EXHIBIT 10.1


 


TWENTIETH
AMENDMENT AND WAIVER TO AMENDED AND RESTATED CREDIT AGREEMENT


 


This TWENTIETH AMENDMENT
AND WAIVER TO AMENDED AND RESTATED CREDIT AGREEMENT (this “Amendment”) is made and entered into as of November
30, 2017 (the “Amendment Closing Date”) by and among Bacterin
International, Inc., a Nevada corporation (the “Borrower”), ROS
acquisition offshore lp, a Cayman Islands Exempted Limited Partnership (“ROS”), ORBIMED ROYALTY
OPPORTUNITIES II, LP, a Delaware limited partnership (“Royalty Opportunities”), and, in their capacity as
Guarantors under the Credit Agreement (as defined below), XTANT MEDICAL HOLDINGS, INC., a Delaware corporation (“Holdings”),
X-SPINE SYSTEMS, INC., an Ohio corporation (“X-Spine” or the “Additional Delayed Draw Borrower”
and, together with the Borrower, the “Borrowers”) and XTANT MEDICAL, INC., a Delaware corporation (“Xtant”
and, along with Holdings and X-Spine, collectively, the “Guarantors”).


 


WHEREAS, the Borrowers,
ROS and Royalty Opportunities are party to that certain Amended and Restated Credit Agreement, dated as of July 27, 2015, as amended
by that certain First Amendment to Amended and Restated Credit Agreement, dated as of March 31, 2016, that certain Second Amendment
to Amended and Restated Credit Agreement, dated as of May 25, 2016, that certain Third Amendment to Amended and Restated Credit
Agreement, dated as of June 30, 2016, that certain Fourth Amendment to Amended and Restated Credit Agreement, dated as of July
29, 2016, that certain Fifth Amendment to the Amended and Restated Credit Agreement, dated as of August 12, 2016, that certain
Sixth Amendment to the Amended and Restated Credit Agreement, dated as of September 27, 2016, that certain Seventh Amendment to
the Amended and Restated Credit Agreement, dated as of December 31, 2016, that certain Eighth Amendment to Amended and Restated
Credit Agreement, dated as of January 13, 2017, that certain Ninth Amendment to Amended and Restated Credit Agreement, dated as
of January 31, 2017, that certain Tenth Amendment to Amended and Restated Credit Agreement, dated as of February 14, 2017, that
certain Eleventh Amendment to Amended and Restated Credit Agreement, dated as of February 28, 2017, that certain Twelfth Amendment
and Waiver to Amended and Restated Credit Agreement, dated as of March 31, 2017, that certain Thirteenth Amendment to Amended and
Restated Credit Agreement, dated as of April 30, 2017, that certain Fourteenth Amendment to Amended and Restated Credit Agreement,
dated as of May 11, 2017, that certain Fifteenth Amendment to Amended and Restated Credit Agreement, dated as of June 30, 2017,
that certain Sixteenth Amendment to Amended and Restated Credit Agreement, dated as of July 15, 2017, that certain Seventeenth
Amendment and Waiver to Amended and Restated Credit Agreement, dated as of August 11, 2017, that certain Eighteenth Amendment to
Amended and Restated Credit Agreement, dated as of September 29, 2017, that certain Nineteenth Amendment to Amended and Restated
Credit Agreement, dated as of October 31, 2017 and that certain Waiver, dated as of November 14, 2017 (the “Credit Agreement”),
pursuant to which (i) ROS and Royalty Opportunities, as Lenders under the Credit Agreement, have extended credit to the Borrowers
on the terms set forth therein and (ii) each Lender has appointed ROS as the administrative agent (the “Administrative
Agent”) for the Lenders;


 




    	 	 	 



     


    

 


WHEREAS, the Guarantors
and the Administrative Agent entered into an Amended and Restated Guarantee, dated as of July 31, 2015 and supplemented on September
11, 2015, pursuant to which the Guarantors have agreed to guarantee the Obligations of the Borrowers under the Credit Agreement;


 


WHEREAS, pursuant
to Section 11.1 of the Credit Agreement, the Credit Agreement may be amended by an instrument in writing signed by each of the
Borrowers and the Administrative Agent (acting on behalf of the Lenders); and


 


WHEREAS, the Borrowers
and the Lenders desire to amend certain provisions of the Credit Agreement as provided in this Amendment.


