0001209191-21-051839.txt : 20210817 0001209191-21-051839.hdr.sgml : 20210817 20210817161251 ACCESSION NUMBER: 0001209191-21-051839 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210815 FILED AS OF DATE: 20210817 DATE AS OF CHANGE: 20210817 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: 211182918 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 2021-08-15 0 0000798354 FISERV INC FISV 0001346629 Bisignano Frank 255 FISERV DRIVE BROOKFIELD WI 53045 1 1 0 0 President and CEO Common Stock 2021-08-15 4 F 0 149020 111.62 D 2314626 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 75000 I By Trust Reflects payment of tax liability by withholding securities incident to vesting of restricted stock units. 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. Held by the Frank J. Bisignano 2020 Grantor Retained Annuity Trust. /s/ Eric C. Nelson (attorney-in-fact) 2021-08-17