FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person* Cox, James W.
(Last) (First) (Middle) 6160 Summit Drive - Suite 500
(Street)
Brooklyn Center, MN 55430
(City) (State) (Zip)
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2. Date of Event Requiring Statement Month/Day/Year 04/15/2003
3. I.R.S. Identification
Number of Reporting Person, if an entity (voluntary) |
4. Issuer Name andTicker or Trading Symbol Fiserv, Inc.
FISV 5. Relationship of Reporting Person(s) to Issuer
(Check all applicable) Director
10% Owner
X Officer (give title below)
Other (specify below) Description
Group President - Health Sol Grp
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6. If Amendment, Date of Original (Month/Day/Year) 7. Individual or Joint/Group
Filing (Check Applicable Line) X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1. Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned
(Instr.4) |
3. Ownership Form:
Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Common Stock - $0.01 par value
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162,028
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I |
By Partnership
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Common Stock - $0.01 par value
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1,218
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D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security
(Instr. 4) |
2. Date Exercisable(DE) and
Expiration Date(ED) (Month/Day/Year) DE / ED
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3. Title and Amount of
Underlying Securities (Instr. 4) Title / Amount or Number of Shares
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4. Conver-
sion or Exercise Price of Deri- vative Security |
5. Owner- ship Form of Deriv- ative Security: Direct (D) or Indirect (I) (Instr.5) |
6. Nature of Indirect Beneficial Ownership (Instr.5) |
Employee Stock Option (right to buy) |
(1) / 02/11/2013
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Common Stock / 4,437
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$30.99 |
D
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(1) Exercisable 20% per year commencing 2/11/04.
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By: | Date: |
/s/ Thomas J. Hirsch (attorney-in-fact) | 04/24/2003 |
** Signature of Reporting Person | SEC 1473 (07-02) |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 5(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). Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |