0001726978-24-000057.txt : 20240509 0001726978-24-000057.hdr.sgml : 20240509 20240509190815 ACCESSION NUMBER: 0001726978-24-000057 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240507 FILED AS OF DATE: 20240509 DATE AS OF CHANGE: 20240509 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lane Peter R. CENTRAL INDEX KEY: 0001570186 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 24932431 MAIL ADDRESS: STREET 1: 1500 SOLANA BOULEVARD STREET 2: BUILDING 4, SUITE 4500 CITY: SOUTHLAKE STATE: TX ZIP: 76092 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Goosehead Insurance, Inc. CENTRAL INDEX KEY: 0001726978 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] ORGANIZATION NAME: 02 Finance IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1500 SOLANA BLVD STREET 2: BUILDING 4, SUITE 4500 CITY: WESTLAKE STATE: TX ZIP: 76262 BUSINESS PHONE: 214-838-5500 MAIL ADDRESS: STREET 1: 1500 SOLANA BLVD STREET 2: BUILDING 4, SUITE 4500 CITY: WESTLAKE STATE: TX ZIP: 76262 4 1 wk-form4_1715296084.xml FORM 4 X0508 4 2024-05-07 0 0001726978 Goosehead Insurance, Inc. GSHD 0001570186 Lane Peter R. 1500 SOLANA BLVD BUILDING 4, SUITE 4500 WESTLAKE TX 76262 1 0 0 0 0 Director Stock Options (right to buy) 61.01 2024-05-07 4 A 0 10000 0 A 2034-05-07 Class A Common Stock 10000 10000 D The shares subject to the option shall vest and become exercisable, subject to continued service, in 12 equal quarterly installments over the three (3) year period following the grant date; provided, that all shares subject to the option will vest and become exercisable upon a "change in control" (as defined in the Issuer's Amended and Restated Omnibus Incentive Plan). /s/ John O'Connor, as Attorney-in-Fact for Peter R. Lane 2024-05-09