SEC Form 4 · accession 0001122304-18-000169

· AET

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Nov 28, 2018

Accepted (ET)

Nov 28, 2018 · 4:36 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001122304

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1	Nov 28, 2018	D	17,519	—	D	0	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Phantom Stock Units^F2	—	Nov 28, 2018	D	7,071	D	—	—	Common Stock	7,071	D
Restricted Stock Units^F3	—	Nov 28, 2018	D	990	D	—	—	Common Stock	990	D
Deferred Restricted Stock Units^F4	—	Nov 28, 2018	D	17,944	D	—	—	Common Stock	17,944	D

F1Converted pursuant to the merger agreement (the "Merger Agreement") between CVS Health Corporation ("CVS Health") and Aetna Inc. ("Aetna") into $145 in cash and 0.8378 shares of CVS Health Common Stock for each share of Aetna Common Stock.
F2Previously reported Units granted under the Non-Employee Director Compensation Plan (the "Plan"). These Units were canceled pursuant to the terms of the Plan in exchange for an amount in cash for each Unit equal to the closing price of Aetna Common Stock on the closing date under the Merger Agreement.
F3Previously reported Restricted Stock Units granted under the Plan on May 18, 2018. These Restricted Stock Units were canceled pursuant to the terms of the Plan in exchange for an amount in cash for each Restricted Stock Unit equal to the closing price of Aetna Common Stock on the closing date under the Merger Agreement.
F4Deferred Restricted Stock Units accrued under the Plan pursuant to the deferral of Restricted Stock Unit grants. These Deferred Restricted Stock Units were canceled pursuant to the terms of the Plan in exchange for an amount in cash for each Deferred Restricted Stock Unit equal to the closing price of Aetna Common Stock on the closing date under the Merger Agreement.