SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
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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*
Boratto Eva C

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

(Street)
WOONSOCKET RI 02895

(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
X Officer (give title below) Other (specify below)
EVP & CFO
3. Date of Earliest Transaction (Month/Day/Year)
03/16/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form 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)
Code V Amount (A) or (D) Price
Common Stock 03/16/2021 M 18,882 A $74.29 89,964.0445 D
Common Stock 03/16/2021 S(1) 18,882 D $74.68(2) 71,082.0445 D
Common Stock (restricted) 3,673 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 (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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option $74.29 03/16/2021 M 18,882 04/01/2015(3) 04/01/2021 Common Stock 18,882 $0 0 D
Stock Option $102.26 04/01/2016(4) 04/01/2022 Common Stock 27,392 27,392 D
Stock Option $104.82 04/01/2017(5) 04/01/2023 Common Stock 21,509 21,509 D
Stock Option $78.05 04/03/2018(6) 04/03/2024 Common Stock 35,062 35,062 D
Stock Option $62.21 04/01/2019(7) 04/01/2025 Common Stock 35,030 35,030 D
Stock Option $54.19 04/01/2020(8) 04/01/2029 Common Stock 202,007 202,007 D
Stock Option $58.34(9) 04/01/2021(10) 04/01/2030 Common Stock 168,956 168,956 D
Explanation of Responses:
1. All sales were effected pursuant to a Rule 10b5-1 plan.
2. Represents weighted average sale price for this group of sales, which occurred on the same trading day. Multiple sales were executed, with sales prices ranging between $74.49 and $75.00 per share.
3. Option became exercisable in four equal annual installments, commencing 4/1/2015.
4. Option became exercisable in four equal annual installments, commencing 4/1/2016.
5. Option becomes exercisable in four equal annual installments, commencing 4/1/2017.
6. Option became exercisable in four equal annual installments, commencing 4/3/2018.
7. Option became exercisable in four equal annual installments, commencing 4/1/2019.
8. Option became exercisable in four equal annual installments, commencing 4/1/2020.
9. The number of shares subject to the option were calculated using a 30-day average price.
10. Option becomes exercisable in four equal annual installments, commencing 4/1/2021.
/s/ Eva C. Boratto 03/17/2021
** 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 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.