at end of tax year. Sutract line 7 from line 6. (a) Accumulated adjustments account , #3 ) 148, , () Other adjustments account (c) Shareholders' undistriuted taxale income previously taxed JVA S34 -rwf Copyright Forms (Software Only) - 28 PA/ Form 1 120S (28)

5 Commission On Health Care SCHEDULE M-1 EXPLANATION ATTACHMENT Computation of Net Income (Loss) Per Books Form 1120, Schedule M-1, Line 1 Income (loss) (Schedule M-1, line 8) carries from Form 1120S, page 3, line ,553 Increases: Deductions on return not charged against ook income (Schedule M-1, line 6) Income recorded on ooks not included on return (Schedule M-1, line 5) Decreases: Expenses recorded on ooks not included on return (Schedule M-1, line 3) Income suject to tax not recorded on ooks (Schedule M-1, line 2) Computed net income (loss) per ooks (Schedule M-1, line 1) 147,553 JVA Copyright Forms (Software Only) - 28 TW M0918A 08_CSM1

6 28 DETAIL STATEMENTS Commission On Health Care Page 1 STATEMENT #1 - Other Deductions (1120S PG1 LINE 19) Other Deductions: Bank Charges 667 Legal & Professional 104 Licenses & Permits 1,3 Office Supplies 5,172 Postage 999 Travel 8,734 Utilities Miscellaneous 4,391 1,699 Computer/IT Expenses 14,534 TOTAL Other Deductions 37,303 TOTAL CARRIED TO 1120S PG1 LINE 19 37,303 STATEMENT #2 - CONTRIBUTIONS (1120S PG 3 LINE 12a) Code A - Cash Contriutions (50%) 753 TOTAL CARRIED TO 1120S PG 3 LINE 12a 753 STATEMENT #3 - Other Reductions (1120S PG 4 M-2 LINE 5(a)) Charitale Contriutions 753 TOTAL CARRIED TO 1120S PG 4 M-2 LINE 5(a) 753 JVA Copyright Forms (Software Only) - 28 TW C0703D 08_LSSTMT

7 28 Federal Depreciation Schedule Commission On Health Care, Certification Inc Description Date Method Year Cost Land/ al 70 Spec Other 4 " Allow Basis Prior Current Form 1120S Computer Eqpt DBHY 5 4, , Computer Eqpt DBHY 5 8, , Computer Eqpt DBHY 5 7, , Assets Totals: 20, , Assets Grand Totals: 20, , Balance Sheet Reconciliation Grand Totals: 20, , Less Future Purchases: Less Current Year Disposals: End of Year Totals: 20, , Buildings and Other Depreciale Assets: 20,838 Prior Depreciation: 0 Current Depreciation: 0 179: 20,838 Special Depreciation Allowance: 0 Land: 0 Ending Accumulated Depreciation (Per Balance Sheet): 20,838 Intangile Assets (Amortizale Only): 0 Prior Amortization: 0 Current Amortization: 0 179: 0 Special Depreciation Allowance: 0 Ending Accumulated Amortization (Per Balance Sheet): 0 * Asset disposed this year -C Carryover asis in like-kind exchange transaction -B Excess asis in like-kind exchange transaction 1

8 . # 1 Schedule K-1 28 (Form 1120S) Department of the Treasury Internal Revenue Service For calendar year 28, or tax year eginning ending Shareholder's Share of Income, Deductions, Credits, etc. See page 2 and separate instructions. Part I Information Aout the Corporation, 28, 20 Part III I Shareholder's Share of Current Year Inc., Deductions, Credits, and Other Items Ordinary usiness inc. (loss) 148,306 2 Net rental real estate inc. (loss) 3 Other net rental income (loss) 4 Interest income 13 Credits Final K-1 Amended K-1 OMB No A Corporation's employer identification numer B Corporation's name, address, city, state, and ZIP code Commission On Health Care Certification Inc Village Mill Drive Midlothian VA a Ordinary dividends 5 Qualified dividends 6 Royalties 7 Net short-term cap. gain (loss) 14 Foreign transactions C IRS Center where corporation filed return CINCINNATI I Part II D Shareholder's identifying numer Information Aout the Shareholder 8a Net long-term cap. gain (loss) 8 Collectiles (28%) gain (loss) 8c Unrecaptured sec gain E Shareholder's name, address, city, state, and ZIP code 9 Net section 1231 gain (loss) Virgil R. May Queensgate Rd VA Midlothian Other income (loss) 15 Alternative min. tax (AMT) items F Shareholder's percentage of stock ownership for tax year 1% For IRS Use Only i I I Section 179 deduction 12 Other deductions A* Items affecting shareholder asis D 147, Other information " See attached statement for additional information. For Paperwork Reduction Act Notice, see Instructions for Form 1120S. Schedule K-1 (Form 1120S) 28 JVA SK112 TWF Copyright Forms (Software Only) - 28 TW

