SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
SHACKELFORD THEKLA R

(Last) (First) (Middle)
255 FISERV DRIVE

(Street)
BROOKFIELD WI 53045

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FISERV INC [ FISV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
03/22/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock - $0.01 par value 03/22/2004 M 6,590 A $17.5185 9,965 D
Common Stock - $0.01 par value 03/22/2004 M 1,350 A $17.7407 11,315 D
Common Stock - $0.01 par value 03/22/2004 M 900 A $19.6667 12,215 D
Common Stock - $0.01 par value 03/22/2004 M 900 A $20.7778 13,115 D
Common Stock - $0.01 par value 03/22/2004 M 900 A $20.1389 14,015 D
Common Stock - $0.01 par value 03/22/2004 M 480 A $25.4167 14,495 D
Common Stock - $0.01 par value 03/22/2004 M 480 A $22.7083 14,975 D
Common Stock - $0.01 par value 03/22/2004 M 480 A $21.3333 15,455 D
Common Stock - $0.01 par value 03/22/2004 M 360 A $35.5833 15,815 D
Common Stock - $0.01 par value 03/22/2004 M 360 A $32.4583 16,175 D
Common Stock - $0.01 par value 03/22/2004 M 7,200 A $32.7917 23,375 D
Common Stock - $0.01 par value 03/23/2004 S 20,000 D $36.31 3,375 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) $17.5185 03/22/2004 M 6,590 03/24/1999(1) 03/24/2008 Common Stock 6,590 $0.00 35,260 D
Stock Option (right to buy) $17.7407 03/22/2004 M 1,350 05/20/1999(2) 05/20/2008 Common Stock 1,350 $0. 0 D
Stock Option (right to buy) $19.6667 03/22/2004 M 900 08/19/1999(3) 08/19/2008 Common Stock 900 $0 0 D
Stock Option (right to buy) $20.7778 03/22/2004 M 900 11/18/1999(4) 11/18/2008 Common Stock 900 $0 0 D
Stock Option (right to buy) $20.1389 03/22/2004 M 900 02/17/2000(5) 02/17/2009 Common Stock 900 $0 0 D
Stock Option (right to buy) $25.4167 03/22/2004 M 480 05/19/2000(6) 05/19/2009 Common Stock 480 $0 120 D
Stock Option (right to buy) $22.7083 03/22/2004 M 480 11/10/2000(7) 11/10/2009 Common Stock 480 $0 120 D
Stock Option (right to buy) $21.3333 03/22/2004 M 480 02/16/2001(8) 02/16/2010 Common Stock 480 $0 120 D
Stock Option (right to buy) $35.5833 03/22/2004 M 360 08/16/2001(9) 08/16/2010 Common Stock 360 $0 240 D
Stock Option (right to buy) $32.4583 03/22/2004 M 360 11/08/2001(10) 11/08/2010 Common Stock 360 $0 240 D
Stock Option (right to buy) $32.7917 03/22/2004 M 7,200 03/29/2002(11) 03/29/2011 Common Stock 7,200 $0 10,800 D
Explanation of Responses:
1. Exercisable 20% per year commencing on 3/24/1999.
2. Exercisable 20% per year commencing on 5/20/1999.
3. Exercisable 20% per year commencing on 8/19/1999.
4. Exercisable 20% per year commencing on 11/18/1999.
5. Exercisable 20% per year commencing on 2/17/2000.
6. Exercisable 20% per year commencing on 5/19/2000.
7. Exercisable 20% per year commencing on 11/10/2000.
8. Exercisable 20% per year commencing on 2/16/2001.
9. Exercisable 20% per year commencing on 8/16/2001.
10. Exercisable 20% per year commencing on 11/8/2001.
11. Exercisable 20% per year commencing on 3/29/2002.
Thomas J. Hirsch (attorney-in-fact) 03/24/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.