0001144204-16-111801.txt : 20160706 0001144204-16-111801.hdr.sgml : 20160706 20160706190716 ACCESSION NUMBER: 0001144204-16-111801 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160701 FILED AS OF DATE: 20160706 DATE AS OF CHANGE: 20160706 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: WICKWIRE JON M. CENTRAL INDEX KEY: 0001514546 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34951 FILM NUMBER: 161755184 MAIL ADDRESS: STREET 1: 600 CRUISER LANE CITY: BELGRADE STATE: MT ZIP: 59714 4 1 v443751_4.xml OWNERSHIP DOCUMENT X0306 4 2016-07-01 1 0001453593 Xtant Medical Holdings, Inc. XTNT 0001514546 WICKWIRE JON M. 664 CRUISER LANE BELGRADE MT 59714 0 0 0 1 Former Director Common Stock 2016-07-01 4 M 0 11764 0 A 43011 D Common Stock 23103 I By trust Common Stock 1330 I By trust Common Stock 1329 I By trust Restricted Stock Unit 2016-07-01 4 M 0 11764 0 D Common Stock 11764 0 D Each restricted stock unit converted into one share of common stock effective July 1, 2016. /s/ Jon M. Wickwire 2016-07-05