# EDGAR Filing Document

**Accession Number:** 0001547903
**File Stem:** 0001547903-23-000011
**Filing Date:** 2023-2
**Character Count:** 7573
**Document Hash:** 5995967d036cd4a6d460fd3dd6c316d5
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001547903-23-000011.hdr.sgml**: 20230210

**ACCESSION NUMBER**: 0001547903-23-000011

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230208

**FILED AS OF DATE**: 20230210

**DATE AS OF CHANGE**: 20230210

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Pollitzer Adam
- **CENTRAL INDEX KEY:** 0001706001

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36174
- **FILM NUMBER:** 23613299

**MAIL ADDRESS:**
- **STREET 1:** 2100 POWELL STREET
- **STREET 2:** 12TH FLOOR
- **CITY:** EMERYVILLE
- **STATE:** CA
- **ZIP:** 94608
**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:** CA
- **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

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

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Pollitzer Adam<br><sub>(Last) (First) (Middle)</sub><br>C/O NMI HOLDINGS, INC.<br>2100 POWELL ST., 12TH FLOOR<br><sub>(Street)</sub><br>EMERYVILLE, CA 94608<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-08 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Executive Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>NMI Holdings, Inc. [ NMIH ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Restricted Stock Unit (right to receive) | 2023-02-08 |  | A |  | 92332<sup>(1)</sup> | A | $0 | 231686 | D |  |
| Class A Common Shares, $0.01 par value per share | 2023-02-08 |  | A |  | 25685<sup>(2)</sup> | A | $0 | 257371 | D |  |
| Class A Common Shares, $0.01 par value per share | 2023-02-08 |  | F |  | 12937<sup>(3)</sup> | D | $0 | 244434 | D |  |
| Class A Common Shares, $0.01 par value per share | 2023-02-09 |  | F |  | 11517<sup>(4)</sup> | D | $0 | 232917<sup>(5)</sup> | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) Represents restricted stock units granted pursuant to the NMIH Amended and Restated 2014 Omnibus Incentive Plan on February 8, 2023.  The restricted stock units vest 40% on each of the first and second anniversaries of the grant date and 20% on the third anniversary of the grant date.

(2) On February 12, 2020, the reporting person was granted performance-based restricted stock units (PRSUs) pursuant to the NMIH Amended and Restated 2014 Omnibus Incentive Plan. Each PRSU represents a contingent right to receive shares of NMIH's Class A common shares upon settlement. The PRSUs vest at the end of the three-year period following the grant on the date that the Compensation Committee of the Board of Directors certifies attainment, based on NMIH's satisfaction of certain performance criteria.  The performance criteria were met on February 8, 2023, resulting in the issuance of 25,685 vested PRSUs.

(3) Represents shares withheld by NMIH to satisfy withholding taxes due in connection with the vesting of the PRSUs granted to the reporting person on February 12, 2020 at a net settlement price equal to the closing stock price on February 8, 2023.

(4) Represents shares withheld by NMIH to satisfy withholding taxes due in connection with the vesting of certain restricted stock units granted to the reporting person on February 9, 2022 at a net settlement price equal to the closing stock price on February 9, 2023. The restricted stock units vest 40% on each of the first and second anniversaries of the grant date and 20% on the third anniversary of the grant date.

(5) Represents 87,721 Class A common shares and 145,196 unvested restricted stock units.

**Signature:** /s/ Lynn Zheng, as Attorney-in-Fact  
**Date:** 2023-02-10

### Remarks:

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 4 (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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**