SEC FORM 4

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

Bisignano Frank

(Last)

(First)

(Middle)

255 FISERV DRIVE

(Street)

BROOKFIELD

53045

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
FISERV INC [ FISV ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	Chairman, President and CEO

3. Date of Earliest Transaction (Month/Day/Year)
02/22/2023

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	02/22/2023		A		76,676⁽¹⁾	A	$0.00	2,890,142	D
Common Stock	02/23/2023		F		11,950⁽²⁾	D	$116.54	2,878,192	D
Common Stock								4,286	I	See Footnote⁽³⁾
Common Stock								81,550	I	By Trust⁽⁴⁾
Common Stock								30,000	I	See Footnote⁽⁵⁾
Common Stock								730	I	See Footnote⁽³⁾
Common Stock								14,940	I	By Spouse
Common Stock								300	I	See Footnote⁽³⁾

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)

Explanation of Responses:

1. On February 22, 2023, the independent members of the board of directors granted Mr. Bisignano's incentive compensation for 2022 entirely in the form of equity awards, with 60% of the awards (112,921 units) in the form of performance share units (PSUs) that vest at the end of a three-year performance period based on the achievement of performance goals and 40% of the awards (76,676 units) in the form of restricted stock units (RSUs). The 60 / 40% ratio of PSUs to RSUs, respectively, reflects an increased level of PSUs compared to the 50 / 50% ratio in the prior year. The restricted stock units are reported on this Form 4 and vest one-third on each anniversary of the grant date.

2. Reflects payment of tax liability by withholding securities incident to vesting of restricted stock units.

3. These shares are held in an account, of which the reporting person acts as custodian, for the benefit of a minor.

4. These shares are held by trusts, of which the reporting person serves as trustee, for the benefit of the reporting person's children.

5. Held by the Frank J. Bisignano 2022 Grantor Retained Annuity Trust.

Remarks:

	/s/ Eric C. Nelson (attorney-in-fact)	02/24/2023
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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