0001726978-23-000174.txt : 20231129
0001726978-23-000174.hdr.sgml : 20231129
20231129183339
ACCESSION NUMBER: 0001726978-23-000174
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231127
FILED AS OF DATE: 20231129
DATE AS OF CHANGE: 20231129
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: 231453596
MAIL ADDRESS:
STREET 1: 1500 SOLANA BLVD
STREET 2: BUILDING 4, SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SLJ Dynasty Trust
CENTRAL INDEX KEY: 0001849957
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38466
FILM NUMBER: 231453597
BUSINESS ADDRESS:
STREET 1: 1500 SOLANA BOULEVARD
STREET 2: SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
BUSINESS PHONE: 2148385500
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
4
1
wk-form4_1701300808.xml
FORM 4
X0508
4
2023-11-27
0
0001726978
Goosehead Insurance, Inc.
GSHD
0001849957
SLJ Dynasty Trust
1500 SOLANA BOULEVARD
STE 4500
WESTLAKE
TX
76262
0
0
1
1
Member of 10% owner group
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
0
Class B Common Stock
2023-11-27
4
C
0
28000
0
D
151246
D
Class A Common Stock
2023-11-27
4
C
0
28000
0
A
28000
D
Class A Common Stock
2023-11-27
4
S
0
27700
74.47
D
300
D
Class A Common Stock
2023-11-27
4
S
0
300
74.99
D
0
D
Class B Common Stock
370442
D
Class B Common Stock
161094
I
SLJ 2023 Grantor Retained Annuity Trust
LLC Units in Goosehead Financial, LLC
0
2023-11-27
4
C
0
28000
0
D
Class A Common Stock
28000
151246
D
LLC Units in Goosehead Financial, LLC
0
Class A Common Stock
370442
370442
D
LLC Units in Goosehead Financial, LLC
0
Class A Common Stock
161094
161094
I
SLJ 2023 Grantor Retained Annuity Trust
Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held directly by the SLJ Dynasty Trust, in which Serena Jones has a pecuniary interest.
The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $73.95 to $74.86, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote to this Form 4.
Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held directly by Serena Jones.
Reflects shares of Class B Common Stock or LLC Units, as applicable, held indirectly by Serena Jones, who serves as a trustee and whose immediate family members are beneficiaries of SLJ 2023 Grantor Retained Annuity Trust.
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/ John O'Connor, Attorney-in-Fact for SLJ Dynasty Trust
2023-11-29
/s/ John O'Connor, as Attorney-in-Fact for Serena Jones
2023-11-29