Delaware
(State or other jurisdiction of
incorporation or organization)
|
5912
(Primary Standard Industrial
Classification Code Number)
|
05-0494040
(I.R.S. Employer
Identification Number)
|
One CVS Drive
Woonsocket, RI 02895
(401) 765-1500
(Address, including zip code, and telephone
number, including area code, of registrant’s
principal executive offices)
|
David M. Denton
Executive Vice President
and Chief Financial Officer
CVS Health Corporation
One CVS Drive
Woonsocket, RI 02895
(401) 765-1500
(Name, address, including zip code, and telephone number, including
area code, of agent for service)
|
Stephen T. Giove
Shearman & Sterling LLP
599 Lexington Ave
New York, New York 10022
(212) 848-4000
|
Thomas M. Moriarty
Executive Vice President, Chief Health Strategy Officer
and General Counsel
CVS Health Corporation
One CVS Drive
Woonsocket, RI 02895
(401) 765-1500
|
Large accelerated filer x
|
Accelerated filer o
|
Non-accelerated filer o (Do not check if a smaller reporting company)
|
Smaller reporting company o
|
If applicable, place an X in the box to designate the appropriate rule provision relied upon in conducting this transaction:
|
|
Exchange Act Rule 13e-4(i) (Cross-Border Issuer Tender Offer) o
|
|
Exchange Act Rule 14d-1(d) (Cross-Border Third-Party Tender Offer) o
|
Title of Each Class of
Securities to be Registered
|
Amount to be Registered
|
Proposed Maximum
Offering Price Per Note(1) |
Proposed Maximum
Aggregate Offering Price(1) |
Amount of
Registration Fee
|
||||||||||||
4.75% Senior Notes due 2022
|
$ | 387,285,000 | 100 | % | $ | 387,285,000 | $ | 38,999.60 | ||||||||
5.00% Senior Notes due 2024
|
$ | 296,255,000 | 100 | % | $ | 296,255,000 | $ | 29,832.88 |
The information in this prospectus is not complete and may be changed. We may not complete this exchange offer until the registration statement filed with the Securities and Exchange Commission is effective. This prospectus is not an offer to sell these securities and is not soliciting an offer to buy these securities in any state where the offer or sale is not permitted.
|
ii
|
|
iii
|
|
1
|
|
9
|
|
10
|
|
11
|
|
14
|
|
15
|
|
24
|
|
40
|
|
41
|
|
42
|
|
43
|
|
43
|
·
|
Annual Report on Form 10-K, filed with the SEC on February 9, 2016.
|
·
|
Current Report on Form 8-K, filed with the SEC on January 26, 2016.
|
·
|
Definitive Proxy Statement on Schedule 14A, filed with the SEC on April 8, 2016 (portions thereof incorporated by reference in Part III of the Annual Report on Form 10-K for the year ended December 31, 2015).
|
The Exchange Offer
|
We are offering to exchange up to $387,285,000 aggregate principal amount of the Old 2022 Notes for up to $387,285,000 aggregate principal amount of the New 2022 Notes, and up to $296,255,000 aggregate principal amount of the Old 2024 Notes for up to $296,255,000 aggregate principal amount of the New 2024 Notes. Old Notes may be exchanged only in minimum denominations of $2,000 and integral multiples of $1,000 in excess of $2,000. New Notes will be issued only in minimum denominations of $2,000 and integral multiples of $1,000 in excess thereof.
|
|
The terms of the New Notes are identical in all material respects to the Old Notes of the same series, except that the New Notes are registered under the Securities Act and will not contain restrictions on transfer or provisions relating to additional interest, will bear a different CUSIP number from the Old Notes of the same series and will not entitle their holders to registration rights. The New Notes and the Old Notes will be governed by the same Senior Indenture dated August 15, 2006 between CVS Health Corporation (formerly known as CVS Corporation), as issuer, and The Bank of New York Mellon Trust Company, N.A. (formerly known as “The Bank of New York Trust Company, N.A.”), as trustee (the “Indenture”). No accrued interest will be paid at the time of the exchange.
|
||
Registration Rights Agreement
|
We issued an aggregate of $387,285,000 of the Old 2022 Notes and $296,255,000 of the Old 2024 Notes in connection with private exchange offers on October 9, 2015 and October 21, 2015. In connection with the private exchange offers, we and the dealer managers entered into the Registration Rights Agreement with respect to the Old Notes in which we agreed that you, as a holder of Old Notes, would be entitled to exchange your Old Notes for the New Notes registered under the Securities Act. This exchange offer is intended to satisfy our obligations under the Registration Rights Agreement. After the exchange offer is completed, you will no longer be entitled to any registration rights with respect to the Old Notes.
|
|
CUSIPs
|
The CUSIP numbers for the Old 2022 Notes are 126650 CP3 (Rule 144A) and U15149 AE4 (Regulation S). The CUSIP number for the New 2022 Notes is 126650 CQ1.
|
|
The CUSIP numbers for the Old 2024 Notes are 126650 CR9 (Rule 144A) and U15149 AF1 (Regulation S). The CUSIP number for the New 2024 Notes is 126650 CS7. | ||
Expiration Date
|
The exchange offer will expire at p.m., New York City time, on , 2016, unless we extend it, in which case the Expiration Date will be the latest date and time to which we extend exchange offer. See “The Exchange Offer—Expiration Date; Extensions; Termination; Amendments.”
|
|
Conditions to the Exchange Offer
|
The exchange offer is subject to customary conditions, which we may waive. See “The Exchange Offer—Conditions to the Exchange Offer.”
|
Procedures for Tendering Old Notes
|
If you wish to accept the exchange offer, sign and date the letter of transmittal that was delivered with this prospectus in accordance with the instructions, and deliver the letter of transmittal, along with the Old Notes and any other required documentation, to the exchange agent. Alternatively, you can tender your outstanding Old Notes by following the procedures for book-entry transfer, as described in this prospectus. See “The Exchange Offer—Procedures for Tendering Old Notes.” By executing the letter of transmittal or by transmitting an agent’s message in lieu thereof, you will represent to us that, among other things:
|
|
• the New Notes you receive will be acquired in the ordinary course of your business;
|
||
• you are not participating, and you have no arrangement with any person or entity to participate, in the distribution of the New Notes;
|
||
• you are not an “affiliate” (as defined in Rule 405 under the Securities Act) of ours, or, if you are such an affiliate, you will comply with the registration and prospectus delivery requirements of the Securities Act to the extent applicable;
|
||
• you are not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for its own account in exchange for the Old Notes;
|
||
• if you are a broker-dealer, you have not entered into any arrangement or understanding with us or any of our “affiliates” to distribute the New Notes; and
|
||
• you are not acting on behalf of any person or entity that could not truthfully make these representations.
|
||
If the exchange offeree is a broker-dealer holding Old Notes acquired for its own account as a result of market-making activities or other trading activities, it will deliver a prospectus meeting the requirements of the Securities Act in connection with any resale of New Notes received in respect of such Old Notes pursuant to the exchange offer. | ||
Special Procedures for Beneficial Owners
|
If you are a beneficial owner whose Old Notes are registered in the name of a broker, dealer, commercial bank, trust company or other nominee and wish to tender such Old Notes in the exchange offer, please contact the registered holder as soon as possible and instruct them to tender on your behalf and comply with our instructions set forth elsewhere in this prospectus. See “The Exchange Offer—Procedures for Tendering Old Notes—Special Procedures for Beneficial Owners.”
|
|
Effect on Holders of Outstanding Old Notes
|
As a result of the making of, and upon acceptance for exchange of all validly tendered outstanding Old Notes pursuant to the terms of, the exchange offer, the Company will have fulfilled its obligation to consummate an exchange offer for the Old Notes under the Registration Rights Agreement. Accordingly, there will be no increase in the interest rate on the outstanding notes under the circumstances described in the Registration Rights Agreement. If you do not tender your Old Notes in the exchange offer, you will continue to be entitled to all the rights and limitations applicable to the outstanding notes as set forth in the Indenture, except the Company will not have any further obligation to you to provide for the exchange and, subject to limited exceptions, registration of untendered outstanding notes under the Registration Rights Agreement. To the extent that Old Notes are tendered and accepted in the exchange offer, the trading market for Old Notes that are not so tendered and accepted could be adversely affected.
|
|
Consequences of Failure to Exchange the Old Notes
|
All untendered outstanding Old Notes will continue to be subject to the restrictions on transfer set forth in the outstanding Old Notes and in the related Indenture. In general, the outstanding Old Notes may not be offered or sold, unless registered under the Securities Act, except pursuant to an exemption from, or in a transaction not subject to, the Securities Act and applicable state securities laws. Other than in connection with the exchange offer, the Company does not currently anticipate that it will register the outstanding Old Notes under the Securities Act.
|
|
Material U.S. Federal Income Tax Considerations
|
The exchange of outstanding Old Notes for New Notes in the exchange offer will not constitute taxable events to holders for United States federal income tax purposes. See “Material U.S. Federal Income Tax Considerations.”
|
|
Use of Proceeds
|
We will not receive any cash proceeds from the issuance of the New Notes in the exchange offer. See “Use of Proceeds.”
|
|
Exchange Agent
|
D.F. King & Co., Inc. is the exchange agent for the exchange offer. The address and telephone numbers of the exchange agent are set forth in the section captioned “The Exchange Offer — Exchange Agent.”
|
|
Information Agent
|
D.F. King & Co., Inc. is the information agent for the exchange offer. The address and telephone numbers of the information agent are set forth in the section captioned “The Exchange Offer — Information Agent.”
|
Issuer
|
CVS Health Corporation
|
|
New Notes
|
Up to $387,285,000 aggregate principal amount of 4.75% Senior Notes due 2022 and up to $296,255,000 aggregate principal amount of 5.00% Senior Notes due 2024.
|
|
Maturity Dates
|
The New 2022 Notes: December 1, 2022.
|
|
The New 2024 Notes: December 1, 2024.
|
||
Interest
|
We will pay interest on the New Notes on June 1 and December 1. The New 2022 Notes will bear interest at 4.75% per year and the New 2024 Notes will bear interest at 5.00% per year. The New Notes will bear interest from the most recent interest payment date on the Old Notes.
