SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
SHACKELFORD THEKLA R

(Last) (First) (Middle)
255 FISERV DRIVE

(Street)
BROOKFIELD WI 53045

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FISERV INC [ FISV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
04/06/2004
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock - $0.01 par value 04/06/2004 M 120 A $25.4167 39,254 D
Common Stock - $0.01 par value 04/06/2004 M 120 A $22.7083 39,374 D
Common Stock - $0.01 par value 04/06/2004 M 120 A $21.3333 39,494 D
Common Stock - $0.01 par value 04/06/2004 M 120 A $23.8333 39,614 D
Common Stock - $0.01 par value 04/06/2004 M 240 A $29.9167 39,854 D
Common Stock - $0.01 par value 04/06/2004 M 240 A $32.4583 40,094 D
Common Stock - $0.01 par value 04/06/2004 M 7,200 A $32.7917 47,294 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) $25.4167 04/06/2004 M 120 05/19/2000(1) 05/19/2009 Common Stock 120 $0 0 D
Stock Option (right to buy) $22.7083 04/06/2004 M 120 11/10/2000(1) 11/10/2009 Common Stock 120 $0 0 D
Stock Option (right to buy) $21.3333 04/06/2004 M 120 02/16/2001(1) 02/16/2010 Common Stock 120 $0 0 D
Stock Option (right to buy) $23.8333 04/06/2004 M 120 03/30/2001(1) 03/30/2010 Common Stock 120 $0 0 D
Stock Option (right to buy) $29.9167 04/06/2004 M 240 05/17/2001(1) 05/17/2010 Common Stock 240 $0 0 D
Stock Option (right to buy) $32.4583 04/06/2004 M 240 11/08/2001(1) 11/08/2010 Common Stock 240 $0 0 D
Stock Option (right to buy) $32.7917 04/06/2004 M 7,200 03/29/2002(1) 03/29/2011 Common Stock 7,200 $0 0 D
Explanation of Responses:
1. 100% Exercisable on retirement date 4/6/2004.
Thomas J. Hirsch (attorney-in-fact) 04/07/2004
** Signature of Reporting Person Date
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 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.