 


NOW, THEREFORE,
in consideration of the mutual agreements herein contained, and for other good and valuable consideration, the receipt and sufficiency
of which are hereby acknowledged, the parties hereto agree as follows:


 


1.          Definitions;
Loan Document. Capitalized terms used herein without definition shall have the meanings assigned to such terms in the Credit
Agreement. This Amendment shall constitute a Loan Document for all purposes of the Credit Agreement and the other Loan Documents.


 


2.          Amendments
to Section 3.6. Section 3.6 of the Credit Agreement is hereby amended by deleting the last sentence from such Section 3.6
in its entirety and inserting the following as the last sentence thereof:


 


“Notwithstanding the foregoing,
interest accrued on the Loans for the Fiscal Quarters ended on December 31, 2016, March 31, 2017, June 30, 2017 and September 30,
2017 and otherwise required to be paid in cash on January 2, 2017, March 31, 2017, June 30, 2017 and October 2, 2017, respectively,
shall instead be required to be paid in cash on December 31, 2017, plus interest accrued on such interest from January 2, 2017,
March 31, 2017, June 30, 2017 and October 2, 2017, as applicable, to the date of payment thereof at a rate equal to the Applicable
Margin plus the higher of (i) the LIBO Rate for the Fiscal Quarter ended on December 31, 2016, the Fiscal Quarter ended on March
31, 2017, the Fiscal Quarter ended on June 30, 2017 or the Fiscal Quarter ended on September 30, 2017, as applicable, and (ii)
1.00%.”


 


3.          Amendments
to Section 8.4(a). Section 8.4(a) of the Credit Agreement is hereby amended and restated in its entirety to read as follows:


 


“(a) Minimum Revenue
Base. The Revenue Base for any Fiscal Quarter shall not be less than the amount set forth below for such Fiscal Quarter:


 


	Fiscal Quarter Ending	 	Minimum Revenue Base	 
	September 30, 2015	 	$	17,500,000	 
	December 31, 2015	 	$	20,000,000	 
	March 31, 2016	 	$	20,000,000	 
	June 30, 2016	 	$	20,000,000	 
	September 30, 2016	 	$	20,000,000	 
	December 31, 2016	 	$	20,000,000	 



 




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	March 31, 2017	 	$	20,000,000	 
	June 30, 2017	 	$	20,000,000	 
	September 30, 2017	 	$	19,500,000	 
	December 31, 2017	 	$	19,000,000	 
	March 31, 2018	 	$	27,500,000	 
	June 30, 2018	 	$	27,500,000	 
	September 30, 2018	 	$	30,000,000	 
	December 31, 2018	 	$	30,000,000	 
	March 31, 2019	 	$	30,000,000	 
	June 30, 2019	 	$	30,000,000	 
	September 30, 2019	 	$	30,000,000	 
	December 31, 2019	 	$	30,000,000	 
	March 31, 2020	 	$	30,000,000	 
	June 30, 2020	 	$	30,000,000	 



 


4.          Amendments
to Section 8.4(b). Section 8.4(b) of the Credit Agreement is hereby amended by deleting the first two sentences from such
Section 8.4(b) in their entirety and inserting the following as the first two sentences thereof:


 


“At
all times prior to December 31, 2017, the Liquidity shall not be less than $500,000. At all times after December 31, 2017, the
Liquidity shall not be less than $5,000,000.”


