0001209191-21-054428.txt : 20210902 0001209191-21-054428.hdr.sgml : 20210902 20210902161622 ACCESSION NUMBER: 0001209191-21-054428 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210901 FILED AS OF DATE: 20210902 DATE AS OF CHANGE: 20210902 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bisignano Frank CENTRAL INDEX KEY: 0001346629 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38962 FILM NUMBER: 211233430 MAIL ADDRESS: STREET 1: 225 LIBERTY STREET, 29TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10281 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FISERV INC CENTRAL INDEX KEY: 0000798354 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374] IRS NUMBER: 391506125 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 255 FISERV DR STREET 2: PO BOX 979 CITY: BROOKFIELD STATE: WI ZIP: 53045 BUSINESS PHONE: 4148795000 MAIL ADDRESS: STREET 1: 255 FISERV DRIVE CITY: BROOKFIELD STATE: WI ZIP: 53045 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-09-01 0 0000798354 FISERV INC FISV 0001346629 Bisignano Frank 255 FISERV DRIVE BROOKFIELD WI 53045 1 1 0 0 President and CEO Common Stock 2021-08-20 5 G 0 E 2656 0.00 D 2311970 D Common Stock 2021-09-01 4 M 0 377955 36.54 A 2718716 D Common Stock 2021-09-01 4 F 0 252546 118.34 D 2466170 D Common Stock 1567 I See Footnote Common Stock 120 I See Footnote Common Stock 15690 I By Spouse Common Stock 76713 I By Trust Common Stock 46209 I By Trust Employee Stock Option (right to buy) 36.54 2021-09-01 4 M 0 377955 0.00 D 2014-05-07 2023-05-07 Common Stock 377955 1259857 D This option exercise was effected pursuant to a Rule 10b5-1 trading plan entered into by the reporting person for estate and financial planning purposes. Reflects 28,791 shares distributed from the Frank J. Bisignano 2020 Grantor Retained Annuity Trust on September 1, 2021. Reflects payment of exercise price and tax liability by withholding securities incident to exercise of stock options. These shares are held in an account, of which the reporting person acts as custodian, for the benefit of a minor. These shares are held by trusts, of which the reporting person serves as trustee, for the benefit of the reporting person's children. Reflects the distribution of 28,791 shares to the reporting person on September 1, 2021. Held by the Frank J. Bisignano 2020 Grantor Retained Annuity Trust. This option vested in five equal installments on each anniversary of the grant date, May 7, 2013. /s/ Eric C. Nelson (attorney-in-fact) 2021-09-02