Adam T. Bergonzi Form 3 MBIA / Adam T. Bergonzi ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Bergonzi Adam T.

(Last) (First) (Middle)

C/O MBIA INC.

1 MANHATTANVILLE ROAD, SUITE 301

(Street)

PURCHASE NY 10577

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
09/15/2017

3. Issuer Name and Ticker or Trading Symbol
MBIA INC [ MBI ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
AVP & Chief Portfolio Officer

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	87,589(1)	D
Common Stock	429(2)	I	By Spouse

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares

Explanation of Responses:

1. Shares acquired prior to status as Reporting Person including a) 17,675 shares held in the Reporting Person's accounts; b) 3,193 shares of restricted stock granted at $12.78 per share and vesting entirely in March 2018, 5,444 shares of restricted stock granted at $14.99 per share and vesting 50% in March 2018 and 50% in March 2019, 13,063 shares of restricted stock granted at $9.37 per share and vesting in one-third increments in each of March 2018, 2019 and 2020, 20,427 shares of restricted stock granted at $8.44 per share and vesting in one-third increments in March 2019, 2020 and 2021, and 12,777 shares of restricted stock granted at $9.58 per share and vesting in one-third increments in March 2020, 2021 and 2022 and c) 15,010 shares held in the Amended and Restated MBIA Inc. Deferred Compensation and Excess Benefit Plan.

2. Shares acquired by spouse prior to designation as Reporting Person includes 429 shares held privately with personal Fidelity 401(k) retirement account.

Remarks:

	/s/ Jonathan C. Harris, Attorney-in-fact	09/25/2017
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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