Statement of Changes in Beneficial Ownership (4)
December 21 2018 - 5:13PM
Edgar (US Regulatory)
FORM 4
[
X
]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
WENTWORTH TIMOTHY C
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2. Issuer Name
and
Ticker or Trading Symbol
Express Scripts Holding Co.
[
ESRX
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
President & CEO
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(Last)
(First)
(Middle)
C/O EXPRESS SCRIPTS HOLDING COMPANY, ONE EXPRESS WAY
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3. Date of Earliest Transaction
(MM/DD/YYYY)
12/20/2018
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(Street)
ST. LOUIS, MO 63121
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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4/6/2018
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G
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V
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45327
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D
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$0
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139736.667
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D
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Common Stock
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4/6/2018
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G
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V
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45327
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A
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$0
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152779
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I
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By trust
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Common Stock
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7/10/2018
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G
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V
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4482
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D
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$0
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135254.667
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D
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Common Stock
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7/10/2018
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G
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V
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4482
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A
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$0
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157261
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I
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By trust
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Common Stock
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12/20/2018
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D
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135254.667
(1)
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D
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(1)
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0
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D
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Common Stock
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12/20/2018
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D
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157261
(1)
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D
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(1)
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0
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I
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By trust
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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. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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Non-Qualified Stock Option (Right to Buy)
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$58.17
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12/20/2018
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D
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33069
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(2)
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3/6/2020
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Express Scripts Holding Company Common Stock
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33069
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$0
(3)
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0
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D
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Non-Qualified Stock Option (Right to Buy)
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$77.15
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12/20/2018
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D
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94140
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(2)
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3/5/2021
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Express Scripts Holding Company Common Stock
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94140
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$0
(3)
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0
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D
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Non-Qualified Stock Option (Right to Buy)
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$47.61
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12/20/2018
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D
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43081
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(2)
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2/24/2022
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Express Scripts Holding Company Common Stock
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43081
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$0
(3)
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0
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D
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Non-Qualified Stock Option (Right to Buy)
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$84.83
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12/20/2018
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D
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106240
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(2)
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3/4/2025
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Express Scripts Holding Company Common Stock
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106240
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$0
(3)
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0
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D
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Non-Qualified Stock Option (Right to Buy)
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$69.57
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12/20/2018
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D
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140115
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(2)
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3/9/2026
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Express Scripts Holding Company Common Stock
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140115
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$0
(3)
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0
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D
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Non-Qualified Stock Option (Right to Buy)
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$72.74
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12/20/2018
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D
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123064
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(2)
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5/4/2026
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Express Scripts Holding Company Common Stock
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123064
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$0
(3)
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0
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D
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Non-Qualified Stock Option (Right to Buy)
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$67.62
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12/20/2018
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D
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271714
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(2)
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3/8/2027
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Express Scripts Holding Company Common Stock
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271714
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$0
(3)
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0
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D
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Phantom Stock Units
(4)
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$0
(5)
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12/20/2018
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D
(6)
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2388.0983
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(7)
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(7)
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Express Scripts Holding Company Common Stock
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2388.0983
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(5)
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0
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D
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Explanation of Responses:
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(1)
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Pursuant to the agreement and plan of merger ("Merger Agreement") between the Issuer and Cigna Corporation, Halfmoon Parent, Inc., Halfmoon I, Inc. and Halfmoon II, Inc., upon closing of the merger of Halfmoon II, Inc. with and into the Issuer (the "Merger"), each common share of the Issuer was converted into the right to receive 0.2434 shares of Halfmoon Parent, Inc. common stock and $48.75 in cash. Each restricted stock unit was converted into a unit with respect to common stock of Halfmoon Parent, Inc. in accordance with the exchange ratio set forth in the Merger Agreement.
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(2)
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The options vest on varying dates pursuant to the terms of the plans and/or agreements under which they were granted.
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(3)
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Pursuant to the Merger Agreement, upon closing of the Merger, the option was converted into an option to purchase common shares of Halfmoon Parent, Inc. in accordance with the exchange ratio set forth in the Merger Agreement.
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(4)
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Phantom Stock Unit credited under the Company's Executive Deferred Compensation Plan.
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(5)
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Upon distribution, each phantom stock unit would have converted into one share of the Issuer's common stock.
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(6)
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Pursuant to the Merger Agreement, upon closing of the Merger, each phantom stock unit was converted into a stock unit relating to the common stock of Halfmoon Parent, Inc. in accordance with the exchange ratio set forth in the Merger Agreement.
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(7)
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Basic Company Credit by the Issuer to Reporting Person's Account in the Executive Deferred Compensation Plan; shares vest 3 (three) years after the plan year to which such credit relates.
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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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WENTWORTH TIMOTHY C
C/O EXPRESS SCRIPTS HOLDING COMPANY
ONE EXPRESS WAY
ST. LOUIS, MO 63121
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X
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President & CEO
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Signatures
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/s/ Nick H. Varsam, as Attorney-in-Fact for Timothy C. Wentworth
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12/21/2018
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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 4(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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