0001726978-23-000081.txt : 20230628 0001726978-23-000081.hdr.sgml : 20230628 20230628184037 ACCESSION NUMBER: 0001726978-23-000081 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230626 FILED AS OF DATE: 20230628 DATE AS OF CHANGE: 20230628 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SLJ 2023 Grantor Retained Annuity Trust CENTRAL INDEX KEY: 0001983108 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 231053799 BUSINESS ADDRESS: STREET 1: 1500 SOLANA BOULEVARD STREET 2: SUITE 4500 CITY: WESTLAKE STATE: TX ZIP: 76262 BUSINESS PHONE: 214-838-5500 MAIL ADDRESS: STREET 1: 1500 SOLANA BOULEVARD STREET 2: 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 3 1 wk-form3_1687992027.xml FORM 3 X0206 3 2023-06-26 0 0001726978 Goosehead Insurance, Inc. GSHD 0001983108 SLJ 2023 Grantor Retained Annuity Trust 1500 SOLANA BOULEVARD, SUITE 4500 WESTLAKE TX 76262 0 0 1 1 Member of 10% owner group Class B Common Stock 161094 D LLC Units in Goosehead Financial, LLC 0 Class A Common Stock 161094 D The reporting person disclaims beneficial ownership of the securities reported herein except to the extent of its pecuniary interest in them. 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. By virtue of being party to a Voting Agreement, dated February 24, 2021 (the "Voting Agreement"), the reporting person on this Form 3 may be deemed to be a member of a "group" for purposes of Section 13(d) of the Securities Exchange Act of 1934, as amended, with respect to the securities reported herein with the other parties who continue to be bound by the Voting Agreement, which such "group" beneficially owns, in the aggregate, more than 10% of the outstanding shares of Class A Common Stock. Together with the reporting person on this Form 3, the parties to the Voting Agreement are Mark and Robyn Jones Descendants Trust 2014, Mark E. Jones, Robyn Jones, Lanni Romney, Lindy Langston, Camille Peterson, Desiree Coleman, Adrienne Jones, Mark Jones Jr., Lannie Elaine Romney Family Trust 2014, Lindy Jean Langston Family Trust 2014, Camille LaVaun Peterson Family Trust 2014, Desiree Robyn Coleman Family Trust 2014, Adrienne Morgan Jones Family Trust 2014, Mark Evan Jones Jr. Family Trust 2014, Serena Jones, P. Ryan Langston, SLJ Dynasty Trust, Jones 2020 Irrevocable Trust, Ryan Langston 2021 Family Trust, Nathan Scott Romney, Nathan Romney 2021 Family Trust, Lindy Langston Spousal Lifetime Access Trust, Lanni Romney Spousal Lifetime Access Trust, CP Descendants' Trust, and Chick & The Bear Irrevocable Trust. /s/ Mark E. Jones as Attorney-in-Fact for SLJ 2023 Grantor Retained Annuity Trust 2023-06-28