0001726978-18-000039.txt : 20181212
0001726978-18-000039.hdr.sgml : 20181212
20181212172103
ACCESSION NUMBER: 0001726978-18-000039
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181211
FILED AS OF DATE: 20181212
DATE AS OF CHANGE: 20181212
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jones Robyn Mary Elizabeth
CENTRAL INDEX KEY: 0001737503
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38466
FILM NUMBER: 181231568
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
wf-form4_154465324575705.xml
FORM 4
X0306
4
2018-12-11
0
0001726978
Goosehead Insurance, Inc.
GSHD
0001737503
Jones Robyn Mary Elizabeth
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BUILDING 4, STE 4500
WESTLAKE
TX
76262
1
0
1
1
Member of 10% owner group
Class B Common Stock
2018-12-11
4
C
0
9044
0
D
15163178
I
By Trust
Class A Common Stock
2018-12-11
4
C
0
9044
0
A
1757325
I
By Mark and Robyn Jones Descendants Trust 2014
Class A Common Stock
2018-12-11
4
S
0
9044
27.0145
D
1748281
I
By Mark and Robyn Jones Descendants Trust 2014
Class B Common Stock
182349
D
Class A Common Stock
757890
D
LLC Units in Goosehead Financial, LLC
0.0
2018-12-11
4
C
0
9044
0
D
Class A Common Stock
9044.0
15163178
I
By Trust
LLC Units in Goosehead Financial, LLC
0.0
Class A Common Stock
182349.0
182349
D
Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held in trust for which the reporting person serves as a trustee and of which immediate family members of the reporting person are beneficiaries.
The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $27.00 to $27.08, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote to this Form 4.
Includes 10,716 shares of Class B Common Stock or LLC Units, as applicable, as a pro rata distribution from Texas Wasatch Insurance Partners, LP.
This does not reflect shares directly held by the reporting person's spouse, who is independently a reporting person of the issuer.
Each LLC Unit, together with a share of Class B common stock, may be converted by the holder into one share of Class A common stock at any time. The LLC Units do not expire.
The sales reported were effected pursuant to a Rule 10b5-1 trading plan adopted by the Mark and Robyn Jones Descendants Trust 2014.
/s/ P. Ryan Langston, as Attorney-in-Fact for Robyn Mary Elizabeth Jones
2018-12-12