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Vault Health, Inc.

Dear Vault Health Shareholder,

Please confirm your Vault Health shareholder information through this secure site. Vault Health’s Board of Directors declared a cash dividend of $2.44 per share payable on December 29, 2022, to Vault’s preferred and common shareholders of record as of December 12, 2022. The Board has also authorized an equivalent cash bonus to option holders for the same per share amount as the dividend with respect to vested options as of December 12, 2022, and every quarter thereafter for options that vest.

We require the IRS form W-9 or IRS form W-8 BEN for the Shareholder on record. Please click the link below to complete the form via Dropbox Sign.

To ensure prompt disbursement, please complete the online form below to verify your holdings of Vault shares, mailing address, phone number, and wire transfer payment information. You can log in to your Carta account and view your shares held and stock options. Your total shareholdings may be a combination of common and preferred shares and previously exercised stock options. The dividend will be paid for shares held as of December 12, 2022. In addition, unexercised, vested options as of December 12, 2022, are eligible for the option equivalent cash bonus.

Note that Vault will not withhold federal or state income tax from this dividend payment. You are responsible for reporting and paying applicable taxes. In January, Vault will issue you a form 1099-DIV to document this payment for tax purposes. Please consult with your tax advisor to understand the tax treatment of this dividend as it applies to you. Note that you will need to contact your bank to verify your wire information as it is often not the same as your bank account and bank routing numbers. Instructions must be verified by December 23rd. 

Please complete this Vault Dividend Shareholder Information Form and W-9/W-8BEN no later than Friday, December 16, 2022. You will receive a call from Vault Health to complete verification of the wire instructions prior to the payment date.

These payments will be made via wire transfer on 12/29/2022.

If there are any questions, please reach out to

Thank you for your prompt response,

The Vault Health Team


1) Please fill out the Vault Dividend Shareholder Information Form below
2) Please complete the appropriate IRS form via Dropbox Sign using the appropriate link in BLUE below. After clicking the link, you will be redirected to a form to provide your email address. Dropbox Sign will then send you an email to complete your W-9 or W-8 BEN.

W-9 Form

W-8 BEN Form

Vault Health Dividend FAQ