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 WI 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)
President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
06/01/2021
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)
Code V Amount (A) or (D) Price
Common Stock 04/16/2021 G V 7,967 D $0.00 2,359,547 D
Common Stock 05/04/2021 G V 1,738 D $0.00 2,357,809 D
Common Stock 06/01/2021 M 377,955(1) A $36.54 2,735,764 D
Common Stock 06/01/2021 F 246,413(2) D $114.43 2,489,351 D
Common Stock 1,567 I See Footnote(3)
Common Stock 120 I See Footnote(3)
Common Stock 15,690 I By Spouse
Common Stock 76,713 I By Trust(4)
Common Stock 75,000 I By Trust(5)
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) $36.54 06/01/2021 M 377,955(1) 05/07/2014(6) 05/07/2023 Common Stock 377,955 $0.00 1,637,812 D
Explanation of Responses:
1. This option exercise was effected pursuant to a Rule 10b5-1 trading plan entered into by the reporting person for estate and financial planning purposes.
2. Reflects payment of exercise price and tax liability by withholding securities incident to exercise of stock options.
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 2020 Grantor Retained Annuity Trust.
6. This option vested in five equal installments on each anniversary of the grant date, May 7, 2013.
Remarks:
/s/ Eric C. Nelson (attorney-in-fact) 06/03/2021
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.