0001235802-19-000121.txt : 20190925 0001235802-19-000121.hdr.sgml : 20190925 20190925162946 ACCESSION NUMBER: 0001235802-19-000121 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190924 FILED AS OF DATE: 20190925 DATE AS OF CHANGE: 20190925 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Peters Jeffrey J CENTRAL INDEX KEY: 0001329814 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34951 FILM NUMBER: 191114522 MAIL ADDRESS: STREET 1: C/O EV3 INC. STREET 2: 4600 NATHAN LANE NORTH CITY: PLYMOUTH STATE: MN ZIP: 55442 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 2019-09-24 0 0001453593 Xtant Medical Holdings, Inc. XTNT 0001329814 Peters Jeffrey J 664 CRUISER LANE BELGRADE MT 59714 1 0 0 0 Common Stock, $0.000001 par value 2019-09-24 4 A 0 5555 0 A 31597 D These shares are subject to a restricted stock unit award granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan and will vest and become issuable on February 15, 2020, conditioned upon the reporting person remaining a director of Xtant through the vesting date. Includes 5,555 shares to be issued upon vesting pursuant to restricted stock unit award granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, conditioned upon the reporting person remaining a director of Xtant through the vesting date, and 13,021 shares issued as part of a restricted stock award granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, which shares are subject to forfeiture until vested. /s/ Amy Culbert, attorney-in-fact 2019-09-25