Document:

Exhibit 4.7

 

Subscription Rights Statement

 

IMPORTANT: Retain a copy of this statement
for your investment, tax and cost-basis records.

 

	Account Summary	Subscription Rights	
        [Date]

        Account # 9999999999

 

 

 

THE TERMS AND CONDITIONS OF THE RIGHTS
OFFERING ARE SET FORTH IN THE COMPANY’S PROSPECTUS DATED , 2016 (THE “PROSPECTUS”) AND ARE INCORPORATED
HEREIN BY REFERENCE. COPIES OF THE PROSPECTUS ARE AVAILABLE THROUGH THE SEC’S INTERNET SITE AT HTTP://WWW.SEC.GOV
AND AS SET FORTH IN THE “INSTRUCTIONS AS TO USE OF XTANT MEDICAL HOLDINGS, INC. RIGHTS STATEMENT” ACCOMPANYING THIS
RIGHTS STATEMENT.

 

THE SUBSCRIPTION RIGHTS WILL EXPIRE
IF NOT EXERCISED ON OR BEFORE 5:00 P.M., EASTERN TIME, ON            , 2016, SUBJECT TO EXTENSION OR EARLIER TERMINATION

 

THIS CERTIFIES THAT the registered owner
whose name is inscribed hereon and is the owner of the number of subscription rights (“Subscription Rights”)
set forth above. Each Subscription Right entitles the holder thereof to subscribe for and purchase (the “Basic Subscription
Right”) one Unit of Xtant Medical Holdings, Inc., a Delaware corporation, at a subscription price of $ per Unit (the
“Subscription Price”), pursuant to a rights offering (the “Rights Offering”), on the terms
and subject to the conditions set forth in the Prospectus and the “Instructions as to Use of Xtant Medical Holdings, Inc.
Subscription Rights Statement” accompanying this Rights Statement. Each Unit consists of one share of common stock, par value
of $0.000001 (“Common Stock”), and of a warrant (“Warrant”) representing the right to purchase
one share of Common Stock. Holders who fully exercise their Basic Subscription Rights are entitled to subscribe for additional
Units that remain unsubscribed for as a result of any unexercised Basic Subscription Rights pursuant to the terms and conditions
of the Rights Offering, subject to proration, as described in the Prospectus (the “Over-subscription Privilege”).
The Subscription Rights represented by this Rights Statement may be exercised by completing the appropriate forms on the reverse
side hereof and by returning the full payment of the subscription price for each Unit. If the subscriber attempts to exercise its
Over-subscription Privilege and the Company is unable to issue the subscriber the full amount of Units requested, the Subscription
Agent will return to the subscriber any excess funds submitted as soon as practicable, without interest or deduction. The Subscription
Rights may be exercised by duly completing Section 1 on the reverse side hereof and by returning the full payment of the exercise
price. THE RIGHTS EVIDENCED BY THIS RIGHTS STATEMENT MAY NOT BE EXERCISED UNLESS THE REVERSE SIDE HEREOF IS PROPERLY COMPLETED
AND DULY SIGNED, WITH A SIGNATURE MEDALLION GUARANTEE, IF APPLICABLE.

 

     

     

    

 

By completing and delivering this rights
statement, the registered owner represents and warrants that they have the right, power and authority, and have taken all action
necessary, to exercise these rights pursuant to the rights offering and to execute, deliver and exercise the Subscription Rights,
and that they are not a person otherwise prevented by legal or regulatory restrictions from exercising or acting on behalf of any
such person on a non-discretionary basis.

 

		o	Please
change my address as indicated.

All registered holders MUST sign in Section 2 on reverse of statement.

 

 

 

SECTION 1. EXERCISE OF RIGHTS TO PURCHASE

 

The registered holder of this Subscription
Rights Certificate is entitled to exercise the number of Subscription Rights shown in the upper right hand corner of the Rights
Statement and may subscribe for additional Units upon the terms and conditions specified in the Prospectus. The undersigned hereby
notifies the Subscription Agent of its irrevocable election to subscribe for Units in the following amounts. To subscribe for Units
pursuant to your Basic Subscription Right, please complete lines (a) and (c) below. To subscribe for additional Units pursuant
to your Over-subscription Privilege, please also complete line (b).

