Sec Form 4 Filing - Lindy Langston Spousal Lifetime Access Trust @ Goosehead Insurance, Inc. - 2023-11-28

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Lindy Langston Spousal Lifetime Access Trust
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
(Last) (First) (Middle)
1500 SOLANA BOULEVARD, STE 4500
3. Date of Earliest Transaction (MM/DD/YY)
11/28/2023
(Street)
WESTLAKE, TX76262
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Lindy Langston Spousal Lifetime Access Trust
1500 SOLANA BOULEVARD
STE 4500
WESTLAKE, TX76262
X Member of 10% owner group
Langston Lindy
C/O GOOSEHEAD INSURANCE, INC.
1500 SOLANA BLVD., BLDG 4, STE 4500
WESTLAKE, TX76262
X Member of 10% owner group
Signatures
/s/ John O'Connor, as Attorney-in-Fact for Lindy Langston 11/30/2023
Signature of Reporting Person Date
/s/ John O'Connor, as Attorney-in-Fact for the Lindy Langston Spousal Lifetime Access Trust 11/30/2023
Signature of Reporting Person Date
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.

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).

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