0001726978-19-000293.txt : 20190828 0001726978-19-000293.hdr.sgml : 20190828 20190828164614 ACCESSION NUMBER: 0001726978-19-000293 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190827 FILED AS OF DATE: 20190828 DATE AS OF CHANGE: 20190828 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jones Serena CENTRAL INDEX KEY: 0001737783 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 191062478 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_156702515851261.xml FORM 4 X0306 4 2019-08-27 0 0001726978 Goosehead Insurance, Inc. GSHD 0001737783 Jones Serena C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BLDG 4, STE 4500 WESTLAKE TX 76262 0 0 1 1 Member of 10% owner group Class B Common Stock 2019-08-27 4 C 0 1600 0 D 995374 D Class A Common Stock 2019-08-27 4 C 0 1600 0 A 1600 D Class A Common Stock 2019-08-27 4 S 0 1600 48 D 0 D LLC Units in Goosehead Financial, LLC 0.0 2019-08-27 4 C 0 1600 0 D Class A Common Stock 1600.0 995374 D 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. /s/ P. Ryan Langston, as Attorney-in-Fact for Serena Jones 2019-08-28