Initial Statement of Beneficial Ownership (3)
May 25 2017 - 4:41PM
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
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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
*
Jelinek Richard M
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/19/2017
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3. Issuer Name
and
Ticker or Trading Symbol
AETNA INC /PA/ [AET]
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(Last)
(First)
(Middle)
AETNA INC., 151 FARMINGTON AVENUE
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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, Enterprise Strategy /
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(Street)
HARTFORD, CT 06156
(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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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 Appreciation Rights
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11/2/2016
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11/1/2025
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Common Stock
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16806
(1)
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$115.34
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D
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Restricted Stock Units
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11/2/2018
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11/6/2018
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Common Stock
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26011
(2)
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(3)
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D
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Stock Appreciation Rights
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2/19/2017
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2/18/2026
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Common Stock
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81038
(4)
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$103.45
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D
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Stock Appreciation Rights
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2/17/2018
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2/16/2027
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Common Stock
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79938
(5)
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$125.27
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D
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Explanation of Responses:
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(1)
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Stock Appreciation Rights ("SARs") granted under the Aetna Inc. 2010 Stock Incentive Plan (the "Plan") are exercisable in three annual installments beginning November 2, 2016.
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(2)
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Restricted Stock Units ("RSUs") granted under the Plan.
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(3)
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Each RSU represents a right to receive one share of Aetna Inc. Common Stock net of taxes.
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(4)
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SARs granted under the Plan are exercisable in three substantially equal annual intallments beginning February 19, 2017.
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(5)
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SARs granted under the Plan are exercisable in three annual installments beginning February 17, 2018.
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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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Jelinek Richard M
AETNA INC.
151 FARMINGTON AVENUE
HARTFORD, CT 06156
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EVP, Enterprise Strategy
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Signatures
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/s/ Richard M. Jelinek by Judith H. Jones, Attorney-in-Fact
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5/25/2017
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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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