 

		(a)	EXERCISE OF BASIC SUBSCRIPTION RIGHT:

 

	Basic Subscription Right:	 	X	$	=	$
	Number of Units	 	Subscription price	 	Payment enclosed

 

		(b)	EXERCISE OF OVER-SUBSCRIPTION PRIVILEGE: If you
have exercised your Basic Subscription Right in full, you may subscribe for additional Units pursuant to your Over-subscription
Privilege

 

	Over Subscription Privilege:	 	X	$	=	$
	Number of Units	 	Subscription price	 	Payment enclosed

 

		(c)	OWNERSHIP LIMITATION; PRE-FUNDED WARRANTS: If you
do not want your subscription for Units to result in beneficial ownership of common stock above 4.99% of the common stock outstanding
after the Rights Offering and wish to receive Pre-Funded Warrants in lieu of any common stock in excess of those thresholds, please
complete the following and contact the dealer-manager in accordance with the “Instructions as to Use of Xtant Medical Holdings,
Inc. Subscription Rights Statement.”

 

		o	I
wish to receive Pre-Funded Warrants in lieu of any common stock in excess of 4.99% of the common stock outstanding after the Rights
Offering.

 

		(d)	If you spoke with a broker who solicited your exercise,
please indicate the name of the person you spoke with: ______________

 

Method
of Payment: 

 

A cashier’s check,
drawn on a U.S. bank payable to “Corporate Stock Transfer, Inc.”.

 

Wire transfer of immediately
available funds directly to the account maintained by Corporate Stock Transfer, Inc., as Subscription Agent for purposes of accepting
subscriptions in this Rights Offering at Corporate Stock Transfer, Inc., ABA           , Credit: Stock Transfer Clearing Account           , For further
credit to Xtant Medical Holdings, Inc., and name of Subscription Rights holder.

 

     

     

    

 

FULL PAYMENT MUST ACCOMPANY
THIS FORM AND MUST BE MADE IN UNITED STATES DOLLARS BY A CASHIER’S CHECK DRAWN A U.S. BANK PAYABLE TO THE RIGHTS AGENT OR
A WIRE TRANSFER MUST BE RECEIVED IN ACCORDANCE WITH THE ENCLOSED INSTRUCTIONS. PERSONAL CHECKS WILL NOT BE ACCEPTED.

 

SECTION 2. SIGNATURE(S)

 

IMPORTANT: THE SIGNATURE(S) MUST CORRESPOND
IN EVERY PARTICULAR, WITHOUT ALTERATION, WITH THE NAME(S) AS PRINTED ON THE FRONT OF THIS RIGHTS STATEMENT. IF YOU ARE SIGNING
ON BEHALF OF A REGISTERED STOCKHOLDER OR ENTITY YOU MUST SIGN IN YOUR LEGAL CAPACITY WITH YOUR SIGNATURE MEDALLION GUARANTEED.
YOUR GUARANTOR (BANK/BROKER) WILL REQUIRE PROOF OF YOUR AUTHORITY TO ACT. CONSULT YOUR GUARANTOR FOR THEIR SPECIFIC REQUIREMENTS.
YOU OR YOUR GUARANTOR MAY ACCESS THE SECURITIES TRANSFER ASSOCIATION (STA) RECOMMENDED REQUIREMENTS ON-LINE AT www.stai.org.

 

 

	 	 	APPLY MEDALLION GUARANTEE STAMP HERE
	 	 	 
	Signature(s) of Subscriber(s)	 	 
	 	 	 
	 	 	 
	Names(s):	 	 
	 	 	 
	 	 	 
	Capacity (Full Title):	 	 

 

 

OVERNIGHT DELIVERY TO THE STREET ADDRESS
BELOW BEST ENSURES RECEIPT BY THE EXPIRATION DATE.

 

Return this statement to

 

By Mail or Courier or Hand-Delivery to:

 

Corporate Stock Transfer, Inc.

3200 Cherry Creek Drive South, Suite 430

Denver, Colorado 80209Exhibit

EXHIBIT 10.1
 WAIVER

This Waiver (the “Waiver”), dated as of August 22, 2016, is hereby executed by Dominion Capital LLC (“Dominion”) and JRjr33, Inc. (formerly known as CVSL Inc. (“CVSL” and together with JRjr33, Inc., the “Company”)). 

