SEC Form 4 · accession 0000814585-16-000047
MBIA INC · MBI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ram D Wertheim
Officer — EVP, Chief Legal Off. & Secy
Period of report
Dec 5, 2016
Accepted (ET)
Dec 7, 2016 · 4:49 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000814585
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Dec 5, 2016 | M | 200,000 | $5.05 | A | 745,561 | D | |
| Common StockF3 | Dec 5, 2016 | F | 148,983 | $10.67 | D | 596,578 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock | $5.05 | Dec 5, 2016 | M | 200,000 | D | Mar 4, 2015 | Mar 4, 2017 | Common Stock | 200,000 | 0 | D |
Explanation of responses
- F1Represents shares acquired pursuant to Net Settlement Procedure for exercise of employee stock options.
- F2Balance reflects adjustment for retirement plan shares.
- F3Represents shares forfeited pursuant to Net Settlement Procedure for exercise of employee stock options.