0001127602-21-028481.txt : 20211105 0001127602-21-028481.hdr.sgml : 20211105 20211105163505 ACCESSION NUMBER: 0001127602-21-028481 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211103 FILED AS OF DATE: 20211105 DATE AS OF CHANGE: 20211105 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: 211385122 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 2021-11-03 0000064803 CVS HEALTH Corp CVS 0001410515 Roberts Jonathan C ONE CVS DRIVE WOONSOCKET RI 02895- 1 EVP & Chief Operating Officer Common Stock 2021-11-03 4 M 0 108870 45.93 A 215984.717 D Common Stock 2021-11-03 4 S 0 108870 95.00 D 107114.717 D Common Stock 34707 I By GRAT Common Stock (restricted) 12812 D ESOP Common Stock 6045 I By ESOP Stock Unit 337833.3369 D Stock Option 45.93 2021-11-03 4 M 0 108870 0 D 2015-09-04 2022-09-04 Common Stock 108870 0 D Phantom Stock Credits 1.00 Common Stock 1422.6711 1422.6711 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 Stock Option 74.30 2022-04-01 2031-04-01 Common Stock 172772 172772 D All sales were effected pursuant to a Rule 10b5-1 plan. Option became exercisable in three equal annual installments, commencing 9/4/2015. 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 installments, commencing 4/1/2021. Option becomes exercisable in four equal installments, commencing 4/1/2022. Jonathan C. Roberts 2021-11-04