Xtant Medical (XTNT) Form 3 Xtant Medical / J. Hemmelgarn Revocable Living Trust dated February 9, 1998, as amended Brian ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Hemmelgarn Brian J.

(Last) (First) (Middle)

PO BOX 421

15643 CAPTIVA DRIVE

(Street)

CAPTIVA FL 33924

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
07/31/2015

3. Issuer Name and Ticker or Trading Symbol
Xtant Medical Holdings, Inc. [ BONE ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

	Form filed by One Reporting Person
X	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	1,272,796(1)	I	By trust(2)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares

1. Name and Address of Reporting Person^*

Hemmelgarn Brian J.

(Last) (First) (Middle)

PO BOX 421

15643 CAPTIVA DRIVE

(Street)

CAPTIVA FL 33924

(City) (State) (Zip)

1. Name and Address of Reporting Person^*

Brian J. Hemmelgarn Revocable Living Trust dated February 9, 1998, as amended

(Last) (First) (Middle)

PO BOX 421

15643 CAPTIVA DRIVE

(Street)

CAPTIVA FL 33924

(City) (State) (Zip)

Explanation of Responses:

1. 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.

2. 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.

Remarks:

	/s/ Brian J. Hemmelgarn, individually and as sole trustee of the Brian J. Hemmelgarn Revocable Living Trust Dated February 9, 1998, as amended	08/07/2015
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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