 


5.          Amendments
to Section 8.4(c). Section 8.4(c) of the Credit Agreement is hereby is hereby amended by restating it in its entirety as
follows:


 


“(c) Consolidated Senior
Leverage Ratio. The Consolidated Senior Leverage Ratio shall not be greater than the amount set forth below at any time, in
each case, other than as set forth in the definition thereof, with respect to the most recent period of four Fiscal Quarters then
ended (starting at the time that the financial statements for the most recent four Fiscal Quarters ended March 31, 2018 are required
to have been delivered hereunder (or have been so delivered, if earlier)):


 


	Four Fiscal 
 Quarters Ended	 	 	Consolidated Senior
 Leverage Ratio	 
	March 31, 2018	 	 	5.00:1.00	 
	June 30, 2018	 	 	5.00:1.00	 
	September 30, 2018	 	 	5.00:1.00	 
	December 31, 2018	 	 	5.00:1.00	 
	March 31, 2019	 	 	2.50:1.00	 
	June 30, 2019	 	 	2.50:1.00	 
	September 30, 2019	 	 	2.50:1.00	 
	December 31, 2019	 	 	2.50:1.00	 
	March 31, 2020	 	 	2.50:1.00	 
	June 30, 2020	 	 	2.50:1.00	 



 




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6.          Conditions
to Effectiveness of Amendment. This Amendment shall become effective upon receipt by the Borrowers, the Administrative
Agent, the Lenders and the Guarantors of a counterpart signature of the others to this Amendment duly executed and delivered by
each of the Borrowers, the Lenders, the Administrative Agent and the Guarantors.


 


7.          Waiver.
The Lenders hereby waive any non-compliance with the covenant set forth in Section 7.1(b) of the Credit Agreement with respect
to the timely filing of Holdings’ quarterly report on Form 10-Q for the quarterly period ended September 30, 2017.


 


8.          Expenses.
The Borrowers agree to pay on demand all expenses of the Administrative Agent (including, without limitation, the fees and out-of-pocket
expenses of Covington & Burling LLP, counsel to the Administrative Agent) incurred in connection with the Administrative Agent’s
review, consideration and evaluation of this Amendment, including the rights and remedies available to it in connection therewith,
and the negotiation, preparation, execution and delivery of this Amendment.


 


9.          Representations
and Warranties. The Borrowers and the Guarantors represent and warrant to each Lender as follows:


 


(a)          After
giving effect to this Amendment, the representations and warranties of the Borrowers and the Guarantors contained in the Credit
Agreement or any other Loan Document shall, (i) with respect to representations and warranties that contain a materiality qualification,
be true and correct in all respects on and as of the date hereof, and (ii) with respect to representations and warranties that
do not contain a materiality qualification, be true and correct in all material respects on and as of the date hereof, and except
that the representations and warranties limited by their terms to a specific date shall be true and correct as of such date.


 


(b)          Before
and after giving effect to this Amendment, no Default or Event of Default under the Credit Agreement has occurred or will occur
or be continuing.


 


10.         No
Implied Amendment or Waiver. Except as expressly set forth in this Amendment, this Amendment shall not, by implication
or otherwise, limit, impair, constitute a waiver of or otherwise affect any rights or remedies of the Administrative Agent or the
Lenders under the Credit Agreement or the other Loan Documents, or alter, modify, amend or in any way affect any of the terms,
obligations or covenants contained in the Credit Agreement or the other Loan Documents, all of which shall continue in full force
and effect. Nothing in this Amendment shall be construed to imply any willingness on the part of the Administrative Agent or the
Lenders to agree to or grant any similar or future amendment, consent or waiver of any of the terms and conditions of the Credit
Agreement or the other Loan Documents.


