X0306 4 2020-05-06 0 0001453593 Xtant Medical Holdings, Inc. XTNT 0001055951 ORBIMED ADVISORS LLC 601 LEXINGTON AVENUE 54TH FLOOR NEW YORK NY 10022 1 0 1 0 0001767936 Orbimed ROF II LLC 601 LEXINGTON AVE., 54TH FLOOR NEW YORK NY 10022 1 0 1 0 Warrant (right to buy) 0.01 2020-05-06 4 A 0 1531984 A 2020-11-06 2030-05-06 Common Stock 1531984 1531984 I See footnotes Warrant (right to buy) 0.01 2020-05-06 4 A 0 868016 A 2020-11-06 2030-05-06 Common Stock 868016 868016 I See footnotes This warrant was issued by Xtant Medical Holdings, Inc. in connection with that certain First Amendment to Second Amended and Restated Credit Agreement, effective as of April 1, 2020. Only represents derivative securities of this class. These securities are held of record by ROS Acquisition Offshore LP ("ROS Acquisition"). OrbiMed Advisors LLC ("Advisors"), a registered investment adviser under the Investment Advisors Act of 1940, as amended, is the investment manager of ROS Acquisition. Advisors is also the investment manager of Royalty Opportunities S.a r.l., of which ROS Acquisition is a wholly-owned subsidiary. By virtue of such relationships, Advisors may be deemed to have voting and investment power with respect to the securities held by ROS Acquisition noted above and as a result may be deemed to have beneficial ownership over such securities. Advisors exercises its investment and voting power through a management committee comprised of Carl L. Gordon, Sven H. Borho, and Jonathan T. Silverstein, each of whom disclaims beneficial ownership of the securities held by ROS Acquisition. This report on Form 4 is jointly filed by Advisors and OrbiMed ROF II LLC ("ROF II"). Each of ROS Acquisition and OrbiMed Royalty Opportunities II, LP ("ORO II") disclaims beneficial ownership of the securities reported herein for purposes of Rule 16a-1(a) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), except to the extent of its pecuniary interest therein, if any. Advisors has designated certain representatives, including Matthew Rizzo and Michael Eggenberg, both of whom are employees of Advisors, to serve on Xtant's board of directors. This report shall not be deemed an admission that any such entity is a beneficial owner of such securities for the purposes of Section 16 of the Exchange Act or for any other purposes. These securities are held of record by ORO II. ROF II is the general partner of ORO II, and Advisors is the managing member of ROF II. By virtue of such relationships, Advisors may be deemed to have voting and investment power with respect to the securities held by ORO II noted above and as a result may be deemed to have beneficial ownership over such securities. Advisors exercises its investment and voting power through a management committee comprised of Carl L. Gordon, Sven H. Borho, and Jonathan T. Silverstein, each of whom disclaims beneficial ownership of the securities held by ORO II. /s/ Sven H. Borho, Member of OrbiMed Advisors LLC 2020-05-20 /s/ Sven H. Borho, Member of OrbiMed Advisors LLC, the managing member of OrbiMed ROF II LLC 2020-05-20