SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Lindy Langston Spousal Lifetime Access Trust

(Last) (First) (Middle)
1500 SOLANA BOULEVARD
STE 4500

(Street)
WESTLAKE TX 76262

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Goosehead Insurance, Inc. [ GSHD ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
3. Date of Earliest Transaction (Month/Day/Year)
11/28/2023
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class B Common Stock 11/28/2023 C 100 D $0 90,170 D(1)
Class A Common Stock 11/28/2023 C 100 A $0 100 D(1)
Class A Common Stock 11/28/2023 S 100 D $74.05 0 D(1)
Class B Common Stock 11/29/2023 C 514 D $0 89,656 D(1)
Class A Common Stock 11/29/2023 C 514 A $0 514 D(1)
Class A Common Stock 11/29/2023 S 514 D $74 0 D(1)
Class B Common Stock 215,079 D(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
LLC Units in Goosehead Financial, LLC $0 11/28/2023 C 100 (3) (3) Class A Common Stock 100 $0 90,170 D(1)
LLC Units in Goosehead Financial, LLC $0 11/29/2023 C 514 (3) (3) Class A Common Stock 514 $0 89,656 D(1)
LLC Units in Goosehead Financial, LLC $0 (3) (3) Class A Common Stock 215,079 215,079 D(2)
1. Name and Address of Reporting Person*
Lindy Langston Spousal Lifetime Access Trust

(Last) (First) (Middle)
1500 SOLANA BOULEVARD
STE 4500

(Street)
WESTLAKE TX 76262

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
1. Name and Address of Reporting Person*
Langston Lindy

(Last) (First) (Middle)
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BLDG 4, STE 4500

(Street)
WESTLAKE TX 76262

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
Explanation of Responses:
1. 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.
2. 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.
3. 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.
Remarks:
/s/ John O'Connor, as Attorney-in-Fact for Lindy Langston 11/30/2023
/s/ John O'Connor, as Attorney-in-Fact for the Lindy Langston Spousal Lifetime Access Trust 11/30/2023
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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