0001209191-22-026710.txt : 20220503
0001209191-22-026710.hdr.sgml : 20220503
20220503162510
ACCESSION NUMBER: 0001209191-22-026710
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220502
FILED AS OF DATE: 20220503
DATE AS OF CHANGE: 20220503
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Simons Doyle
CENTRAL INDEX KEY: 0001185922
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38962
FILM NUMBER: 22887333
MAIL ADDRESS:
STREET 1: 220 OCCIDENTAL AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98104
FORMER NAME:
FORMER CONFORMED NAME: SIMONS DOYLE R
DATE OF NAME CHANGE: 20020904
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FISERV INC
CENTRAL INDEX KEY: 0000798354
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
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
2022-05-02
0
0000798354
FISERV INC
FISV
0001185922
Simons Doyle
255 FISERV DRIVE
BROOKFIELD
WI
53045
1
0
0
0
Common Stock
2022-05-02
4
M
0
10904
16.68
A
91642
D
Stock Option (right to buy)
16.68
2022-05-02
4
M
0
10904
0.00
D
2013-05-23
2022-05-23
Common Stock
10904
0
D
This option vested in full on May 23, 2013.
/s/ Eric C. Nelson (attorney-in-fact)
2022-05-03