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Bisaccia Lisa – ‘4’ for 1/12/21 re: CVS Health Corp.

On:  Wednesday, 1/13/21, at 5:08pm ET   ·   For:  1/12/21   ·   Accession #:  1127602-21-1603   ·   File #:  1-01011

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 1/13/21  Bisaccia Lisa                     4                      1:14K  CVS Health Corp.                  Restricted Stock Sy… Inc

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Statement of Changes in Beneficial Ownership of     HTML      3K 
                Securities by an Insider -- form4.xml/3.6                        




        

This ‘4’ Document is an XML Data File that may be rendered in various formats:

  Form 4    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 

 
SEC Info rendering:  Statement of Changes in Beneficial Ownership of Securities by an Insider
 
FORM 4UNITED 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
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number:3235-0287
Estimated average burden
hours per response:0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Bisaccia Lisa

(Last)(First)(Middle)
ONE CVS DRIVE

(Street)
WOONSOCKETRI02895

(City)(State)(Zip)
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
XOfficer (give title below) Other (specify below)
EVP and Chief HR Officer
3. Date of Earliest Transaction (Month/Day/Year)
1/12/21
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
XForm filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year)2A. Deemed Execution Date, if any (Month/Day/Year)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)
CodeVAmount(A) or (D)Price
Common Stock 1/12/21 M 25,177A$74.2971,765D
Common Stock 1/12/21 S (1) 25,177D$7746,588D
Common Stock (restricted) 6,147D
ESOP Common Stock 634IDirect
Stock Unit 32,020.2324D
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 (Month/Day/Year)3A. Deemed Execution Date, if any (Month/Day/Year)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 (Month/Day/Year)7. Title and Amount of Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Stock Option$74.29 1/12/21 M 25,177 4/1/15 (2) 4/1/21Common Stock25,177$00D
Phantom Stock Credits$1 (3) (4)Common Stock468.9237 468.9237D
Stock Option$102.26 4/1/16 (5) 4/1/22Common Stock34,241 34,241D
Stock Option$104.82 4/1/17 (6) 4/1/23Common Stock39,433 39,433D
Stock Option$78.05 4/3/18 (7) 4/3/24Common Stock55,098 55,098D
Stock Option$62.21 4/1/19 (8) 4/1/25Common Stock64,222 64,222D
Stock Option$54.19 4/1/20 (9) 4/1/29Common Stock141,405 141,405D
Stock Option$58.34 (10) 4/1/21 (11) 4/1/30Common Stock98,558 98,558D
Explanation of Responses:
(1)  All sales were effected pursuant to a Rule 10b5-1 plan.
(2)  Option became exercisable in four equal annual installments, commencing 4/1/15.
(3)  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.
(4)  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.
(5)  Option became exercisable in four equal annual installments, commencing 4/1/16.
(6)  Option became exercisable in four equal annual installments, commencing 4/1/17.
(7)  Option became exercisable in four equal annual installments, commencing 4/3/18.
(8)  Option became exercisable in four equal annual installments, commencing 4/1/19.
(9)  Option became exercisable in four equal annual installments, commencing 4/1/20.
(10)  The number of shares subject to the option were calculated using a 30-day average price.
(11)  Option becomes exercisable in four equal annual installments, commencing 4/1/21.
Lisa G. Bisaccia 1/13/21
** Signature of Reporting PersonDate
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 4 (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.
____________
Transaction Codes:
    M    Exercise or conversion of derivative security exempted pursuant to Rule 16b-3.
    S    Open market or private sale of non-derivative or derivative security.

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Filing Submission 0001127602-21-001603   –   Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)

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