G Is the corporation If "Yes," attach Form 2553 if not already filed electing to be an S corporation beginning with this tax year? Yes _

I Enter the number of shareholders who were shareholders during any part of the tax year

0 For Privacy Act and Paperwork Reduction Act Notice, see instructions.

JVA 08 1120S12 TWF 27388 Copyright Forms (Software Only) - 2008 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 be an S corporation.

► See separate instructions.

OMB No. 1545-0130

2008

For calendar year 2008 or t ax year beginning , 2008, ending , 20

A S election effective date

07-16-2002 Use IRS label.

Other-wise, print or

type.

Name Number, street, room/suite no. City/town, state, & Zip code

Commission On Health Care Certification Inc. 13801 Village Mill Drive Midlothian VA 23113

D Employer ID no.

22-3859071 B Business activity

code number (see instructions)

541990

E Date incorporated

07-16-2002 F Total assets (see inst.)

824 C Check if Sch. M-3

attached

H Check if: (1)

(4)

Final return

Amended return

(2) change Name chan _ (3) 0 Address change

(5) 0 S election termination or revocation

Caution. Include only trade or business income and expenses on lines la through 21. See the instructions for more information.

-Z

OO

EL

LI I

la Gross receipts or sales 192,408 b Less returns and allowances C Bal ► 1C 192,408 2 Cost of goods sold (Schedule A, line 8)

3 Gross profit. Subtract 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 ►

2

3 192,408 4

5

6 192,408 I u

_OX

-,-2

—/-<

--O

Zco

............

-,,....

,......-,,,

, ,-,-.

...

7 Compensation of officers

8 Salaries and wages (less employment credits)

9 Repairs and maintenance

10 Bad debts

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 benefit programs

19 Other deductions (attach statement)

20 Total deductions. Add lines 7 through 19 ► 21 Ordinary business income (loss).Subtract line 20 from line 6

7

8

9

10

11 6,799 12

13

14

15

16

17

18

19 37,303 20 44,102 21 148,306 I

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QX

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C1 0

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22a Excess net passive income or LIFO recapture tax (see instructions). . .

b Tax from Schedule D (Form 1120S)

c Add lines 22a and 22b (see instructions for additional taxes)

23a 2008 estimated tax payments and 2007 overpayment credited to 2008

22a

22c 0

22b

23a

23d 0

b Tax deposited with Form 7004 23b

c Credit for federal tax paid on fuels (attach Form 4136) 23c

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 2009 estimated tax ► 0 Refunded ►

24

25 0

26

27 0

Sign Here

Under alties of eru , I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief arer (other than taxpayer) is based on all information of which preparer has any knowledge.

-' :1/44' , , 4

1 •.- la' I President May the IRS discuss this return with the preparer shown below

Signature of officer Date r Title (see inst.)? Yes n No

. Preparer's L • -.40- - .

Pa id signature I Date

07-20-2011 Check if self-

employed n Preparer's SSN or PTIN

Preparer's Kevin J Perlo i CPA EIN 54-1761867 Firm's name (or

Use Only yours if self-employed), 9409 Hull Street Rd Phone no.

(804) 745-5895 address, and ZIP code Richmond, VA 23236

D E D U C T

0 N S

Form 1120S Department of the Treasury Internal Revenue Service

1 2

3

4 5 6 7

8

Commission On Health Care 22-3859071 Form 1120S (2008) Page 2 Schedule A Cost of Goods Sold (see instructions)

Inventory at beginning of year 1

Purchases 2

Cost of labor 3

Additional section 263A costs (attach statement) 4

Other costs (attach statement)

Total. Add lines 1 through 5 6

Inventory at end of year 7 Cost of goods sold. Subtract 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 described in Regulations section 1.471-3

(ii)_ Lower of cost or market as described in Regulations section 1.471-4

(iii) Other (Specify method used and attach explanation.) ► b Check if there was a writedown of subnormal goods as described in Regulations section 1.471-2(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? Yes

f Was there any change in determining quantities, cost, or valuations between opening and closing inventory? Yes

If "Yes," attach explanation.