 


11.         Waiver
and Release. TO INDUCE THE ADMINISTRATIVE AGENT, ACTING ON BEHALF OF THE LENDERS, TO AGREE TO THE TERMS OF THIS AMENDMENT,
THE BORROWERS, THE GUARANTORS AND THEIR AFFILIATES (COLLECTIVELY, THE RELEASING PARTIES”) REPRESENT AND WARRANT THAT
AS OF THE DATE HEREOF THERE ARE NO CLAIMS OR OFFSETS AGAINST OR RIGHTS OF RECOUPMENT WITH RESPECT TO OR DEFENSES OR COUNTERCLAIMS
TO THEIR OBLIGATIONS UNDER THE LOAN DOCUMENTS AND IN ACCORDANCE THEREWITH THEY:


 




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(a)          WAIVE
ANY AND ALL SUCH CLAIMS, OFFSETS, RIGHTS OF RECOUPMENT, DEFENSES OR COUNTERCLAIMS, WHETHER KNOWN OR UNKNOWN, ARISING PRIOR TO THE
DATE HEREOF; AND


 


(b)          FOREVER
RELEASE, RELIEVE, AND DISCHARGE THE ADMINISTRATIVE AGENT, THE LENDERS, THEIR OFFICERS, DIRECTORS, SHAREHOLDERS, MEMBERS, PARTNERS,
PREDECESSORS, SUCCESSORS, ASSIGNS, ATTORNEYS, ACCOUNTANTS, AGENTS, EMPLOYEES, AND REPRESENTATIVES (COLLECTIVELY, THE "RELEASED
PARTIES"), AND EACH OF THEM, FROM ANY AND ALL CLAIMS, LIABILITIES, DEMANDS, CAUSES OF ACTION, DEBTS, OBLIGATIONS, PROMISES,
ACTS, AGREEMENTS, AND DAMAGES, OF WHATEVER KIND OR NATURE, WHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, CONTINGENT OR FIXED,
LIQUIDATED OR UNLIQUIDATED, MATURED OR UNMATURED, WHETHER AT LAW OR IN EQUITY, WHICH THE RELEASING PARTIES EVER HAD, NOW HAVE,
OR MAY, SHALL, OR CAN HEREAFTER HAVE, DIRECTLY OR INDIRECTLY ARISING OUT OF OR IN ANY WAY BASED UPON, CONNECTED WITH, OR RELATED
TO MATTERS, THINGS, ACTS, CONDUCT, AND/OR OMISSIONS AT ANY TIME FROM THE BEGINNING OF THE WORLD THROUGH AND INCLUDING THE DATE
HEREOF, INCLUDING WITHOUT LIMITATION ANY AND ALL CLAIMS AGAINST THE RELEASED PARTIES ARISING UNDER OR RELATED TO THE LOAN DOCUMENTS
OR THE TRANSACTIONS CONTEMPLATED THEREBY.


 


(c)          IN
CONNECTION WITH THE RELEASE CONTAINED HEREIN, THE RELEASING PARTIES ACKNOWLEDGE THAT THEY ARE AWARE THAT THEY MAY HEREAFTER DISCOVER
CLAIMS PRESENTLY UNKNOWN OR UNSUSPECTED, OR FACTS IN ADDITION TO OR DIFFERENT FROM THOSE WHICH THEY KNOW OR BELIEVE TO BE TRUE,
WITH RESPECT TO THE MATTERS RELEASED HEREIN. NEVERTHELESS, IT IS THE INTENTION OF THE RELEASING PARTIES, THROUGH THIS AGREEMENT
AND WITH ADVICE OF COUNSEL, FULLY, FINALLY, AND FOREVER TO RELEASE ALL SUCH MATTERS, AND ALL CLAIMS RELATED THERETO, WHICH DO NOW
EXIST, OR HERETOFORE HAVE EXISTED. IN FURTHERANCE OF SUCH INTENTION, THE RELEASES HEREIN GIVEN SHALL BE AND REMAIN IN EFFECT AS
A FULL AND COMPLETE RELEASE OR WITHDRAWAL OF SUCH MATTERS NOTWITHSTANDING THE DISCOVERY OR EXISTENCE OF ANY SUCH ADDITIONAL OR
DIFFERENT CLAIMS OR FACTS RELATED THERETO.


