SEC Form 4 · accession 0001181431-15-002095
FISERV INC · FISV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jeffery W Yabuki
Officer — President and CEO · Director
Period of report
Feb 5, 2015
Accepted (ET)
Feb 6, 2015 · 5:35 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000798354
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Dec 30, 2014 | G | 12,850 | $0.00 | D | 257,874 | D | |
| Common StockF1 | Dec 30, 2014 | G | 12,850 | $0.00 | A | 36,450 | I | By Trust |
| Common StockF2 | Feb 5, 2015 | M | 290,000 | $23.05 | A | 548,314 | D | |
| Common StockF3 | Feb 5, 2015 | F | 187,761 | $76.75 | D | 360,553 | D | |
| Common Stock | Feb 5, 2015 | M | 450,000 | $23.05 | A | 810,553 | D | |
| Common StockF3 | Feb 5, 2015 | F | 291,332 | $76.73 | D | 519,221 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (right to buy) | $23.05 | Feb 5, 2015 | M | 290,000 | D | Dec 1, 2006 | Dec 1, 2015 | Common Stock | 290,000 | 0 | D |
| Employee Stock Option (right to buy) | $23.05 | Feb 5, 2015 | M | 450,000 | D | Dec 1, 2006 | Dec 1, 2015 | Common Stock | 450,000 | 0 | D |
Explanation of responses
- F1By the Yabuki Family Foundation of which Mr. Yabuki serves as trustee.
- F2Includes 440 shares acquired under the Fiserv, Inc. Employee Stock Purchase Plan.
- F3Reflects payment of exercise price and tax liability by withholding securities incident to exercise of stock options.