9 28 Virginia Pass-Through Entity Form 502 Return of Income and Return of Department of Taxation Nonresident Withholding Tax P.O. Box 15 Richmond, VA Check if: Initial return Federal Employer ID Numer Name change ' Entity Name ommission On Health Care Numer and Street Village Mill Drive Address continued City or Town, State and ZIP Code idlothian VA Date of Formation Date Operations Began in Virginia Entity Type (Enter Code -- See instructions) C I I FISCAL or SHORT Year Filer: Beginning Date I I Address change I I Change in fiscal year NAICS I I Ending Date State or Country Where Incorporated or Organized VA Description of Business Activity Professional, Scientif I I Official Use Only Ai Amended return Final return 1-1 Unified nonresident return filed Electing large partnership Suject to ank franchise tax Numers And Types Of Owners Count all owners that were issued a federal Schedule K-1 for the taxale year and enter: a. The Total Numer Of Owners (Include individuals and any other entity types). The Total Numer Of Nonresident Owners (See Instructions) c. Total Amount Withheld for Nonresident Owners (Total of "line e" from all VK-1's with withholding amounts).. d. If entity is exempt from withholding enter exemption code (see instructions) Distriutive Or Pro Rata Income And Deductions See instructions. 1. Total Of Taxale Income Amounts Total Of Deductions Tax-exempt Interest Income 3. Allocation And Apportionment 4. Income Allocated To Virginia (From Schedule 502A, Part A, Line 2) Income Allocated Outside Of Virginia (From Schedule 502A, Part A, Line 3e) Apportionale Income (From Schedule 502A, Part A, Line 4) Virginia Apportionment Percentage (From Schedule 502A, Part B or Part C or 1%) 7. Virginia Additions -- See Schedule 502 ADJ For Other Additions 8. Fixed-date Conformity -- Depreciation Fixed-date Conformity -- Other Net Income Tax Or Other Tax Used As A Deduction In Determining Taxale Income (See Instructions) Interest On Municipal Or State Oligations Other Than From Virginia Total additions from attached Schedule 502 ADJ, Section A, line Total additions (Add lines 8-12) 13. Virginia Sutractions -- See Schedule 502ADJ For Other Sutractions 14. Fixed-date Conformity -- Depreciation Fixed-date Conformity -- Other 15. a.. c. d , ,306 1 % Va. Dept. Of Taxation (Rev 08/08) VA5021 TWF Copyright Forms (Software Only) - 28 TW

10 28 Va. Name Commission On Health Care Form 502 FEIN Page 2 iii 16. Income From Oligations Of The United States 17. Total Sutractions from attached Schedule 502ADJ, Section B, line Total Sutractions (Add lines 14-17) Virginia Tax Credits And Related Information From Schedule 502ADJ 19. Total nonrefundale credits (From Section C, Line 26 from attached Schedule 502ADJ) 20. Total refundale credits (From Section C, line 33 from attached Schedule 502ADJ) Reconciliation of Withholding, Penalties, Interest and Overpayment/Tax Due Section 1: Withholding Payment Reconciliation 1. Total withholding tax due for nonresident owners 2. Total withholding tax paid 3. Overpayment (If line 2 is greater than line 1, sutract line 1 from line 2) 4. Balance of tax due (If line 2 is less than line 1, sutract line 2 from line 1) Section 2: Penalty and Interest Charges on Withholding Tax 5. Extension penalty (may apply if the difference etween line 1 and line 2 is more than 10 percent of line 1) 6. Late filing penalty (will apply if there is a alance 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 alance due on line 4) 8. Total penalty and interest charges due (add lines 5, 6, and 7) Section 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 $1,2 Section 4: Disposition of Overpayment 10. Net overpayment. Sutract lines 8 and 9 from line 3. If lines 8 and 9 exceed line 3, go to line 13 elow 11. Amount of overpayment to e credited to Amount of overpayment to e refunded Section 5: Total Payment Due With Form Balance of tax due from line 4, or total of lines 8 and 9 less line 3, whichever is applicale 14. Penalty and interest charges on withholding tax from line 8 if not included on line Late filing penalty from line 9 if not included on line Total payment due (Add lines 13, 14, and 15) By checking the ox to the right, I (we) authorize the Department of Taxation to discuss this return with the undersigned preparer. --> I, the undersigned owner and authorized representative of the pass-through entity for which this return is made, declare under the penalties provided y law that this return (including any accompanying schedules, statements and attachments) has een examined y me and is, to the est of my knowledge and elief, a true, correct, and complete 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 declares the same, and such declaration is ased on all information of which he or she has any knowledge. President (Signature and Phone Numer of Owner or Authorized Representative) (Title) (Date) 9409 Hull Street Rd Richmond, VA (Individual or Firm, Signature of Preparer, Phone Numer, and Address) (Date) Preparers FEIN, PTIN or SSN Approved Vendor Code 1043 Attach a copy of your Federal Return and Schedule VK-1 for each owner to the Form 502. Do Not Attach Form 765 With This Return -- Mail to Address On Form VA5022 TWF Copyright Forms (Software Only) - 28 TW

