SEC Form 4 · accession 0000950103-18-005551
Goosehead Insurance, Inc. · GSHD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Evan Jones
Officer — Chief Executive Officer · Director
Period of report
Apr 26, 2018
Accepted (ET)
Apr 30, 2018 · 9:27 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001726978
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class B Common Stock | Apr 30, 2018 | A | 1 | $0.01 | A | 1 | D |
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 | 320,000 | A | — | Apr 26, 2028 | Class A Common Stock | 320,000 | 320,000 | D |
| LLC Units in Goosehead Financial, LLCF2 | $0.00 | Apr 30, 2018 | A | 1 | A | — | — | Class A Common Stock | 1 | 1 | 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. Jones' employment is terminated without "cause" or for "good reason" (each as defined in either Mr. Jones' 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).
- F2Each LLC Unit is coupled with a share of Class B Common stock and may collectively be converted by the holder into one share of Class A common stock at any time. The LLC Units do not expire.