# EDGAR Filing Document

**Accession Number:** 0001333760
**File Stem:** 0001127602-23-003331
**Filing Date:** 2023-2
**Character Count:** 8012
**Document Hash:** c09eae0117abc8ecc4a97261438cf6fb
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001127602-23-003331.hdr.sgml**: 20230203

**ACCESSION NUMBER**: 0001127602-23-003331

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230202

**FILED AS OF DATE**: 20230203

**DATE AS OF CHANGE**: 20230203

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Lynch Karen S
- **CENTRAL INDEX KEY:** 0001333760

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-01011
- **FILM NUMBER:** 23586446

**MAIL ADDRESS:**
- **STREET 1:** 151 FARMINGTON AVENUE
- **STREET 2:** RW61
- **CITY:** HARTFORD
- **STATE:** CT
- **ZIP:** 06156

**FORMER NAME:**
- **FORMER CONFORMED NAME:** Rohan Karen
- **DATE OF NAME CHANGE:** 20050721
**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>Lynch Karen S<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>2023-02-02 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_President and CEO_ |
| **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 | 2023-02-02 |  | A |  | 206610<sup>(1)</sup> | A | $0 | 206610 | D |  |
| Common Stock (By Trust) |  |  |  |  |  |  |  | 304459 | 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 | $101.09 |  |  |  |  |  |  | 2023-04-01<sup>(2)</sup> | 2032-04-01 | Common Stock | 171517 |  | 171517 | D |  |
| Stock Appreciation Rights<sup>(3)</sup> | $45.91 |  |  |  |  |  |  | 2019-02-17 | 2027-02-16 | Common Stock | 192741 |  | 192741 | D |  |
| Stock Appreciation Rights | $37.91 |  |  |  |  |  |  | 2019-02-19<sup>(4)</sup> | 2026-02-18 | Common Stock | 93989 |  | 93989 | D |  |
| Stock Option | $54.19 |  |  |  |  |  |  | 2020-04-01<sup>(5)</sup> | 2029-04-01 | Common Stock | 242408 |  | 242408 | D |  |
| Stock Option | 58.34<sup>(6)</sup> |  |  |  |  |  |  | 2021-04-01<sup>(7)</sup> | 2030-04-01 | Common Stock | 211196 |  | 211196 | D |  |
| Stock Option | $74.30 |  |  |  |  |  |  | 2022-04-01 | 2031-04-01 | Common Stock | 224604 |  | 224604 | D<sup>(8)</sup> |  |

---

### Footnotes:

(1) Represents shares earned by the reporting person pursuant to certain performance stock units (the "PSUs"), which were granted to the reporting person under the Issuer's 2017 Incentive Compensation Plan on August 31, 2020. The PSUs were earned based on the attainment of certain performance metrics, which performance metrics were certified by the Management and Planning Committee of the Board of Directors of the Issuer on February 2, 2023.

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

(3) Represents unvested Aetna Inc. Stock Appreciation Rights ("SARs") granted under the Aetna Plan on February 17, 2017 that were converted into CVS Health SARs pursuant to the terms of the CVS/Aetna Merger Agreement. These SARs vest in two substantially equal annual installments beginning on February 17, 2019.

(4) Represents unvested SARs granted under the Aetna Plan on February 19, 2016 that were converted into CVS Health SARs pursuant to the terms of the CVS/Aetna Merger Agreement. These SARs vested on February 19, 2019.

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

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

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

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

**Signature:** /s/ Karen S. Lynch  
**Date:** 2023-02-03

### 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.**