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