0001726978-21-000169.txt : 20210830 0001726978-21-000169.hdr.sgml : 20210830 20210830102646 ACCESSION NUMBER: 0001726978-21-000169 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210812 FILED AS OF DATE: 20210830 DATE AS OF CHANGE: 20210830 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Colby Michael C. CENTRAL INDEX KEY: 0001737258 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 211221541 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/A 1 wf-form4a_163033359205383.xml FORM 4/A X0306 4/A 2021-08-12 2021-08-14 0 0001726978 Goosehead Insurance, Inc. GSHD 0001737258 Colby Michael C. C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BUILDING 4, STE 4500 WESTLAKE TX 76262 0 1 0 0 President and COO Class A Common Stock 2021-08-12 4 M 0 0 10 A 76464 D Class A Common Stock 2021-08-12 4 S 0 43657 134.50 D 32807 D Class A Common Stock 2021-08-12 4 S 0 9556 135.32 D 23251 D Class A Common Stock 2021-08-12 4 S 0 120 136.05 D 23131 D Class A Common Stock 83402 I Colby 2014 Family Trust Employee Stock Options (right to buy) 10.0 2021-08-12 4 M 0 53333 0 D 2028-04-26 Class A Stock 53333.0 53334 D The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $133.98 to $134.97, 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. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $134.98 to $135.97, 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. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $136.03 to $136.13, 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. 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. 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). Amended to include indirect holding of Class A Common Stock by trust. /s/ P. Ryan Langston, as Attorney-in-Fact for Michael C. Colby 2021-08-30