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