11 28 VIRGINIA Schedule VK-1 (Form 502) Check if - Final Amended Return Owner's Share of Income And Virginia Modifications And Credits Check Here if Owner is Participating 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 Certification Inc Address Address Tax Year End Date Address Address Queensgate Rd City or Town, State And ZIP Code VA Midlothian Village Mill Drive City or Town, State And ZIP Code Midlothian VA Additional Owner Information a. Date Owner Acquired Interest In The Pass-Through Entity (MM/DD/YYYY). Owner's Entity Type (Enter code; see instructions) SC c. Owner's Participation Type (Enter code; see instructions) SHR d. Owner's Participation Percentage (Example: 47.35% -- see instructions.) % e. Amount Withheld y PTE for Owner f. If Owner or Entity is exempt from withholding enter exemption code (see instructions) Distriutive or Pro Rata Income and Deductions See instructions. 1. Total of Taxale Income Amounts , Total of Deductions Tax-exempt Interest Income 3. Allocation and Apportionment 4. Income Allocated To Virginia (Owner's Share From PTE's Schedule 502A, Part A, Line 2) Income Allocated Outside Of Virginia (Owner's Share From PTE's Schedule 502A, Part A, Line 3e) Apportionale Income (Owner's Share From PTE's Schedule 502A, Part A, Line 4) , Virginia Apportionment Percentage (From PTE's Schedule 502A, Part B or Part C or 1%) 7. 1 % Virginia Additions -- Owner's Share 8. Fixed-date Conformity -- Depreciation Fixed-date Conformity -- Other Net Income Tax Or Other Tax Used As A Deduction In Determining Taxale Income (See Instructions) Interest On Municipal Or State Oligations Other Than From Virginia Other additions (see instructions for addition codes) Code Amount Code Amount 12a 12 12c 12d 13. Total additions (add lines 8-11 and 12a-12d) 13. Virginia Sutractions -- Owner's Share 14. Fixed-date Conformity -- Depreciation Fixed-date Conformity -- Other Income From Oligations Of The United States Other sutractions (see instructions for sutraction codes) Code Amount Code Amount 17a 17 17c 17d 18. Total Sutractions (Add lines and 17a-17d) 18. Va. Dept. Of Taxation VK-1 (Rev 10/08) VAVK11 TWF Copyright Forms (Software Only) - 28 TW

12 VA Schedule VK-1 (10/08) 28 Owner FEIN or SSN Va. Schedule VK-1 PTE FEIN Page 2 SECTION C -- Virginia Tax Credits Nonrefundale Credits 1. State Income Tax Paid (See instructions) Neighorhood Assistance Act Credit Enterprise Zone Act General Tax Credit Enterprise Zone Act Zone Investment Tax Credit Reserved for future use Conservation Tillage Equipment Credit Bio-Diesel Credit Fertilizer & Pesticide Application Equipment Credit Recyclale Materials Processing Equipment Credit Rent Reduction Program Credit Vehicle Emissions Testing Equipment Credit Major Business Facility Jo Tax Credit Clean Fuel Vehicle Jo Creation Tax Credit Day-care Facility Investment Tax Credit Low-income Housing Tax Credit Agricultural Best Management Practices Tax Credit Worker Retraining Credit Waste Motor Oil Burning Equipment Credit Riparian Forest Buffer Protection For Waterways Virginia Coal And Production Incentive Tax Credit Enter the amount of credit assigned to another party Virginia Coal and Production Incentive Tax Credit availale for use y owner (Sutract line 21 from line 20) Historic Rehailitation Tax Credit 24. Land Preservation Tax Credit 25. Qualified Equity & Suordinated Det Investments Tax Credit 26. Total Nonrefundale credits (Total lines 1-19 and 22-25) fl iii Refundale Credits 27. 1% Coalfield Employment Enhancement and/or Virginia Coal Employment and Production Incentive Tax Credits from Line 1 of your 28 Schedule 306B % Coalfield Employment Enhancement Tax Credit from Line 2 of your 28 Schedule 306B 29. Full credit: Enter amount from 28 Form 306, Line 12a 30. Full credit: Enter amount from your 28 Form 306, line % Credit: Enter amount from 28 Form 306, line 13a % Credit: Enter amount from your 28 Form 306, line Total Coal Related Tax Credits allowale this year: Add Lines 29, 30, 31 and Coalfield Employment Enhancement Tax Credit earned to e used when completing your 2011 return Enter amount from your 28 Form 306, Line Notice You have received this Schedule VK-1 ecause the aove named Pass-Through Entity (PTE) earned income from Virginia sources and has passed through to you a portion of that Virginia source income ased on your ownership of the PTE. A copy of this schedule has een filed with the Virginia Department of Taxation. Everyone who receives Virginia source income is suject to taxation y Virginia regardless of state of residency or domicile. You may e required to file a Virginia tax return even though you may e a nonresident individual or a usiness domiciled outside of Virginia. To determine if you are required to file a Virginia income tax return, consult your tax professional. Information and forms may e otained at or call the Virginia Department of Taxation at (individuals) or (usinesses) VAVK12 TWF Copyright Forms (Software Only) - 28 TW