SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
Wilderness Trace Veterinary Partners, LLC

(Last) (First) (Middle)
780 LYNNHAVEN PARKWAY
SUITE 400

(Street)
VIRGINIA BEACH VA 23452

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/29/2023
3. Issuer Name and Ticker or Trading Symbol
INSPIRE VETERINARY PARTNERS, INC. [ IVP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class B Common Stock(1)(2)(3) 2,150,000 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock(1)(2)(3) (3) (3) Class A Common Stock 2,150,000 (3) I See footnote(3)
Explanation of Responses:
1. Shares of Class B common stock are held by Wilderness Trace Veterinary Partners, LLC, which is 100% owned and controlled by Charles Stith Keiser, the issuer's Director and Chief Operating Officer.
2. Following consummation of the initial public offering, Wilderness Trace Veterinary Partners, LLC owns no shares of Class A common stock, approximately 18.7% of all shares of common stock outstanding (Class A and Class B, collectively) and approximately 46.9% of the voting control of the registrant, prior to the conversion or election of any outstanding convertible securities or warrants of the issuer.
3. Each share of Class B common stock is entitled to the same rights applicable to each share of Class A common stock, except each share of Class B common stock is entitled to 25 votes per share of Class B common stock and is convertible at the option of the holder, at any time and from time to time, without the payment of additional consideration, into one share of Class A common stock.
Remarks:
Shares of Class B common stock are held by Wilderness Trace Veterinary Partners, LLC, which is 100% owned and controlled by Charles Stith Keiser, the registrant's Director and Chief Operating Officer
/s/ Charles Stith Keiser 09/27/2023
** 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 5 (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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