SEC FORM 4

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^*

Roberts Jonathan C

(Last)

(First)

(Middle)

ONE CVS DRIVE

(Street)

WOONSOCKET

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 & Chief Operating Officer

3. Date of Earliest Transaction (Month/Day/Year)
11/03/2021

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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	11/03/2021		M		108,870	A	$45.93	215,984.717	D
Common Stock	11/03/2021		S⁽¹⁾		108,870	D	$95	107,114.717	D
Common Stock								34,707	I	By GRAT
Common Stock (restricted)								12,812	D
ESOP Common Stock								6,045	I	By ESOP
Stock Unit								337,833.3369	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)
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)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Stock Option	$45.93	11/03/2021		M			108,870	09/04/2015⁽²⁾	09/04/2022	Common Stock	108,870	$0	0	D
Phantom Stock Credits	$1							⁽³⁾	⁽³⁾	Common Stock	1,422.6711		1,422.6711	D
Stock Option	$102.26							04/01/2016⁽⁴⁾	04/01/2022	Common Stock	68,482		68,482	D
Stock Option	$104.82							04/01/2017⁽⁵⁾	04/01/2023	Common Stock	161,318		161,318	D
Stock Option	$78.05							04/03/2018⁽⁶⁾	04/03/2024	Common Stock	200,358		200,358	D
Stock Option	$62.21							04/01/2019⁽⁷⁾	04/01/2025	Common Stock	248,131		248,131	D
Stock Option	$54.19							04/01/2020⁽⁸⁾	04/01/2029	Common Stock	303,010		303,010	D
Stock Option	$58.34⁽⁹⁾							04/01/2021⁽¹⁰⁾	04/01/2030	Common Stock	239,355		239,355	D
Stock Option	$74.3							04/01/2022⁽¹¹⁾	04/01/2031	Common Stock	172,772		172,772	D

Explanation of Responses:

1. All sales were effected pursuant to a Rule 10b5-1 plan.

2. Option became exercisable in three equal annual installments, commencing 9/4/2015.

3. 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.

4. Option became exercisable in four equal annual installments, commencing 4/1/2016.

5. Option became 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. Options became exercisable in four equal installments, commencing 4/1/2021.

11. Option becomes exercisable in four equal installments, commencing 4/1/2022.

	Jonathan C. Roberts	11/04/2021
	** 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).
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