W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
Copy B — To Be Filed With Employee's FEDERAL Tax Return
a Employee's social security number
731-03-1972
b Employer identification number (EIN)
830672898
c Employer's name, address, and ZIP code
VMS Palliative Hospice Care LLC
20127 Ivory Valley Lane
Cypress , TX 77433
d Control number
e Employee's first name and initial     Last name     Suff.
Carlos Lara
10802 Bette Haven Dr
Houston, TX 77065
1 Wages, tips, other compensation
$6860.00
2 Federal income tax withheld
$404.26
3 Social security wages
$4660.00
4 Social security tax withheld
$288.92
5 Medicare wages and tips
$6860.00
6 Medicare tax withheld
$67.57
7 Social security tips
$0.00
8 Allocated tips
$0.00
9
 
10 Dependent care benefits
$0.00
11 Nonqualified plans
$0.00
12a See instructions for box 12
13
☐ Statutory employee   ☐ Retirement plan   ☐ Third-party sick pay
14 Other
 
15 State
TX
Employer's state ID
16 State wages
$6860.00
17 State income tax
$0.00
18 Local wages
$0.00
Form W-2 • 2026 • OMB No. 1545-0008
W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
Copy C — For EMPLOYEE'S RECORDS
a Employee's social security number
731-03-1972
b Employer identification number (EIN)
830672898
c Employer's name, address, and ZIP code
VMS Palliative Hospice Care LLC
20127 Ivory Valley Lane
Cypress , TX 77433
d Control number
e Employee's first name and initial     Last name     Suff.
Carlos Lara
10802 Bette Haven Dr
Houston, TX 77065
1 Wages, tips, other compensation
$6860.00
2 Federal income tax withheld
$404.26
3 Social security wages
$4660.00
4 Social security tax withheld
$288.92
5 Medicare wages and tips
$6860.00
6 Medicare tax withheld
$67.57
7 Social security tips
$0.00
8 Allocated tips
$0.00
9
 
10 Dependent care benefits
$0.00
11 Nonqualified plans
$0.00
12a See instructions for box 12
13
☐ Statutory employee   ☐ Retirement plan   ☐ Third-party sick pay
14 Other
 
15 State
TX
Employer's state ID
16 State wages
$6860.00
17 State income tax
$0.00
18 Local wages
$0.00
Form W-2 • 2026 • OMB No. 1545-0008
W-2 Wage and Tax Statement
Department of the Treasury — Internal Revenue Service
Copy 2 — To Be Filed With Employee's State/Local Tax Return
a Employee's social security number
731-03-1972
b Employer identification number (EIN)
830672898
c Employer's name, address, and ZIP code
VMS Palliative Hospice Care LLC
20127 Ivory Valley Lane
Cypress , TX 77433
d Control number
e Employee's first name and initial     Last name     Suff.
Carlos Lara
10802 Bette Haven Dr
Houston, TX 77065
1 Wages, tips, other compensation
$6860.00
2 Federal income tax withheld
$404.26
3 Social security wages
$4660.00
4 Social security tax withheld
$288.92
5 Medicare wages and tips
$6860.00
6 Medicare tax withheld
$67.57
7 Social security tips
$0.00
8 Allocated tips
$0.00
9
 
10 Dependent care benefits
$0.00
11 Nonqualified plans
$0.00
12a See instructions for box 12
13
☐ Statutory employee   ☐ Retirement plan   ☐ Third-party sick pay
14 Other
 
15 State
TX
Employer's state ID
16 State wages
$6860.00
17 State income tax
$0.00
18 Local wages
$0.00
Form W-2 • 2026 • OMB No. 1545-0008
Generated Jun 22, 2026 at 10:27 AM • Censorium Payroll