Exhibit 10.19


 


amendment
No. 1 to CREDIT, SECURITY AND GUARANTY AGREEMENT
(TERM LOAN)


 


This
AMENDMENT NO. 1 TO CREDIT, SECURITY AND GUARANTY AGREEMENT (TERM LOAN) (this “Agreement”) is made as of March 7, 2022,
by and among XTANT MEDICAL HOLDINGS, INC., a Delaware corporation (“Holdings”) as a Guarantor, each of Holdings’
direct and indirect Subsidiaries set forth on the signature pages hereto as a “Borrower” (collectively, the “Borrowers”
and each individually, a “Borrower”), MidCap Financial Trust, a Delaware statutory trust, as Agent (in such capacity,
together with its successors and assigns, “Agent”) and the other financial institutions or other entities from time
to time parties to the Credit Agreement referenced below, each as a Lender.


 


RECITALS


 


A.
Agent, Lenders, and the Credit Parties have entered into that certain Credit, Security and Guaranty Agreement, dated as of May 6, 2021
(Term Loan) (the “Original Credit Agreement” and as amended hereby and as it may be further amended, modified, supplemented
and restated from time to time, the “Credit Agreement”), pursuant to which the Lenders have agreed to make certain
advances of money and to extend certain financial accommodations to Borrowers in the amounts and manner set forth in the Credit Agreement.


 


B.
The Credit Parties have requested, and Agent and all Lenders have agreed, to amend certain provisions of the Original Credit Agreement,
all in accordance with the terms and subject to the conditions set forth herein.


 


AGREEMENT


 


NOW,
THEREFORE, in consideration of the foregoing, the terms and conditions set forth in this Agreement, and other good and valuable consideration,
the receipt and sufficiency of which are hereby acknowledged, Agent, Lenders and the Credit Parties hereby agree as follows:


 


1.
Recitals. This
Agreement shall constitute a Financing Document and the Recitals and each reference to the Credit Agreement, unless otherwise expressly
noted, will be deemed to reference the Credit Agreement as amended hereby. The Recitals set forth above shall be construed as part of
this Agreement as if set forth fully in the body of this Agreement and capitalized terms used but not otherwise defined herein shall
have the meanings ascribed to them in the Credit Agreement (including those capitalized terms used in the Recitals hereto).


 


2.
Amendments to Original Credit
Agreement. Subject to the terms and conditions
of this Agreement, including, without limitation, the conditions to effectiveness set forth in Section 4 below, the Original Credit
Agreement is hereby amended as follows:


 


(a)
Section 1.1 of the Original Credit Agreement is hereby amended by adding the following definitions in alphabetical order:


 


“First
Amendment” shall mean that certain Amendment No. 1 to Credit, Security and Guaranty Agreement (Term Loan), dated as of the
First Amendment Effective Date, by and among Holdings, as Guarantor, each of direct and indirect Subsidiaries of Holdings set forth on
the signature pages thereto as a Borrower, Agent and Lenders.


 


“First
Amendment Effective Date” shall mean March 7, 2022.


 




    	 



    	 



    

 


“Liquidity
Threshold” means $14,000,000.


 


“Minimum
EBITDA Covenant Waiver Period” means the period (x) beginning on the date upon which the Credit Parties deliver to Agent a
Compliance Certificate in accordance with Section 4.1(i) evidencing that the Liquidity of the Credit Parties as of such date is greater
than the Liquidity Threshold and (y) ending on the earlier to occur of (i) the occurrence of any Default or Event of Default or (ii)
the date upon which the Credit Parties deliver to Agent a Compliance Certificate in accordance with Section 4.1(i) evidencing that the
Liquidity of the Credit Parties as of such date is equal to or less than the Liquidity Threshold; provided that the financial
covenant described in Section 6.3 shall be tested on any date upon which the Minimum EBITDA Covenant Waiver Period is terminated by operation
of clause (y)(ii) of this definition.


 


(b)
Section 2.2(h) of the Original Credit Agreement is hereby amended by replacing each occurrence of the words “Closing Date”
with the words “First Amendment Effective Date”.


 


(c)
Section 6.3 of the Original Credit Agreement is hereby amended and restated in its entirety as follows:


 


“Minimum
EBITDA. Credit Parties will not permit the consolidated EBITDA of the Credit Parties for any Defined Period, as tested quarterly
on the last day of the applicable Defined Period (other than any Defined Period ending during a Minimum EBITDA Covenant Waiver Period
that has not been terminated on such date of determination as a result of the Credit Parties’ failure to maintain Liquidity in
excess of the Liquidity Threshold), to be less than $500,000.


