SEC Form 4 · accession 0001181431-15-007381
FISERV INC · FISV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Thomas J Hirsch
Officer — Chief Financial Officer
Period of report
May 21, 2015
Accepted (ET)
May 22, 2015 · 4:42 pm EDT
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 StockF1 | May 21, 2015 | M | 12,500 | $27.35 | A | 89,527 | D | |
| Common StockF2 | May 21, 2015 | F | 8,333 | $80.81 | D | 81,194 | D | |
| Common StockF3 | May 21, 2015 | S | 13,198 | $80.81 | D | 67,996 | 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) | $27.35 | May 21, 2015 | M | 12,500 | D | Feb 23, 2007 | Feb 23, 2017 | Common Stock | 12,500 | 25,000 | D |
Explanation of responses
- F1Includes 314 shares acquired under the Fiserv, Inc. Employee Stock Purchase Plan.
- F2Reflects payment of exercise price and tax liability by withholding securities incident to exercise of stock options.
- F3This transaction was executed in multiple trades at prices ranging from $80.75 to $80.93. 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.