0001726978-21-000112.txt : 20210601
0001726978-21-000112.hdr.sgml : 20210601
20210601165835
ACCESSION NUMBER: 0001726978-21-000112
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210528
FILED AS OF DATE: 20210601
DATE AS OF CHANGE: 20210601
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Burks Drew
CENTRAL INDEX KEY: 0001737235
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38466
FILM NUMBER: 21986143
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_162258109603981.xml
FORM 4
X0306
4
2021-05-28
0
0001726978
Goosehead Insurance, Inc.
GSHD
0001737235
Burks Drew
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BLDG 4, SUITE 4500
WESTLAKE
TX
76262
0
1
0
0
Chief Information Officer
Class A Common Stock
2021-05-28
4
M
0
1000
10
A
1039
D
Class A Common Stock
2021-05-28
4
S
0
1000
90.69
D
39
D
Employee Stock Options
10.0
2021-05-28
4
M
0
1000
0
D
2028-04-26
Class A Stock
1000.0
34500
D
One third (1/3rd) of the shares subject to the option shall vest and become exercisable, subject to continued employment, on each of the second, third and fourth anniversaries of the grant date; provided, that all shares subject to the option will vest and become exercisable if Mr. Burks' employment is terminated without "cause" or for "good reason" (each as defined in either Mr. Burks' option award agreement or the issuer's omnibus incentive plan) within six month following a "change in control" (as defined in the issuer's omnibus incentive plan).
/s/ P. Ryan Langston, as Attorney-in-Fact for Drew Burks
2021-06-01