WHEREAS, CVSL issued that certain 9.75% Senior Secured Convertible Note (the “Note”) in the aggregate original principal amount of $4,000,000 to Dominion (or its registered assigns) on November 20, 2016. Unless otherwise defined herein, each capitalized term defined herein shall have the meaning set forth in the Note.

WHEREAS, pursuant to the terms of Note, the Company is required to timely file its Quarterly Report on Form 10-Q for the quarter ended June 30, 2016 (the “June Quarterly Report”) with the Securities and Exchange Commission the (“SEC”) pursuant to the Securities Exchange Act of 1934, as amended (the “Exchange Act”).

WHEREAS, pursuant to the terms of Note, the Company is required to timely file its Quarterly Report on Form 10-Q for the quarter ended September 30, 2016 (the “September Quarterly Report”) with the SEC pursuant to the Exchange Act.

WHEREAS, Section 17 of the Note provides, with limited exception, that the prior written consent of the Company and Holders of Notes representing at least sixty-five (65%) of the aggregate principal amount of the Notes then outstanding shall be required for any change, waiver or amendment to the Note, and that any change, waiver or amendment so approved shall be binding upon all existing and future holders of the Note.

NOW, THEREFORE, the Company and Dominion (as the sole Holder of the Note) acknowledge and agree as follows:

		
	1.
	Dominion hereby irrevocably waives any rights it may have as a Holder to deem the Company’s failure to timely file with the SEC the June Quarterly Report as an Event of Default under the Note, or to require any further notice to it under the Note in respect of same, such waiver to be effective for successive periods, each consisting of ten (10) Business Days), until the date the June Quarterly Report is filed with the SEC (the “June Waiver Period”), provided that the Company issues to Dominion 50,000 shares of the Company’s Common Stock for each such ten (10) day period required beyond August 22, 2016, which is the due date of the June Quarterly Report (without regard to whether the Company requires the full ten (10) Business Day period for any given extension).

Upon the filing of the June Quarterly Report with the SEC during the June Waiver Period (as it may be extended), the related Event of Default shall be cured as of the original SEC filing due date of the June Quarterly Report.

		
	2.
	Dominion hereby irrevocably waives any rights it may have as a Holder to deem the Company’s failure to timely file with the SEC the September Quarterly Report as an Event of Default under the Note, or to require any further notice to it under the Note in respect of same, such waiver to be effective for successive periods, each consisting of ten (10) Business Days), until the date the September Quarterly Report is filed with the SEC (the “September Waiver Period”), provided that the Company issues to Dominion 50,000 shares of the Company’s Common Stock for each such ten (10) day period required beyond November 21, 2016, which is the due date of the September Quarterly Report (without regard to whether the Company requires the full ten (10) Business Day period for any given extension).

Upon the filing of the September Quarterly Report with the SEC during the September Waiver Period (as it may be extended), the related Event of Default shall be cured as of the original SEC filing due date of the September Quarterly Report. 

		
	3.
	Dominion hereby irrevocably waives any rights it may have as a Holder to deem the Company’s failure to comply with any of the other covenants set forth in Section 14 of the Note as an Event of Default under the Note, or to require any further notice to it under the Note in respect of same; provided that the Company issues to Dominion 100,000 shares of the Company’s Common Stock and provided further that such waiver shall not apply to any compliance failures that occur after January 1, 2017.

		
	4.
	The definition of Installment Amount  as set forth in the Note is hereby amended as follows (any terms set forth below not otherwise defined shall have the meanings set forth in the Note): (w) “Installment Amount” means, with respect to any given Installment Date, the lesser of (x) the Conversion Amount of this Note as of such Installment Date and (y) the sum of (i) with respect to (A) any Installment Date occurring after February 1, 2015 and before January 19, 2017, Fifty Thousand Dollars ($50,000); (B) any Installment Date occurring on January 19, 2017 and before the Maturity Date, Three Hundred Twenty Five Thousand Dollars ($325,000); and (D) with respect to the 

Installment Date that is the Maturity Date, the Principal amount then outstanding under this Note as of such Installment Date, and (ii) the sum of any accrued and unpaid Interest as of such Installment Date under this Note, if any, and accrued and unpaid Late Charges, if any, under this Note as of such Installment Date (in each case, as any such Installment Amount may be reduced pursuant to the terms of this Note, whether upon conversion, redemption prepayment or otherwise and as applied against Installment Amounts scheduled hereunder in accordance with the written direction of the Holder or, in absence of such direction, as applied against the Installment Amount payable on the last Installment Date in which an Installment Amount then remains scheduled to be paid hereunder). In the event the Holder shall sell or otherwise transfer any portion of this Note, the transferee shall be allocated a pro rata portion of the each unpaid Installment Amount hereunder.
 
