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UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON , DC 20549 FORM 10 - K ( Mark One ) [ X ] ANNUAL REPORT PURSUANT TO SECTION 13 OR 15 ( d ) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31 , 2020 [ ] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15 ( d ) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from Commission file number : 001-34951 [ X ] to Delaware ( State or other jurisdiction of incorporation or organization ) Xtant Medical Holdings , Inc. ( Exact Name of Registrant as Specified in Its Charter ) 664 Cruiser Lane Belgrade , Montana ( Address of Principal Executive Offices ) or Securities registered pursuant to Section 12 ( b ) of the Act : ( 406 ) 388-0480 ( Registrant's Telephone Number , Including Area Code ) Large accelerated filer Non - accelerated filer Trading symbol ( s ) XTNT 20-5313323 ( IRS Employer Identification No. ) 59714 ( Zip Code ) Title of each class Common stock , par value $ .000001 per share Securities registered pursuant to Section 12 ( g ) of the Act : None Indicate by check mark if the registrant is a well - known seasoned issuer , as defined in Rule 405 of the Securities Act . Yes [ ] No [ X ] Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15 ( d ) of the Act . Yes [ ] No Name of each exchange on which registered NYSE American LLC Indicate by check mark whether the registrant ( 1 ) has filed all reports required to be filed by Section 13 or 15 ( d ) of the Securities Exchange Act of 1934 during the preceding 12 months ( or for such shorter period that the registrant was required to file such reports ) , and ( 2 ) has been subject to such filing requirements for the past 90 days . Yes [ X ] No [ ] Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S - T ( § 232.405 of this chapter ) during the preceding 12 months ( or for such shorter period that the registrant was required to submit such files ) . Yes [ X ] No [ ] [ ] [ X ] Indicate by check mark whether the registrant is a large accelerated filer , an accelerated filer , a non - accelerated filer , a smaller reporting company , or an emerging growth company . See the definitions of " large accelerated filer , " " accelerated filer , ” “ smaller reporting company " and " emerging growth company " in Rule 12b - 2 of the Exchange Act .: Accelerated filer Smaller reporting company Emerging growth company [ ] [ X ] [ ]