SEC Form 4 · accession 0001209191-16-153011
FISERV INC · FISV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Kevin P. Gregoire
Officer — Group President
Period of report
Nov 30, 2016
Accepted (ET)
Dec 2, 2016 · 4:17 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 StockF1 | Nov 30, 2016 | M | 2,408 | $23.85 | A | 44,019 | D | |
| Common Stock | Nov 30, 2016 | S | 2,408 | $105.09 | D | 41,611 | D | |
| Common Stock | Nov 30, 2016 | M | 6,584 | $30.86 | A | 48,195 | D | |
| Common StockF2 | Nov 30, 2016 | S | 6,584 | $105.10 | D | 41,611 | 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)F3 | $23.85 | Nov 30, 2016 | M | 2,408 | D | Feb 24, 2011 | Feb 24, 2020 | Common Stock | 2,408 | 0 | D |
| Employee Stock Option (right to buy)F4 | $30.86 | Nov 30, 2016 | M | 6,584 | D | Feb 23, 2012 | Feb 23, 2021 | Common Stock | 6,584 | 0 | D |
Explanation of responses
- F1Includes 243 shares acquired under the Fiserv, Inc. Employee Stock Purchase Plan.
- F2This transaction was executed in multiple trades at prices ranging from $105.09 to $105.11. 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.
- F3This option vested in three equal installments on each anniversary of the grant date, February 24, 2010.
- F4This option vested in three equal installments on each anniversary of the grant date, February 23, 2011.