SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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X
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Gronniger Tim

(Last) (First) (Middle)
C/O SIGNIFY HEALTH, INC.
4055 VALLEY VIEW LN, SUITE 700

(Street)
DALLAS TX 75244

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Signify Health, Inc. [ SGFY ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Ch. Value-Based Sols. Off
3. Date of Earliest Transaction (Month/Day/Year)
03/29/2023
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Rule 10b5-1(c) Transaction Indication

  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 03/29/2023 D(1)(2) 188,576 D (1)(2) 135,008 D
Class A Common Stock 03/29/2023 D(3) 135,008 D (3) 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Options (Right to Buy) $14.19 03/29/2023 D 132,138 (4)(5)(6) (4)(5)(6) Class A Common Stock 132,138 (4)(5)(6) 0 D
Explanation of Responses:
1. On March 29, 2023, pursuant to that certain Agreement and Plan of Merger, dated September 2, 2022, between the Issuer, CVS Pharmacy, Inc. ("Parent") and Noah Merger Sub, Inc. (the "Merger Agreement"), as of the effective time of the merger (the "Effective Time"), each restricted stock unit with respect to shares of the Issuer's Class A Common Stock (each, an "Issuer RSU") that was not (i) outstanding immediately prior to the Effective Time to the extent vested and unsettled or (ii) outstanding immediately prior to the Effective Time and was held by any person who is a non-employee director, consultant or independent contractor engaged by the Issuer and was outstanding immediately prior to the Effective Time (each, a "Rollover RSU") was converted into a restricted stock unit, subject to substantially the same terms and conditions as were applicable under such Rollover RSU,
2. (Continued from Footnote 1) with respect to a number of shares of common stock of CVS Health Corporation ("CVS Health Stock") equal to the number of shares of the Issuer's Class A Common Stock ("Class A Common Stock") subject to such Rollover RSU multiplied by a fraction, the numerator of which is $30.50 (the "Per Share Consideration") and the denominator of which is the volume weighted average trading price (rounded to the nearest $0.01) of one share of CVS Health Stock on the New York Stock Exchange as reported on Bloomberg L.P. under the function "VWAP" (or, if not reported therein, in another authoritative source mutually selected by the parties) for the ten (10) consecutive trading days ending on (and including) the trading day that is three (3) trading days prior to the date of the closing of the Merger (the "Exchange Ratio").
3. Pursuant to the Merger Agreement, each share of Class A Common Stock outstanding and held by the Reporting Person immediately prior to the Effective Time, was cancelled and converted into the right to receive the Per Share Consideration.
4. Pursuant to the Merger Agreement, each option to purchase a share of Class A Common Stock (each, an "Issuer Option") granted by Issuer under an Issuer stock plan that was (i) outstanding as of immediately prior to the Effective Time and was vested and unexercised (but not, for the avoidance of doubt, (x) any unvested Issuer Option that was outstanding immediately prior to the Effective Time with an exercise price that is equal to or greater than $30.50 or (y) any Issuer Option that is forfeited due to failure to satisfy performance-based conditions) or (ii) outstanding immediately prior to the Effective Time and was held by a non-employee director, consultant or independent contractor of the Issuer (whether vested or unvested) (each, a "Cash-Out Option"), was cancelled and converted into the right to receive an amount in cash equal to the product of (1) the excess,
5. (Continued from Footnote 4) if any, of the Per Share Consideration over the per-share exercise price of such Cash-Out Option, multiplied by (2) the number of shares of Class A Common Stock then subject to such Cash-Out Option as of immediately prior to the Effective Time.
6. Pursuant to the Merger Agreement, each Issuer Option that is not a Cash-Out Option and is outstanding immediately prior to the Effective Time (each, a "Rollover Stock Option") was converted into an option to acquire, on substantially the same terms and conditions as were applicable under such Rollover Stock Option, the number of shares of CVS Health Stock (rounded down to the nearest whole share), determined by multiplying (x) the number of shares of Class A Common Stock subject to such Rollover Stock Option immediately prior to the Effective Time by (y) the Exchange Ratio, at an exercise price per share of CVS Health Stock (rounded up to the nearest whole cent) equal to (A) the exercise price per share of Class A Common Stock subject to such Rollover Stock Option divided by (B) the Exchange Ratio.
Remarks:
/s/ Adam McAnaney, as attorney-in-fact for Tim Gronniger 03/29/2023
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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