0001127602-21-031962.txt : 20211228 0001127602-21-031962.hdr.sgml : 20211228 20211228170430 ACCESSION NUMBER: 0001127602-21-031962 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211227 FILED AS OF DATE: 20211228 DATE AS OF CHANGE: 20211228 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lotvin Alan CENTRAL INDEX KEY: 0001472795 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-01011 FILM NUMBER: 211525529 MAIL ADDRESS: STREET 1: 55 NOD ROAD CITY: AVON STATE: CT ZIP: 06001 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 2021-12-27 0000064803 CVS HEALTH Corp CVS 0001472795 Lotvin Alan ONE CVS DRIVE WOONSOCKET RI 02895 1 EVP&President-PharmacyServices Common Stock (restricted) 2021-12-27 4 F 0 200 88.78 D 5827 D Common Stock 61341.3689 D Common Stock 492 I By Children's Trusts Stock Unit 29851.1611 D Phantom Stock Credits 1.00 Common Stock 556.7643 556.7643 D Stock Option 102.26 2016-04-01 2022-04-01 Common Stock 21386 21386 D Stock Option 104.82 2017-04-01 2023-04-01 Common Stock 27395 27395 D Stock Option 78.05 2018-04-03 2024-04-03 Common Stock 32911 32911 D Stock Option 62.21 2019-04-01 2025-04-01 Common Stock 22541 22541 D Stock Option 54.19 2020-04-01 2029-04-01 Common Stock 70702 70702 D Stock Option 58.34 2021-04-01 2030-04-01 Common Stock 140797 140797 D Stock Option 74.30 2022-04-01 2031-04-01 Common Stock 120940 120940 D Transaction represents the withholding of shares by the Issuer to satisfy FICA taxes arising from the reporting person being retirement eligible. 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. Option became exercisable in four equal annual installments, commencing 4/1/2021. Option becomes exercisable in four equal annual installments, commencing 4/1/2022. /s/ Alan M. Lotvin 2021-12-28