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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Deferred Compensation Notional Units | (3) | (3) | (3) | Common Stock | 15,862 (2) | 15,862 | D | ||||||||
Stock Option (right to buy) | $ 61.38 (2) | 05/23/2018 | 05/24/2027 | Common Stock | 4,288 (2) | 4,288 | D | ||||||||
Stock Option (right to buy) | $ 51.23 (2) | 05/18/2017 | 05/18/2026 | Common Stock | 5,178 (2) | 5,178 | D | ||||||||
Stock Option (right to buy) | $ 40.56 (2) | 05/18/2016 | 05/20/2025 | Common Stock | 6,594 (2) | 6,594 | D | ||||||||
Stock Option (right to buy) | $ 29.95 (2) | 05/20/2015 | 05/28/2024 | Common Stock | 7,096 (2) | 7,096 | D | ||||||||
Stock Option (right to buy) | $ 22.34 (2) | 05/22/2014 | 05/22/2023 | Common Stock | 10,064 (2) | 10,064 | D | ||||||||
Stock Option (right to buy) | $ 16.68 (2) | 05/22/2013 | 05/23/2022 | Common Stock | 10,904 (2) | 10,904 | D | ||||||||
Stock Option (right to buy) | $ 15.65 (2) | 05/23/2012 | 05/25/2021 | Common Stock | 10,388 (2) | 10,388 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ROBAK KIM M MUELLER ROBAK, LLC 530 SOUTH 13TH STREET, SUITE 110 LINCOLN, NE 68508 |
X |
/s/ Lynn S. McCreary (attorney-in-fact) | 05/24/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | These restricted stock units each represent a contingent right to receive one share of Fiserv, Inc. common stock. The restricted stock units vest 100% on the earlier of: (i) the first anniversary of the grant date; or (ii) immediately prior to the first annual meeting of shareholders after the grant date. |
(2) | Adjusted to reflect the two-for-one split of Fiserv, Inc. common stock distributed at the close of business on March 19, 2018 to holders of record on March 5, 2018. |
(3) | These deferred compensation notional units were allocated under the Fiserv, Inc. Non-Employee Director Deferred Compensation Plan (the "Plan"), under which director fees otherwise payable in cash may be deferred in exchange for the allocation of notional units under the Plan. The number of notional units credited is calculated by dividing the amount of compensation that is deferred by the closing price of the company's common stock on the date of deferral, or last business day prior. Upon termination of the reporting person's service to the company, each notional unit will be settled in shares of Fiserv, Inc. common stock on a one-for-one basis. |