Schedule B Other Information (see instructions) Yes No

1 Check

2 See

a

accounting method: a Cash b LIAccrual c 11 the instructions and enter the:

Business activity ► Professional, Scien b Product or service

Other (specify) ►

► 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 attribution, see section 267(c).) If "Yes," attach a statement showing:(a) name and employer

identification number (EIN), (b) percentage owned, and (c) if 100% owned, was a QSub election made? X

4 Has this corporation filed, or is it required to file, a return under section 6111 to provide information on any reportable

transaction? X

5 Check this box if the corporation issued publicly offered debt instruments with original issue discount ► I If checked, the corp. may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount Instruments.

6 If the corporation: (a) was a C corporation before it elected to be an S corporation or the corporation acquired an asset with

a basis determined by reference to its basis (or the basis of any other property) in the hands of a C corporation and (b) has

net unrealized built-in gain (defined in section 1374(d)(1)) in excess of the net recognized built-in gain from prior years,

enter the net unrealized built-in gain reduced by net recognized built-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 $250,000? If "Yes," the corporation is not required to complete Schedules L and M-1 X

Schedule K Shareholders' Pro Rata Share Items Total amount

-Z

OO

EU

J

-I 0

u) u)

1 Ordinary business income (loss) (page 1, line 21) 1 148,306 2 Net rental real estate income (loss) (attach Form 8825) 2

3a Other gross rental income (loss)

b Expenses from other rental activities (attach statement)

3a

3b

c Other net rental income (loss). Subtract line 3b from line 3a 3c

4 Interest income 4

5 Dividends: a Ordinary dividends 5a

b Qualified dividends 1 5b

6 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))

b Collectibles (28%) gain (loss)

c Unrecaptured section 1250 gain (attach statement)

8b

8a

8c

9 Net section 1231 gain (loss) (attach Form 4797) 9

10 Other income (loss) (see instructions) Type ► 10 .. —

9d

No

No

JVA

08 1120S12

TWF 27389

Copyright Forms (Software Only) - 2008 TW orm

Commission On Health, Care 22-3859071 Form 1120S (2008)

Page 3

Deduc-tions

Shareholders' Pro Rata Share Items (continued) Total amount

11 Section 179 deduction (attach Form 4562)

12a Contributions

b Investment interest expense

c Section 59(e)(2) expenditures (1) Type ► (2) Amount ►

11

12a 753 12b

12c(2)

d Other deductions (see instructions) Type ► 12d

Credits

13a Low-income housing credit (section 42(j)(5))

b Low-income housing credit (other)

c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468)

d Other rental real estate credits (see instructions) Type ►

13a

13b

13c 13d

e Other rental credits (see instructions) Type ► 13e

f Alcohol and cellulosic biofuel fuels credit (attach Form 6478)

g Other credits (see instructions)... Type ► 13f 13g

Foreign Trans- actions

14a Name of country or U.S. possession ► 14b b Gross income from all sources

c Gross income sourced at shareholder level

Foreign gross income sourced at corporate level

d Passive category

e General category

f Other (attach statement)

Deductions allocated and apportioned at shareholder level

g Interest expense

h Other

Deductions allocated and apportioned at corporate level to foreign source income

i Passive category

j General category

k Other (attach statement)

Other information

14c

14d

14e

14f

14g

14h

14i

14j

14k

141 I Total foreign taxes (check one): ► I Paid 111 Accrued

m Reduction in taxes available for credit (attach statement)

n Other foreign tax information (attach statement)

14m

Altern- ative Mini- mum Tax (AMT) Items

15a Post-1986 depreciation adjustment

b Adjusted gain or loss

c Depletion (other than oil and gas)

d Oil, gas, and geothermal properties--gross income

e Oil, gas, and geothermal properties--deductions

f Other AMT items (attach statement)

