Statement of Changes in Beneficial Ownership (4)
September 03 2021 - 6:35PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Jones Mark E. Jr. |
2. Issuer Name and Ticker or Trading Symbol
Goosehead Insurance, Inc.
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GSHD
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) __X__ Other (specify below) Member of 10% owner group |
(Last)
(First)
(Middle)
C/O GOOSEHEAD INSURANCE, INC., 1500 SOLANA BLVD., BLDG 4, STE 4500 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/1/2021 |
(Street)
WESTLAKE, TX 76262
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class B Common Stock | 9/1/2021 | | C | | 5000 | D | $0 | 370553 | D | |
Class A Common Stock | 9/1/2021 | | C | | 5000 | A | $0 | 5000 | D | |
Class A Common Stock | 9/1/2021 | | S | | 5000 | D | $150.13 (1) | 0 | D | |
Class B Common Stock | 9/1/2021 | | C | | 5000 | D | $0 | 365553 | D | |
Class A Common Stock | 9/1/2021 | | C | | 5000 | A | $0 | 5000 | D | |
Class A Common Stock | 9/1/2021 | | S | | 2302 | D | $149.24 (2) | 2698 | D | |
Class A Common Stock | 9/1/2021 | | S | | 2698 | D | $150 (3) | 0 | D | |
Class B Common Stock | | | | | | | | 82005 | I | Jones 2020 Irrevocable Trust (4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
LLC Units in Goosehead Financial, LLC | $0.0 | 9/1/2021 | | C | | | 5000 | (5) | (5) | Class A Common Stock | 5000.0 | $0 | 370553 | D | |
LLC Units in Goosehead Financial, LLC | $0.0 | 9/1/2021 | | C | | | 5000 | (5) | (5) | Class A Common Stock | 5000.0 | $0 | 365553 | D | |
Explanation of Responses: |
(1) | This transaction was pursuant to a 10b5-1 plan. |
(2) | The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $148.72 to $149.71, 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. |
(3) | The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $149.77 to $150.22, 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. |
(4) | Reflects 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. |
(5) | 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. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Jones Mark E. Jr. C/O GOOSEHEAD INSURANCE, INC. 1500 SOLANA BLVD., BLDG 4, STE 4500 WESTLAKE, TX 76262 |
| X |
| Member of 10% owner group |
Signatures
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/s/ P. Ryan Langston, as Attorney-in-Fact for Camille Peterson | | 9/3/2021 |
**Signature of Reporting Person | Date |
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