SEC Form 4 · accession 0000950103-18-005520
Goosehead Insurance, Inc. · GSHD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Drew Burks
Officer — Chief Information Officer
Period of report
Apr 26, 2018
Accepted (ET)
Apr 30, 2018 · 8:46 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001726978
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Options (right to buy)F1 | $10.00 | Apr 26, 2018 | A | 50,000 | A | — | Apr 26, 2028 | Class A Common Stock | 50,000 | 50,000 | D |
Explanation of responses
- F1One 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).