0001726978-23-000119.txt : 20230830 0001726978-23-000119.hdr.sgml : 20230830 20230830191547 ACCESSION NUMBER: 0001726978-23-000119 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230829 FILED AS OF DATE: 20230830 DATE AS OF CHANGE: 20230830 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jones Robyn Mary Elizabeth CENTRAL INDEX KEY: 0001737503 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 231226472 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 wk-form4_1693437337.xml FORM 4 X0508 4 2023-08-29 0 0001726978 Goosehead Insurance, Inc. GSHD 0001737503 Jones Robyn Mary Elizabeth C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BUILDING 4, STE 4500 WESTLAKE TX 76262 1 0 1 1 Member of 10% owner group 0 Class A Common Stock 2023-08-29 4 G 0 150000 0 D 181290 D Class B Common Stock 132349 D Class B Common Stock 10012497 I By Trust LLC Units in Goosehead Financial, LLC 0 Class A Common Stock 132349 132349 D LLC Units in Goosehead Financial, LLC 0 Class A Common Stock 10012497 10012497 I By Trust Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held directly by Robyn Mary Elizabeth Jones, and does not reflect Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held by her spouse, Mark Evan Jones, who is independently a reporting person of the issuer. Reflects a reduction in shares due to a same-day sale by Desiree Robyn Coleman Family Trust 2014, a separate reporting person and for which a separate Form 4 will be filed. 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. 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. /s/ John O'Connor, as Attorney-in-Fact for Robyn Mary Elizabeth Jones 2023-08-30