0001726978-20-000404.txt : 20201130 0001726978-20-000404.hdr.sgml : 20201130 20201130162503 ACCESSION NUMBER: 0001726978-20-000404 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201124 FILED AS OF DATE: 20201130 DATE AS OF CHANGE: 20201130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jones Serena CENTRAL INDEX KEY: 0001737783 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 201358382 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 wf-form4_160677148951360.xml FORM 4 X0306 4 2020-11-24 0 0001726978 Goosehead Insurance, Inc. GSHD 0001737783 Jones Serena C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BLDG 4, STE 4500 WESTLAKE TX 76262 0 0 1 1 Member of 10% owner group Class B Common Stock 2020-11-24 4 C 0 200 0 D 864775 D Class A Common Stock 2020-11-24 4 C 0 200 0 A 200 D Class A Common Stock 2020-11-24 4 S 0 200 123.28 D 0 D LLC Units in Goosehead Financial, LLC 0.0 2020-11-24 4 C 0 200 0 D Class A Common Stock 200.0 864775 D 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/ P. Ryan Langston, as Attorney-in-Fact for Serena Jones 2020-11-30