Sec Form 3 Filing - Hemmelgarn Brian J. @ Xtant Medical Holdings, Inc. - 2015-07-31

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 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.
2. Issuer Name and Ticker or Trading Symbol
Xtant Medical Holdings, Inc. [ BONE]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
PO BOX 421, 15643 CAPTIVA DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
07/31/2015
(Street)
CAPTIVA, FL33924
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 1,272,796 ( 1 ) I By trust ( 2 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Hemmelgarn Brian J.
PO BOX 421
15643 CAPTIVA D RIVE
CAPTIVA, FL33924
X
Brian J. Hemmelgarn Revocable Living Trust dated February 9, 1998, as amended
PO BOX 421
15643 CAPTIVA DRIVE
CAPTIVA, FL33924
X
Signatures
/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
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.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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