0001209191-23-005496.txt : 20230130 0001209191-23-005496.hdr.sgml : 20230130 20230130164706 ACCESSION NUMBER: 0001209191-23-005496 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230129 FILED AS OF DATE: 20230130 DATE AS OF CHANGE: 20230130 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: 23568519 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-BUSINESS SERVICES, NEC [7389] 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 2023-01-29 0 0000798354 FISERV INC FISV 0001346629 Bisignano Frank 255 FISERV DRIVE BROOKFIELD WI 53045 1 1 0 0 Chairman, President and CEO Common Stock 2022-08-23 5 G 0 E 94 0.00 D 2809103 D Common Stock 2022-09-12 5 G 0 E 7243 0.00 D 2840813 D Common Stock 2022-11-01 5 G 0 E 3091 0.00 D 2837722 D Common Stock 2022-12-02 5 G 0 E 479 0.00 D 2807243 D Common Stock 2022-12-16 5 G 0 E 511 0.00 D 2806732 D Common Stock 2023-01-29 4 F 0 16451 106.49 D 2790281 D Common Stock 4286 I See Footnote Common Stock 81550 I By Trust Common Stock 30000 I See Footnote Common Stock 730 I See Footnote Common Stock 14940 I By Spouse Common Stock 300 I See Footnote Includes 38,953 shares acquired upon distribution from the Frank J. Bisignano 2020 Grantor Retained Annuity Trust on September 9, 2022. Includes the contribution of 30,000 shares to the Frank J. Bisignano 2022 Grantor Retained Annuity Trust on November 22, 2022. Reflects payment of tax liability by withholding securities incident to vesting of restricted stock units. Includes 2,419 shares acquired upon distribution from the Frank J. Bisignano 2020 Grantor Retained Annuity Trust on September 9, 2022. These shares are held in an account, of which the reporting person acts as custodian, for the benefit of a minor. Includes 4,837 shares acquired upon distribution from the Frank J. Bisignano 2020 Grantor Retained Annuity Trust on September 9, 2022. These shares are held by trusts, of which the reporting person serves as trustee, for the benefit of the reporting person's children. Held by the Frank J. Bisignano 2022 Grantor Retained Annuity Trust. /s/ Eric C. Nelson (attorney-in-fact) 2023-01-30