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