0001382963-15-000102.txt : 20150807
0001382963-15-000102.hdr.sgml : 20150807
20150807204221
ACCESSION NUMBER: 0001382963-15-000102
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: Kenneth J. Hemmelgarn, Jr. Revocable Living Trust dated February 9, 1998, as amended
CENTRAL INDEX KEY: 0001650009
STATE OF INCORPORATION: FL
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34951
FILM NUMBER: 151038996
BUSINESS ADDRESS:
STREET 1: 9485 GULFSHORE DRIVE
STREET 2: B-201
CITY: NAPLES
STATE: FL
ZIP: 34108
BUSINESS PHONE: (937) 609-2245
MAIL ADDRESS:
STREET 1: 9485 GULFSHORE DRIVE
STREET 2: B-201
CITY: NAPLES
STATE: FL
ZIP: 34108
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hemmelgarn Kenneth J. Jr.
CENTRAL INDEX KEY: 0001650002
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-34951
FILM NUMBER: 151038997
MAIL ADDRESS:
STREET 1: 9485 GULFSHORE DRIVE
STREET 2: B-201
CITY: NAPLES
STATE: FL
ZIP: 34108
3
1
edgar.xml
PRIMARY DOCUMENT
X0206
3
2015-07-31
0
0001453593
Xtant Medical Holdings, Inc.
BONE
0001650002
Hemmelgarn Kenneth J. Jr.
9485 GULFSHORE DRIVE
B-201
NAPLES
FL
34108
0
0
1
0
0001650009
Kenneth J. Hemmelgarn, Jr. Revocable Living Trust dated February 9, 1998, as amended
9485 GULFSHORE DRIVE
B-201
NAPLES
FL
34108
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 Kenneth J. Hemmelgarn, Jr. 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/ Kenneth J. Hemmelgarn, Jr., individually and as sole trustee of the Kenneth J. Hemmelgarn, Jr. Revocable Living Trust dated February 9, 1998, as amended
2015-08-07