|
|
Ranking
|
The New Notes will be our general unsecured senior obligations, will rank equally in right of payment with all of our other existing and future unsecured and unsubordinated debt and will be structurally subordinated to the secured and unsecured debt of our subsidiaries. The New Notes will not be guaranteed by any of our future or existing subsidiaries.
|
|
Change of Control
|
Upon the occurrence of a Change of Control Triggering Event (as defined in the Indenture), we will be required to make an offer to purchase the New Notes at a price equal to 101% of their principal amount plus accrued and unpaid interest to, but excluding, the date of repurchase. See “Description of the Notes—Change of Control.”
|
|
Optional Redemption
|
Prior to (i) with respect to the New 2022 Notes, September 1, 2022 (three months prior to the maturity date of such notes) and (ii) with respect to the New Notes, September 1, 2024 (three months prior to the maturity date of such notes), a series of New Notes will be redeemable, in whole or in part at any time, at our option upon not less than 30 nor more than 60 days’ notice at a “make-whole” premium, plus accrued and unpaid interest to the redemption date.
|
|
On or after (i) with respect to the New 2022 Notes, September 1, 2022 (three months prior to the maturity date of such notes) and (ii) with respect to the New 2024 Notes, September 1, 2024 (three months prior to the maturity date of such New Notes), a series of New Notes will be redeemable, in whole or in part at any time, at our option upon not less than 30 nor more than 60 days’ notice at a redemption price equal to 100% of the principal amount of the New Notes being redeemed plus accrued and unpaid interest on such New Notes to, but excluding, the redemption date.
|
||
Restrictive Covenants
|
We will issue the New Notes under the same Indenture under which the Old Notes were issued. The Indenture under which the New Notes will be issued contains covenants that, among other things,
|
limit our ability and the ability of our Restricted Subsidiaries (as defined in the Indenture) to secure indebtedness with a security interest on certain property or stock or engage in certain sale and leaseback transactions with respect to certain properties. See “Description of the New Notes—Certain Covenants”. | ||
Governing Law
|
The New Notes will be, and the Indenture is, governed by, and construed in accordance with, the laws of the State of New York.
|
|
Trustee, Transfer Agent and Paying Agent
|
The Bank of New York Mellon Trust Company, N.A.
|
Year Ended December 31,
|
||||||||||||||||||||
2015
|
2014
|
2013
|
2012
|
2011
|
||||||||||||||||
(in millions, except per share amounts, number of stores and ratios)
|
||||||||||||||||||||
Statement of Operations Data:
|
||||||||||||||||||||
Net revenues
|
$ | 153,290 | $ | 139,367 | $ | 126,761 | $ | 123,120 | $ | 107,080 | ||||||||||
Gross profit
|
26,528 | 25,367 | 23,783 | 22,488 | 20,562 | |||||||||||||||
Operating expenses
|
17,074 | 16,568 | 15,746 | 15,278 | 14,231 | |||||||||||||||
Operating profit
|
9,454 | 8,799 | 8,037 | 7,210 | 6,331 | |||||||||||||||
Interest expense, net
|
838 | 600 | 509 | 557 | 584 | |||||||||||||||
Loss on early extinguishment of debt
|
— | 521 | — | 348 | — | |||||||||||||||
Income tax provision
|
3,386 | 3,033 | 2,928 | 2,436 | 2,258 | |||||||||||||||
Income from continuing operations
|
5,230 | 4,645 | 4,600 | 3,869 | 3,489 | |||||||||||||||
Income (loss) from discontinued operations, net of tax
|
9 | (1 | ) | (8 | ) | (7 | ) | (31 | ) | |||||||||||
Net income
|
5,239 | 4,644 | 4,592 | 3,862 | 3,458 | |||||||||||||||
Net income/(loss) attributable to noncontrolling interest
|
(2 | ) | — | — | 2 | 4 | ||||||||||||||
Net income attributable to CVS Health
|
$ | 5,237 | $ | 4,644 | $ | 4,592 | $ | 3,864 | $ | 3,462 | ||||||||||
Per Common Share Data:
|
||||||||||||||||||||
Income from continuing operations attributable to CVS Health:
|
||||||||||||||||||||
Basic
|
$ | 4.65 | $ | 3.98 | $ | 3.78 | $ | 3.05 | $ | 2.61 | ||||||||||
Diluted
|
4.62 | 3.96 | 3.75 | 3.02 | 2.59 | |||||||||||||||
Income (loss) from discontinued operations attributable to CVS Health:
|
||||||||||||||||||||
Basic
|
$ | 0.01 | $ | — | $ | (0.01 | ) | $ | (0.01 | ) | $ | (0.02 | ) | |||||||
Diluted
|
0.01 | — | (0.01 | ) | (0.01 | ) | (0.02 | ) | ||||||||||||
Net income attributable to CVS Health:
|
||||||||||||||||||||
Basic
|
$ | 4.66 | $ | 3.98 | $ | 3.77 | $ | 3.04 | $ | 2.59 | ||||||||||
Diluted
|
4.63 | 3.96 | 3.74 | 3.02 | 2.57 | |||||||||||||||
Cash dividends per common share
|
1.40 | 1.10 | 0.90 | 0.65 | 0.50 | |||||||||||||||
Balance Sheet:
|
||||||||||||||||||||
Total working capital
|
$ | 7,209 | $ | 6,956 | $ | 9,900 | $ | 6,011 | $ | 6,600 | ||||||||||
Total assets
|
93,657 | 74,187 | 71,452 | 66,167 | 64,794 | |||||||||||||||
Long-term debt
|
26,267 | 11,630 | 12,767 | 9,079 | 9,150 | |||||||||||||||
Total shareholders’ equity
|
37,203 | 37,963 | 37,938 | 37,653 | 38,014 | |||||||||||||||
Other Operating Data:
|
||||||||||||||||||||
Ratio of earnings to fixed charges(1)
|
6.26 | x | 6.39 | x | 6.81 | x | 5.72 | x | 5.26 | x | ||||||||||
Total same store sales growth
|
1.70 | % | 2.10 | % | 1.70 | % | 5.60 | % | 2.30 | % | ||||||||||
Pharmacy same store sales growth
|
4.50 | % | 4.80 | % | 2.60 | % | 6.60 | % | 3.00 | % | ||||||||||
Number of stores (at end of period) | 9,681 | 7,866 | 7,702 | 7,508 | 7,388 |
(1)
|
“Fixed charges” consist of interest expense, capitalized interest, amortization of debt discount, and a portion of net rental expense deemed to be representative of the interest factor. The ratio of earnings to fixed charges is calculated as income from continuing operations, before provision for income taxes, plus fixed charges (excluding capitalized interest), plus amortization of capitalized interest, with the sum divided by fixed charges.
|
|
·
|
Risks relating to the health of the economy in general and in the markets we serve, which could impact consumer purchasing power, preferences and/or spending patterns, drug utilization trends, the financial health of our PBM and LTC clients, retail and specialty pharmacy payors or other payors doing business with us and our ability to secure necessary financing, suitable store locations and sale-leaseback transactions on acceptable terms.
|
|
·
|
Efforts to reduce reimbursement levels and alter health care financing practices, including pressure to reduce reimbursement levels for generic drugs.
|
|
·
|
The possibility of PBM and LTC client loss and/or the failure to win new PBM and LTC business, including as a result of failure to win renewal of expiring contracts, contract termination rights that may permit clients to terminate a contract prior to expiration and early or periodic renegotiation of pricing by clients prior to expiration of a contract.
|
|
·
|
The possibility of loss of Medicare Part D business and/or failure to obtain new Medicare Part D business, whether as a result of the annual Medicare Part D competitive bidding process, a sanction or otherwise.
|
|
·
|
Risks related to the frequency and rate of the introduction of generic drugs and brand name prescription products.
|
|
·
|
Risks of declining gross margins attributable to increased competitive pressures, increased client demand for lower prices, enhanced service offerings and/or higher service levels and market dynamics and, with respect to the PBM industry, regulatory changes that impact our ability to offer plan sponsors pricing that includes the use of retail “differential” or “spread” or the use of maximum allowable cost pricing.
|
|
·
|
Regulatory changes, business changes and compliance requirements and restrictions that may be imposed by Centers for Medicare and Medicaid Services (“CMS”), Office of Inspector General or other government agencies relating to our participation in Medicare, Medicaid and other federal and state government-funded programs, including sanctions and remedial actions that may be imposed by CMS on our Medicare Part D business.
|
|
·
|
Risks and uncertainties related to the timing and scope of reimbursement from Medicare, Medicaid and other government-funded programs, including the impact of sequestration, the impact of other federal budget, debt and deficit negotiations and legislation that could delay or reduce reimbursement from such programs and the impact of any closure, suspension or other changes affecting federal or state government funding or operations.
|
|
·
|
Possible changes in industry pricing benchmarks used to establish pricing in many of our PBM and LTC client contracts, pharmaceutical purchasing arrangements, retail network contracts, specialty payor agreements and other third party payor contracts.
|
|
·
|
A highly competitive business environment, including the uncertain impact of increased consolidation in the PBM industry, uncertainty concerning the ability of our retail and specialty pharmacy businesses to secure and maintain contractual relationships with PBMs and other payors on acceptable terms, uncertainty concerning the ability of our PBM business to secure and maintain competitive access, pricing and other contract terms from retail network pharmacies in an environment where some PBM clients are willing to consider adopting narrow or more restricted retail pharmacy networks.
|
|
·
|
Our ability to timely identify or effectively respond to changing consumer preferences and spending patterns, an inability to expand the products being purchased by our customers, or the failure or inability to obtain or offer particular categories of products.
|
|
·
|
Risks relating to our ability to secure timely and sufficient access to the products we sell from our domestic and/or international suppliers.
|
|
·
|
Reform of the U.S. health care system, including ongoing implementation of the Patient Protection and Affordable Care Act, continuing legislative efforts, regulatory changes and judicial interpretations impacting our health care system and the possibility of shifting political and legislative priorities related to reform of the health care system in the future.
|
|
·
|
Risks relating to any failure to properly maintain our information technology systems, our information security systems and our infrastructure to support our business and to protect the privacy and security of sensitive customer and business information.
