0001209191-19-060098.txt : 20191211 0001209191-19-060098.hdr.sgml : 20191211 20191211180409 ACCESSION NUMBER: 0001209191-19-060098 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191209 FILED AS OF DATE: 20191211 DATE AS OF CHANGE: 20191211 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: YABUKI JEFFERY W CENTRAL INDEX KEY: 0001207371 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38962 FILM NUMBER: 191280579 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 doc4.xml FORM 4 SUBMISSION X0306 4 2019-12-09 0 0000798354 FISERV INC FISV 0001207371 YABUKI JEFFERY W 255 FISERV DRIVE BROOKFIELD WI 53045 1 1 0 0 Chairman and CEO Common Stock 2019-12-09 4 M 0 658380 15.43 A 869809 D Common Stock 2019-12-09 4 F 0 356319 114.85 D 513490 D Common Stock 2019-12-10 4 S 0 45000 114.29 D 468490 D Common Stock 344080 I By Trust Employee Stock Option (right to buy) 15.43 2019-12-09 4 M 0 658380 0.00 D 2012-02-23 2021-02-23 Common Stock 658380 0 D Reflects payment of exercise price and tax liability by withholding securities incident to exercise of stock options. This transaction was executed in multiple trades at prices ranging from $113.96 to $114.62. The price reported above reflects the weighted average sale price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected. By the Yabuki Family Foundation of which Mr. Yabuki serves as trustee. This option vested in three equal installments on February 23, 2012, 2013 and 2014. /s/ Robert W. Hau (attorney-in-fact) 2019-12-11