SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/19/2018 | 3. Issuer Name and Ticker or Trading Symbol CVS HEALTH Corp [ CVS ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 8,040.2554 | D | |
Common Stock (restricted) | 858(1) | D | |
Common Stock (restricted) | 537(2) | D | |
Common Stock (restricted) | 831(3) | D | |
Common Stock (restricted) | 2,214(4) | D | |
Common Stock (restricted) | 274(5) | D | |
Common Stock (restricted) | 2,009(6) | D | |
Common Stock (restricted) | 1,057(7) | D | |
Common Stock (restricted) | 790(8) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option | 04/02/2013(9) | 04/02/2019 | Common Stock | 1,664 | 45.07 | D | |
Stock Option | 04/01/2014(10) | 04/01/2020 | Common Stock | 3,030 | 54.53 | D | |
Stock Option | 04/01/2015(11) | 04/01/2021 | Common Stock | 5,350 | 74.29 | D | |
Stock Option | 04/01/2016(12) | 04/01/2022 | Common Stock | 6,059 | 102.26 | D | |
Stock Option | 04/01/2017(13) | 04/01/2023 | Common Stock | 7,044 | 104.82 | D | |
Stock Option | 04/03/2018(14) | 04/03/2024 | Common Stock | 9,050 | 78.05 | D | |
Stock Option | 04/01/2019(15) | 04/01/2025 | Common Stock | 7,513 | 62.21 | D |
Explanation of Responses: |
1. Consists of Restricted Stock Units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 4/1/2020. |
2. Consists of Restricted Stock Units (RSUs) awarded pursuant to Issuer's Performance-Based Restricted Stock Unit Plan, a sub-plan under its 2010 Incentive Compensation Plan. Restrictions on remaining RSUs lapse in two equal installments on 2/28/2019 and 2/28/2020. |
3. Consists of Restricted Stock Units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 4/1/2019. |
4. Consists of Restricted Stock Units awarded pursuant to Issuer's 2017 Incentive Compensation Plan. Restrictions lapse 2/28/2021. |
5. Consists of Restricted Stock Units (RSUs) awarded pursuant to Issuer's Performance-Based Restricted Stock Unit Plan, a sub-plan under its 2010 Incentive Compensation Plan. Restrictions on remaining RSUs lapse 2/28/2019. |
6. Consists of Restricted Stock Units awarded pursuant to Issuer's 2017 Incentive Compensation Plan. Restrictions lapse 4/1/2022. |
7. Consists of Restricted Stock Units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 4/3/2021. |
8. Consists of Restricted Stock Units awarded pursuant to Issuer's Performance-Based Restricted Stock Unit Plan, a sub-plan under its 2017 Incentive Compensation Plan. Restrictions lapse in three equal installments, commencing 2/28/2019. |
9. Remaining Options became exercisable in four equal annual installments beginning on 4/2/2013. |
10. Remaining Options became exercisable in four equal annual installments beginning on 4/1/2014. |
11. Remaining Options became exercisable in four equal annual installments beginning on 4/1/2015. |
12. Options became exercisable in four equal annual installments beginning on 4/1/2016. |
13. Options became exercisable in four equal annual installments beginning on 4/1/2017. |
14. Options became exercisable in four equal annual installments beginning on 4/3/2018. |
15. Options become exercisable in four equal annual installments, commencing 4/1/2019. |
/s/ James D. Clark | 11/20/2018 | |
** Signature of Reporting Person | Date | |
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 5 (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. |