-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, I55K2BtoTBv0n9xhaYnAl+695o1On+aPexc1l4sHXTrJB42N6/zzynVbJ4PVAKwd XDq2iW90tuOIGMFkn6IhlQ== 0001181431-04-019709.txt : 20040407 0001181431-04-019709.hdr.sgml : 20040407 20040407094523 ACCESSION NUMBER: 0001181431-04-019709 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040406 FILED AS OF DATE: 20040407 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHACKELFORD THEKLA R CENTRAL INDEX KEY: 0001201606 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-14948 FILM NUMBER: 04721454 MAIL ADDRESS: STREET 1: 255 FISERV DRIVE CITY: BROOKFIELD STATE: WI ZIP: 53045 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FISERV INC CENTRAL INDEX KEY: 0000798354 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 391506125 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 255 FISERV DR STREET 2: PO BOX 979 CITY: BROOKFIELD STATE: WI ZIP: 53045 BUSINESS PHONE: 4148795000 MAIL ADDRESS: STREET 1: 255 FISERV DRIVE CITY: BROOKFIELD STATE: WI ZIP: 53045 4 1 rrd38955.xml X0201 4 2004-04-06 0 0000798354 FISERV INC FISV 0001201606 SHACKELFORD THEKLA R 255 FISERV DRIVE BROOKFIELD WI 53045 1 0 0 0 Common Stock - $0.01 par value 2004-04-06 4 M 0 120 25.4167 A 39254 D Common Stock - $0.01 par value 2004-04-06 4 M 0 120 22.7083 A 39374 D Common Stock - $0.01 par value 2004-04-06 4 M 0 120 21.3333 A 39494 D Common Stock - $0.01 par value 2004-04-06 4 M 0 120 23.8333 A 39614 D Common Stock - $0.01 par value 2004-04-06 4 M 0 240 29.9167 A 39854 D Common Stock - $0.01 par value 2004-04-06 4 M 0 240 32.4583 A 40094 D Common Stock - $0.01 par value 2004-04-06 4 M 0 7200 32.7917 A 47294 D Stock Option (right to buy) 25.4167 2004-04-06 4 M 0 120 0 D 2000-05-19 2009-05-19 Common Stock 120 0 D Stock Option (right to buy) 22.7083 2004-04-06 4 M 0 120 0 D 2000-11-10 2009-11-10 Common Stock 120 0 D Stock Option (right to buy) 21.3333 2004-04-06 4 M 0 120 0 D 2001-02-16 2010-02-16 Common Stock 120 0 D Stock Option (right to buy) 23.8333 2004-04-06 4 M 0 120 0 D 2001-03-30 2010-03-30 Common Stock 120 0 D Stock Option (right to buy) 29.9167 2004-04-06 4 M 0 240 0 D 2001-05-17 2010-05-17 Common Stock 240 0 D Stock Option (right to buy) 32.4583 2004-04-06 4 M 0 240 0 D 2001-11-08 2010-11-08 Common Stock 240 0 D Stock Option (right to buy) 32.7917 2004-04-06 4 M 0 7200 0 D 2002-03-29 2011-03-29 Common Stock 7200 0 D 100% Exercisable on retirement date 4/6/2004. Thomas J. Hirsch (attorney-in-fact) 2004-04-07 -----END PRIVACY-ENHANCED MESSAGE-----