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