15a

15b

15c

15d

15e

15f

Items Affect- in Share- holder Basis

16a Tax-exempt interest income

b Other tax-exempt income

c Nondeductible expenses

d Property distributions

e Repayment of loans from shareholders

16a

16b 16c

16d 147,553 16e

Other Inform- ation

17a Investment income

b Investment expenses

c Dividend distributions paid from accumulated earnings and profits

d Other items and amounts (attach statement)

17a

17b

17c

Recon- ciliation

18 Income/loss reconciliation. Combine the amounts on lines 1 through 10 in the far right

column. From the result, subtract the sum of the amounts on lines 11 through 12d and 141 18 147,553 JVA

08 1120S34

TWF 27390

Copyright Forms (Software Only) - 2008 TW orm

Commission On Health Care 22-3859071 Form 1120S (2008) Page 4

Schedule L Balance Sheets per Books Beginning of tax year End of tax year

1

2a

b

3

4

5

6

7

8 9

10a

b

hia b

12

13a

b

14 15

16

17

18

19

20

21

22

23

24

25

26

27

Assets

Cash

Trade notes and accounts receivable ....

Less allowance for bad debts

Inventories

U.S. government obligations

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 depreciable assets

Less accumulated depreciation

Depletable assets

Less accumulated depletion

Land (net of any amortization)

Intangible assets (amortizable only)

Less accumulated amortization

Other assets (attach statement)

Total assets

Liabilities and Shareholders' Equity Accounts payable

Mortgages, notes, bonds payable in less than 1 yr

Other current liabilities (attach statement)

Loans from shareholders

Mortgages, notes, bonds payable in 1 year or more

Other liabilities (attach statement)

Capital stock

Additional paid-in capital

Retained earnings

Adjustments to shareholders' equity (attach stmt.)

Less cost of treasury stock

Total liabilities and shareholders' equity

(a) (b) (c) (d)

324 324

( ) ( )

20,838 20,838 ( 20,838) ( 20,838)

( ) ( )

( ) ( )

500 500 824 824

824 824

( ) ( )

824 824 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 2

3

a

b

4

Net income (loss) per books

Income included on Schedule K, lines 1, 2, 3c, 4, 5a, 6, 7, 8a, 9, and 10, not recorded on books this year (itemize):

147,553 5 Income recorded on books this year not included on Schedule K, lines 1 through 10 (itemize):

a Tax-exempt interest $

Expenses recorded on books this year not included on Schedule K, lines 1 through 12 and 141 (itemize):

Depreciation $

6 Deductions included on Schedule K, lines 1 through 12 and 141, not charged against book income this year (itemize):

a Depreciation $

Travel and entertainment $

7 Add lines 5 and 6

8 Income (loss) (Schedule K, line 18). Line 4 less line 7 Add lines 1 through 3 147,553 147,553

Analysis of Accumulated Adjustments Account, Other Adjustments Account, and Shareholders' Undistributed Taxable Income Previously Taxed (see instructions) Schedule M-2

(a) Accumulated adjustments account

(b) Other adjustments account

(c) Shareholders' undistributed taxable

income previously taxed

824 1 Balance at beginning 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 Combine lines 1 through 5

7 Distributions other than dividend distributions

8 Balance at end of tax year. Subtract line 7 from line 6 .

JVA

08 1120S34 -rwF 27391 Copyright Forms (Software Only) - 2008 PA/ Form 1 120S (2008)

148,306

753#3 ) 148,377 147,553

824

2008 SCHEDULE M-1 EXPLANATION ATTACHMENT

Commission On Health Care 22-3859071

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 18 147,553

Increases:

Deductions on return not charged against book income (Schedule M-1, line 6)

Income recorded on books not included on return (Schedule M-1, line 5)

Decreases:

Expenses recorded on books not included on return (Schedule M-1, line 3)

Income subject to tax not recorded on books (Schedule M-1, line 2)

