Form Type: 4

SEC EDGAR Link
Accession Number:0001726978-21-000165
Date:2021-08-26
Issuer: GOOSEHEAD INSURANCE, INC. (GSHD)
Original Submission Date:

Reporting Person:

COLBY MICHAEL C.
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BUILDING 4, STE 4500 WESTLAKE, TX 76262

Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
Title of SecurityTransaction Date2a. Deemed Execution Date Transaction CodeSharesAcquired or DisposedPrice per share 5. Amount of Securities Beneficially Owned Following Reported Transaction 6. Ownership Form Direct or IndirectNature of Indirect Ownership
CLASS B COMMON STOCK 2021-08-26 C 4,394 d $0.00 621,732 indirect f1
CLASS A COMMON STOCK 2021-08-26 C 4,394 a $0.00 87,796 indirect f1
CLASS A COMMON STOCK 2021-08-26 S 4,394 d $130.06 83,402 indirect f1
CLASS B COMMON STOCK 2021-08-26 0 $0.00 427,024 direct
CLASS A COMMON STOCK 2021-08-26 0 $0.00 23,131 direct
CLASS B COMMON STOCK 2021-08-26 0 $0.00 36,396 indirect f1
CLASS B COMMON STOCK 2021-08-26 0 $0.00 36,396 indirect f1
Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, convertible securities
Title of Derivative Security Conversion or Exercise Price of Derivative Security Transaction Date Deemed Execution Date Transaction Code Number of Derivative Securities Acquired (A) or Disposed of (D) Date ExercisableExpiration Date Title and Amount of Securities Underlying Derivative Security Price of Derivative Security Number of derivative Securities Beneficially Owned Following Reported Transaction(s) Ownership Form: Direct (D) or Indirect (I) Nature of Indirect Beneficial Ownership
LLC UNITS IN GOOSEHEAD FINANCIAL, LLC 0.0 2021-08-26 deemed execution date C 4,394 (d) class a common stock 4,394 $0.00 621,732 indirect by colby 2014 family trust
LLC UNITS IN GOOSEHEAD FINANCIAL, LLC 0.0 deemed execution date 0 ( ) class a common stock 427,024 $0.00 427,024 direct
LLC UNITS IN GOOSEHEAD FINANCIAL, LLC 0.0 deemed execution date 0 ( ) class a common stock 36,396 $0.00 36,396 indirect by lyla kate colby 2014 trust
LLC UNITS IN GOOSEHEAD FINANCIAL, LLC 0.0 deemed execution date 0 ( ) class a common stock 36,396 $0.00 36,396 indirect by preston michael colby 2014 trust
Footnotes
IDfootnote
f1 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.
f2 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.
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