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