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