0000950103-18-005526.txt : 20180430 0000950103-18-005526.hdr.sgml : 20180430 20180430205701 ACCESSION NUMBER: 0000950103-18-005526 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180426 FILED AS OF DATE: 20180430 DATE AS OF CHANGE: 20180430 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Colby Michael C. CENTRAL INDEX KEY: 0001737258 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 18792707 MAIL ADDRESS: STREET 1: 1500 SOLANA BLVD STREET 2: BUILDING 4, SUITE 4500 CITY: WESTLAKE STATE: TX ZIP: 76262 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Goosehead Insurance, Inc. CENTRAL INDEX KEY: 0001726978 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] 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 dp90335_4-mccolby.xml FORM 4 X0306 4 2018-04-26 0 0001726978 Goosehead Insurance, Inc. GSHD 0001737258 Colby Michael C. 1500 SOLANA BLVD BUILDING 4, SUITE 4500 WESTLAKE TX 76262 0 1 0 0 President and COO Employee Stock Options (right to buy) 10 2018-04-26 4 A 0 160000 0 A 2028-04-26 Class A Common Stock 160000 160000 D One third (1/3rd) of the shares subject to the option shall vest and become exercisable, subject to continued employment, on each of the second, third and fourth anniversaries of the grant date; provided, that all shares subject to the option will vest and become exercisable if Mr. Colby's employment is terminated without "cause" or for "good reason" (each as defined in either Mr. Colby's option award agreement or the issuer's omnibus incentive plan) within six month following a "change in control" (as defined in the issuer's omnibus incentive plan). /s/ P. Ryan Langston, as Attorney-in-Fact for Michael C. Colby 2018-04-30