0001144204-16-136550.txt : 20161125 0001144204-16-136550.hdr.sgml : 20161125 20161125151510 ACCESSION NUMBER: 0001144204-16-136550 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161114 FILED AS OF DATE: 20161125 DATE AS OF CHANGE: 20161125 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Xtant Medical Holdings, Inc. CENTRAL INDEX KEY: 0001453593 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 205313323 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 664 CRUISER LANE CITY: BELGRADE STATE: MT ZIP: 59714 BUSINESS PHONE: 406-388-0480 MAIL ADDRESS: STREET 1: 664 CRUISER LANE CITY: BELGRADE STATE: MT ZIP: 59714 FORMER COMPANY: FORMER CONFORMED NAME: Bacterin International Holdings, Inc. DATE OF NAME CHANGE: 20100615 FORMER COMPANY: FORMER CONFORMED NAME: K KITZ INC DATE OF NAME CHANGE: 20090108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Goldberger Daniel S CENTRAL INDEX KEY: 0001382042 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34951 FILM NUMBER: 162018252 MAIL ADDRESS: STREET 1: 11400 W OLYMPIC BLVD STREET 2: SUITE 200 CITY: LOS ANGELES STATE: CA ZIP: 90064 4 1 v453905_4.xml OWNERSHIP DOCUMENT X0306 4 2016-11-14 0 0001453593 Xtant Medical Holdings, Inc. XTNT 0001382042 Goldberger Daniel S 664 CRUISER LANE BELGRADE MT 59714 1 1 0 0 Chief Executive Officer Common Stock 2016-11-17 4 X 0 120000 0.75 A 135510 D Common Stock 86522 I By IRA Subscription Rights (right to receive) 0.75 2016-11-14 4 X 0 120000 0 D 2016-10-31 2016-11-14 See footnote 120000 0 D Warrants (right to buy) 0.90 2016-11-17 4 X 0 120000 A 2016-11-17 2021-11-17 Common Stock 120000 120000 D The common stock and the warrants reported on this Form 4 were acquired pursuant to the exercise of subscription rights previously distributed by the Issuer to all holders of the Issuer's common stock and outstanding convertible notes. Each holder received 2 subscription rights per share of stock owned, and each right allowed the recipient to purchase one unit, consisting of one share of common stock and one warrant to purchase one share of common stock. The subscription price per unit was $0.75. Each warrant entitles the holder to purchase one share of the Company's common stock at an exercise price of $0.90 from the date of issuance through November 17, 2021. /s/ Daniel Goldberger 2016-11-25