0001726978-23-000176.txt : 20231130 0001726978-23-000176.hdr.sgml : 20231130 20231130185654 ACCESSION NUMBER: 0001726978-23-000176 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 Patrick Ryan CENTRAL INDEX KEY: 0001736766 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 231457068 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: Ryan Langston 2021 Family Trust CENTRAL INDEX KEY: 0001849883 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38466 FILM NUMBER: 231457069 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_1701388603.xml FORM 4 X0508 4 2023-11-28 0 0001726978 Goosehead Insurance, Inc. GSHD 0001849883 Ryan Langston 2021 Family Trust 1500 SOLANA BOULEVARD STE 4500 WESTLAKE TX 76262 0 0 1 1 Member of 10% owner group 0001736766 Langston Patrick Ryan 1500 SOLANA BLVD BUILDING 4, SUITE 4500 WESTLAKE TX 76262 0 1 1 1 Chief Legal Officer Member of 10% owner group 0 Class B Common Stock 2023-11-28 4 C 0 100 0 D 82400 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 0 513 0 D 81887 D Class A Common Stock 2023-11-29 4 C 0 513 0 A 513 D Class A Common Stock 2023-11-29 4 S 0 513 74 D 0 D Class A Common Stock 5000 D Class B Common Stock 5 D LLC Units in Goosehead Financial, LLC 0 2023-11-28 4 C 0 100 0 D Class A Common Stock 100 82400 D LLC Units in Goosehead Financial, LLC 0 2023-11-29 4 C 0 513 0 D Class A Common Stock 513 81887 D LLC Units in Goosehead Financial, LLC 0 Class A Common Stock 5 5 D Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held (i) directly by the Ryan Langston 2021 Family Trust and (ii) indirectly by Patrick Ryan Langston, who serves as trustee of the Ryan Langston 2021 Family Trust and whose immediate family members are beneficiaries of the Ryan Langston 2021 Family Trust. Reflects shares of Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held directly by Patrick Ryan Langston, and does not reflect Class A Common Stock, shares of Class B Common Stock or LLC Units, as applicable, held by his 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 Ryan Langston 2021 Family Trust 2023-11-30 /s/ John O'Connor, as Attorney-in-Fact for Patrick Ryan Langston 2023-11-30