Computed net income (loss) per books (Schedule M-1, line 1) 147,553

JVA Copyright Forms (Software Only) - 2008 TW M0918A 08_CSM1

2008 DETAIL STATEMENTS Commission On Health Care 22-3859071 Page 1

STATEMENT #1 - Other Deductions (1120S PG1 LINE 19)

Other Deductions: Bank Charges 667 Legal & Professional 104 Licenses & Permits 1,003 Office Supplies 5,172 Postage 999 Travel 8,734 Utilities 4,391 Miscellaneous 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 Contributions (50%)

753

TOTAL CARRIED TO 1120S PG 3 LINE 12a

753

STATEMENT #3 - Other Reductions (1120S PG 4 M-2 LINE 5(a))

Charitable Contributions

753

TOTAL CARRIED TO 1120S PG 4 M-2 LINE 5(a)

753

JVA Copyright Forms (Software Only) - 2008 TW C0703D

08_LSSTMT

2008 Federal Depreciation Schedule Commission On Health Care, Certification Inc. 22-3859071 07-20-2011

Description Date Method Year Cost Land/ al 70 Spec Basis Prior Other 4 " Allow

Current

Form 1120S Computer Eqpt 09-20-02 200DBHY 5 4,958 0 4,958 0 0 0 0 Computer Eqpt 06-30-05 200DBHY 5 8,287 0 8,287 0 0 0 0 Computer Eqpt 06-30-06 200DBHY 5 7,593 0 7,593 0 0 0 0

3 Assets Totals: 20,838 0 20,838 0 0 0 0

3 Assets Grand Totals: 20,838 0 20,838 0 0 0 0

Balance Sheet Reconciliation

Grand Totals: 20,838 0 20,838 0 0 0 0 Less Future Purchases: 0 0 0 0 0 0 0

Less Current Year Disposals: 0 0 0 0 0 0 0

End of Year Totals: 20,838 0 20,838 0 0 0 0

Buildings and Other Depreciable Assets: 20,838 Prior Depreciation: 0 Current Depreciation: 0

179: 20,838 Special Depreciation Allowance: 0

Ending Accumulated Depreciation (Per Balance Sheet): 20,838

Land: 0

Intangible Assets (Amortizable 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 basis in like-kind exchange transaction -B Excess basis in like-kind exchange transaction

1

5a Ordinary dividends A Corporation's employer identification number

22-3859071

8a Net long-term cap. gain (loss) C IRS Center where corporation filed return

CINCINNATI

D Shareholder's identifying number

224-78-6225 8c Unrecaptured sec. 1250 gain

, 2008

, 20

Schedule K-1

2008 (Form 1120S) Department of the Treasury

For calendar year 2008, or tax

Internal Revenue Service year beginning

ending

Shareholder's Share of Income, Deductions, Credits, etc. ► See page 2 and separate instructions.

Part III Shareholder's Share of Current Year Inc., Deductions, Credits, and Other Items

I Ordinary business inc. (loss)

148,306 13 Credits

2 Net rental real estate inc. (loss)

3 Other net rental income (loss)

Information About the Corporation 4 Interest income

B Corporation's name, address, city, state, and ZIP code

Commission On Health Care Certification Inc. 13801 Village Mill Drive Midlothian VA 23113

5b Qualified dividends

6 Royalties

7 Net short-term cap. gain (loss)

14 Foreign transactions

I Part II Information About the Shareholder 8b Collectibles (28%) gain (loss)

E Shareholder's name, address, city, state, and ZIP code 9 Net section 1231 gain (loss)

10 Other income (loss)

Virgil R. May 13325 Queensgate Rd VA Midlothian 23114

F Shareholder's percentage of stock ownership for tax year 100.0000%

For IRS Use Only

15 Alternative min. tax (AMT) items

11 Section 179 deduction

12 Other deductions

A* 753

16 Items affecting

shareholder basis

D 147,553

17 Other information

" See attached statement for additional information.