 


3.
Representations and Warranties; Reaffirmation
of Security Interest. Each Credit Party hereby confirms that all of the representations and warranties set forth in the Credit
Agreement are true and correct in all material respects (without duplication of any materiality qualifier in the text of such representation
or warranty) with respect to such Credit Party as of the date hereof except to the extent that any such representation or warranty relates
to a specific date in which case such representation or warranty shall be true and correct as of such earlier date. Nothing herein is
intended to impair or limit the validity, priority or extent of Agent’s security interests in and Liens on the Collateral. Each
Credit Party acknowledges and agrees that the Credit Agreement, the other Financing Documents and this Agreement constitute the legal,
valid and binding obligation of such Credit Party, and are enforceable against such Credit Party in accordance with its terms, except
as the enforceability thereof may be limited by bankruptcy, insolvency or other similar laws relating to the enforcement of creditors’
rights generally and by general equitable principles.


 


4.
Conditions to Effectiveness. This Agreement
shall become effective as of the date on which each of the following conditions have been satisfied, as determined by Agent in its sole
discretion:


 


(d)
Each Credit Party shall have delivered to Agent this Agreement and the Amended and Restated Fee Letter, in each case, executed by an
authorized officer of such Credit Party;


 


(e)
all representations and warranties of Credit Parties contained herein shall be true and correct in all material respects (without duplication
of any materiality qualifier in the text of such representation or warranty) as of the date hereof except to the extent that any such
representation or warranty relates to a specific date in which case such representation or warranty shall be true and correct as of such
earlier date (and such parties’ delivery of their respective signatures hereto shall be deemed to be its certification thereof);
and


 




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(f)
prior to and after giving effect to the agreements set forth herein, no Default or Event of Default shall exist under any of the Financing
Documents.


 


5.
Release. In consideration of the agreements
of Agent and Lenders contained herein and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged,
Credit Party, voluntarily, knowingly, unconditionally and irrevocably, with specific and express intent, for and on behalf of itself
and all of its respective parents, subsidiaries, affiliates, members, managers, predecessors, successors, and assigns, and each of their
respective current and former directors, officers, shareholders, agents, and employees, and each of their respective predecessors, successors,
heirs, and assigns (individually and collectively, the “Releasing Parties”) does hereby fully and completely release,
acquit and forever discharge each of Agent, Lenders, and each their respective parents, subsidiaries, affiliates, members, managers,
shareholders, directors, officers and employees, and each of their respective predecessors, successors, heirs, and assigns (individually
and collectively, the “Released Parties”), of and from any and all actions, causes of action, suits, debts, disputes,
damages, claims, obligations, liabilities, costs, expenses and demands of any kind whatsoever, at law or in equity, whether matured or
unmatured, liquidated or unliquidated, vested or contingent, choate or inchoate, known or unknown that the Releasing Parties (or any
of them) has against the Released Parties or any of them (whether directly or indirectly). Each Credit Party acknowledges that the foregoing
release is a material inducement to Agent’s and each Lender’s decision to enter into this Agreement and agree to the modifications
contemplated hereunder, and has been relied upon by Agent and Lenders in connection therewith.


 


6.
No Waiver or Novation. The execution,
delivery and effectiveness of this Agreement shall not, except as expressly provided in this Agreement, operate as a waiver of any right,
power or remedy of Agent, nor constitute a waiver of any provision of the Credit Agreement, the Financing Documents or any other documents,
instruments and agreements executed or delivered in connection with any of the foregoing. Nothing herein is intended or shall be construed
as a waiver of any existing Defaults or Events of Default under the Credit Agreement or the other Financing Documents or any of Agent’s
rights and remedies in respect of such Defaults or Events of Default. This Agreement (together with any other document executed in connection
herewith) is not intended to be, nor shall it be construed as, a novation of the Credit Agreement.


 


7.
Affirmation. Except as specifically amended
pursuant to the terms hereof, each Credit Party hereby acknowledges and agrees that the Credit Agreement and all other Financing Documents
(and all covenants, terms, conditions and agreements therein) shall remain in full force and effect, and are hereby ratified and confirmed
in all respects by such Credit Party. Each Credit Party covenants and agrees to comply with all of the terms, covenants and conditions
of the Credit Agreement and the Financing Documents, notwithstanding any prior course of conduct, waivers, releases or other actions
or inactions on Agent’s or any Lender’s part which might otherwise constitute or be construed as a waiver of or amendment
to such terms, covenants and conditions.


