0001209191-17-035267.txt : 20170525 0001209191-17-035267.hdr.sgml : 20170525 20170525141826 ACCESSION NUMBER: 0001209191-17-035267 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170524 FILED AS OF DATE: 20170525 DATE AS OF CHANGE: 20170525 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simons Doyle CENTRAL INDEX KEY: 0001185922 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-14948 FILM NUMBER: 17869485 MAIL ADDRESS: STREET 1: 220 OCCIDENTAL AVENUE SOUTH CITY: SEATTLE STATE: WA ZIP: 98104 FORMER NAME: FORMER CONFORMED NAME: SIMONS DOYLE R DATE OF NAME CHANGE: 20020904 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-05-24 0 0000798354 FISERV INC FISV 0001185922 Simons Doyle 220 OCCIDENTAL AVENUE SOUTH SEATTLE WA 98104 1 0 0 0 Common Stock 2017-05-24 4 A 0 701 0.00 A 18147 D Stock Option (right to buy) 122.76 2017-05-24 4 A 0 2144 0.00 A 2027-05-24 Common Stock 2144 2144 D These restricted stock units each represent a contingent right to receive one share of Fiserv common stock. The restricted stock units vest 100% on the earlier of: (i) the first anniversary of the grant date; or (ii) immediately prior to the first annual meeting of shareholders after the grant date. These options vest 100% on the earlier of: (i) the first anniversary of the grant date; or (ii) immediately prior to the first annual meeting of shareholders after the grant date. /s/ Lynn S. McCreary (attorney-in-fact) 2017-05-25