FEC Form 1 for Fiserv, Inc. Political Action Committee (Fiserv PAC)Form 1 for Fiserv, Inc. Political Action Committee (Fiserv PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1447259

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

255 Fiserv Drive
Brookfield, WI 53045
Email: kim.ford@fiserv.com;eric.nelson@fiserv.com

NOTE: Email address is different than previously reported

2. Date: 10/13/2020

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:

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

Treasurer:

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

Designated Agent(s):

Eric Nelson
255 Fiserv Drive
Brookfield, Wisconsin 53045
Title: Assistant Treasurer
Phone # (262) 879-5350

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1447259

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

NOTE: Email address is different than previously reported

2. Date: 10/13/2020

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Kimberly Ford
Date Signed: 10/13/2020

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1447259

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

NOTE: Email address is different than previously reported

2. Date: 10/13/2020

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Kimberly Ford Date Signed: 10/13/2020

(End FEC FORM 1)

Signed: Kimberly Ford
Date Signed: 10/13/2020