0000814585-21-000004.txt : 20210114 0000814585-21-000004.hdr.sgml : 20210114 20210114174132 ACCESSION NUMBER: 0000814585-21-000004 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201231 FILED AS OF DATE: 20210114 DATE AS OF CHANGE: 20210114 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bergonzi Adam T. CENTRAL INDEX KEY: 0001717578 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09583 FILM NUMBER: 21529835 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 5 1 primary_doc.xml PRIMARY DOCUMENT X0306 5 2020-12-31 0 0 0 0000814585 MBIA INC MBI 0001717578 Bergonzi Adam T. C/O MBIA INC. 1 MANHATTANVILLE ROAD, SUITE 301 PURCHASE NY 10577 0 1 0 0 Assistant Vice President Common Stock 2020-12-31 5 D 0 35765 0 D 755976 D Represents forfeiture of previously granted restricted stock award due to non-achievement of performance criteria. /s/ Jonathan C. Harris, Attorney-in-Fact 2021-01-14