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