|
|
·
|
Risks related to compliance with a broad and complex regulatory framework, including compliance with new and existing federal, state and local laws and regulations relating to health care, accounting standards, corporate securities, tax, environmental and other laws and regulations affecting our business.
|
|
·
|
Risks related to litigation, government investigations and other legal proceedings as they relate to our business, the pharmacy services, retail pharmacy, LTC pharmacy or retail clinic industries or to the health care industry generally.
|
|
·
|
The risk that any condition related to the closing of any proposed acquisition may not be satisfied on a timely basis or at all, including the inability to obtain required regulatory approvals of any proposed acquisition, or on the terms desired or anticipated; the risk that such approvals may result in the imposition of conditions that could adversely affect the resulting combined company or the expected benefits of any proposed transaction; and the risk that the proposed transactions fail to close for any other reason.
|
|
·
|
The possibility that the anticipated synergies and other benefits from any acquisition by us will not be realized, or will not be realized within the expected time periods.
|
|
·
|
The risks and uncertainties related to our ability to integrate the operations, products, services and employees of any entities acquired by us and the effect of the potential disruption of management’s attention from ongoing business operations due to any pending acquisitions.
|
|
·
|
The accessibility or availability of adequate financing on a timely basis and on reasonable terms in connection with any proposed acquisition.
|
|
·
|
Risks related to the outcome of any legal proceedings related to, or involving any entity that is a part of, any proposed acquisition contemplated by us.
|
|
·
|
Other risks and uncertainties detailed from time to time in our filings with the SEC.
|
|
·
|
you are not our affiliate within the meaning of Rule 405 of the Securities Act or, if you are such an affiliate, you will comply with the registration and prospectus delivery requirements of the Securities Act, to the extent applicable;
|
|
·
|
you are not participating, and you have no arrangement or understanding with any person to participate in a distribution (within the meaning of the Securities Act) of the New Notes in violation of the provisions of the Securities Act;
|
|
·
|
you are not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for your own account in exchange for the Old Notes;
|
|
·
|
if you are a broker dealer, you have not entered into any arrangement or understanding with us or any of our affiliates to distribute the New Notes;
|
|
·
|
you are acquiring the New Notes in the ordinary course of your business; and
|
|
·
|
you are not acting on behalf of any person or entity that could not truthfully make these representations.
|
|
·
|
to delay our acceptance of Old Notes for exchange;
|
|
·
|
to terminate the exchange offer if any of the conditions set forth under “— Conditions to the Exchange Offer” exist;
|
|
·
|
to waive any condition to the exchange offer;
|
|
·
|
to amend any of the terms of the exchange offer; and
|
|
·
|
to extend the Expiration Date and retain all Old Notes tendered in the exchange offer, subject to your right to withdraw your tendered Old Notes as described under “— Withdrawal of Tenders.”
|
|
·
|
outstanding Old Notes or a timely book-entry confirmation of such outstanding Old Notes into the exchange agent’s account at the book-entry transfer facility; and
|
|
·
|
a properly completed and duly executed letter of transmittal and all other required documents or a properly transmitted agent’s message.
|
|
·
|
you are not our affiliate within the meaning of Rule 405 of the Securities Act or, if you are such an affiliate, you will comply with the registration and prospectus delivery requirements of the Securities Act, to the extent applicable;
|
|
·
|
you are not participating, and you have no arrangement or understanding with any person to participate in a distribution (within the meaning of the Securities Act) of the New Notes in violation of the provisions of the Securities Act;
|
|
·
|
you are not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for your own account in exchange for the Old Notes;
|
|
·
|
if you are a broker-dealer, you have not entered into any arrangement or understanding with us or any of our affiliates to distribute the New Notes;
|
|
·
|
you are acquiring the New Notes in the ordinary course of your business; and
|
|
·
|
you are not acting on behalf of any person or entity that could not truthfully make these representations.
|
|
·
|
complete, sign and date the letter of transmittal, or a facsimile of the letter of transmittal, have the signature(s) on the letter of transmittal guaranteed if required by the letter of transmittal and mail or deliver such letter of transmittal or facsimile thereof to the exchange agent at the address set forth below under “— Exchange Agent” prior to the Expiration Date; or
|
|
·
|
comply with the procedures of the Automated Tender Offer Program of The Depository Trust Company (“DTC”) described below.
|
|
·
|
the exchange agent must receive certificates for outstanding Old Notes along with the letter of transmittal prior to the Expiration Date; or
|
|
·
|
the exchange agent must receive a timely confirmation of book-entry transfer of outstanding Old Notes into the exchange agent’s account at DTC according to the procedures for book-entry transfer described below or a properly transmitted agent’s message prior to the Expiration Date.
|
|
·
|
by a registered holder of the outstanding Old Notes who has not completed the box entitled “Special Registration Instructions” or “Special Delivery Instructions” on the letter of transmittal; or
|
|
·
|
for the account of an eligible guarantor institution.
|
|
·
|
DTC has received an express acknowledgment from a participant in its Automated Tender Offer Program that is tendering outstanding Old Notes that are the subject of the book-entry confirmation;
|
|
·
|
the participant has received and agrees to be bound by the terms of the letter of transmittal; and
|
|
·
|
we may enforce that agreement against such participant.
|
|
·
|
certificates for (or a timely book-entry confirmation with respect to) your Old Notes;
|
|
·
|
a properly completed and duly executed letter of transmittal or facsimile thereof with any required signature guarantees, or, in the case of a book-entry transfer, an agent’s message; and
|
|
·
|
any other documents required by the letter of transmittal.
|
|
·
|
the exchange agent must receive a written notice of withdrawal at the address set forth on the inside of the back cover of this prospectus; or
|
|
·
|
you must comply with the appropriate procedures of DTC’s Automated Tender Offer Program system.
|
|
·
|
specify the name of the person who tendered the Old Notes to be withdrawn;
|
|
·
|
identify the Old Notes to be withdrawn, including the certificate numbers and principal amount of the Old Notes;
|
|
·
|
be signed by the person who tendered the Old Notes in the same manner as the original signature on the letter of transmittal, including any required signature guarantees; and
|
|
·
|
specify the name in which the Old Notes are to be re-registered, if different from that of the withdrawing holder.
|
|
·
|
the exchange offer or the making of any exchange by a holder violates any applicable law or interpretation of the SEC; or
|
|
·
|
any action or proceeding has been instituted or threatened in writing in any court or by or before any governmental agency with respect to the exchange offer that, in our judgment, would reasonably be expected to impair our ability to proceed with the exchange offer.
|
|
·
|
the representations described under “— Purpose and Effect of the Exchange Offer,” “— Procedures for Tendering Outstanding Notes” and “Acceptance of Old Notes for Exchange”; or
|
|
·
|
any other representations as may be reasonably necessary under applicable SEC rules, regulations or interpretations to make available to us an appropriate form for registration of the New Notes under the Securities Act.
|
|
·
|
delivery of the New Notes and/or certificates for Old Notes for principal amounts not exchanged, are to be made to any person other than the record holder of the Old Notes tendered;
|
|
·
|
tendered certificates for Old Notes are recorded in the name of any person other than the person signing any letter of transmittal; or
|
|
·
|
a transfer tax is imposed for any reason other than the transfer and exchange of Old Notes to us or our order,
|
|
·
|
as set forth in the legend printed on the Old Notes as a consequence of the issuance of the Old Notes pursuant to the exemptions from, or in transactions not subject to, the registration requirements of the Securities Act and applicable state securities laws; and
|
|
·
|
otherwise set forth in the offering memorandum distributed in connection with the private offering of the Old Notes.
|
|
·
|
you are not our affiliate within the meaning of Rule 405 of the Securities Act;
|
|
·
|
you are not participating, and you have no arrangement or understanding with any person to participate in a distribution (within the meaning of the Securities Act) of the New Notes in violation of the provisions of the Securities Act;
|
|
·
|
you are not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for your own account in exchange for the Old Notes;
|
|
·
|
if you are a broker dealer, you have not entered into any arrangement or understanding with us or any of our affiliates to distribute the New Notes; and
|
|
·
|
you are acquiring the New Notes in the ordinary course of your business.
|
|
·
|
You cannot rely on the position of the SEC set forth in Morgan Stanley & Co. Incorporated (available June 5, 1991) and Exxon Capital Holdings Corporation (available May 13, 1988), as interpreted in the SEC’s letter to Shearman & Sterling, dated July 2, 1993, and similar no-action letters; and
|
|
·
|
in the absence of an exception from the position stated immediately above, you must comply with the registration and prospectus delivery requirements of the Securities Act in connection with any secondary resale transaction of the New Notes, in which case the registration statement must contain the selling security holder information required by Item 507 or Item 508, as applicable, of Regulation S-K of the SEC.
|
|
·
|
accept for payment all New Notes properly tendered pursuant to the Change of Control Offer;
|
|
·
|
deposit with the paying agent an amount equal to the Change of Control Payment in respect of all New Notes or portions of New Notes properly tendered; and
|
|
·
|
deliver or cause to be delivered to the trustee the New Notes properly accepted together with an officers’ certificate stating the aggregate principal amount of New Notes or portions of New Notes being purchased.
|
|
·
|
DTC notifies us that it is unwilling, unable or ineligible to continue as depositary for the global securities and a successor depositary is not appointed by us within 90 days of such notification or of our becoming aware of DTC’s ineligibility;
|
|
·
|
there shall have occurred and be continuing an Event of Default under the Indenture with respect to any of the global securities and the outstanding New Notes of the series represented by such global securities shall have become due and payable pursuant to the Indenture and the trustee has requested that certificated New Notes be issued; or
|
|
·
|
we have decided to discontinue use of book-entry transfers through DTC. DTC has advised us that, under its current practices, it would notify its participants of our request, but would only withdraw beneficial interests from the global securities at the request of its participants.
|
|
·
|
DTC is a limited-purpose trust company organized under the laws of the State of New York, a “banking organization” within the meaning of the New York Banking Law, a member of the Federal Reserve System, a “clearing corporation” within the meaning of the New York Uniform Commercial Code, and a “clearing agency” registered pursuant to the provisions of Section 17A of the Exchange Act. DTC holds securities that its participants deposit with DTC. DTC also facilitates the settlement among participants of securities transactions, such as transfers and pledges, in deposited securities through electronic computerized book entry changes in participants’ accounts, thereby eliminating the need for physical movement of securities certificates. Direct participants include securities brokers and dealers, banks, trust companies, clearing corporations and certain other organizations. Access to DTC’s system is available to securities brokers and dealers, banks and trust companies that clear through or maintain a custodial relationship with a direct participant, either directly or indirectly.
