SEC Form 4 · accession 0001209191-17-053267
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
Sep 15, 2017
Accepted (ET)
Sep 19, 2017 · 2:03 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 Stock | Sep 15, 2017 | M | 180,000 | $16.37 | A | 449,151 | D | |
| Common StockF1 | Sep 15, 2017 | F | 101,316 | $123.39 | D | 347,835 | D | |
| Common StockF2 | holding | — | — | — | 60,214 | I | By Trust |
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 | $16.37 | Sep 15, 2017 | M | 180,000 | D | Feb 26, 2010 | Feb 26, 2019 | Common Stock | 180,000 | 363,984 | D |
Explanation of responses
- F1Reflects payment of exercise price and tax liability by withholding securities incident to exercise of stock options.
- F2By the Yabuki Family Foundation of which Mr. Yabuki serves as trustee.
- F3This option, representing a right to purchase a total of 543,984 shares, vested in three equal installments on February 26, 2010, 2011 and 2012.