0000950103-22-001968.txt : 20220203 0000950103-22-001968.hdr.sgml : 20220203 20220203060531 ACCESSION NUMBER: 0000950103-22-001968 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220202 FILED AS OF DATE: 20220203 DATE AS OF CHANGE: 20220203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McConnon Thomas CENTRAL INDEX KEY: 0001908314 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 22586374 MAIL ADDRESS: STREET 1: C/O WILDCAT CAPITAL MANAGEMENT, LLC STREET 2: 888 7TH AVENUE, 37TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10106 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 dp166562_4-mcconnon.xml FORM 4 X0306 4 2022-02-02 0 0001726978 Goosehead Insurance, Inc. GSHD 0001908314 McConnon Thomas 1500 SOLANA BLVD., BLDG 4, STE 4500 WESTLAKE TX 76262 1 0 0 0 Director Stock Option (right to buy) 92.08 2022-02-02 4 A 0 12667 0 A 2032-02-02 Class A Common Stock 12667 12667 D The shares subject to the option shall vest and become exercisable, subject to continued service, in 8 equal quarterly installments over the two (2) 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 omnibus incentive plan). /s/ P. Ryan Langston, as attorney-in-fact for Thomas E. McConnon 2022-02-02