|
|
·
|
Persons who are not participants may beneficially own the New Notes held by DTC only through direct participants or indirect participants. Purchases of the New Notes under DTC’s system must be made by or through direct participants, which will receive a credit for such New Notes on DTC’s records. The ownership interest of each actual purchaser of each note represented by a global security (a “Beneficial Owner”) is in turn to be recorded on the direct participants’ and indirect participants’ records. Beneficial Owners will not receive written confirmation from DTC of their purchase, but Beneficial Owners are expected to receive written confirmations providing details of the transaction, as well as periodic statements of their holdings, from the direct participants or indirect participants through which such Beneficial Owner entered into the transaction. Transfers of ownership interests in the global securities representing the New Notes are to be accomplished by entries made on the books of participants acting on behalf of Beneficial Owners. Beneficial Owners of the global securities representing the New Notes will not receive certificated New Notes representing their ownership interests therein, except in the event that use of the book-entry system for such New Notes is discontinued and in certain other limited circumstances.
|
|
·
|
Principal, premium, if any, and interest payments on the global securities representing the New Notes will be made to DTC. DTC’s practice is to credit direct participants’ accounts on the applicable payment date in accordance with their respective holdings shown on DTC’s records unless DTC has reason to believe that it will not receive payment on such date. Payments by participants to Beneficial Owners will be governed by standing instructions and customary practices, as is the case with securities held for the accounts of customers in bearer form or registered in “street name,” and will be the responsibility of such participant and not of DTC, the trustee or ours, subject to any statutory or regulatory requirements as may be in effect from time to time. Payment of principal, premium, if any, and interest to DTC is our and the trustee’s responsibility, disbursement of such payments to direct participants is the responsibility of DTC, and disbursement of such payments to the Beneficial Owners is the responsibility of direct participants and indirect participants.
|
|
·
|
DTC may discontinue providing its services as securities depository with respect to the New Notes at any time by giving reasonable notice to us or the trustee. Under such circumstances, in the event that a successor securities depository is not obtained, certificated New Notes are required to be printed and delivered.
|
By Regular, Registered or Certified Mail, Hand or Overnight Delivery:
D.F. King & Co., Inc.
48 Wall Street, 22nd Floor
New York, New York 10005
Attn: Peter Aymar
|
By Facsimile (for Eligible Institutions only):
(212) 709-3328
Attn: Peter Aymar
For Confirmation:
(212) 232-3235
|
|
(a)
|
Exhibits.
|
Exhibit
Number |
Description
|
|
4.1
|
—
|
Senior Indenture, dated as of August 15, 2006, between CVS Health Corporation (formerly CVS Corporation) and The Bank of New York Mellon Trust Company, N.A. (formerly known as The Bank of New York Trust Company, N.A.) (incorporated by reference to Exhibit 4.1 to CVS Health Corporation’s (formerly CVS Corporation) Current Report on Form 8-K filed August 15, 2006).
|
4.2
|
—
|
Form of 4.75% Senior Note due 2022 (incorporated by reference to Exhibit 4.1 to CVS Health Corporation’s Current Report on Form 8-K filed October 14, 2015).
|
4.3
|
—
|
Form of 5.00% Senior Note due 2024 (incorporated by reference to Exhibit 4.2 to CVS Health Corporation’s Current Report on Form 8-K filed October 14, 2015).
|
4.4
|
—
|
Registration Rights Agreement dated October 9, 2015 among the Company and the dealer managers named therein (incorporated by reference to Exhibit 4.3 to CVS Health Corporation’s Current Report on Form 8-K filed October 14, 2015).
|
5.1*
|
—
|
Opinion of Shearman & Sterling LLP as to the legality of the securities offered hereby.
|
12.1*
|
—
|
Statement regarding Computation of Ratio of Earnings to Fixed Charges.
|
23.1*
|
—
|
Consent of Shearman & Sterling LLP (Included in Exhibit 5.1).
|
23.2*
|
—
|
Consent of Ernst & Young LLP.
|
24.1*
|
—
|
Powers of Attorney (included on signature page of this Registration Statement).
|
25.1*
|
—
|
Statement of Eligibility of The Bank of New York Mellon Trust Company, N.A. on Form T-1 for the Senior Indenture, dated as of August 15, 2006.
|
99.1*
|
—
|
Form of Letter of Transmittal (with accompanying IRS Form W-9 and related Guidelines).
|
99.2*
|
—
|
Form of Letter to Registered Holders and The Depository Trust Company Participants.
|
99.3*
|
—
|
Form of Letter to Clients (with form of Instructions to Registered Holder and/or The Depository Trust Company Participant).
|
|
*
|
Filed herewith.
|
CVS Health Corporation
|
|||
|
By:
|
/s/ David M. Denton
|
|
David M. Denton
|
|||
Executive Vice President and Chief Financial Officer
|
|||
Signature
|
Title
|
Date
|
|
/s/ Eva C. Boratto
|
Senior Vice President – Controller and Chief Accounting Officer (Principal Accounting Officer)
|
April 22, 2016
|
|
Eva C. Boratto
|
|||
/s/ Richard M. Bracken
|
Director
|
April 22, 2016
|
|
Richard M. Bracken
|
|||
/s/ C. David Brown II
|
Director
|
April 22, 2016
|
|
C. David Brown II
|
|||
/s/ Alecia A. DeCoudreaux
|
Director
|
April 22, 2016
|
|
Alecia A. DeCoudreaux
|
|||
/s/ David M. Denton
|
Executive Vice President and Chief Financial Officer (Principal Financial Officer)
|
April 22, 2016
|
|
David M. Denton
|
|||
/s/ Nancy-Ann M. DeParle
|
Director
|
April 22, 2016
|
|
Nancy-Ann M. DeParle
|
|||
/s/ David W. Dorman
|
Director
|
April 22, 2016
|
|
David W. Dorman
|
|||
/s/ Anne M. Finucane
|
Director
|
April 22, 2016
|
|
Anne M. Finucane
|
|||
/s/ Larry J. Merlo
|
President and Chief Executive Officer (Principal Executive Officer) and Director
|
April 22, 2016
|
|
Larry J. Merlo
|
|||
/s/ Jean-Pierre Millon
|
Director
|
April 22, 2016
|
|
Jean-Pierre Millon
|
|||
/s/ Richard J. Swift
|
Director
|
April 22, 2016
|
|
Richard J. Swift
|
|||
/s/ William C. Weldon
|
Director
|
April 22, 2016
|
|
William C. Weldon
|
|||
/s/ Tony L. White
|
Director
|
April 22, 2016
|
|
Tony L. White
|
Exhibit Number
|
Description
|
|
4.1
|
—
|
Senior Indenture, dated as of August 15, 2006, between CVS Health Corporation (formerly CVS Corporation) and The Bank of New York Mellon Trust Company, N.A. (formerly known as The Bank of New York Trust Company, N.A.) (incorporated by reference to Exhibit 4.1 to CVS Health Corporation’s (formerly CVS Corporation) Current Report on Form 8-K filed August 15, 2006).
|
4.2
|
—
|
Form of 4.75% Senior Note due 2022 (incorporated by reference to Exhibit 4.1 to CVS Health Corporation’s Current Report on Form 8-K filed October 14, 2015).
|
4.3
|
—
|
Form of 5.00% Senior Note due 2024 (incorporated by reference to Exhibit 4.2 to CVS Health Corporation’s Current Report on Form 8-K filed October 14, 2015).
|
4.4
|
—
|
Registration Rights Agreement dated October 9, 2015 among the Company and the dealer managers named therein (incorporated by reference to Exhibit 4.3 to CVS Health Corporation’s Current Report on Form 8-K filed October 14, 2015).
|
5.1*
|
—
|
Opinion of Shearman & Sterling LLP as to the legality of the securities offered hereby.
|
12.1*
|
—
|
Statement regarding Computation of Ratio of Earnings to Fixed Charges.
|
23.1*
|
—
|
Consent of Shearman & Sterling LLP (Included in Exhibit 5.1).
|
23.2*
|
—
|
Consent of Ernst & Young LLP.
|
24.1*
|
—
|
Powers of Attorney (included on signature page of this Registration Statement).
|
25.1*
|
—
|
Statement of Eligibility of The Bank of New York Mellon Trust Company, N.A. (formerly known as The Bank of New York Trust Company, N.A.) on Form T-1 for the Senior Indenture, dated as of August 15, 2006.
|
99.1*
|
—
|
Form of Letter of Transmittal (with accompanying IRS Form W-9 and related Guidelines).
|
99.2*
|
—
|
Form of Letter to Registered Holders and The Depository Trust Company Participants.
|
99.3*
|
—
|
Form of Letter to Clients (with form of Instructions to Registered Holder and/or The Depository Trust Company Participant).
|
|
*
|
Filed herewith.
|
|
(a)
|
The Indenture.
|
|
(b)
|
The form of the Exchange Notes.
|
|
(a)
|
The Registration Statement.
|
|
(b)
|
The Prospectus.
|
|
(d)
|
The registration rights agreement, dated as of October 9, 2015, among the Company and the dealer managers named therein.
|
|
(e)
|
Originals or copies of such other corporate records of the Company, certificates of public officials and of officers of the Company and agreements and other documents as we have deemed necessary as a basis for the opinions expressed below.
|
|
(a)
|
The genuineness of all signatures.
|
|
(b)
|
The authenticity of the originals of the documents submitted to us.
|
|
(c)
|
The conformity to authentic originals of any documents submitted to us as copies.
|
|
(d)
|
As to matters of fact, the truthfulness of the representations made in the Opinion Documents and in certificates of public officials and officers of the Company.
|
|
(e)
|
That each of the Opinion Documents is the legal, valid and binding obligation of each party thereto, other than the Company, enforceable against each such party in accordance with its terms.
