0001547903-17-000078.txt : 20170515
0001547903-17-000078.hdr.sgml : 20170515
20170515173351
ACCESSION NUMBER: 0001547903-17-000078
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170511
FILED AS OF DATE: 20170515
DATE AS OF CHANGE: 20170515
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: 17846166
MAIL ADDRESS:
STREET 1: C/O NMI
STREET 2: 2100 POWELL STREET, 12TH FLOOR
CITY: EMERYVILLE
STATE: CA
ZIP: 94608
4
1
wf-form4_149488401683554.xml
FORM 4
X0306
4
2017-05-11
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
Restricted Stock Unit (right to receive)
2017-05-11
4
A
0
7239
0
A
84706
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
35000
I
By LLC
Represents restricted stock units granted pursuant to the NMIH Amended and Restated 2014 Omnibus Incentive Plan on May 11, 2017. The restricted stock units vest on the first anniversary of the grant date.
Represents 67,467 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 the sole trustee and sole beneficiary and 7,239 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
2017-05-15