0001209191-23-031177.txt : 20230519
0001209191-23-031177.hdr.sgml : 20230519
20230519174038
ACCESSION NUMBER: 0001209191-23-031177
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230517
FILED AS OF DATE: 20230519
DATE AS OF CHANGE: 20230519
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: 23941718
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-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
X0407
4
2023-05-17
0
0000798354
FISERV INC
FISV
0001732108
DiSimone Harry
255 FISERV DRIVE
BROOKFIELD
WI
53045
1
0
0
0
0
Common Stock
2023-05-17
4
A
0
1755
0.00
A
14702
D
Common Stock
2706
I
By Trust
These restricted stock units each represent a contingent right to receive one share of Fiserv, Inc. common stock. The restricted stock units vest 100% on the earlier of: (i) the first anniversary of the grant date; or (ii) immediately prior to the first annual meeting of shareholders after the grant date.
Held by the Harry DiSimone 2021 Irrevocable Exemption Trust for the benefit of family members of the reporting person and of which such family members serve as trustee.
/s/ Eric C. Nelson (attorney-in-fact)
2023-05-19