 


(d)          THE
RELEASING PARTIES COVENANT AND AGREE NOT TO BRING ANY CLAIM, ACTION, SUIT, OR PROCEEDING AGAINST THE RELEASED PARTIES, DIRECTLY
OR INDIRECTLY, REGARDING OR RELATED IN ANY MANNER TO THE MATTERS RELEASED HEREBY, AND FURTHER COVENANT AND AGREE THAT THIS AGREEMENT
IS A BAR TO ANY SUCH CLAIM, ACTION, SUIT, OR PROCEEDING.


 




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(e)          THE
RELEASING PARTIES REPRESENT AND WARRANT TO THE RELEASED PARTIES THAT THEY HAVE NOT HERETOFORE ASSIGNED OR TRANSFERRED, OR PURPORTED
TO ASSIGN OR TRANSFER, TO ANY PERSON OR ENTITY ANY CLAIMS OR OTHER MATTERS HEREIN RELEASED.


 


12.         Counterparts;
Governing Law. This Amendment may be executed in any number of counterparts and by different parties hereto on separate
counterparts, each of such when so executed and delivered shall be an original, but all of such counterparts shall together constitute
but one and the same agreement. Delivery of an executed counterpart of a signature page of this Amendment by fax transmission or
other electronic mail transmission (e.g., “pdf” or “tif”) shall be effective as delivery of a manually
executed counterpart of this Amendment. THIS AMENDMENT SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE INTERNAL LAWS
OF THE STATE OF NEW YORK (INCLUDING FOR SUCH PURPOSE SECTIONS 5-1401 AND 5-1402 OF THE GENERAL OBLIGATIONS LAW OF THE STATE OF
NEW YORK).


 


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IN WITNESS WHEREOF, the parties hereto
have caused this Amendment to be executed by their respective officers thereunto duly authorized as of the day and year first above
written.


 


	 	BACTERIN INTERNATIONAL, INC.,
	 	as the Borrower
	 	 	 
	 	By:   	/s/ Carl D. O’Connell
	 	Name:  	Carl D. O’Connell
	 	Title:    	Chief Executive Officer
	 	 	 
	 	XTANT MEDICAL HOLDINGS, INC.,
	 	(fka: Bacterin International Holdings, Inc.)
	 	as a Guarantor
	 	 	 
	 	By:   	/s/ Carl D. O’Connell
	 	Name:  	Carl D. O’Connell
	 	Title:    	Chief Executive Officer
	 	 	 
	 	X-SPINE SYSTEMS, INC.,
	 	as a Guarantor and the Additional Delayed Draw Borrower
	 	 	 
	 	By:   	/s/ Carl D. O’Connell
	 	Name:  	Carl D. O’Connell
	 	Title:    	Chief Executive Officer
	 	 	 
	 	XTANT MEDICAL, INC.,
	 	as a Guarantor
	 	 	 
	 	By:   	/s/ Carl D. O’Connell
	 	Name:  	Carl D. O’Connell
	 	Title:    	Chief Executive Officer


 


Signature Page to Twentieth Amendment
and Waiver to A&R Credit Agreement


 




    	 	 	 



     


    

 


	 	ROS Acquisition Offshore LP,
	 	as a Lender and as the Administrative Agent
	 	 
	 	By OrbiMed Advisors LLC, solely in its
	 	capacity as Investment Manager
	 	 	 
	 	By:   	/s/ W. Carter Neild
	 	Name:  	W. Carter Neild
	 	Title:    	Member
	 	 	 
	 	ORBIMED ROYALTY OPPORTUNITIES II, LP,
	 	as a Lender
	 	 	 
	 	By OrbiMed ROF II LLC,
	 	its General Partner
	 	By OrbiMed Advisors LLC,
	 	its Managing Member
	 	 	 
	 	By:   	/s/ W. Carter Neild
	 	Name:  	W. Carter Neild
	 	Title:    	Member


 


Signature Page to Twentieth Amendment
and Waiver to A&R Credit Agreement