0000814585-16-000047.txt : 20161207 0000814585-16-000047.hdr.sgml : 20161207 20161207164954 ACCESSION NUMBER: 0000814585-16-000047 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161205 FILED AS OF DATE: 20161207 DATE AS OF CHANGE: 20161207 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MBIA INC CENTRAL INDEX KEY: 0000814585 STANDARD INDUSTRIAL CLASSIFICATION: SURETY INSURANCE [6351] IRS NUMBER: 061185706 STATE OF INCORPORATION: CT FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1 MANHATTANVILLE ROAD STREET 2: SUITE 301 CITY: PURCHASE STATE: NY ZIP: 10577 BUSINESS PHONE: 914-273-4545 MAIL ADDRESS: STREET 1: 1 MANHATTANVILLE ROAD STREET 2: SUITE 301 CITY: PURCHASE STATE: NY ZIP: 10577 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WERTHEIM RAM D CENTRAL INDEX KEY: 0001237582 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09583 FILM NUMBER: 162039518 MAIL ADDRESS: STREET 1: 113 KING STREET CITY: ARMONK STATE: NY ZIP: 10504 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2016-12-05 0 0000814585 MBIA INC MBI 0001237582 WERTHEIM RAM D C/O MBIA INC. 1 MANHATTANVILLE ROAD, SUITE 301 PURCHASE NY 10577 0 1 0 0 EVP, Chief Legal Off. & Secy Common Stock 2016-12-05 4 M 0 200000 5.05 A 745561 D Common Stock 2016-12-05 4 F 0 148983 10.67 D 596578 D Common Stock 5.05 2016-12-05 4 M 0 200000 0 D 2015-03-04 2017-03-04 Common Stock 200000 0 D Represents shares acquired pursuant to Net Settlement Procedure for exercise of employee stock options. Balance reflects adjustment for retirement plan shares. Represents shares forfeited pursuant to Net Settlement Procedure for exercise of employee stock options. /S/ Ram D. Wertheim, Attorney-in-Fact 2016-12-07