0001235802-18-000155.txt : 20181015 0001235802-18-000155.hdr.sgml : 20181015 20181015160808 ACCESSION NUMBER: 0001235802-18-000155 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20181015 FILED AS OF DATE: 20181015 DATE AS OF CHANGE: 20181015 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mainelli Michael CENTRAL INDEX KEY: 0001315983 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34951 FILM NUMBER: 181122321 MAIL ADDRESS: STREET 1: C/O ORTHOFIX INTERNATIONAL N. V. STREET 2: 3451 PLANO PARKWAY CITY: LEWISVILLE STATE: TX ZIP: 75056 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2018-10-15 0 0001453593 Xtant Medical Holdings, Inc. XTNT 0001315983 Mainelli Michael 664 CRUISER LANE BELGRADE MT 59714 1 1 0 0 Interim CEO Common Stock, $0.000001 par value 20833 D Stock Option (right to buy) 3.22 2018-10-15 4 A 0 240000 0 A 2028-10-15 Common Stock 240000 240000 D These shares are subject to vesting pursuant to a restricted stock award granted under the Amended and Restated Xtant Medical Equity Incentive Plan. This option vests with respect to 10,000 of the shares subject to the option on the 15th day of each of the twenty-four (24) months commencing on November 15, 2018, subject to such Reporting Person's continued employment as Chief Executive Officer of Xtant Medical Holdings, Inc. /s/ Amy Culbert, attorney-in-fact 2018-10-15 EX-24 2 poa-mainelli.txt POWER OF ATTORNEY POWER OF ATTORNEY MICHAEL MAINELLI With respect to holdings of and transactions in securities issued by Xtant Medical Holdings, Inc. (the Company), the undersigned hereby constitutes and appoints the officers of the Company listed on Schedule A attached hereto and as may be amended from time to time, or any of them signing singly, with full power of substitution and resubstitution, to act as the undersigned's true and lawful attorney-in-fact to: 1. execute for and on behalf of the undersigned, Forms 3, 4, and 5 in accordance with Section 16 of the Securities Exchange Act of 1934, as amended, any Form 144 in accordance with Rule 144 under the Securities Act of 1933, as amended, and the rules and regulations thereunder; 2. do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5 or Form 144 or complete and execute any amendment or amendments thereto, and timely file such forms with the United States Securities and Exchange Commission (the SEC) and any stock exchange or similar authority; and 3. take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in the discretion of such attorney-in- fact. The undersigned hereby grants to each such attorney- in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution and resubstitution or revocation, hereby ratifying and confirming all that such attorney-in- fact, or such attorney-in-facts substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. The undersigned hereby acknowledges that the attorneys- in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended, or Rule 144 of the Securities Act of 1933, as amended, and any similar law, rule or regulation. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 and Forms 144 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 1st day of August, 2018. /s/ Michael Mainelli Michael Mainelli Schedule A Individuals Appointed as Attorney-in-Fact with Full Power of Substitution and Resubstitution 1. Carl O'Connell, Chief Executive Officer 2. Jeffrey Peters, Chairman of the Board 3. Amy Culbert, Secretary 4. Thomas Letscher, Assistant Secretary