i I I 11

Part I

. # 1

671108 Final K-1

Amended K-1

OMB No. 1545-0130

For Paperwork Reduction Act Notice, see Instructions for Form 1120S. Schedule K-1 (Form 1120S) 2008

JVA 08 120SK112 TWF 27396 Copyright Forms (Software Only) - 2008 TW

Ai I I I I I I

•

•

•

•

•

•

• • • • • • • • •

• •

00

00

00

00

00

00

00

00

2008 Virginia Pass-Through Entity Form 502 Return of Income and Return of Department of Taxation Nonresident Withholding Tax P.O. Box 1500

Richmond, VA 23218-1500

FISCAL or SHORT Year Filer: Beginning Date •

Check if:

Initial return

Ending Date •

Name change I I Address change I I Change in fiscal year

Federal Employer ID Number

'2-3859071 Official Use Only

Entity Name

ommission On Health Care Number and Street

13801 Village Mill Drive Address continued

City or Town, State and ZIP Code

idlothian VA 23113 Date of Formation

07-16-2002 Date Operations Began in Virginia

07-16-2002 State or Country Where Incorporated or Organized

VA Entity Type (Enter Code -- See instructions)

C NAICS

541990 Description of Business Activity

Professional, Scientif

Amended return

Final return

1-1 Unified nonresident return filed

Electing large partnership

Subject to bank franchise tax

Numbers And Types Of Owners

Count all owners that were issued a federal Schedule K-1 for the taxable year and enter:

a. The Total Number Of Owners (Include individuals and any other entity types)

b. The Total Number 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)

Distributive Or Pro Rata Income And Deductions See instructions.

a.

b.

c.

d.

1 • •

00 • •

• • •

1. Total Of Taxable Income Amounts 1.

2. Total Of Deductions 2.

3. Tax-exempt Interest Income 3.

Allocation And Apportionment

4. Income Allocated To Virginia (From Schedule 502A, Part A, Line 2) 4.

5. Income Allocated Outside Of Virginia (From Schedule 502A, Part A, Line 3e) 5.

6. Apportionable Income (From Schedule 502A, Part A, Line 4) 6.

7. Virginia Apportionment Percentage (From Schedule 502A, Part B or Part C or 100%) 7.

Virginia Additions -- See Schedule 502 ADJ For Other Additions

8. Fixed-date Conformity -- Depreciation 8.

9. Fixed-date Conformity -- Other 9.

10. Net Income Tax Or Other Tax Used As A Deduction In Determining Taxable Income (See Instructions) 10.

11. Interest On Municipal Or State Obligations Other Than From Virginia 11.

12. Total additions from attached Schedule 502 ADJ, Section A, line 5 12.

13. Total additions (Add lines 8-12) 13.

Virginia Subtractions -- See Schedule 502ADJ For Other Subtractions

14. Fixed-date Conformity -- Depreciation 14.

15. Fixed-date Conformity -- Other 15.

148,306 00

753 00 00

00

00

148,306 00

100.0000 %

Va. Dept. Of Taxation 2601015 502 (Rev 08/08)

1043 08 VA5021 TWF 29493 Copyright Forms (Software Only) - 2008 TW

• 2008 Va. Name Commission On Health Care Form 502 FEIN 22-3859071 Page 2 iii

Section 2: Penalty and Interest Charges on Withholding Tax 5. Extension penalty (may apply if the difference between line 1 and line 2 is more than 10 percent of line 1)

6. Late filing penalty (will apply if there is a balance due on line 4 and Form 502 is being filed more than six months

after the original due date)

