SEC Form 3
FORM 3 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
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
GUPTA RAHUL

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

(Street)
BROOKFIELD WI 53045

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/11/2011
3. Issuer Name and Ticker or Trading Symbol
FISERV INC [ FISV ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP, Group President
5. 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 Beneficially Owned
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 22,998 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) 12/18/2008(1) 12/18/2016 Common Stock 15,000 52.49 D
Stock Option (right to buy) 03/30/2008(2) 03/30/2017 Common Stock 17,425 53.06 D
Stock Option (right to buy) 02/27/2009(3) 02/27/2018 Common Stock 13,836 54.21 D
Stock Option (right to buy) 02/27/2011(4) 02/27/2018 Common Stock 16,141 54.21 D
Stock Option (right to buy) 02/26/2010(5) 02/26/2019 Common Stock 16,924 32.74 D
Stock Option (right to buy) 02/24/2011(6) 02/24/2020 Common Stock 7,222 47.69 D
Stock Option (right to buy) 02/23/2012(7) 02/23/2021 Common Stock 7,682 61.71 D
Explanation of Responses:
1. One-third of these options vest each year commencing on December 18, 2008.
2. One-fifth of these options vest each year commencing on March 30, 2008.
3. One-third of these options vest each year commencing on February 27, 2009.
4. The options vested and became exercisable on February 27, 2011.
5. One-third of these options vest each year commencing on February 26, 2010.
6. One-third of these options vest each year commencing on February 24, 2011.
7. One-third of these options vest each year commencing on February 23, 2012.
/s/ Charles W. Sprague (attorney-in-fact) 10/14/2011
** 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 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.
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.