|
|
(f)
|
That:
|
|
(a)
|
Our opinions are subject to the effect of any applicable bankruptcy, insolvency, reorganization, moratorium or similar laws affecting creditors’ rights generally (including without limitation all laws relating to fraudulent transfers).
|
|
(b)
|
Our opinions are also subject to the effect of general principles of equity, including without limitation concepts of materiality, reasonableness, good faith and fair dealing (regardless of whether considered in a proceeding in equity or at law).
|
|
(c)
|
Our opinions are limited to Generally Applicable Law and we do not express any opinion herein concerning any other law.
|
Fiscal Years
|
||||||||||||||||||||
In millions
|
2015
|
2014
|
2013
|
2012
|
2011
|
|||||||||||||||
Earnings:
|
||||||||||||||||||||
Earnings from continuing operations before income taxes and extraordinary items
|
$ | 8,613.5 | $ | 7,677.1 | $ | 7,527.1 | $ | 6,307.1 | $ | 5,750.5 | ||||||||||
Interest portion of net rental expense
|
763.7 | 785.3 | 750.3 | 741.7 | 715.8 | |||||||||||||||
Interest expense (net of interest capitalized)
|
859.5 | 615.4 | 517.5 | 561.2 | 588.5 | |||||||||||||||
Adjusted earnings
|
$ | 10,236.7 | $ | 9,077.8 | $ | 8,794.9 | $ | 7,610.0 | $ | 7,054.8 | ||||||||||
Fixed Charges:
|
||||||||||||||||||||
Interest portion of net rental expense
|
763.7 | 785.3 | 750.3 | 741.7 | 715.8 | |||||||||||||||
Interest expense (net of interest capitalized)
|
859.5 | 615.4 | 517.5 | 561.2 | 588.5 | |||||||||||||||
Interest capitalized
|
11.8 | 18.9 | 24.6 | 28.6 | 36.5 | |||||||||||||||
Total fixed charges
|
$ | 1,635.0 | $ | 1,419.6 | $ | 1,292.4 | $ | 1,331.5 | $ | 1,340.8 | ||||||||||
Ratio of earnings to fixed charges
|
6.26 | x | 6.39 | x | 6.81 | x | 5.72 | x | 5.26 | x |
/s/ Ernst & Young LLP
|
(Jurisdiction of incorporation
if not a U.S. national bank)
|
95-3571558
(I.R.S. employer
identification no.)
|
400 South Hope Street
Suite 500
Los Angeles, California
(Address of principal executive offices)
|
90071
(Zip code)
|
Delaware
(State or other jurisdiction of
incorporation or organization)
|
05-0494040
(I.R.S. employer
identification no.)
|
One CVS Drive
Woonsocket, Rhode Island
(Address of principal executive offices)
|
02895
(Zip code)
|
1.
|
General information. Furnish the following information as to the trustee:
|
|
(a)
|
Name and address of each examining or supervising authority to which it is subject.
|
Name
|
Address
|
Comptroller of the Currency
United States Department of the Treasury
|
Washington, DC 20219
|
Federal Reserve Bank
|
San Francisco, CA 94105
|
Federal Deposit Insurance Corporation
|
Washington, DC 20429
|
|
(b)
|
Whether it is authorized to exercise corporate trust powers.
|
2.
|
Affiliations with Obligor.
|
16.
|
List of Exhibits.
|
|
1.
|
A copy of the articles of association of The Bank of New York Mellon Trust Company, N.A., formerly known as The Bank of New York Trust Company, N.A. (Exhibit 1 to Form T-1 filed with Registration Statement No. 333-121948 and Exhibit 1 to Form T-1 filed with Registration Statement No. 333-152875).
|
|
2.
|
A copy of certificate of authority of the trustee to commence business. (Exhibit 2 to Form T-1 filed with Registration Statement No. 333-121948).
|
|
3.
|
A copy of the authorization of the trustee to exercise corporate trust powers (Exhibit 3 to Form T-1 filed with Registration Statement No. 333-152875).
|
|
4.
|
A copy of the existing by-laws of the trustee (Exhibit 4 to Form T-1 filed with Registration Statement No. 333-162713).
|
|
6.
|
The consent of the trustee required by Section 321(b) of the Act (Exhibit 6 to Form T-1 filed with Registration Statement No. 333-152875).
|
|
7.
|
A copy of the latest report of condition of the Trustee published pursuant to law or to the requirements of its supervising or examining authority.
|
THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A. | |||||
By: | /s/ | R. Tarnas | |||
Name: | R. Tarnas | ||||
Title: | Vice President | ||||
Dollar amounts
in thousands
|
||||
ASSETS
|
||||
Cash and balances due from depository institutions:
|
||||
Noninterest-bearing balances
and currency and coin |
6,117 | |||
Interest-bearing balances
|
272,045 | |||
Securities:
|
||||
Held-to-maturity securities
|
0 | |||
Available-for-sale securities
|
679,285 | |||
Federal funds sold and securities
purchased under agreements to resell: |
||||
Federal funds sold
|
0 | |||
Securities purchased under agreements to resell
|
0 | |||
Loans and lease financing receivables:
|
||||
Loans and leases held for sale
|
0 | |||
Loans and leases,
net of unearned income |
0 | |||
LESS: Allowance for loan and
lease losses |
0 | |||
Loans and leases, net of unearned
income and allowance |
0 | |||
Trading assets
|
0 | |||
Premises and fixed assets
(including capitalized leases) |
11,408 | |||
Other real estate owned
|
0 | |||
Investments in unconsolidated
subsidiaries and associated companies |
0 | |||
Direct and indirect investments in real estate ventures
|
0 | |||
Intangible assets:
|
||||
Goodwill
|
856,313 | |||
Other intangible assets
|
77,335 | |||
Other assets
|
118,036 | |||
Total assets
|
$ | 2,020,539 | ||
LIABILITIES
|
||||
Deposits:
|
||||
In domestic offices
|
505 | |||
Noninterest-bearing
|
505 | |||
Interest-bearing
|
0 | |||
Not applicable
|
||||
Federal funds purchased and securities
sold under agreements to repurchase: |
||||
Federal funds purchased
|
0 | |||
Securities sold under agreements to repurchase
|
0 | |||
Trading liabilities
|
0 | |||
Other borrowed money:
|
||||
(includes mortgage indebtedness and obligations under capitalized leases)
|
0 | |||
Not applicable
|
||||
Not applicable
|
||||
Subordinated notes and debentures
|
0 | |||
Other liabilities
|
276,953 | |||
Total liabilities
|
277,458 | |||
Not applicable
|
||||
EQUITY CAPITAL
|
||||
Perpetual preferred stock and related surplus
|
0 | |||
Common stock
|
1,000 | |||
Surplus (exclude all surplus related to preferred stock)
|
1,122,455 | |||
Not available
|
||||
Retained earnings
|
620,521 | |||
Accumulated other comprehensive income
|
895 | |||
Other equity capital components
|
0 | |||
Not available
|
||||
Total bank equity capital
|
1,743,081 | |||
Noncontrolling (minority) interests in consolidated subsidiaries
|
0 | |||
Total equity capital
|
1,743,081 | |||
Total liabilities and equity capital
|
2,020,539 |
Matthew J. McNulty
|
)
|
CFO
|
Antonio I. Portuondo, President
|
)
|
|
William D. Lindelof, Director
|
)
|
Directors (Trustees)
|
Alphonse J. Briand, Director
|
)
|
THE EXCHANGE OFFER WILL EXPIRE AT P.M., NEW YORK CITY TIME, ON , 2016, UNLESS EXTENDED (THE “EXPIRATION DATE”). TENDERS IN THE EXCHANGE OFFER MAY BE WITHDRAWN AT ANY TIME PRIOR TO P.M., NEW YORK CITY TIME, ON THE EXPIRATION DATE.
|
D.F. King & Co., Inc.
48 Wall Street, 22nd Floor
New York, New York 10005
or
Banks and Brokers Call Collect:
(212) 269-5550
All Others Call Toll Free: (866) 745-0265
Email: cvs@dfking.com
|
||
By Regular, Registered or Certified Mail, Hand or Overnight Delivery:
D.F. King & Co., Inc.
48 Wall Street, 22nd Floor
New York, New York 10005
Attn: Peter Aymar
|
By Facsimile (for Eligible Institutions only):
(212) 709-3328
Attn: Peter Aymar
For Confirmation:
(212) 232-3235
|
|
DESCRIPTION OF OLD NOTES TENDERED
|
||||
Tendered
Old Note(s)
|
||||
Name(s) and Address(es) of Registered Holder(s)
Exactly as Name(s) Appear(s)
on the Old Notes.
(Please Fill in, if Blank).
|
Series of Old Notes (Please check applicable boxes)
|
Certificate
Number(s)*
|
Aggregate Principal Amount Represented
by Old Notes*
|
Principal
Amount
Tendered**
|
□ 4.75% Senior Notes Due 2022
|
||||
□ 5.00% Senior Notes Due 2024
|
||||
Total Principal Amount
|
||||
* Need not be completed if Old Notes are being transferred by book-entry transfer. Such holders should check the boxes below as appropriate and provide the requested information.
