0001726978-23-000178.txt : 20231130
0001726978-23-000178.hdr.sgml : 20231130
20231130190000
ACCESSION NUMBER: 0001726978-23-000178
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231128
FILED AS OF DATE: 20231130
DATE AS OF CHANGE: 20231130
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Langston Lindy
CENTRAL INDEX KEY: 0001737765
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38466
FILM NUMBER: 231457076
MAIL ADDRESS:
STREET 1: 1500 SOLANA BLVD
STREET 2: BUILDING 4, SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lindy Langston Spousal Lifetime Access Trust
CENTRAL INDEX KEY: 0001850722
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38466
FILM NUMBER: 231457077
BUSINESS ADDRESS:
STREET 1: 1500 SOLANA BOULEVARD
STREET 2: SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
BUSINESS PHONE: 2148385500
MAIL ADDRESS:
STREET 1: 1500 SOLANA BOULEVARD
STREET 2: SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Goosehead Insurance, Inc.
CENTRAL INDEX KEY: 0001726978
STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1500 SOLANA BLVD
STREET 2: BUILDING 4, SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
BUSINESS PHONE: 214-838-5500
MAIL ADDRESS:
STREET 1: 1500 SOLANA BLVD
STREET 2: BUILDING 4, SUITE 4500
CITY: WESTLAKE
STATE: TX
ZIP: 76262
4
1
wk-form4_1701388791.xml
FORM 4
X0508
4
2023-11-28
0
0001726978
Goosehead Insurance, Inc.
GSHD
0001850722
Lindy Langston Spousal Lifetime Access Trust
1500 SOLANA BOULEVARD
STE 4500
WESTLAKE
TX
76262
0
0
1
1
Member of 10% owner group
0001737765
Langston Lindy
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BLDG 4, STE 4500
WESTLAKE
TX
76262
0
0
1
1
Member of 10% owner group
0
Class B Common Stock
2023-11-28
4
C
0
100
0
D
90170
D
Class A Common Stock
2023-11-28
4
C
0
100
0
A
100
D
Class A Common Stock
2023-11-28
4
S
0
100
74.05
D
0
D
Class B Common Stock
2023-11-29
4
C
0
514
0
D
89656
D
Class A Common Stock
2023-11-29
4
C
0
514
0
A
514
D
Class A Common Stock
2023-11-29
4
S
0
514
74
D
0
D
Class B Common Stock
215079
D
LLC Units in Goosehead Financial, LLC
0
2023-11-28
4
C
0
100
0
D
Class A Common Stock
100
90170
D
LLC Units in Goosehead Financial, LLC
0
2023-11-29
4
C
0
514
0
D
Class A Common Stock
514
89656
D
LLC Units in Goosehead Financial, LLC
0
Class A Common Stock
215079
215079
D
Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held (i) directly by the Lindy Langston Spousal Lifetime Access Trust and (ii) indirectly by Lindy Langston, who serves as trustee of the Lindy Langston Spousal Lifetime Access Trust and whose immediate family members are beneficiaries of the Lindy Langston Spousal Lifetime Access Trust.
Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held directly by Lindy Langston, and does not reflect Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held by her spouse, who is independently a reporting person of the issuer.
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.
/s/ John O'Connor, as Attorney-in-Fact for Lindy Langston
2023-11-30
/s/ John O'Connor, as Attorney-in-Fact for the Lindy Langston Spousal Lifetime Access Trust
2023-11-30