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