** Unless otherwise indicated, any tendering holder of Old Notes will be deemed to have tendered the entire aggregate principal amount represented by such Old Notes. Notes may be tendered and accepted for payment only in principle amounts equal to minimum denominations of $2,000 and integral multiples of $1,000 in excess thereof. No alternative, conditional or contingent tenders will be accepted.
|
¨
|
CHECK HERE IF TENDERED OLD NOTES ARE ENCLOSED HEREWITH.
|
¨
|
CHECK HERE IF TENDERED OLD NOTES ARE BEING DELIVERED BY BOOK-ENTRY TRANSFER MADE TO THE ACCOUNT MAINTAINED BY THE EXCHANGE AGENT WITH DTC AND COMPLETE THE FOLLOWING (FOR USE BY ELIGIBLE INSTITUTIONS ONLY):
|
Name of Tendering Institution:
|
Account Number:
|
Transaction Code Number:
|
¨
|
CHECK HERE IF YOU ARE A BROKER-DEALER AND WISH TO RECEIVE 10 ADDITIONAL COPIES OF THE PROSPECTUS AND 10 COPIES OF ANY AMENDMENTS OR SUPPLEMENTS THERETO:
|
Name:
|
Address:
|
|
·
|
deliver such Old Notes, or transfer ownership of such Old Notes on the account books maintained by DTC, to CVS Health and deliver all accompanying evidence of transfer and authenticity, and
|
|
·
|
present such Old Notes for transfer on the books of CVS Health and receive all benefits and otherwise exercise all rights of beneficial ownership of such Old Notes,
|
|
·
|
it is not an affiliate of CVS Health within the meaning of Rule 405 of the Securities Act or, if it is such an affiliate, it will comply with the registration and prospectus delivery requirements of the Securities Act, to the extent applicable;
|
|
·
|
it is not participating, and it has no arrangement or understanding with any person to participate in a distribution (within the meaning of the Securities Act) of the New Notes in violation of the provisions of the Securities Act;
|
|
·
|
it is not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for its own account in exchange for the Old Notes;
|
|
·
|
if it is a broker dealer, it has not entered into any arrangement or understanding with CVS Health or any of CVS Health’s affiliates to distribute the New Notes;
|
|
·
|
it is acquiring the New Notes in the ordinary course of its business; and
|
·
|
it is not acting on behalf of any person or entity that could not truthfully make these representations.
|
|
·
|
the undersigned cannot rely on the position of the staff of the SEC enunciated in Morgan Stanley and Co., Inc. (available June 5, 1991) and Exxon Capital Holdings Corporation (available May 13, 1988), as interpreted in the SEC’s letter to Shearman & Sterling dated July 2, 1993, and similar no-action letters, and, in the absence of an exemption therefrom, must comply with the registration and prospectus delivery requirements of the Securities Act in connection with any secondary resale transaction of the New Notes, in which case the registration statement must contain the selling security holder information required by Item 507 or Item 508, as applicable, of Regulation S-K of the SEC; and
|
|
·
|
failure to comply with such requirements in such instance could result in the undersigned incurring liability for which the undersigned is not indemnified by CVS Health.
|
Name:
|
(Please Print or Type)
|
Address:
|
(Include Zip Code)
|
(Tax Identification or Social Security Number)
(See IRS Form W-9 Included Herein)
|
¨
|
Credit unexchanged Old Notes delivered by book-entry transfer to DTC account number set forth below:
|
DTC account number: |
(Please Complete IRS Form W-9 Herein, See Instruction 7)
|
Name:
|
(Please Print or Type)
|
Address:
|
(Include Zip Code)
|
(Tax Identification or Social Security Number)
(See IRS Form W-9 Included Herein)
|
X:
|
X
|
(Signature(s) of Registered Holder(s) of Old Notes)
|
Name:
|
(Please Type or Print)
|
Capacity:
|
Address:
|
(Include Zip Code)
|
Address Code and Telephone Number:
|
Signature(s) guaranteed by an eligible institution: |
(Authorized Signature)
|
(Title)
|
(Name of Firm)
|
(Address, Include Zip Code)
|
(Area Code and Telephone Number)
|
|
·
|
this Letter of Transmittal (or facsimile hereof) is signed by the registered holder(s) of the Old Notes tendered herein (or by a participant in DTC whose name appears on a security position listing as the owner of the tendered Old Notes) and the New Notes are to be issued directly to such registered holder(s) (or, if signed by a participant in DTC, deposited to such participant’s account at DTC) and neither the box entitled “Special Delivery Instructions” nor the box entitled “Special Issuance Instructions” has been completed; or
|
|
·
|
such Old Notes are tendered for the account of an eligible institution.
|
Form W-9
(Rev. December 2014)
Department of the Treasury
Internal Revenue Service
|
Request for Taxpayer
Identification Number and Certification
|
Give Form to the
requester. Do not
send to the IRS.
|
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
|
|||||||||||||
2 Business name/disregarded entity name, if different from above
|
|||||||||||||
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
|
4 Exemptions (codes apply only
|
||||||||||||
Print or type
See Specific
|
o |
lndividual/sole proprietor or single-member LLC
|
o |
C Corporation
|
o |
S Corporation
|
o |
Partnership
|
o |
Trust/estate
|
to certain entities, not individuals; see
instructions on page 3): |
||
Instructions
on page 2.
|
o |
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ► _____________
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box In the line above for the tax classification of the single-member owner
|
Exempt payee code (if any) ____________
Exemption from FATCA reporting
code (if any) ________________________
|
||||||||||
o |
Other (see instructions) ►
|
(Applies to accounts maintained outside the U.S.)
|
5 Address (number, street, and apt. or suite no.)
|
Requester’s name and address (optional) | ||
6 City, state, and ZIP code
|
|||
7 List account number(s) here (optional)
|
Part I
|
|
Taxpayer Identification Number (TIN)
|
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
|
Social security number
|
|||||||||||
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
|
–
|
–
|
||||||||||
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities,
|
or | |||||||||||
it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
|
Employer identification number | |||||||||||
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.
|
– |
Part II
|
|
Certification
|
1.
|
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
|
|
2. |
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
|
|
3. |
I am a U.S. citizen or other U.S. person (defined below); and
|
|
4. |
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
|
Sign
Here
|
Signature of
U.S. person u
|
Date u
|
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
|
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2.
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What Is FATCA reporting? on page 2 for further information.
|
Cat. No. 10231X
|
Form W-9 (Rev. 12-2014)
|
Form W-9 (Rev. 12-2014)
|
Page 2
|
Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.
Definition of a U.S. parson. For federal tax purposes, you are considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.
In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States:
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items:
1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the term of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II instructions on page 3 for details),
|
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W-9 for more information.
Also see Special rules for partnerships above.
What is FATCA reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account, list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.
Note. ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.
c. Partnership, LLC that is not a single-member LLC, C Corporation, or S Corporation. Enter the entity’s name as shown on the entity’s tax return on line 1 and any business, trade, or DBA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner’s name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner’s name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity’s name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.
|
Form W-9 (Rev. 12-2014)
|
Page 3
|
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.
Line 3
Check the appropriate box in line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box in line 3.
Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the “Limited Liability Company” box and enter “P” in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation, check the “Limited Liability Company” box and in the space provided enter “C” for C corporation or “S” for S corporation. If it is a single-member LLC that is a disregarded entity, do not check the “Limited Liability Company” box; instead check the first box in line 3 “Individual/sole proprietor or single-member LLC.”
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space in line 4 any code(s) that may apply to you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup withholding.
• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies, or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or custodian
13—A trust exempt from tax under section 664 or described in section 4947
The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.
|
2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form If you are uncertain If the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701 (a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1 (c)(1)(i)
F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note. You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number). This is where the requester of this
Form W-9 will mail your information returns.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer Identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity separate from Its owner (see Limited Liability Company (LLC) on this page), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.
|
IF the payment is for...
|
THEN the payment is exempt for...
|
Note. See the chart on page 4 for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately, To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.
Note. Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.
|
|
Interest and dividend payments
|
All exempt payees except for 7
|
||
Broker transactions
|
Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.
|
||
Barter exchange transactions and patronage dividends
|
Exempt payees 1 through 4
|
||
Payments over $600 required to be reported and direct sales over $5,0001
|
Generally, exempt payees 1 through 52
|
||
Payments made in settlement of payment card or third party network transactions
|
Exempt payees 1 through 4
|
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
|
Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.
|
Form W-9 (Rev. 12-2014)
|
Page 4
|
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items I, 4, or 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as indicated in items 1 through 5 below.
1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
|
3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 2.
* Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS identity Theft Hotline at 1-800-908-4490 or submit Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance.
Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
|
For this type of account:
|
Give name and SSN of:
|
Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
|
||
1.
|
Individual
|
The individual
|
||
2.
|
Two or more individuals (joint account)
|
The actual owner of the account or, if combined funds, the first individual on the account1
|
||
3.
|
Custodian account of a minor (Uniform Gift to Minors Act)
|
The minor2
|
||
4.
|
a. The usual revocable savings trust (grantor is
also trustee) b.So-called trust account that is not a legal or valid trust under state law
|
The grantor-trustee1
The actual owner1 |
||
5.
|
Sole proprietorship or disregarded entity owned by an individual
|
The owner3
|
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
|
|
6.
|
Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i)(A))
|
The grantor*
|
||
For this type of account:
|
Give name and EIN of:
|
|||
7.
|
Disregarded entity not owned by an individual
|
The owner
|
||
8.
|
A valid trust, estate, or pension trust
|
Legal entity4
|
||
9.
|
Corporation or LLC electing corporate status on Form 8832 or Form 2553
|
The corporation
|
||
10.
|
Association, club, religious, charitable, educational, or other taxexempt organization
|
The organization
|
||
11.
|
Partnership or multi-member LLC
|
The partnership
|
||
12.
|
A broker or registered nominee
|
The broker or nominee
|
||
13.
|
Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments
|
The public entity
|
||
14.
|
Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B))
|
The trust
|
||
1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
|
||||
|
Instructions for the
Requester of Form W-9
(Rev. December 2014)
Request for Taxpayer Identification Number
and Certification
|
![]() |
Department of the Treasury
Internal Revenue Service
|
Section references are to the Internal Revenue Code unless otherwise noted.
Future Developments
For the latest developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/w9.
Reminders
Foreign Account Tax Compliance Act (FATCA). FATCA requires a participating foreign financial institution to report all U.S. account holders that are specified U.S. persons. Form W-9 and the Instructions for the Requester of Form W-9 have an Exemptions box on the front of the form that includes entry for the Exempt payee code (if any) and Exemption from FATCA Reporting Code (if any). The references for the appropriate codes are in the Exemptions section of Form W-9, and in the Payees Exempt from Backup Withholding and Payees and Account Holders Exempt From FATCA Reporting sections of these instructions.
The Certification section in Part II of Form W-9 includes certification relating to FATCA reporting.
Payment card and third party network transactions. References to payments made in settlement of payment card and third party network transactions are included in the Purpose of Form section of Form W-9. For more information, see the Instructions for Form 1099-K, Payment Card and Third Party Network Transactions on IRS.gov. Also, visit www.irs.gov/1099k.
Backup withholding rate. The backup withholding rate is 28% for reportable payments.
TIN matching e-services. The IRS website offers TIN Matching e-services for certain payers to validate name and TIN combinations. See Taxpayer Identification Number (TIN) Matching on page 4.
