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