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