0000814585-21-000034.txt : 20210601 0000814585-21-000034.hdr.sgml : 20210601 20210601160326 ACCESSION NUMBER: 0000814585-21-000034 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210528 FILED AS OF DATE: 20210601 DATE AS OF CHANGE: 20210601 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shasta Theodore CENTRAL INDEX KEY: 0001468776 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09583 FILM NUMBER: 21985215 MAIL ADDRESS: STREET 1: C/O MBIA INC. STREET 2: 113 KING STREET CITY: ARMONK STATE: NY ZIP: 10504 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 2021-05-28 0 0000814585 MBIA INC MBI 0001468776 Shasta Theodore C/O MBIA INC. 1 MANHATTANVILLE ROAD, SUITE 301 PURCHASE NY 10577 1 0 0 0 Common Stock 2021-05-28 4 S 0 20696 10 D 52049 D The reporting officer via an IRA ("Individual Retirement Account") indirectly owns an additional 20,000 shares of the issuer's stock as reported upon the reporting officer's previously filed August 29, 2017 Form 4 filing. /s/ Jonathan C. Harris, Attorney-in-Fact 2021-06-01