How Do I Know When To Use Form W-9?
Use Form W-9 to request the taxpayer identification number (TIN) of a U.S. person (including a resident alien) and to request certain certifications and claims for exemption.
(See Purpose of Form on Form W-9.) Withholding agents may require signed Forms W-9 from U.S. exempt recipients to overcome a presumption of foreign status. For federal purposes, a U.S. person includes but is not limited to:
● An individual who is a U.S. citizen or U.S. resident alien,
● A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,
● Any estate (other than a foreign estate), or
|
● A domestic trust (as defined in Regulations section 301.7701-7).
A partnership may require a signed Form W-9 from its U.S. partners to overcome a presumption of foreign status and to avoid withholding on the partner’s allocable share of the partnership’s effectively connected income. For more information, see Regulations section 1.1446-1.
Advise foreign persons to use the appropriate Form W-8 or Form 8233, Exemption From Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual. See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities, for more information and a list of the W-8 forms.
Also, a nonresident alien individual may, under certain circumstances, claim treaty benefits on scholarships and fellowship grant income. See Pub. 515 or Pub. 519, U.S. Tax Guide for Aliens, for more information.
Electronic Submission of Forms W-9
Requesters may establish a system for payees and payees’ agents to submit Forms W-9 electronically, including by fax. A requester is anyone required to file an information return. A payee is anyone required to provide a taxpayer identification number (TIN) to the requester.
Payee’s agent. A payee’s agent can be an investment advisor (corporation, partnership, or individual) or an introducing broker. An investment advisor must be registered with the Securities and Exchange Commission (SEC) under the Investment Advisers Act of 1940. The introducing broker is a broker-dealer that is regulated by the SEC and the National Association of Securities Dealers, Inc., and that is not a payer. Except for a broker who acts as a payee’s agent for “readily tradable instruments,” the advisor or broker must show in writing to the payer that the payee authorized the advisor or broker to transmit the Form W-9 to the payer.
Electronic system. Generally, the electronic system must:
● Ensure the information received is the information sent, and document all occasions of user access that result in the submission;
● Make reasonably certain that the person accessing the system and submitting the form is the person identified on Form W-9, the investment advisor, or the introducing broker;
● Provide the same information as the paper Form W-9;
● Be able to supply a hard copy of the electronic Form W-9 if the Internal Revenue Service requests it; and
● Require as the final entry in the submission an electronic signature by the payee whose name is on Form W-9 that authenticates and verifies the submission. The electronic signature must be under penalties of perjury and the perjury statement must contain the language of the paper Form W-9.
|
Dec 15, 2014
|
Cat. No. 20479P
|
![]() |
For Forms W-9 that are not required to be signed, the electronic system need not provide for an electronic signature or a perjury statement. |
A substitute Form W-9 that contains a separate signature line just for the certifications satisfies the requirement that the certifications be clearly stated.
|
||
For more details, see the following.
● Announcement 98-27, which is on page 30 of Internal Revenue Bulletin 1998-15 at www.irs.gov/pub/irs-irbs/irb98-15.pdf.
● Announcement 2001-91, which is on page 221 of Internal Revenue Bulletin 2001-36 at www.irs.gov/pub/irs-irbs/irb01-36.pdf.
Individual Taxpayer Identification Number (ITIN)
Form W-9 (or an acceptable substitute) is used by persons required to file information returns with the IRS to get the payee’s (or other person’s) correct name and TIN. For individuals, the TIN is generally a social security number (SSN).
However, in some cases, individuals who become U.S. resident aliens for tax purposes are not eligible to obtain an SSN. This includes certain resident aliens who must receive information returns but who cannot obtain an SSN.
These individuals must apply for an ITIN on Form W-7, Application for IRS Individual Taxpayer Identification Number, unless they have an application pending for an SSN. Individuals who have an ITIN must provide it on Form W-9.
Substitute Form W-9
You may develop and use your own Form W-9 (a substitute Form W-9) if its content is substantially similar to the official IRS Form W-9 and it satisfies certain certification requirements.
You may incorporate a substitute Form W-9 into other business forms you customarily use, such as account signature cards. However, the certifications on the
substitute Form W-9 must clearly state (as shown on the official Form W-9) that under penalties of perjury: 1. The payee’s TIN is correct,
2. The payee is not subject to backup withholding due to failure to report interest and dividend income,
3. The payee is a U.S. person, and
4. The FATCA code entered on this form (if any) indicating that the payee is exempt from FATCA reporting is correct.
You may provide certification instructions on a substitute Form W-9 in a manner similar to the official form. If you are not collecting a FATCA exemption code by omitting that field from the substitute Form W-9 (see Payees and Account Holders Exempt From FATCA Reporting, later), you may notify the payee that item 4 does not apply.
You may not:
1. Use a substitute Form W-9 that requires the payee, by signing, to agree to provisions unrelated to the required certifications, or
|
If a single signature line is used for the required certifications and other provisions, the certifications must be highlighted, boxed, printed in bold-face type, or presented in some other manner that causes the language to stand out from all other information contained on the substitute form. Additionally, the following statement must be presented to stand out in the same manner as described above and must appear immediately above the single signature line:
“The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.”
If you use a substitute form, you are required to provide the Form W-9 instructions to the payee only if he or she requests them. However, if the IRS has notified the payee that backup withholding applies, then you must instruct the payee to strike out the language in the certification that relates to underreporting. This instruction can be given orally or in writing. See item 2 of the Certification on Form W-9. You can replace “defined below” with “defined in the instructions” in item 3 of the Certification on Form W-9 when the instructions will not be provided to the payee except upon request. For more information, see Rev. Proc. 83-89,1983-2 C.B. 613; amplified by Rev. Proc. 96-26, which is on page 22 of Internal Revenue Bulletin 1996-8 at www.irs.gov/pub/irs-irbs/irb96-08.pdf.
TIN Applied for
For interest and dividend payments and certain payments with respect to readily tradable instruments, the payee may return a properly completed, signed Form W-9 to you with “Applied For” written in Part I. This is an “awaiting-TIN” certificate. The payee has 60 calendar days, from the date you receive this certificate, to provide a TIN. If you do not receive the payee’s TIN at that time, you must begin backup withholding on payments.
Reserve rule. You must backup withhold on any reportable payments made during the 60-day period if a payee withdraws more than $500 at one time, unless the payee reserves an amount equal to the current year’s backup withholding rate on all reportable payments made to the account.
Alternative rule. You may also elect to backup withhold during this 60-day period, after a 7-day grace period, under one of the two alternative rules discussed below.
Option 1. Backup withhold on any reportable payments if the payee makes a withdrawal from the account after the close of 7 business days after you receive the awaiting-TIN certificate. Treat as reportable payments all cash withdrawals in an amount up to the reportable payments made from the day after you receive the awaiting-TIN certificate to the day of withdrawal.
Option 2. Backup withhold on any reportable payments made to the payee’s account, regardless of whether the payee makes any withdrawals, beginning no later than 7 business days after you receive the awaiting-TIN certificate.
|
2. Imply that a payee may be subject to backup withholding unless the payee agrees to provisions on the substitute form that are unrelated to the required certifications.
|
![]() |
The 60-day exemption from backup withholding does not apply to any payment other than interest, dividends, and certain payments relating
to readily tradable instruments. Any other reportable payment, such as nonemployee compensation, is subject to backup
|
|
-2-
|
Instr. for Req. of Form W-9 (Rev. 12-2014)
|
withholding immediately, even if the payee has applied for and is awaiting a TIN.
Even if the payee gives you an awaiting-TIN certificate, you must backup withhold on reportable interest and dividend payments if the payee does not certify, under penalties of perjury, that the payee is not subject to backup withholding.
If you do not collect backup withholding from affected payees as required, you may become liable for any uncollected amount.
Payees Exempt From Backup Withholding
The following payees are exempt from backup withholding with respect to the payments below, and should enter the corresponding exempt payee code on Form W-9. If a payee is not exempt, you are required to backup withhold on reportable
payments if the payee does not provide a TIN in the manner required or sign the certification, if required.
1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2);
2. The United States or any of its agencies or instrumentalities;
3. A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions, agencies, or instrumentalities;
4. A foreign government or any of its political subdivisions, agencies, or instrumentalities; or
5. A corporation;
6. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession;
7. A futures commission merchant registered with the Commodity Futures Trading Commission;
8. A real estate investment trust;
9. An entity registered at all times during the tax year under the Investment Company Act of 1940;
10. A common trust fund operated by a bank under section 584(a);
11. A financial institution;
12. A middleman known in the investment community as a nominee or custodian; or
13. A trust exempt from tax under section 664 or described in section 4947.
The following types of payments are exempt from backup withholding as indicated for payees listed in 1 through 13, above.
Interest and dividend payments. All listed payees are exempt except the payee in item 7.
Broker transactions. All payees listed in items 1 through 4 and 6 through 11 are exempt. Also, C corporations are exempt. A person registered under the Investment Advisers Act of 1940 who regularly acts as a broker is also exempt.
Barter exchange transactions and patronage dividends. Only payees listed in items 1 through 4 are exempt.
Payments reportable under sections 6041 and 6041A. Payees listed in items 1 through 5 are generally exempt.
|
However, the following payments made to a corporation and reportable on Form 1099-MISC, Miscellaneous Income, are not exempt from backup withholding.
● Medical and health care payments.
● Attorneys’ fees (also gross proceeds paid to an attorney, reportable under section 6045(f)).
● Payments for services paid by a federal executive agency. (See Rev. Rul. 2003-66, which is on page 1115 of Intenal Revenue Bulletin 2003-26 at www.irs.gov/pub/irs-irbs/irb03-26.pdf.)
Payments made in settlement of payment card or third party network transactions. Only payees listed in items 1 through 4 are exempt.
Payments Exempt From Backup Withholding
Payments that are not subject to information reporting also are not subject to backup withholding. For details, see sections 6041, 6041A, 6042, 6044, 6045, 6049, 6050A, 6050N, and 6050W and their regulations. The following payments are generally exempt from backup withholding.
Dividends and patronage dividends
● Payments to nonresident aliens subject to withholding under section 1441.
