0001209191-23-056697.txt : 20231127 0001209191-23-056697.hdr.sgml : 20231127 20231127174612 ACCESSION NUMBER: 0001209191-23-056697 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231124 FILED AS OF DATE: 20231127 DATE AS OF CHANGE: 20231127 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: 231441386 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 X0508 4 2023-11-24 0 0000798354 FISERV INC FI 0001346629 Bisignano Frank 255 FISERV DRIVE BROOKFIELD WI 53045 1 1 0 0 Chairman, President and CEO 0 Common Stock 2023-11-24 4 G 0 1360 0.00 D 2923314 D Common Stock 14235 I By Spouse Common Stock 4568 I See Footnote Common Stock 1012 I See Footnote Common Stock 582 I See Footnote Common Stock 17173 I See Footnote Common Stock 81550 I By Trust Includes 12,827 shares distributed from the Frank J. Bisignano 2022 Grantor Retained Annuity Trust to the reporting person on November 22, 2023. These shares are held in an account, of which the reporting person acts as custodian, for the benefit of a minor. Reflects the distribution of 12,827 shares to the reporting person on November 22, 2023. Held by the Frank J. Bisignano 2022 Grantor Retained Annuity Trust. These shares are held by trusts, of which the reporting person serves as trustee, for the benefit of the reporting person's children. /s/ Eric C. Nelson (attorney-in-fact) 2023-11-27