0001209191-21-067922.txt : 20211203 0001209191-21-067922.hdr.sgml : 20211203 20211203172532 ACCESSION NUMBER: 0001209191-21-067922 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211203 FILED AS OF DATE: 20211203 DATE AS OF CHANGE: 20211203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chiarello Guy CENTRAL INDEX KEY: 0001654667 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38962 FILM NUMBER: 211471220 MAIL ADDRESS: STREET 1: 225 LIBERTY STREET STREET 2: 29TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10281 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 2021-12-03 0 0000798354 FISERV INC FISV 0001654667 Chiarello Guy 255 FISERV DRIVE BROOKFIELD WI 53045 0 1 0 0 Chief Operating Officer Common Stock 2021-12-03 4 M 0 60000 36.54 A 257375 D Common Stock 2021-12-03 4 S 0 60000 100.18 D 197375 D Common Stock 26118 I By Trust Employee Stock Option (right to buy) 36.54 2021-12-03 4 M 0 60000 0.00 D 2014-07-11 2023-07-11 Common Stock 60000 189292 D This transaction was executed in multiple trades at prices ranging from $100.00 to $100.26. 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. Held by The Guy Chiarello 2020 Trust for the benefit of the reporting person's spouse and children and of which the reporting person's spouse serves as trustee and the reporting person serves as investment advisor. This option vested in five equal installments on each anniversary of the grant date, July 11, 2013. /s/ Eric C. Nelson (attorney-in-fact) 2021-12-03