7. Interest (may apply if there is a balance 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 502

9. If Form 502 is being filed more than six months after the original due date, or more than 30 days after the federal

extended due date, enter $1,200

16. Income From Obligations Of The United States

17. Total Subtractions from attached Schedule 502ADJ, Section B, line 5

18. Total Subtractions (Add lines 14-17)

Virginia Tax Credits And Related Information From Schedule 502ADJ

19. Total nonrefundable credits (From Section C, Line 26 from attached Schedule 502ADJ)

20. Total refundable 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, subtract line 1 from line 2)

4. Balance of tax due (If line 2 is less than line 1, subtract line 2 from line 1)

Section 4: Disposition of Overpayment 10. Net overpayment. Subtract lines 8 and 9 from line 3. If lines 8 and 9 exceed line 3, go to line 13 below

11. Amount of overpayment to be credited to 2009

12. Amount of overpayment to be refunded

Section 5: Total Payment Due With Form 502 13. Balance of tax due from line 4, or total of lines 8 and 9 less line 3, whichever is applicable

14. Penalty and interest charges on withholding tax from line 8 if not included on line 13

15. Late filing penalty from line 9 if not included on line 13

16. Total payment due (Add lines 13, 14, and 15)

16.

17.

18.

19.

20.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

00

00 • 00 •

00 • 00 •

00 • 00 • 00 • 00 •

00 •

00 • 00 • 00 •

00 •

00 • 00 • 00 •

00 • 00 • 00 • 00

By checking the box 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 by law that this return (including any accompanying schedules, statements and attachments) has been examined by me and is, to the

best of my knowledge and belief, a true, correct, and complete return, made in good faith, for the taxable 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 based on all

information of which he or she has any knowledge.

President (Signature and Phone Number of Owner or Authorized Representative) (Title) (Date)

9409 Hull Street Rd 804-745-5895 Richmond, VA 23236 07-20-2011

(Individual or Firm, Signature of Preparer, Phone Number, 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 765

•

1043 08 VA5022 TWF 29494 Copyright Forms (Software Only) - 2008 TW

2008 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 Owner Information Pass-Through Entity (PTE) Information

Name

Virgil R. May FEIN or SSN

224-78-6225 Name Commission On Health Certification Inc.

FEIN

22-3859071 Address Address Tax Year End Date

12-31-08 Address

13325 Queensgate Rd Address

13801 Village Mill Drive City or Town, State And ZIP Code

VA Midlothian 23114 City or Town, State And ZIP Code

Midlothian VA 23113

Additional Owner Information

a. Date Owner Acquired Interest In The Pass-Through Entity (MM/DD/YYYY) •

b. 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.) 1 00 . 0 0 % • e. Amount Withheld by PTE for Owner •

f. If Owner or Entity is exempt from withholding enter exemption code (see instructions) •

Distributive or Pro Rata Income and Deductions

See instructions.

1. Total of Taxable Income Amounts 1. 148,306 .00.

2. Total of Deductions 2. 753 .00.

3. Tax-exempt Interest Income 3. .00 •

Allocation and Apportionment

4. Income Allocated To Virginia (Owner's Share From PTE's Schedule 502A, Part A, Line 2) 4. .00 •

5. Income Allocated Outside Of Virginia (Owner's Share From PTE's Schedule 502A, Part A, Line 3e) 5. .00 •

6. Apportionable Income (Owner's Share From PTE's Schedule 502A, Part A, Line 4) 6. 148,306 .00•

7. Virginia Apportionment Percentage (From PTE's Schedule 502A, Part B or Part C or 100%) 7. 100.0000 %•

Virginia Additions -- Owner's Share

8. Fixed-date Conformity -- Depreciation 8. .00

9. Fixed-date Conformity -- Other 9. .00

10. Net Income Tax Or Other Tax Used As A Deduction In Determining Taxable Income (See Instructions) 10. .00

11. Interest On Municipal Or State Obligations Other Than From Virginia 11. .00

12. Other additions (see instructions for addition codes)

Code Amount Code Amount

12a .00 12b .00

12c

.00 12d

.00

13. Total additions (add lines 8-11 and 12a-12d)

13. .00 •

Virginia Subtractions -- Owner's Share

14. Fixed-date Conformity -- Depreciation 14. .00

15. Fixed-date Conformity -- Other 15. .00

16. Income From Obligations Of The United States 16. .00

17. Other subtractions (see instructions for subtraction codes)

Code Amount Code Amount

17a .00 17b .00

17c .00 17d .00

18. .00 •

Va. Dept. Of Taxation 2601024 VK-1 (Rev 10/08)

