SEC Form 4 · accession 0001726978-18-000033
Goosehead Insurance, Inc. · GSHD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael Patrick Moxley
Officer — VP of Service Delivery
Period of report
Nov 29, 2018
Accepted (ET)
Nov 30, 2018 · 6:41 pm 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 B Common StockF1 | Nov 29, 2018 | C | 3,000 | $0.00 | D | 84,871 | D | |
| Class A Common Stock | Nov 29, 2018 | C | 3,000 | $0.00 | A | 40,137 | D | |
| Class A Common StockF2 | Nov 29, 2018 | S | 3,000 | $26.59 | D | 37,137 | D |
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, LLCF1,F3 | $0.00 | Nov 29, 2018 | C | 3,000 | D | — | — | Class A Common Stock | 3,000 | 84,871 | D |
Explanation of responses
- F1Reflects 87,871 shares of Class B Common Stock and LLC Units received pursuant to a pro rata distribution from Texas Wasatch Insurance Partners, LP.
- F2The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $26.32 to $26.87, 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.
- 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.