● Payments to partnerships not engaged in a trade or business in the United States and that have at least one nonresident alien partner.
● Payments of patronage dividends not paid in money.
● Payments made by certain foreign organizations.
● Section 404(k) distributions made by an ESOP.
Interest payments
● Payments of interest on obligations issued by individuals. However, if you pay $600 or more of interest in the course of your trade or business to a payee, you must report the payment. Backup withholding applies to the reportable payment if the payee has not provided a TIN or has provided an incorrect TIN.
● Payments described in section 6049(b)(5) to nonresident aliens.
● Payments on tax-free covenant bonds under section 1451.
● Payments made by certain foreign organizations.
● Mortgage or student loan interest paid to you.
Other types of payment
● Wages.
● Distributions from a pension, annuity, profit-sharing or stock bonus plan, any IRA, an owner-employee plan, or other deferred compensation plan.
● Distributions from a medical or health savings account and long-term care benefits.
● Certain surrenders of life insurance contracts.
● Distribution from qualified tuition programs or Coverdell ESAs.
● Gambling winnings if regular gambling winnings withholding is required under section 3402(q). However, if regular gambling winnings withholding is not required under section 3402(q), backup withholding applies if the payee fails to furnish a TIN.
● Real estate transactions reportable under section 6045(e).
● Cancelled debts reportable under section 6050P.
|
Instr. for Req. of Form W-9 (Rev. 12-2014)
|
-3-
|
● Fish purchases for cash reportable under section 6050R.
Payees and Account Holders Exempt From FATCA Reporting
Reporting under chapter 4 (FATCA) with respect to U.S. persons generally applies only to foreign financial institutions (FFI) (including a branch of a U.S. financial institution that is treated as an FFI under an applicable intergovernmental agreement (IGA)). Thus, for example, a U.S. financial institution maintaining an account in the United States does not need to collect an exemption code for FATCA reporting. If you are providing a Form W-9, you may pre-populate the FATCA exemption code with “Not Applicable,” “N/A,” or a similar indication that an exemption from FATCA reporting does not apply. Any payee that provides such a form, however, cannot be treated as exempt from FATCA reporting. For details on the FATCA reporting requirements, including specific information regarding which financial institutions are required to report, see sections 1471 to 1474 and related regulations. See Regulations section 1.1471-3(d)(2) for when an FFI may rely on documentary evidence to treat a U.S. person as other than a specified U.S. person and see Regulations section 1.1471-3(f)(3) for when an FFI may presume a U.S. person as other than a specified U.S. person.
If you receive a Form W-9 with a FATCA exemption code and you know or have reason to know the person is a specified U.S. person, you may not rely on the Form W-9 to treat the person as exempt from FATCA reporting. However, you may still rely on an otherwise completed Form W-9 to treat a person as a specified U.S. person. An exemption from FATCA reporting (or lack thereof) does not affect backup withholding as described earlier in these instructions. The following are not specified U.S. persons and are thus exempt from FATCA reporting:
|
K. A broker;
L. A trust exempt from tax under section 664 or described in section 4947; or
M. A tax-exempt trust under a section 403(b) plan or section 457(g) plan.
Joint Foreign Payees
If the first payee listed on an account gives you a Form W-8 or a similar statement signed under penalties of perjury, backup withholding applies unless:
1. Every joint payee provides the statement regarding foreign status, or
2. Any one of the joint payees who has not established foreign status gives you a TIN.
If any one of the joint payees who has not established foreign status gives you a TIN, use that number for purposes of backup withholding and information reporting.
For more information on foreign payees, see the Instructions for the Requester of Forms W-8BEN, W-8ECI, W-8EXP, and W-8IMY.
Names and TINs To Use for Information Reporting
Show the full name and address as provided on Form W-9 on the information return filed with the IRS and on the copy furnished to the payee. If you made payments to more than one payee or the account is in more than one name, enter on the
first name line of the information return only the name of the payee whose TIN is shown on Form W-9. You may show the names of any other individual payees in the area below the first name line on the information return. Forms W-9 showing an ITIN must have the name exactly as shown on line 1a of the Form W-7 application.
|
|||
A. An organization exempt from tax under section 501(a), or any individual retirement plan as defined in section 7701(a)(37);
B. The United States or any of its agencies or instrumentalities;
|
![]() |
For more information on the names and TINs to use for information reporting, see section J of the General Instructions for Certain Information Returns.
|
||
C. A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions, agencies, or instrumentalities;
D. A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg, section 1.1472-1(c)(1)(i);
E. A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i);
F. A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any State;
G. A real estate investment trust;
H. A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940;
I. A common trust fund as defined in section 584(a);
J. A bank as defined in section 581;
|
Notices From the IRS
The IRS will send you a notice if the payee’s name and TIN on the information return you filed do not match the IRS’s records. (See Taxpayer Identification Number (TIN) Matching.) You may have to send a “B” notice to the payee to solicit another TIN. Pub. 1281, Backup Withholding for Missing and Incorrect Name/TIN(s), contains copies of the two types of “B” notices.
Taxpayer Identification Number (TIN) Matching
TIN Matching allows a payer or authorized agent who is required to file Forms 1099-B, DIV, INT, K, MISC, OID, and/or PATR to match TIN and name combinations with IRS records before submitting the forms to the IRS. TIN Matching is one of the e-services products that is offered and is accessible through the IRS website. Go to IRS.gov and enter e-services in the search box. It is anticipated that payers who validate the TIN and name combinations before filing information returns will receive fewer backup withholding (CP2100) notices and penalty notices.
Additional Information
For more information on backup withholding, see Pub. 1281.
|
|
-4-
|
Instr. for Req. of Form W-9 (Rev. 12-2014)
|
D.F. King & Co., Inc.
48 Wall Street, 22nd Floor
New York, New York 10005
or
Banks and Brokers Call Collect:
(212) 269-5550
All Others Call Toll Free: (866) 745-0265
Email: cvs@dfking.com
|
||
By Regular, Registered or Certified Mail, Hand or Overnight Delivery:
D.F. King & Co., Inc.
48 Wall Street, 22nd Floor
New York, New York 10005
Attn: Peter Aymar
|
By Facsimile (for Eligible Institutions only):
(212) 709-3328
Attn: Peter Aymar
For Confirmation:
(212) 232-3235
|
THE EXCHANGE OFFER WILL EXPIRE AT P.M., NEW YORK CITY TIME, ON , 2016 UNLESS EXTENDED (THE “EXPIRATION DATE”). TENDERS IN THE EXCHANGE OFFER MAY BE WITHDRAWN AT ANY TIME PRIOR TO P.M., NEW YORK CITY TIME, ON THE EXPIRATION DATE.
|
|
·
|
it is not an affiliate of CVS Health within the meaning of Rule 405 of the Securities Act or, if it is such an affiliate, it will comply with the registration and prospectus delivery requirements of the Securities Act, to the extent applicable;
|
|
·
|
it is not participating, and it has no arrangement or understanding with any person to participate in a distribution (within the meaning of the Securities Act) of the New Notes in violation of the provisions of the Securities Act;
|
|
·
|
it is not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for its own account in exchange for the Old Notes;
|
|
·
|
if it is a broker dealer, it has not entered into any arrangement or understanding with CVS Health or any of CVS Health’s affiliates to distribute the New Notes;
|
|
·
|
it is acquiring the New Notes in the ordinary course of its business; and
|
|
·
|
it is not acting on behalf of any person or entity that could not truthfully make these representations.
|
Very truly yours,
|
|
CVS HEALTH CORPORATION
|
THE EXCHANGE OFFER WILL EXPIRE AT P.M., NEW YORK CITY TIME, ON , 2016 UNLESS EXTENDED (THE “EXPIRATION DATE”). TENDERS IN THE EXCHANGE OFFER MAY BE WITHDRAWN AT ANY TIME PRIOR TO P.M., NEW YORK CITY TIME, ON THE EXPIRATION DATE.
|
|
o
|
To tender the following Old Notes held by you for the account of the undersigned (insert principal amount of Old Notes to be tendered) (if any): $______________________________
|
.
|
|
o
|
not to tender any Old Notes held by you for the account of the undersigned.
|
|
·
|
it is not an affiliate of CVS Health within the meaning of Rule 405 of the Securities Act or, if it is such an affiliate, it will comply with the registration and prospectus delivery requirements of the Securities Act, to the extent applicable;
|
|
·
|
it is not participating, and it has no arrangement or understanding with any person to participate in a distribution (within the meaning of the Securities Act) of the New Notes in violation of the provisions of the Securities Act;
|
|
·
|
it is not a broker-dealer who tendered 4.75% notes due December 1, 2022 issued by Omnicare, Inc. or 5.00% notes due December 1, 2024 issued by Omnicare, Inc. acquired directly from Omnicare, Inc. for its own account in exchange for the Old Notes;
|
|
·
|
if it is a broker dealer, it has not entered into any arrangement or understanding with CVS Health or any of CVS Health’s affiliates to distribute the New Notes;
|
|
·
|
it is acquiring the New Notes in the ordinary course of its business; and
|
·
|
it is not acting on behalf of any person or entity that could not truthfully make these representations.
|
Name(s) of beneficial owner(s):
|
Signature(s):
|
Name(s):
|
(Please Print)
|
Address(es):
|
Telephone Number(s):
|
Taxpayer Identification or Social Security Number(s):
|
Date:
|
'9),6UT-6PS1$EW<5!K9D5D:FEX9D](+T]84&MX67)J4R].
M.75$>'5$.5%V>'56.5)6)B-X03M,=W8Q,DQ) 60X>F5A3E%+*VY&<4QX47A6;S@P>5 E5T2FDK4-6,D8W8U=&.6)8,7,S1S1T6E5N:&)W94YG>6XW>&ER.4%R-WIB
M6GAE435V3G-:0712<' Q)B-X03M+2W!Q3TIG.5I"-S$R1TQ&*V9%
5')4
M;'A)2]4:7(V
M42\U>44X;V5E9GI!,4QY)B-X03LY8656F%!9%!1=5 S)B-X03MQ068V;V9J.4=,24U2=#=I
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M03M3
E U>B]*=CAW+TM*95163DMK:W-52B]W0GE&<%=E,V]0
M,FEY:7%$+UA#-'-R651I