-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, SZJ8k2mb1O/5qWlYGt7gWJW0HEQHDbYVCJe0J+gOHb7pqKk7jDwXX7XF3t+a/p/Q FLCfwDW4bizQe8v+xIPAZg== 0001181431-04-019710.txt : 20040407 0001181431-04-019710.hdr.sgml : 20040407 20040407094601 ACCESSION NUMBER: 0001181431-04-019710 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040402 FILED AS OF DATE: 20040407 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHACKELFORD THEKLA R CENTRAL INDEX KEY: 0001201606 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-14948 FILM NUMBER: 04721456 MAIL ADDRESS: STREET 1: 255 FISERV DRIVE CITY: BROOKFIELD STATE: WI ZIP: 53045 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 rrd38953.xml X0201 4 2004-04-02 0 0000798354 FISERV INC FISV 0001201606 SHACKELFORD THEKLA R 255 FISERV DRIVE BROOKFIELD WI 53045 1 0 0 0 Common Stock - $0.01 par value 2004-04-02 4 M 0 34593 6.4630 A 37968 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 8.00 A 38811 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 8.1481 A 39654 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 7.8519 A 40497 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 9.037 A 41340 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 7.8519 A 42183 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 10.2963 A 43026 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 10.8889 A 43869 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 10.6667 A 44712 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 11.1111 A 45555 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 11.1111 A 46398 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 13.8519 A 47241 D Common Stock - $0.01 par value 2004-04-02 4 M 0 843 14.5185 A 48084 D Common Stock - $0.01 par value 2004-04-02 4 M 0 1350 16.0 A 49434 D Common Stock - $0.01 par value 2004-04-02 4 M 0 35260 17.5185 A 84694 D Common Stock - $0.01 par value 2004-04-02 4 M 0 480 23.8333 A 85174 D Common Stock - $0.01 par value 2004-04-02 4 M 0 360 29.9167 A 85534 D Common Stock - $0.01 par value 2004-04-02 4 M 0 3600 32.7917 A 89134 D Common Stock - $0.01 par value 2004-04-05 4 S 0 50000 34.98 D 39134 D Stock Option (right to buy) 6.463 2004-04-02 4 M 0 34593 0.00 D 1996-02-08 2005-02-08 Common Stock 34593 0 D Stock Option (right to buy) 8. 2004-04-02 4 M 0 843 0. D 1996-03-30 2005-03-30 Common Stock 843 0 D Stock Option (right to buy) 8.1481 2004-04-02 4 M 0 843 0 D 1996-08-23 2005-08-23 Common Stock 843 0 D Stock Option (right to buy) 7.8519 2004-04-02 4 M 0 843 0 D 1996-11-29 2005-11-29 Common Stock 843 0 D Stock Option (right to buy) 9.037 2004-04-02 4 M 0 843 0 D 1997-02-27 2006-02-27 Common Stock 843 0 D Stock Option (right to buy) 7.8519 2004-04-02 4 M 0 843 0 D 1997-03-21 2006-03-21 Common Stock 843 0 D Stock Option (right to buy) 10.2963 2004-04-02 4 M 0 843 0 D 1997-08-28 2006-08-28 Common Stock 843 0 D Stock Option (right to buy) 10.8889 2004-04-02 4 M 0 843 0 D 1997-11-19 2006-11-19 Common Stock 843 0 D Stock Option (right to buy) 10.6667 2004-04-02 4 M 0 843 0 D 1998-02-11 2007-02-11 Common Stock 843 0 D Stock Option (right to buy) 11.1111 2004-04-02 4 M 0 843 0 D 1998-03-20 2007-03-20 Common Stock 843 0 D Stock Option (right to buy) 11.1111 2004-04-02 4 M 0 843 0 D 1998-05-21 2007-05-21 Common Stock 843 0 D Stock Option (right to buy) 13.8519 2004-04-02 4 M 0 843 0 D 1998-08-27 2007-08-27 Common Stock 843 0 D Stock Option (right to buy) 14.5185 2004-04-02 4 M 0 843 0 D 1998-11-18 2007-11-18 Common Stock 843 0 D Stock Option (right to buy) 16. 2004-04-02 4 M 0 1350 0 D 1999-02-23 2008-02-23 Common Stock 1350 0 D Stock Option (right to buy) 17.5185 2004-04-02 4 M 0 35260 0 D 1999-03-24 2008-03-24 Common Stock 35260 0 D Stock Option (right to buy) 23.8333 2004-04-02 4 M 0 480 0 D 2001-03-30 2010-03-30 Common Stock 480 120 D Stock Option (right to buy) 29.9167 2004-04-02 4 M 0 360 0 D 2001-05-17 2010-05-17 Common Stock 360 240 D Stock Option (right to buy) 32.7917 2004-04-02 4 M 0 3600 0 D 2002-03-29 2011-03-29 Common Stock 3600 7200 D Exercisable 20% per year commencing on 2/8/1996. Exercisable 20% per year commencing on 3/30/1996. Exercisable 20% per year commencing on 8/23/1996. Exercisable 20% per year commencing on 11/29/1996. Exercisable 20% per year commencing on 2/27/1997. Exercisable 20% per year commencing on 3/21/1997. Exercisable 20% per year commencing on 8/28/1997. Exercisable 20% per year commencing on 11/19/1997. Exercisable 20% per year commencing on 2/11/1998. Exercisable 20% per year commencing on 3/20/1998. Exercisable 20% per year commencing on 5/21/1998. Exercisable 20% per year commencing on 8/27/1998. Exercisable 20% per year commencing on 11/18/1998. Exercisable 20% per year commencing on 2/23/1999. Exercisable 20% per year commencing on 3/24/1999. Exercisable 20% per year commencing on 3/30/2001. Exercisable 20% per year commencing on 5/17/2001. Exercisable 20% per year commencing on 3/29/2002. Thomas J. Hirsch (attorney-in-fact) 2004-04-06 -----END PRIVACY-ENHANCED MESSAGE-----