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