0001209191-21-048331.txt : 20210727 0001209191-21-048331.hdr.sgml : 20210727 20210727180151 ACCESSION NUMBER: 0001209191-21-048331 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210726 FILED AS OF DATE: 20210727 DATE AS OF CHANGE: 20210727 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rosman Adam L. CENTRAL INDEX KEY: 0001549373 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38962 FILM NUMBER: 211119129 MAIL ADDRESS: STREET 1: 200 LIBERTY STREET CITY: NEW YORK STATE: NY ZIP: 10281 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 2021-07-26 0 0000798354 FISERV INC FISV 0001549373 Rosman Adam L. 255 FISERV DRIVE BROOKFIELD WI 53045 0 1 0 0 Chief Admin. and Legal Officer Common Stock 2021-07-26 4 A 0 23350 0.00 A 26380 D Employee Stock Option (right to buy) 111.35 2021-07-26 4 A 0 105549 0.00 A 2022-07-26 2031-07-26 Common Stock 105549 105549 D One-third of these restricted stock units vest on each anniversary of the grant date. One-third of these options vest on each anniversary of the grant date. /s/ Eric C. Nelson (attorney-in-fact) 2021-07-27