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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1403710

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1. Fiserv, Inc. Political Action Committee (Fiserv PAC)

    NOTE:Commmittee Name is different than previously reported

    255 Fiserv Drive
    Brookfield, WI 53045

    NOTE: Address is different than previously reported

    Email: kim.ford@fiserv.com;scot.silverglate@fiserv.com

    NOTE: Email address is different than previously reported

2. Date: 04/29/2020

3. FEC Committee ID #: C00583336 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Fiserv, Inc.
255 Fiserv Drive
Brookfield, Wisconsin 53045
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mrs. Kimberly Ford
1000 F Street NW,
Suite 550
Washington, DC 20004
Title: Treasurer
Phone # (202) 478-1112

Treasurer:

Mrs. Kimberly Ford
1000 F Street NW
Suite 550
Washington, DC 20004
Title: Treasurer
Phone # (202) 478-1112

Designated Agent(s):

Mr. Scot Silverglate
3975 NW 120th Ave
Coral Springs, Florida 33065
Title: Assistant Treasurer
Phone # (954) 845-5251

Banks or Depositories

Wells Fargo Bank
90 S. 7th St.
Minneapolis, Minnesota 55402

Signed: Mrs. Kimberly Ford
Date Signed: 04/29/2020

(End FEC FORM 1)

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