0001127602-22-011635.txt : 20220405 0001127602-22-011635.hdr.sgml : 20220405 20220405192635 ACCESSION NUMBER: 0001127602-22-011635 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220401 FILED AS OF DATE: 20220405 DATE AS OF CHANGE: 20220405 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shah Prem S CENTRAL INDEX KEY: 0001900910 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-01011 FILM NUMBER: 22808943 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 2022-04-01 0000064803 CVS HEALTH Corp CVS 0001900910 Shah Prem S ONE CVS DRIVE WOONSOCKET RI 02895 1 EVP and Co-President of Retail Common Stock 2022-04-01 4 F 0 18747 101.09 D 40324.24 D Common Stock 2022-04-01 4 F 0 3731 101.09 D 46583.24 D Common Stock (pep) 4413.0017 D Common Stock (restricted) 18447 D ESOP Common Stock 4538.8882 D Common Stock (restricted) 1866 D Stock Unit (deferred) 5672.1478 D Stock Option 101.09 2022-04-01 4 A 0 41580 101.09 A 2023-04-01 2032-04-01 Common Stock 41580 41580 D Stock Option 104.82 2017-04-01 2023-04-01 Common Stock 2935 2935 D Stock Option 62.2011 2019-04-01 2025-04-01 Common Stock 1691 1691 D Stock Option 54.19 2020-04-01 2029-04-01 Common Stock 12626 12626 D Stock Option 58.34 2021-04-01 2030-04-01 Common Stock 34315 34315 D Stock Option 74.30 2022-04-01 2031-04-01 Common Stock 32826 32826 D Stock Option 75.24 2021-08-31 2028-08-31 Common Stock 26580 26580 D Phantom Stock Credits 1.00 Common Stock 11259.1952 11259.1952 D Surrender of shares in payment of taxes due upon the vesting and settlement of PSUs on April 1, 2022. Surrender of shares in payment of withholding taxes due upon the vesting of a restricted stock award. 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. 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. 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. Option becomes exercisable in four equal installments, commencing 4/1/2023. Option becomes exercisable in four equal installments commencing 04/01/2017. Option becomes exercisable in four equal installments commencing 04/01/2019. Additional options from this award have been exercised. Option becomes exercisable in four equal installments commencing 04/01/2020. Additional options from this award have been exercised. Option becomes exercisable in four equal installments commencing 04/01/2021. Additional options from this award have been exercised. Option becomes exercisable in three equal installments commencing 04/01/2022. Option vests in three equal installments, on 8/31/2021, 8/31/2022 and 8/31/2023. 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. /s/ Prem S. Shah 2022-04-05