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