0001726978-21-000167.txt : 20210827 0001726978-21-000167.hdr.sgml : 20210827 20210827194913 ACCESSION NUMBER: 0001726978-21-000167 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210826 FILED AS OF DATE: 20210827 DATE AS OF CHANGE: 20210827 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Langston Patrick Ryan CENTRAL INDEX KEY: 0001736766 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 211220603 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_163010814014085.xml FORM 4 X0306 4 2021-08-26 0 0001726978 Goosehead Insurance, Inc. GSHD 0001736766 Langston Patrick Ryan 1500 SOLANA BLVD BUILDING 4, SUITE 4500 WESTLAKE TX 76262 0 1 1 1 VP and General Counsel Member of 10% owner group Class A Common Stock 2021-08-26 4 M 0 10000 10 A 15000 D Class A Common Stock 2021-08-26 4 S 0 10000 130.20 D 5000 D Employee Stock Options (right to buy) 10.0 2021-08-26 4 M 0 10000 0 D 2028-04-26 Class A Stock 10000.0 70000 D One third (1/3rd) of the option, which represents the right to purchase a total of 120,000 shares, shall vest and become exercisable, subject to continued employment, on each of the second, third and fourth anniversaries of the grant date, which was April 26, 2018; provided, that all shares subject to the option will vest and become exercisable if Mr. Langston's employment is terminated without "cause" or for "good reason" (each as defined in either Mr. Langston'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 2021-08-27