0001209191-17-053269.txt : 20170919
0001209191-17-053269.hdr.sgml : 20170919
20170919140713
ACCESSION NUMBER: 0001209191-17-053269
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170918
FILED AS OF DATE: 20170919
DATE AS OF CHANGE: 20170919
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ROBAK KIM M
CENTRAL INDEX KEY: 0001264141
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-14948
FILM NUMBER: 171091685
MAIL ADDRESS:
STREET 1: 530 SOUTH 13TH STREET
STREET 2: SUITE 110
CITY: LINCOLN
STATE: NE
ZIP: 68508
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FISERV INC
CENTRAL INDEX KEY: 0000798354
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374]
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
2017-09-18
0
0000798354
FISERV INC
FISV
0001264141
ROBAK KIM M
MUELLER ROBAK, LLC
530 SOUTH 13TH STREET, SUITE 110
LINCOLN
NE
68508
1
0
0
0
Common Stock
2017-09-18
4
M
0
6124
25.50
A
42141
D
Common Stock
2017-09-18
4
S
0
6124
124.54
D
36017
D
Stock Option (right to buy)
25.50
2017-09-18
4
M
0
6124
0.00
D
2009-05-20
2018-05-21
Common Stock
6124
0
D
This transaction was executed in multiple trades at prices ranging from $124.42 to $124.68. The price reported above reflects the weighted average sale price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.
This option vested in full on May 20, 2009.
/s/ Lynn S. McCreary (attorney-in-fact)
2017-09-19