Sec Form 4 Filing - Shah Prem S @ CVS HEALTH Corp - 2022-02-26

Insider filing report for Changes in Beneficial Ownership
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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
Shah Prem S
2. Issuer Name and Ticker or Trading Symbol
CVS HEALTH Corp [ CVS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
EVP and Co-President of Retail
(Last) (First) (Middle)
ONE CVS DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
02/26/2022
(Street)
WOONSOCKET, RI02895
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 02/26/2022 F 226( 1 ) D $ 104.3 59,394.24 D
Common Stock 02/28/2022 F 141( 1 ) D $ 103.65 60,760.24 D
Common Stock (PSUs) 41,463 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 ) 1,866 D
Stock Unit (deferred)( 9 ) 5,672.1478 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 Option( 10 ) $ 104.82 04/01/2017 04/01/2023 Common Stock 5,870 5,870 D
Stock Option( 11 ) $ 102.26 04/01/2016 04/01/2022 Common Stock 5,346 5,346 D
Stock Option( 12 ) $ 62.2011 04/01/2019 04/01/2025 Common Stock 1,691 1,691 D
Stock Option( 13 ) $ 54.19 04/01/2020 04/01/2029 Common Stock 12,626 12,626 D
Stock Option( 14 ) $ 58.34 04/01/2021 04/01/2030 Common Stock 34,315 34,315 D
Stock Option( 15 ) $ 74.3 04/01/2022 04/01/2031 Common Stock 32,826 32,826 D
Stock Option( 16 ) $ 75.24 08/31/2021 08/31/2028 Common Stock 26,580 26,580 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Shah Prem S
ONE CVS DRIVE
WOONSOCKET, RI02895
EVP and Co-President of Retail
Signatures
/s/ Prem S. Shah 03/01/2022
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Surrender of shares in payment of withholding taxes due upon the vesting of a restricted stock award.
( 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.

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