0001209191-21-064189.txt : 20211112 0001209191-21-064189.hdr.sgml : 20211112 20211112162538 ACCESSION NUMBER: 0001209191-21-064189 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211110 FILED AS OF DATE: 20211112 DATE AS OF CHANGE: 20211112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DiSimone Harry CENTRAL INDEX KEY: 0001732108 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38962 FILM NUMBER: 211403966 MAIL ADDRESS: STREET 1: 18 HICKORY DRIVE CITY: OLD BROOKVILLE STATE: NY ZIP: 11545 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 2021-11-10 0 0000798354 FISERV INC FISV 0001732108 DiSimone Harry 255 FISERV DRIVE BROOKFIELD WI 53045 1 0 0 0 Common Stock 2021-11-10 4 M 0 960 69.90 A 12422 D Stock Option (right to buy) 69.90 2021-11-10 4 M 0 960 0.00 D 2018-05-23 2028-02-21 Common Stock 960 0 D This option vested in full on May 23, 2018. /s/ Eric C. Nelson (attorney-in-fact) 2021-11-12