0001382963-15-000099.txt : 20150807
0001382963-15-000099.hdr.sgml : 20150807
20150807203218
ACCESSION NUMBER: 0001382963-15-000099
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150731
FILED AS OF DATE: 20150807
DATE AS OF CHANGE: 20150807
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: 600 CRUISER LANE
CITY: BELGRADE
STATE: MT
ZIP: 59714
BUSINESS PHONE: 406-388-0480
MAIL ADDRESS:
STREET 1: 600 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: Brian J. Hemmelgarn Revocable Living Trust dated February 9, 1998, as amended
CENTRAL INDEX KEY: 0001650008
STATE OF INCORPORATION: FL
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34951
FILM NUMBER: 151038980
BUSINESS ADDRESS:
STREET 1: PO BOX 421
STREET 2: 15643 CAPTIVA DRIVE
CITY: CAPTIVA
STATE: FL
ZIP: 33924
BUSINESS PHONE: (937) 609-2245
MAIL ADDRESS:
STREET 1: PO BOX 421
STREET 2: 15643 CAPTIVA DRIVE
CITY: CAPTIVA
STATE: FL
ZIP: 33924
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hemmelgarn Brian J.
CENTRAL INDEX KEY: 0001650005
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34951
FILM NUMBER: 151038981
MAIL ADDRESS:
STREET 1: PO BOX 421
STREET 2: 15643 CAPTIVA DRIVE
CITY: CAPTIVA
STATE: FL
ZIP: 33924
3
1
edgar.xml
PRIMARY DOCUMENT
X0206
3
2015-07-31
0
0001453593
Xtant Medical Holdings, Inc.
BONE
0001650005
Hemmelgarn Brian J.
PO BOX 421
15643 CAPTIVA DRIVE
CAPTIVA
FL
33924
0
0
1
0
0001650008
Brian J. Hemmelgarn Revocable Living Trust dated February 9, 1998, as amended
PO BOX 421
15643 CAPTIVA DRIVE
CAPTIVA
FL
33924
0
0
1
0
Common Stock
1272796
I
By trust
The shares are currently held in escrow and subject to forfeiture to satisfy claims arising under the Stock Purchase Agreement dated July 27, 2015 whereby Xtant Medical Holdings, Inc. (formerly known as Bacterin International Holdings, Inc.) acquired all of the capital stock of X-spine Systems, Inc.
The shares are held by the Brian J. Hemmelgarn Revocable Living Trust dated February 9, 1998, as amended, which may be revoked by Mr. Hemmelgarn and of which Mr. Hemmelgarn is a beneficiary and the sole trustee.
/s/ Brian J. Hemmelgarn, individually and as sole trustee of the Brian J. Hemmelgarn Revocable Living Trust Dated February 9, 1998, as amended
2015-08-07