0001726978-20-000140.txt : 20200506 0001726978-20-000140.hdr.sgml : 20200506 20200506163238 ACCESSION NUMBER: 0001726978-20-000140 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200505 FILED AS OF DATE: 20200506 DATE AS OF CHANGE: 20200506 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Colby Mark S. CENTRAL INDEX KEY: 0001736854 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 20853093 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_158879714110383.xml FORM 4 X0306 4 2020-05-05 0 0001726978 Goosehead Insurance, Inc. GSHD 0001736854 Colby Mark S. C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BUILDING 4, STE 4500 WESTLAKE TX 76262 0 1 0 0 Chief Financial Officer Class A Common Stock 2020-05-05 4 M 0 40000 10 A 58576 D Employee Stock Options (right to buy) 10.0 2020-05-05 4 M 0 40000 0 D 2028-04-26 Class A Stock 40000.0 80000 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 Mark S. Colby 2020-05-06