SEC Form 4 · accession 0001127602-16-048880
CVS HEALTH Corp · CVS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Helena Foulkes
Officer — EVP, President-CVS Pharmacy
Period of report
Apr 1, 2016
Accepted (ET)
Apr 5, 2016 · 5:50 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000064803
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Apr 1, 2016 | F | 4,411 | $104.82 | D | 45,900 | D | |
| Common Stock (restricted)F2 | Apr 1, 2016 | A | 9,540 | $104.82 | A | 36,556 | D | |
| Common Stock (pep) | holding | — | — | — | 4,616 | D | ||
| ESOP Common Stock | holding | — | — | — | 3,992 | I | By ESOP | |
| Stock Unit | holding | — | — | — | 30,530 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock OptionF3 | $104.82 | Apr 1, 2016 | A | 71,696 | A | Apr 1, 2017 | Apr 1, 2023 | Common Stock | 71,696 | 71,696 | D |
| Stock OptionF4 | $34.96 | holding | — | — | — | Apr 1, 2012 | Apr 1, 2018 | Common Stock | 12,058 | 12,058 | D |
| Stock OptionF5 | $45.07 | holding | — | — | — | Apr 2, 2013 | Apr 2, 2019 | Common Stock | 19,965 | 19,965 | D |
| Stock OptionF6 | $54.53 | holding | — | — | — | Apr 1, 2014 | Apr 1, 2020 | Common Stock | 39,340 | 39,340 | D |
| Stock OptionF7 | $34.96 | holding | — | — | — | Apr 1, 2014 | Apr 1, 2021 | Common Stock | 28,607 | 28,607 | D |
| Stock OptionF8 | $74.29 | holding | — | — | — | Apr 1, 2015 | Apr 1, 2021 | Common Stock | 52,452 | 52,452 | D |
| Stock OptionF9 | $102.26 | holding | — | — | — | Apr 1, 2016 | Apr 1, 2022 | Common Stock | 59,922 | 59,922 | D |
Explanation of responses
- F1Surrender of shares in payment of withholding taxes due upon the vesting of a restricted stock unit award.
- F2Consists of restricted stock units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 50% on 4/1/2019 and 50% on 4/1/2021.
- F3Option becomes exercisable in four equal annual installments, commencing 4/1/2017.
- F4Option became exercisable in four equal annual installments, commencing 4/1/2012.
- F5Option became exercisable in four equal annual installments, commencing 4/2/2013.
- F6Option became exercisable in four equal annual installments, commencing 4/1/2014.
- F7Option became exercisable in three equal annual installments, commencing 4/1/2014.
- F8Option became exercisable in four equal annual installments, commencing 4/1/2015.
- F9Option became exercisable in four equal annual installments, commencing 4/1/2016.