0001127602-21-012689.txt : 20210402 0001127602-21-012689.hdr.sgml : 20210402 20210402165738 ACCESSION NUMBER: 0001127602-21-012689 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210201 FILED AS OF DATE: 20210402 DATE AS OF CHANGE: 20210402 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bisaccia Lisa CENTRAL INDEX KEY: 0001479663 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-01011 FILM NUMBER: 21802650 MAIL ADDRESS: STREET 1: ONE CVS DRIVE CITY: WOONSOCKET STATE: RI ZIP: 02895 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CVS HEALTH Corp CENTRAL INDEX KEY: 0000064803 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DRUG STORES AND PROPRIETARY STORES [5912] IRS NUMBER: 050494040 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ONE CVS DR. CITY: WOONSOCKET STATE: RI ZIP: 02895 BUSINESS PHONE: 4017651500 MAIL ADDRESS: STREET 1: ONE CVS DR. CITY: WOONSOCKET STATE: RI ZIP: 02895 FORMER COMPANY: FORMER CONFORMED NAME: CVS CAREMARK CORP DATE OF NAME CHANGE: 20070509 FORMER COMPANY: FORMER CONFORMED NAME: CVS/CAREMARK CORP DATE OF NAME CHANGE: 20070322 FORMER COMPANY: FORMER CONFORMED NAME: CVS CORP DATE OF NAME CHANGE: 19970128 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2021-02-01 1 0000064803 CVS HEALTH Corp CVS 0001479663 Bisaccia Lisa ONE CVS DRIVE WOONSOCKET RI 02895 1 Former EVP & Chief HR Officer Common Stock 2021-02-01 4 A 0 77457 0 A 100103 D Common Stock 2021-04-01 4 F 0 35120 74.30 D 64983 D Common Stock 2021-04-01 4 F 0 1190 74.30 D 66417 D Common Stock 23942 I By GRAT Common Stock (restricted) 3523 D ESOP Common Stock 655 I Direct Stock Unit 32145.773 D Phantom Stock Credits 1.00 Common Stock 469.0358 469.0358 D Stock Option 102.26 2016-04-01 2022-04-01 Common Stock 34241 34241 D Stock Option 104.82 2017-04-01 2023-04-01 Common Stock 39433 39433 D Stock Option 78.05 2018-04-03 2024-04-03 Common Stock 55098 55098 D Stock Option 62.21 2019-04-01 2025-04-01 Common Stock 64222 64222 D Stock Option 54.19 2020-04-01 2029-04-01 Common Stock 141405 141405 D Stock Option 58.34 2021-04-01 2030-04-01 Common Stock 98558 98558 D Represents shares earned by the reporting person pursuant to certain performance stock units (the "PSUs"), which were granted to the reporting person under the Issuer's 2017 Incentive Compensation Plan on February 1, 2021. The PSUs were earned based on the attainment of certain performance metrics, which performance metrics were certified by the Management and Planning Committee of the Board of Directors of the Issuer on February 1, 2021. The PSUs vested and settled on April 1, 2021. Surrender of shares in payment of taxes due upon the vesting and settlement of the PSUs on April 1, 2021. Surrender of shares in payment of taxes due upon the vesting and settlement of a restricted stock unit award on April 1, 2021. Reflects year-end company-match share credits under a non-qualified deferred compensation plan; share credits are payable in cash only, at such time as has been elected by the reporting person. Reflects year-end company-match share credits under a non-qualified deferred compensation plan; share credits are payable in cash only, at such time as has been elected by the reporting person. Option became exercisable in four equal annual installments, commencing 4/1/2016. Option became exercisable in four equal annual installments, commencing 4/1/2017. Option became exercisable in four equal annual installments, commencing 4/3/2018. Option became exercisable in four equal annual installments, commencing 4/1/2019. Option became exercisable in four equal annual installments, commencing 4/1/2020. The number of shares subject to the option were calculated using a 30-day average price. Options became exercisable in four equal annual installments, commencing 4/1/2021. Lisa G. Bisaccia 2021-04-02