0001547903-16-000243.txt : 20160516 0001547903-16-000243.hdr.sgml : 20160516 20160516170858 ACCESSION NUMBER: 0001547903-16-000243 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160512 FILED AS OF DATE: 20160516 DATE AS OF CHANGE: 20160516 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NMI Holdings, Inc. CENTRAL INDEX KEY: 0001547903 STANDARD INDUSTRIAL CLASSIFICATION: SURETY INSURANCE [6351] IRS NUMBER: 454914248 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2100 POWELL STREET, 12TH FLOOR CITY: EMERYVILLE STATE: CA ZIP: 94608 BUSINESS PHONE: (855) 530-6642 MAIL ADDRESS: STREET 1: 2100 POWELL STREET, 12TH FLOOR CITY: EMERYVILLE STATE: CA ZIP: 94608 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: OZANNE JAMES CENTRAL INDEX KEY: 0001245515 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36174 FILM NUMBER: 161655034 MAIL ADDRESS: STREET 1: C/O UNITED RENTALS, INC STREET 2: 100 FIRST STAMFORD PLACE, 7TH FLOOR CITY: STAMFORD STATE: CT ZIP: 06902 4 1 wf-form4_146343292543291.xml FORM 4 X0306 4 2016-05-12 0 0001547903 NMI Holdings, Inc. NMIH 0001245515 OZANNE JAMES C/O NMI HOLDINGS, INC. 2100 POWELL STREET, 12TH FL. EMERYVILLE CA 94608 1 0 0 0 Class A Common Shares, $0.01 par value per share 2016-05-12 4 A 0 8169 0 A 77467 D Class A Common Shares, $0.01 par value per share 10000 I By Susan A. Ozanne Family Trust, of which Mr. Ozanne and his wife are co-trustees and beneficiaries Class A Common Shares, $0.01 par value per share 20000 I By LLC Represents restricted stock units granted pursuant to the NMIH 2014 Omnibus Incentive Plan on May 12, 2016. The restricted stock units vest on the first anniversary of the grant date. Represents 59,298 class A common shares, 10,000 class A common shares held by the James H. Ozanne Revocable Trust, a living trust of which the reporting person is in the sole trustee and sole beneficiary and 8,169 unvested restricted stock units. The common stock is held by Greenrange Partners LLC, a venture capital investment company, for which the reporting person serves as principal. As a principal, the reporting person may be deemed to beneficially own the shares of stock held by Greenrange Partners LLC. /s/ Nicole C. Sanchez as Attorney-in-Fact 2016-05-16