Initial Statement of Beneficial Ownership (3)
09 June 2018 - 7:19AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
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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
*
Hourican Kevin
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2. Date of Event Requiring Statement (MM/DD/YYYY)
6/4/2018
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3. Issuer Name
and
Ticker or Trading Symbol
CVS HEALTH Corp [CVS]
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(Last)
(First)
(Middle)
ONE CVS DRIVE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
EVP & President, CVS Pharmacy /
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(Street)
WOONSOCKET, RI 02895
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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7709
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D
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Common Stock (restricted)
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1232
(1)
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D
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Common Stock (restricted)
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399
(2)
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D
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Common Stock (restricted)
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840
(3)
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D
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Common Stock (restricted)
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2444
(4)
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D
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Common Stock (restricted)
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2146
(5)
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D
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Common Stock (restricted)
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3523
(6)
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option
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4/1/2014
(7)
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4/1/2020
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Common Stock
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4426
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$54.53
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D
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Stock Option
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4/1/2015
(8)
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4/1/2021
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Common Stock
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9442
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$74.29
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D
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Stock Option
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4/1/2016
(9)
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4/1/2022
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Common Stock
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17822
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$102.26
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D
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Stock Option
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4/1/2017
(10)
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4/1/2023
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Common Stock
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17611
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$104.82
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D
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Stock Option
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4/3/2018
(11)
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4/3/2024
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Common Stock
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30169
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$78.05
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D
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Stock Option
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4/1/2019
(12)
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4/1/2025
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Common Stock
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87575
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$62.21
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D
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Explanation of Responses:
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(1)
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Consists of remaining Restricted Stock Units awarded pursuant to Issuer's 2017 Incentive Compensation Plan and its Performance-Based Restricted Stock Unit Plan. Restrictions lapse in three equal installments, commening 2/28/2019.
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(2)
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Consists of remaining Restricted Stock Units awarded pursuant to Issuer's Performance-Based Restricted Stock Unit Plan, under its 2010 Incentive Compensation Plan. Restrictions lapse 2/28/2019.
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(3)
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Consists of remaining Restricted Stock Units awarded pursuant to Issuer's Performance-Based Restricted Stock Unit Plan, under its 2010 Incentive Compensation Plan. Restrictions lapse in two equal installments on 2/28/2019 and 2/28/2020.
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(4)
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Consists of Restricted Stock Units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 4/1/2019.
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(5)
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Consists of Restricted Stock Units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 4/1/2020.
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(6)
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Consists of Restricted Stock Units awarded pursuant to Issuer's 2010 Incentive Compensation Plan. Restrictions lapse 4/3/2021.
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(7)
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Remaining options became exercisable in four equal annual installments beginning on 4/1/2014.
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(8)
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Remaining options became exercisable in four equal annual installments beginning on 4/1/2015.
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(9)
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Option became exercisable in four equal annual installments beginning on 4/1/2016.
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(10)
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Option became exercisable in four equal annual installments beginning on 4/1/2017.
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(11)
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Option became exercisable in four equal annual installments beginning on 4/3/2018.
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(12)
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Option becomes exercisable in four equal annual installments beginning on 4/1/2019.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Hourican Kevin
ONE CVS DRIVE
WOONSOCKET, RI 02895
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EVP & President, CVS Pharmacy
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Signatures
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/s/ Kevin P. Hourican
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6/8/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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