		
	5.
	Schedule 32(w) to the Note is hereby deleted in its entirety and replaced with the new Schedule A annexed hereto.

		
	6.
	The Company represents and warrants to Dominion that it has no disagreements with its auditors and expects and intends to complete the filing of the June Quarterly Report and September Quarterly Report at the earliest possible date, which the Company fully expects to be well in advance of any grace period allowed by the NYSE MKT LLC (the “NYSE”).

		
	7.
	Dominion acknowledges that all of the Company’s undertakings hereunder to issue any shares of its Common Stock to it are wholly subject to, and conditioned on attaining, NYSE approval.

[Signature page follows]

IN WITNESS WHEREOF, Dominion and the Company have executed this Waiver as of the date first written above. 

	
		
	 
	/s/ Mikhail Gurevich

	 
	Mikhail Gurevich

	 
	Managing Member

	 
	 

	 
	/s/ Christopher L. Brooks

	 
	Christopher L. Books

	 
	Chief Financial Officer

Schedule A
	
																
	JRJR33, Inc. (f/ka/ CVSL Inc.)
	 
	 
	 

	Adjusted Dominion Loan Amortization Schedule
	 
	 
	 

	Prepared on August 22, 2016
	 
	 
	 
	 

	 
	 
	 
	 
	 

	Date
	Beginning Balance
	Interest
	Interest Payment
	Principal Payment
	Ending Balance

	11/20/2015
	$
	—
	

	$
	—
	

	$
	—
	

	$
	—
	

	$
	4,000,000
	

	12/21/2015
	4,000,000
	

	32,500
	

	(32,500
	)
	—
	

	4,000,000
	

	1/20/2016
	4,000,000
	

	32,500
	

	(32,500
	)
	—
	

	4,000,000
	

	2/19/2016
	4,000,000
	

	32,500
	

	(32,500
	)
	—
	

	4,000,000
	

	3/18/2016
	4,000,000
	

	32,500
	

	(32,500
	)
	(50,000
	)
	3,950,000
	

	4/18/2016
	3,950,000
	

	32,094
	

	(32,094
	)
	(50,000
	)
	3,900,000
	

	5/18/2016
	3,900,000
	

	31,688
	

	(31,688
	)
	(50,000
	)
	3,850,000
	

	6/20/2016
	3,850,000
	

	31,281
	

	(31,281
	)
	(50,000
	)
	3,800,000
	

	7/20/2016
	3,800,000
	

	30,875
	

	(30,875
	)
	(50,000
	)
	3,750,000
	

	8/19/2016
	3,750,000
	

	30,469
	

	(30,469
	)
	(50,000
	)
	3,700,000
	

	9/19/2016
	3,700,000
	

	30,063
	

	(30,063
	)
	(50,000
	)
	3,650,000
	

	10/19/2016
	3,650,000
	

	29,656
	

	(29,656
	)
	(50,000
	)
	3,600,000
	

	11/18/2016
	3,600,000
	

	29,250
	

	(29,250
	)
	(50,000
	)
	3,550,000
	

	12/19/2016
	3,550,000
	

	28,844
	

	(28,844
	)
	(50,000
	)
	3,500,000
	

	1/19/2017
	3,500,000
	

	28,438
	

	(28,438
	)
	(325,000
	)
	3,175,000
	

	2/21/2017
	3,175,000
	

	25,797
	

	(25,797
	)
	(325,000
	)
	2,850,000
	

	3/21/2017
	2,850,000
	

	23,156
	

	(23,156
	)
	(325,000
	)
	2,525,000
	

	4/21/2017
	2,525,000
	

	20,516
	

	(20,516
	)
	(325,000
	)
	2,200,000
	

	5/19/2017
	2,200,000
	

	17,875
	

	(17,875
	)
	(2,200,000
	)
	—

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