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