 


8.
Miscellaneous.


 


(a)
Reference to the Effect on the Credit Agreement.
Upon the effectiveness of this Agreement, each reference in the Credit Agreement to “this Agreement,” “hereunder,”
“hereof,” “herein,” or words of similar import shall mean and be a reference to the Credit Agreement, as amended
by this Agreement. Except as specifically amended above, the Credit Agreement, and all other Financing Documents (and all covenants,
terms, conditions and agreements therein), shall remain in full force and effect, and are hereby ratified and confirmed in all respects
by each Credit Party.


 




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(b)
Governing Law. THIS AGREEMENT AND ALL DISPUTES
AND OTHER MATTERS RELATING HERETO OR ARISING THEREFROM (WHETHER SOUNDING IN CONTRACT LAW, TORT LAW OR OTHERWISE), SHALL BE GOVERNED BY,
AND SHALL BE CONSTRUED AND ENFORCED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK, WITHOUT REGARD TO CONFLICTS OF LAWS PRINCIPLES


 


(c)
Incorporation of Credit Agreement Provisions.
The provisions contained in Section 11.6 (Indemnification), Section 13.8(b) (Submission to Jurisdiction) and Section
13.9 (Waiver of Jury Trial) of the Credit Agreement are incorporated herein by reference to the same extent as if reproduced herein
in their entirety.


 


(d) Headings.
Section headings in this Agreement are included for convenience of reference only and shall not constitute a part of this Agreement
for any other purpose.


 


(e) Counterparts.
This Agreement may be signed in any number of counterparts, each of which shall be deemed an original and all of which when taken
together shall constitute one and the same instrument. Signatures by facsimile or by electronic mail delivery of an electronic
version of any executed signature page shall bind the parties hereto.


 


(f) Entire
Agreement.This Agreement constitutes the entire agreement and understanding among the parties hereto and supersedes any and
all prior agreements and understandings, oral or written, relating to the subject matter hereof.


 


(g) Severability.
In case any provision of or obligation under this Agreement shall be invalid, illegal or unenforceable in any applicable
jurisdiction, the validity, legality and enforceability of the remaining provisions or obligations, or of such provision or
obligation in any other jurisdiction, shall not in any way be affected or impaired thereby.


 


(h) Successors/Assigns.
This Agreement shall bind, and the rights hereunder shall inure to, the respective successors and assigns of the parties hereto,
subject to the provisions of the Credit Agreement and the other Financing Documents.


 


[SIGNATURES
APPEAR ON FOLLOWING PAGES]


 




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IN
WITNESS WHEREOF, intending to be legally bound, and intending that this document constitute an agreement executed under seal, the undersigned
have executed this Agreement under seal as of the day and year first hereinabove set forth.


 


	AGENT:	MIDCAP
    FINANCIAL TRUST,
	 	as
    Agent


 


	 	By:
    	Apollo
    Capital Management, L.P.,
	 	 	its
    investment manager
	 	 	 
	 	By:	Apollo
    Capital Management GP, LLC,
	 	 	its
    general partner


 


	 	By:	/s/
Maurice Amsellem
	 	Name:	Maurice
Amsellem
	 	Title:	Authorized
Signatory


 


[Signatures
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	LENDERS:	ELM
    2020-3 TRUST


 


	 	By:	MidCap
Financial Services Capital Management,
	 	 	LLC,
    as Servicer


 


	 	By:	/s/
    John O’Dea
	 	Name:	John
    O’Dea
	 	Title:	Authorized
    Signatory


 


	 	ELM
    2020-4 TRUST


 


	 	By:
    	MidCap
    Financial Services Capital Management,
	 	 	LLC,
    as Servicer


 


	 	By:	/s/
    John O’Dea
	 	Name:	John
    O’Dea
	 	Title:	Authorized
    Signatory


 


[Signatures
Continue on Following Page]


 




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BORROWERS:


 


	 	XTANT
    MEDICAL, INC.


 


	 	By:	/s/
    Sean E. Browne
	 	Name	Sean
    E. Browne
	 	Title:	President,
    CEO


 


	 	BACTERIN
    INTERNATIONAL, INC.


 


	 	By:	/s/
    Sean E. Browne
	 	Name	Sean
    E. Browne
	 	Title:	President,
    CEO


 


	 	X-SPINE
    SYSTEMS, INC.


 


	 	By:	/s/
    Sean E. Browne
	 	Name	Sean
    E. Browne
	 	Title:	President,
    CEO


 


GUARANTOR:



 


	 	XTANT
    MEDICAL HOLDINGS, LLC


 


	 	By:	/s/
    Sean E. Browne
	 	Name	Sean
    E. Browne
	 	Title:	President,
    CEO


 



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