0001127602-21-012812.txt : 20210402 0001127602-21-012812.hdr.sgml : 20210402 20210402175922 ACCESSION NUMBER: 0001127602-21-012812 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: Roberts Jonathan C CENTRAL INDEX KEY: 0001410515 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-01011 FILM NUMBER: 21803193 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 0000064803 CVS HEALTH Corp CVS 0001410515 Roberts Jonathan C ONE CVS DRIVE WOONSOCKET RI 02895- 1 EVP & Chief Operating Officer Common Stock 2021-02-01 4 A 0 175811 0 A 176474.717 D Common Stock 2021-04-01 4 F 0 79714 74.30 D 96760.717 D Common Stock 45061 I By GRAT Common Stock (restricted) 12812 D ESOP Common Stock 6045 I By ESOP Stock Unit 333720.845 D Stock Option 74.30 2021-04-01 4 A 0 172772 74.30 A 2022-04-01 2031-04-01 Common Stock 172772 172772 D Phantom Stock Credits 1.00 Common Stock 1422.6711 1422.6711 D Stock Option 45.93 2015-09-04 2022-09-04 Common Stock 108870 108870 D Stock Option 102.26 2016-04-01 2022-04-01 Common Stock 68482 68482 D Stock Option 104.82 2017-04-01 2023-04-01 Common Stock 161318 161318 D Stock Option 78.05 2018-04-03 2024-04-03 Common Stock 200358 200358 D Stock Option 62.21 2019-04-01 2025-04-01 Common Stock 248131 248131 D Stock Option 54.19 2020-04-01 2029-04-01 Common Stock 303010 303010 D Stock Option 58.34 2021-04-01 2030-04-01 Common Stock 239355 239355 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. Option becomes exercisable in four equal installments, commencing 4/1/2022. 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 three equal annual installments, commencing 9/4/2015. 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 installments, commencing 4/1/2021. Jonathan C. Roberts 2021-04-02