0001127602-22-002431.txt : 20220128 0001127602-22-002431.hdr.sgml : 20220128 20220128165803 ACCESSION NUMBER: 0001127602-22-002431 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220127 FILED AS OF DATE: 20220128 DATE AS OF CHANGE: 20220128 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: 22569724 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 2022-01-27 0000064803 CVS HEALTH Corp CVS 0001410515 Roberts Jonathan C ONE CVS DRIVE WOONSOCKET RI 02895- 1 EVP & Chief Operating Officer Common Stock 2022-01-27 4 M 0 68482 102.26 A 175596.717 D Common Stock 2022-01-27 4 S 0 68482 107.50 D 107114.717 D Common Stock 34707 I By GRAT Common Stock (restricted) 12812 D ESOP Common Stock 6045 I By ESOP Stock Option 102.26 2022-01-27 4 M 0 68482 0 D 2016-04-01 2022-04-01 Common Stock 68482 0 D Phantom Stock Credits 1.00 Common Stock 1422.6711 1422.6711 D All sales were effected pursuant to a Rule 10b5-1 plan. Option became exercisable in four equal annual installments, commencing 4/1/2016. 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. Jonathan C. Roberts 2022-01-28