Goosehead Insurance, Inc. — Director's Dealing 2021

Feb 12, 2021

SEC Form 5 — Annual Statement of Changes in Beneficial Ownership

Issuer: Goosehead Insurance, Inc. (GSHD)
CIK: 0001726978
Period of Report: 2020-12-31

Reporting Person: Jones Serena (10% Owner, Member of 10% owner group)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2020-12-29	Class B Common Stock	G	97943	—	Disposed	727031	Direct
2020-12-29	Class B Common Stock	G	97943	—	Acquired	97943	Indirect

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2020-12-29	LLC Units in Goosehead Financial, LLC	$0.0	G	97943	Disposed		Class A Common Stock (97943.0)	Direct
2020-12-29	LLC Units in Goosehead Financial, LLC	$0.0	G	97943	Acquired		Class A Common Stock (97943.0)	Indirect

Footnotes

F1: This transaction involved a gift of securities by the reporting person to the SLJ Dynasty Trust.

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.