0001209191-21-067266.txt : 20211201
0001209191-21-067266.hdr.sgml : 20211201
20211201161248
ACCESSION NUMBER: 0001209191-21-067266
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20211201
FILED AS OF DATE: 20211201
DATE AS OF CHANGE: 20211201
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kereere Suzan
CENTRAL INDEX KEY: 0001896086
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38962
FILM NUMBER: 211463086
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2021-12-01
0
0000798354
FISERV INC
FISV
0001896086
Kereere Suzan
255 FISERV DRIVE
BROOKFIELD
WI
53045
0
1
0
0
EVP, Head of GBS
Common Stock
18497
D
Employee Stock Option (right to buy)
108.13
2031-06-28
Common Stock
31055
D
Represents restricted stock units granted to the reporting person on June 28, 2021. One-third of these restricted stock units vest on each anniversary of the grant date.
One-third of these options vest on each anniversary of the grant date, June 28, 2021.
/s/ Eric C. Nelson (attorney-in-fact)
2021-12-01
EX-24
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
Know all by these presents that the undersigned hereby constitutes and appoints
each of Frank J. Bisignano, Robert W. Hau, Adam L. Rosman and Eric C. Nelson,
signing singly, the undersigned's true and lawful attorney-in-fact with respect
to the undersigned's holdings of and transactions in securities issued by
Fiserv, Inc. to:
(1) execute for and on behalf of the undersigned Forms 3, 4 and 5 in accordance
with Section 16(a) of the Securities Exchange Act of 1934 and the rules
thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete the execution of any such Form 3, 4 or
5 and the timely filing of such form with the United States Securities and
Exchange Commission ("SEC") and any other authority, including completing and
executing a Uniform Application for Access Codes to File on Edgar on Form ID;
(3) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable, and to complete and execute any requests, forms
or documents, including without limitation completing, executing and submitting
an Update Passphrase request with the SEC and discussing the undersigned's EDGAR
access codes with the SEC (collectively, "Documents"), and timely submit or file
such Documents with the SEC, in connection with the maintenance and
administration of the undersigned's EDGAR access codes; and
(4) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in the
undersigned's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform all and every act and exercise of any of the rights
and powers herein granted, as fully to all intents and purposes as such
attorney-in-fact might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or his or her substitute or substitutes, shall lawfully do or
cause to be done by virtue of this power of attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not assuming any of the undersigned's responsibilities to
comply with Section 16 of the Securities Exchange Act of 1934.
The undersigned hereby revokes any power of attorney granted by the undersigned
prior to the date hereof with respect to the undersigned's holdings of and
transactions in securities issued by Fiserv, Inc. This Power of Attorney shall
remain in full force and effect until the undersigned is no longer required to
file Forms 3, 4 or 5 with respect to the undersigned's holdings of and
transactions in securities issued by Fiserv, Inc., unless earlier revoked by the
undersigned in a signed writing delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed this 23 day of November, 2021.
/s/ Suzan Kereere
Signature
Suzan Kereere
Print Name