1043 08 VAVK11 TWF 29490 Copyright Forms (Software Only) - 2008 TW

18. Total Subtractions (Add lines 14-16 and 17a-17d)

VA Schedule VK-1 (10/08)

2008 Owner FEIN or SSN 224-78-6225

Va. Schedule VK-1 PTE FEIN 22-3859071 Page 2

SECTION C -- Virginia Tax Credits Nonrefundable Credits

1. State Income Tax Paid (See instructions) 1.

2. Neighborhood Assistance Act Credit

2.

3. Enterprise Zone Act General Tax Credit

3.

4. Enterprise Zone Act Zone Investment Tax Credit

4.

5. Reserved for future use

5.

6. Conservation Tillage Equipment Credit

6.

7. Bio-Diesel Credit

7.

8. Fertilizer & Pesticide Application Equipment Credit

8. 9. Recyclable Materials Processing Equipment Credit

9.

10. Rent Reduction Program Credit

10.

11. Vehicle Emissions Testing Equipment Credit

11.

12. Major Business Facility Job Tax Credit

12.

13. Clean Fuel Vehicle Job Creation Tax Credit

13.

14. Day-care Facility Investment Tax Credit

14.

15. Low-income Housing Tax Credit

15.

16. Agricultural Best Management Practices Tax Credit

16.

17. Worker Retraining Credit

17.

18. Waste Motor Oil Burning Equipment Credit

18.

19. Riparian Forest Buffer Protection For Waterways

19.

20. Virginia Coal And Production Incentive Tax Credit 20. .00

21. Enter the amount of credit assigned to another party 21. .00

22. Virginia Coal and Production Incentive Tax Credit available for use by owner (Subtract line 21 from line 20) ..

23. Historic Rehabilitation Tax Credit

24. Land Preservation Tax Credit

25. Qualified Equity & Subordinated Debt Investments Tax Credit

26. Total Nonrefundable credits (Total lines 1-19 and 22-25)

Refundable Credits

27. 100% Coalfield Employment Enhancement and/or Virginia Coal Employment and Production

Incentive Tax Credits from Line 1 of your 2008 Schedule 306B

28. 25% Coalfield Employment Enhancement Tax Credit from Line 2 of your 2008 Schedule 306B

29. Full credit: Enter amount from 2008 Form 306, Line 12a

30. Full credit: Enter amount from your 2008 Form 306, line 12b

31. 85% Credit: Enter amount from 2008 Form 306, line 13a

32. 90% Credit: Enter amount from your 2008 Form 306, line 13b

33. Total Coal Related Tax Credits allowable this year: Add Lines 29, 30, 31 and 32

34. 2008 Coalfield Employment Enhancement Tax Credit earned to be used when completing your 2011 return

Enter amount from your 2008 Form 306, Line 11

fl iii .00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

22. .00

23. .00

24. .00

25. .00

26. .00 •

27. .00

28. .00

29. .00

30. .00

31. .00

32. .00

33. .00

34. .00

Notice

You have received this Schedule VK-1 because the above named Pass-Through Entity (PTE) earned income from Virginia sources and has passed

through to you a portion of that Virginia source income based on your ownership of the PTE. A copy of this schedule has been filed with the Virginia

Department of Taxation. Everyone who receives Virginia source income is subject to taxation by Virginia regardless of state of residency or domicile.

You may be required to file a Virginia tax return even though you may be a nonresident individual or a business 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 be obtained at

www.tax.virginia.gov , or call the Virginia Department of Taxation at 804-367-8031 (individuals) or 804-367-8037 (businesses).

1043 08 VAVK12 TWF 29491 Copyright Forms (Software Only) - 2008 TW