SEC Form 4 · accession 0001726978-18-000028
Goosehead Insurance, Inc. · GSHD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Evan Jones
Officer — CEO · Director · 10% Owner · Other
Period of report
Nov 27, 2018
Accepted (ET)
Nov 29, 2018 · 10:48 am EST
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 A Common Stock | Nov 27, 2018 | G | 8,573 | $0.00 | D | 749,317 | D | |
| Class B Common StockF1 | holding | — | — | — | 182,349 | D | ||
| Class B Common StockF2 | holding | — | — | — | 15,188,926 | I | By Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LLC Units in Goosehead Financial, LLCF2,F3 | $0.00 | holding | — | — | — | — | — | Class A Common Stock | 15,188,926 | 15,188,926 | I |
| LLC Units in Goosehead Financial, LLCF1,F3 | $0.00 | holding | — | — | — | — | — | Class A Common Stock | 182,349 | 182,349 | D |
Explanation of responses
- F1Reflects the distribution of shares acquired through the dissolution of Texas Wasatch Insurance Partners, LP, which was not a reportable transaction.
- F2Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held in trust for which the reporting person serves as a trustee and of which immediate family members of the reporting person are beneficiaries.
- F3Each 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.