0000814585-19-000011.txt : 20190307 0000814585-19-000011.hdr.sgml : 20190307 20190307180029 ACCESSION NUMBER: 0000814585-19-000011 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190305 FILED AS OF DATE: 20190307 DATE AS OF CHANGE: 20190307 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bergonzi Adam T. CENTRAL INDEX KEY: 0001717578 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09583 FILM NUMBER: 19666986 MAIL ADDRESS: STREET 1: C/O MBIA INC. STREET 2: 1 MANHATTANVILLE ROAD CITY: PURCHASE STATE: NY ZIP: 10577 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2019-03-05 0 0000814585 MBIA INC MBI 0001717578 Bergonzi Adam T. C/O MBIA INC. 1 MANHATTANVILLE ROAD PURCHASE NY 10577 0 1 0 0 Assistant Vice President Common Stock 2019-03-05 4 F 0 1479 10.65 D 639812 D Common Stock 2019-03-05 4 A 0 21127 0 A 660939 D Common Stock 2019-03-05 4 A 0 33182 0 A 694121 D Common Stock 2018-03-06 4 F 0 925 10.68 D 693196 D Represents shares surrendered to Issuer for payment of tax liability upon vesting of restricted stock. Balance reflects adjustment for retirement plan shares. Time based shares that will vest in equal installments on the third, fourth and fifth anniversary of the grant date, subject to the NEO's continued employment on the vesting date (subject to certain exceptions). Restricted Stock granted pursuant to long-term incentive award under 16b-3 exemption. The shares issued are the target number of performance-based restricted stock that may be earned (in a range of 0% to 200% of the target number of shares issued) based on the achievement of a certain performance metric as of December 31, 2021. Any shares that are not earned on such date will be forfeited. The shares that are earned on such date will vest in one-third increments on each of the third, fourth and fifth anniversaries of the date of grant, subject to certain continued service conditions. /s/ Jonathan C. Harris, Attorney-in-Fact 2019-03-07