Sec Form 4 Filing - Jelinek Richard M @ AETNA INC /PA/ - 2018-11-28

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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Jelinek Richard M
2. Issuer Name and Ticker or Trading Symbol
AETNA INC /PA/ [ AET]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
EVP, Enterprise Strategy
(Last) (First) (Middle)
AETNA INC., 151 FARMINGTON AVENUE
3. Date of Earliest Transaction (MM/DD/YY)
11/28/2018
(Street)
HARTFORD, CT06156
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/28/2018 D 14,227 ( 1 ) D 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Appreciation Rights $ 115.34 11/28/2018 D 16,806 ( 3 ) ( 3 ) Common Stock 16,806 ( 3 ) 0 D
Stock Appreciation Rights $ 103.45 11/28/2018 D 81,038 ( 4 ) ( 4 ) Common Stock 81,038 ( 4 ) 0 D
Stock Appreciation Rights $ 125.27 11/28/2018 D 79,938 ( 5 ) ( 5 ) Common Stock 79,938 ( 5 ) 0 D
Performance Stock Units ( 6 ) 11/28/2018 D 23,200 ( 6 ) ( 6 ) Common Stock 23,200 ( 6 ) 0 D
Performance Stock Units ( 7 ) 11/28/2018 D 9,939 ( 7 ) ( 7 ) Common Stock 9,939 ( 7 ) 0 D
Restricted Stock Units ( 8 ) 11/28/2018 D 23,377 ( 8 ) ( 8 ) Common Stock 23,377 ( 8 ) 0 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Jelinek Richard M
AETNA INC.
151 FARMINGTON AVENUE
HARTFORD, CT06156
EVP, Enterprise Strategy
Signatures
/s/ Richard M. Jelinek by Adam F. McAnaney, Attorney-in-Fact 11/28/2018
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Includes 140 shares acquired under Aetna Inc. Employee Stock Purchase Plan on June 1, 2018.
( 2 )Converted pursuant to the merger agreement (the "Merger Agreement") between CVS Health Corporation ("CVS Health") and Aetna Inc. ("Aetna") into $145 in cash and 0.8378 shares of CVS Health Common Stock for each share of Aetna Common Stock.
( 3 )Represents Stock Appreciation Rights ("SARs") granted pursuant to the Aetna Inc. 2010 Stock Incentive Plan (the "Plan") on November 2, 2015. These SARs were canceled pursuant to the terms of the Merger Agreement in exchange for an amount in cash for each SAR equal to (a) $145 plus (b) 0.8378 multiplied by the average of the volume weighted averages of the trading prices of CVS Health Common Stock on each of the five consecutive trading days ending on the trading day two trading days prior to the closing date, less (c) the exercise price (the "SAR Amount").
( 4 )Represents SARs granted under the Plan on February 19, 2016, of which 66.7% had vested. Each vested SAR was canceled pursuant to the terms of the Merger Agreement in exchange for an amount in cash equal to the SAR Amount. Each unvested SAR was converted to a CVS Health SAR pursuant to the terms of the Merger Agreement.
( 5 )Represents SARs granted under the Plan on February 17, 2017, of which 33.3% had vested. Each vested SAR was canceled pursuant to the terms of the Merger Agreement in exchange for an amount in cash equal to the SAR Amount. Each unvested SAR was converted to a CVS Health SAR pursuant to the terms of the Merger Agreement.
( 6 )Represents Performance Stock Units ("PSUs") earned at a specified level in conjunction with the change in control of Aetna and pursuant to the terms of the relevant PSU award agreement. The PSUs were originally granted under the Plan on February 19, 2016. These PSUs were converted to time-vesting CVS Health Restricted Stock Units ("RSUs") pursuant to the terms of the Merger Agreement.
( 7 )PSUs earned at a specified level in conjunction with the change in control of Aetna and pursuant to the terms of the relevant PSU award agreement. The PSUs were originally granted under the Plan on February 17, 2017. These PSUs were converted to time-vesting CVS Health RSUs pursuant to the terms of the Merger Agreement.
( 8 )RSUs granted under the Plan on March 2, 2018. These RSUs were converted to CVS Health RSUs pursuant to the Merger Agreement.

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