0001726978-23-000152.txt : 20231122
0001726978-23-000152.hdr.sgml : 20231122
20231122173156
ACCESSION NUMBER: 0001726978-23-000152
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231120
FILED AS OF DATE: 20231122
DATE AS OF CHANGE: 20231122
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jones Mark Evan
CENTRAL INDEX KEY: 0001736768
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38466
FILM NUMBER: 231434584
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_1700692306.xml
FORM 4
X0508
4
2023-11-20
0
0001726978
Goosehead Insurance, Inc.
GSHD
0001736768
Jones Mark Evan
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BUILDING 4, STE 4500
WESTLAKE
TX
76262
1
1
1
1
CEO
Member of 10% owner group
0
Class A Common Stock
2023-11-20
4
G
0
6950
0
D
189551
D
Class B Common Stock
182349
D
Class B Common Stock
9676847
I
By Trust
LLC Units in Goosehead Financial, LLC
0
Class A Common Stock
182349
182349
D
LLC Units in Goosehead Financial, LLC
0
Class A Common Stock
9676847
9676847
I
By Trust
Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held directly by Mark Evan Jones, and does not reflect Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held by his spouse, Robyn Mary Elizabeth Jones, who is independently a reporting person of the issuer.
Reflects a reduction in shares due to 11/20/2023 and 11/21/2023 sales by certain trusts for which the reporting person serves as a trustee and of which immediate family members of the reporting person are beneficiaries, each a separate reporting person and for which separate Form 4s 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 Mark Evan Jones
2023-11-22