0001726978-22-000015.txt : 20220214 0001726978-22-000015.hdr.sgml : 20220214 20220214153029 ACCESSION NUMBER: 0001726978-22-000015 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211231 FILED AS OF DATE: 20220214 DATE AS OF CHANGE: 20220214 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: 22630541 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 wf-form5_164487060829963.xml FORM 5 X0306 5 2021-12-31 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 2022-01-11 5 G 0 250 0 D 22881 D Class A Common Stock 2022-01-11 5 G 0 250 0 D 22631 D Class A Common Stock 83402 I By Colby 2014 Family Trust This transaction involved two equal gifts of securities by the reporting person. The total holdings reflected in the Forms 4 filed by the reporting person subsequent the date of the gifts reported hereby will be reduced to reflect such gifts. /s/ P. Ryan Langston, as Attorney-in-Fact for Michael C. Colby 2022-02-14