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