# EDGAR Filing Document

**Accession Number:** 0000064803
**File Stem:** 0001127602-23-000476
**Filing Date:** 2023-1
**Character Count:** 7268
**Document Hash:** 2a96d82ed515b8adf596e6bf61187490
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001127602-23-000476.hdr.sgml**: 20230104

**ACCESSION NUMBER**: 0001127602-23-000476

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20221231

**FILED AS OF DATE**: 20230104

**DATE AS OF CHANGE**: 20230104

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Moriarty Thomas M
- **CENTRAL INDEX KEY:** 0001412221

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-01011
- **FILM NUMBER:** 23506611

**MAIL ADDRESS:**
- **STREET 1:** 100 PARSONS POND DRIVE
- **CITY:** FRANKLIN LAKES
- **STATE:** NJ
- **ZIP:** 07417
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** CVS HEALTH Corp
- **CENTRAL INDEX KEY:** 0000064803
- **STANDARD INDUSTRIAL CLASSIFICATION:** RETAIL-DRUG STORES AND PROPRIETARY STORES [5912]
- **IRS NUMBER:** 050494040
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** ONE CVS DR.
- **CITY:** WOONSOCKET
- **STATE:** RI
- **ZIP:** 02895
- **BUSINESS PHONE:** 4017651500

**MAIL ADDRESS:**
- **STREET 1:** ONE CVS DR.
- **CITY:** WOONSOCKET
- **STATE:** RI
- **ZIP:** 02895

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** CVS CAREMARK CORP
- **DATE OF NAME CHANGE:** 20070509

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** CVS/CAREMARK CORP
- **DATE OF NAME CHANGE:** 20070322

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** CVS CORP
- **DATE OF NAME CHANGE:** 19970128

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Moriarty Thomas M<br><sub>(Last) (First) (Middle)</sub><br>ONE CVS DRIVE<br><sub>(Street)</sub><br>WOONSOCKET, RI 02895<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2022-12-31 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_EVP & General Counsel_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>CVS HEALTH Corp [ CVS ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2022-12-31 |  | F |  | 292856<sup>(1)</sup> | D | $93.19 | 315273.0221 | D |  |
| Common Stock |  |  |  |  |  |  |  | 159120 | I | By GRAT |
| Stock Unit |  |  |  |  |  |  |  | 47325.339 | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Stock Option | $104.82 |  |  |  |  |  |  | 2017-04-01<sup>(2)</sup> | 2023-04-01 | Common Stock | 71696 |  | 71696 | D |  |
| Stock Option | $78.05 |  |  |  |  |  |  | 2018-04-03<sup>(3)</sup> | 2024-04-03 | Common Stock | 24248 |  | 24248 | D |  |
| Stock Option | $54.19 |  |  |  |  |  |  | 2020-04-01<sup>(4)</sup> | 2029-04-01 | Common Stock | 50502 |  | 50502 | D |  |
| Stock Option | 58.34<sup>(5)</sup> |  |  |  |  |  |  | 2021-04-01<sup>(6)</sup> | 2030-04-01 | Common Stock | 98558 |  | 98558 | D |  |
| Stock Option<sup>(7)</sup> | $74.30 |  |  |  |  |  |  | 2022-04-01 | 2031-04-01 | Common Stock | 116622 |  | 116622 | D |  |
| Stock Option | $101.09 |  |  |  |  |  |  | 2023-04-01<sup>(8)</sup> | 2032-04-01 | Common Stock | 46777 |  | 46777 | D |  |

---

### Footnotes:

(1) Surrender of shares in payment of withholding taxes due upon the vesting and settlement of the PSUs.

(2) Option became exercisable in four equal annual installments, commencing 4/1/2017.

(3) Option became exercisable in four equal annual installments, commencing 4/3/2018.

(4) Option became exercisable in four equal annual installments, commencing 4/1/2020.

(5) The number of shares subject to the option were calculated using a 30-day average price.

(6) Option became exercisable in four equal annual installments, commencing 4/1/2021.

(7) Option became exercisable in four equal annual installments, commencing 4/1/2022.

(8) Option becomes exercisable in four equal annual installments, commencing 4/1/2023.

**Signature:** /s/ Thomas M. Moriarty  
**Date:** 2023-01-04

### Remarks:

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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**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 Number.**