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