FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/01/2022 |
3. Issuer Name and Ticker or Trading Symbol
CVS HEALTH Corp [ CVS ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 11,980.24 | D | |
Common Stock (restricted)(1) | 575 | D | |
Common Stock (restricted)(2) | 2,884 | D | |
Common Stock (restricted)(3) | 15,427 | D | |
Common Stock (restricted)(4) | 1,808 | D | |
Common Stock (restricted)(5) | 1,925 | D | |
Common Stock (restricted)(6) | 6,393 | D | |
Common Stock (restricted)(7) | 4,372.62 | D | |
Common Stock (restricted)(8) | 2,798 | D | |
Stock Unit (deferred)(9) | 5,625.28 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option(10) | 04/01/2017 | 04/01/2023 | Common Stock | 5,870 | $104.82 | D | |
Stock Option(11) | 04/01/2016 | 04/01/2022 | Common Stock | 5,346 | $102.26 | D | |
Stock Option(12) | 04/01/2019 | 04/01/2025 | Common Stock | 1,691 | $62.2011 | D | |
Stock Option(13) | 04/01/2020 | 04/01/2029 | Common Stock | 12,626 | $54.19 | D | |
Stock Option(14) | 04/01/2021 | 04/01/2030 | Common Stock | 34,315 | $58.34 | D | |
Stock Option(15) | 04/01/2022 | 04/01/2031 | Common Stock | 32,826 | $74.3 | D | |
Stock Option(16) | 08/31/2021 | 08/31/2028 | Common Stock | 26,580 | $75.24 | D |
Explanation of Responses: |
1. Consists of remaining Restricted Stock Units (RSUs) awarded pursuant to Issuer's Performance-Based Restricted Stock Plan, a sub-plan under its 2017 Incentive Compensation Plan (ICP). Restrictions lapse on 02/28/2022. |
2. Consists of RSUs awarded pursuant to Issuer's 2017 ICP. Restrictions on remaining RSUs lapse in two equal installments commencing on 04/01/2022. |
3. Consists of RSUs awarded pursuant to Issuer's 2017 ICP. Restrictions on remaining RSUs lapse in three equal installments commencing on 04/01/2022. |
4. Consists of RSUs awarded pursuant to Issuer's 2017 ICP. Restrictions lapse on 04/01/2022. |
5. Consists of remaining RSUs awarded pursuant to Issuer's Performance-Based Restricted Stock Plan, a sub-plan under its 2017 ICP. Restrictions lapse in two equal installments commencing on 02/28/2022. |
6. Consists of RSUs awarded pursuant to Issuer's 2017 ICP. Restrictions on remaining RSUs lapse in four equal installments commencing on 04/01/2022. |
7. Consists of Matching RSUs awarded pursuant to Issuer's Partnership Equity Program, a sub-plan under its ICP, and dividend equivalents on the Matching RSUs. Restrictions lapse on the RSUs on 08/31/2023. |
8. Consists of RSUs awarded pursuant to Issuer's Performance-Based Restricted Stock Plan under its 2017 ICP. Restrictions lapse in three equal installments commencing on 02/26/2022. |
9. Consists of Stock Units awarded pursuant to Issuer's 2010 & 2017 Incentive Compensation Plans, the receipt of which the reporting person has elected to defer. |
10. Option becomes exercisable in four equal installments commencing 04/01/2017. |
11. Option becomes exercisable in four equal installments commencing 04/01/2016. |
12. Option becomes exercisable in four equal installments commencing 04/01/2019. Additional options from this award have been exercised. |
13. Option becomes exercisable in four equal installments commencing 04/01/2020. Additional options from this award have been exercised. |
14. Option becomes exercisable in four equal installments commencing 04/01/2021. Additional options from this award have been exercised. |
15. Option becomes exercisable in three equal installments commencing 04/01/2022. |
16. Option vests in three equal installments, on 8/31/2021, 8/31/2022 and 8/31/2023. |
/s/ Prem S. Shah | 01/10/2022 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |