0001726978-23-000038.txt : 20230426 0001726978-23-000038.hdr.sgml : 20230426 20230426175446 ACCESSION NUMBER: 0001726978-23-000038 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230424 FILED AS OF DATE: 20230426 DATE AS OF CHANGE: 20230426 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: 23851105 MAIL ADDRESS: STREET 1: 1500 SOLANA BLVD STREET 2: BUILDING 4, SUITE 4500 CITY: WESTLAKE STATE: TX ZIP: 76262 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SLJ Dynasty Trust CENTRAL INDEX KEY: 0001849957 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 23851104 BUSINESS ADDRESS: STREET 1: 1500 SOLANA BOULEVARD STREET 2: SUITE 4500 CITY: WESTLAKE STATE: TX ZIP: 76262 BUSINESS PHONE: 2148385500 MAIL ADDRESS: STREET 1: 1500 SOLANA BOULEVARD STREET 2: 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_168254605887116.xml FORM 4 X0407 4 2023-04-24 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 0001849957 SLJ Dynasty Trust 1500 SOLANA BOULEVARD STE 4500 WESTLAKE TX 76262 0 0 1 1 Member of 10% owner group 0 Class B Common Stock 2023-04-24 4 G 0 72800 0 D 645728 D Class B Common Stock 2023-04-24 4 G 0 72800 0 A 179246 I SLJ Dynasty Trust LLC Units in Goosehead Financial, LLC 0.0 2023-04-24 4 G 0 72800 0 D Class A Common Stock 72800.0 645728 D LLC Units in Goosehead Financial, LLC 0.0 2023-04-24 4 G 0 72800 0 A Class A Common Stock 72800.0 179246 I SLJ Dynasty Trust 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. This transaction involved a gift of securities by the reporting person to the SLJ Dynasty Trust. /s/ P. Ryan Langston, as Attorney-in-Fact for Serena Jones 2023-04-26 /s/ Mark E. Jones as Attorney-in-Fact for SLJ Dynasty Trust 2023-04-26