0000950103-20-002816.txt : 20200214 0000950103-20-002816.hdr.sgml : 20200214 20200214161356 ACCESSION NUMBER: 0000950103-20-002816 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191231 FILED AS OF DATE: 20200214 DATE AS OF CHANGE: 20200214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Colby Michael C. CENTRAL INDEX KEY: 0001737258 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 20619919 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 5 1 dp121458_5-colby.xml FORM 5 X0306 5 2019-12-31 0 0 0 0001726978 Goosehead Insurance, Inc. GSHD 0001737258 Colby Michael C. C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BUILDING 4, STE 4500 WESTLAKE TX 76262 0 1 0 0 President and COO Class A Common Stock 2019-02-06 5 G 0 17000 0 D 63631 D Class A Common Stock 143402 I By Colby 2014 Family Trust This transaction involved a gift of securities by the reporting person to his mother-in-law. /s/ P. Ryan Langston, as Attorney-in-Fact for Michael C. Colby 2020-02-14