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