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