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*
Bisaccia Lisa
(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)
Former EVP & Chief HR Officer
3. Date of Earliest Transaction (Month/Day/Year)
02/01/2021
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 02/01/2021 A 77,457(1) A $0 100,103 D
Common Stock 04/01/2021 F 35,120(2) D $74.3 64,983 D
Common Stock 04/01/2021 F 1,190(3) D $74.3 66,417 D
Common Stock 23,942 I By GRAT
Common Stock (restricted) 3,523 D
ESOP Common Stock 655 I Direct
Stock Unit 32,145.773 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
Phantom Stock Credits $1 (4) (5) Common Stock 469.0358 469.0358 D
Stock Option $102.26 04/01/2016(6) 04/01/2022 Common Stock 34,241 34,241 D
Stock Option $104.82 04/01/2017(7) 04/01/2023 Common Stock 39,433 39,433 D
Stock Option $78.05 04/03/2018(8) 04/03/2024 Common Stock 55,098 55,098 D
Stock Option $62.21 04/01/2019(9) 04/01/2025 Common Stock 64,222 64,222 D
Stock Option $54.19 04/01/2020(10) 04/01/2029 Common Stock 141,405 141,405 D
Stock Option $58.34(11) 04/01/2021(12) 04/01/2030 Common Stock 98,558 98,558 D
Explanation of Responses:
1. Represents shares earned by the reporting person pursuant to certain performance stock units (the "PSUs"), which were granted to the reporting person under the Issuer's 2017 Incentive Compensation Plan on February 1, 2021. The PSUs were earned based on the attainment of certain performance metrics, which performance metrics were certified by the Management and Planning Committee of the Board of Directors of the Issuer on February 1, 2021. The PSUs vested and settled on April 1, 2021.
2. Surrender of shares in payment of taxes due upon the vesting and settlement of the PSUs on April 1, 2021.
3. Surrender of shares in payment of taxes due upon the vesting and settlement of a restricted stock unit award on April 1, 2021.
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. 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.
6. Option became exercisable in four equal annual installments, commencing 4/1/2016.
7. Option became exercisable in four equal annual installments, commencing 4/1/2017.
8. Option became exercisable in four equal annual installments, commencing 4/3/2018.
9. Option became exercisable in four equal annual installments, commencing 4/1/2019.
10. Option became exercisable in four equal annual installments, commencing 4/1/2020.
11. The number of shares subject to the option were calculated using a 30-day average price.
12. Options became exercisable in four equal annual installments, commencing 4/1/2021.
Lisa G. Bisaccia 04/02/2021
** 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).
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