Document:

Exhibit 10.16

 

LICENSE AGREEMENT

 

THIS LICENSE AGREEMENT
(this “Agreement”) is made and entered into as of May 31, 2017, by and between COOK BIOTECH INCORPORATED, an
Indiana corporation with its principal office at 1425 Innovation Place, West Lafayette, Indiana 47906 (“Cook”),
and AZIYO MED, LLC, a Delaware limited liability company with its principal office at 12510 Prosperity Drive, Suite 370, Silver
Spring, Maryland 20904 (“Aziyo”).

 

W I T N E S E T H:

 

WHEREAS, Cook and CorMatrix
Cardiovascular, Inc., a Georgia corporation with its principal office at 1100 Old Ellis Rd., Roswell, Georgia 30076 (“CorMatrix”),
are parties to a Cross License Agreement dated November 23, 2004, as amended by a First Amendment dated December 3, 2010, a Third
Amendment dated November 14, 2012, and a Fifth Amendment dated March 25, 2014, there being no Second or Fourth Amendments, and
a further amendment on an even date herewith, (collectively, the “CorMatrix Agreement”), which includes
certain intellectual property rights related to extracellular matrices;

 

WHEREAS, Aziyo desires
to acquire as of the Effective Date certain Specific Licensed Products that are covered by the CorMatrix Agreement in order to
have certain rights pertaining to such Specific Licensed Products in the Aziyo Fields of Use;

 

WHEREAS, CorMatrix
has agreed to sell all of its rights in, to and under the Specific Licensed Products to Aziyo and to allow Aziyo to obtain a license
from Cook pertaining to such Specific Licensed Products (the “Sale Transaction”); and

 

WHEREAS, Cook agrees
to license Aziyo under the Cook Patents pertaining to such Specific Licensed Products instead of and in place of CorMatrix in the
Aziyo Fields of Use, under the conditions stated herein;

 

NOW, THEREFORE, for
and in consideration of the mutual covenants and the premises herein contained, the parties, intending to be legally bound, hereby
agree as follows.

 

ARTICLE 1. DEFINITIONS

 

The following terms
as used herein shall have the following meaning:

 

“Affiliates”
means any corporation, partnership or other business entity which is directly or indirectly controlled by or under common control
with Aziyo or Cook or any entity which directly or indirectly controls Aziyo or Cook, as the case may be. “Control”
as used herein means the ownership, directly or indirectly, of greater than fifty percent (50%) of the voting power of such entity.

 

“Agreement”
or “License Agreement” means this Agreement, including Exhibits A and B attached hereto.

 

     

     

    

 

“CorMatrix
Agreement” has the meaning set forth in the recitals.

 

“Aziyo Fields
of Use” means:

 

(a)        the
use of SIS for the repair of myocardial tissue, and for the repair of the pericardial sac. By way of clarification, the Aziyo Fields
of Use do include placing the SIS patch material directly into or onto myocardial tissue but do not include the use of SIS for
the repair or replacement of the coronary arteries, or for epicardial infarct repair;

 

(b)       the
use of SIS for all Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) repair, except for the transvascular approach
to ASD and VSD repair;

 

(c)       the
use of SIS to repair carotid arteries in an open surgery but not the use of SIS in conjunction with a stent or other frame; and
for clarity, “open surgery” for purposes of this subparagraph (c) does not include (i) any form of percutaneous access
(using a cut down or not) to or through a carotid artery using SIS, including but not limited to any vascular patching via percutaneous
delivery (e.g. as in the repair of punctures created by percutaneous access devices), (ii) any form of indirect access to the carotid
artery through a vascular vessel using SIS, or (iii) any form of access to or through a carotid artery over or through a device
using SIS (e.g. transcatheter access);

 

(d)       the
use of SIS to patch repair the wall of peripheral veins and arteries, other than carotid arteries, using a sheet form patch product
in open surgery and where a surface of the implanted patch forms part of the blood contacting lumen of the vein or artery, but
not including the use of SIS in conjunction is with a stent or other frame; and for clarity, (i) “open surgery” for
purposes of this subparagraph (d) does not include (a) any form of percutaneous access (using a cut-down or not) to or through
a vein or artery using SIS, including but not limited to any vascular patching via percutaneous delivery (e.g. as in the repair
of punctures created by percutaneous access devices), (b) any form of indirect access to the vein or artery through a vascular
vessel using SIS, or (c) any form of access to or through a vein or artery over or through a device using SIS (e.g. transcatheter
access), and (ii) patch repair shall be limited to patch repair as specified above only and does not include the creation or use
of a vessel or conduit made out of SIS and does not include any use of SIS to replace or repair any valve; and

 

(e)       SIS
pouch devices into which implantable cardiac pacemaker or defibrillator devices are to be inserted at the point of care for subcutaneous
implantation in human patients.

 

“Cook Patents”
means the patent applications and patents that are identified in Exhibit E of the CorMatrix Agreement as of the Effective Date
and specifically including the patent applications and patents that are listed in Exhibit A of this Agreement, as it may
be amended from time to time by mutual agreement of the Parties, together with all divisionals, continuations-in-part, continuations,
reissues, reexaminations and foreign counterparts of such applications.

 

“Effective
Date” has the meaning set forth in Section 6.1.

 

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“License”
has the meaning set forth in Section 2.1(a). 

 

“Specific
Licensed Products” means the specific regulatory-approved products listed in Exhibit B of this Agreement for their
regulatory-approved indications.

 

“Licensed
Territory” means the world.

 

“Sale Transaction”
has the meaning set forth in the recitals.

 

“SIS”
means a composition of solid extracellular matrix composition prepared from intestinal tissue.

 

“Valid Enforceable
Claim” means any claim in force or bona fide pending claim contained in the Cook Patents unless held invalid or
unenforceable by a court of competent jurisdiction and of last resort or by any inferior court of competent jurisdiction, tribunal
or agency from which no appeal is taken.

 

ARTICLE 2. GRANT OF LICENSES/COVENANT

 

2.1       Cook
License Grant to Aziyo.

 

(a)       Cook
hereby grants to Aziyo an exclusive (subject to Section 2.1(b)) worldwide right and license to all of Cook’s rights under
the Cook Patents to make, have made, use, offer for sale, sell and import the Specific Licensed Products for the Aziyo Fields of
Use in the Licensed Territory during the term of this Agreement (the “License”). This License shall be royalty-free
as to Specific Licensed Products utilizing SIS material purchased by Aziyo from Cook. Aziyo shall have the right to grant sublicenses
of the rights granted herein upon prior written approval from Cook, which approval will not be unreasonably withheld.

 

(b)       Aziyo
acknowledges and agrees that Cook shall have co-exclusive rights as set forth in the CorMatrix Agreement to the Vascular Patch
product recited in Exhibit B that uses SIS to repair the wall of peripheral
veins and arteries as specified in subparagraph (d) of the definition of “Aziyo Fields of
Use” above, and that Cook’s continuing license of CorMatrix in a field corresponding to such subparagraph (d) under
the CorMatrix Agreement shall not be taken into account in any way in determining Cook’s exploitation of Cook’s co-exclusive
rights. 

 

2.2       Covenant.
Cook agrees that to the extent that Cook has or acquires patents other than the Cook Patents, where such patents have an earliest
claimed application priority date prior to the Effective Date (“Other Patents”), Cook covenants not to sue Aziyo for
infringement of such Other Patents for Aziyo’s marketing, distribution, sale and use of the Specific Licensed Products in
the Aziyo Fields of Use for Specific Licensed Products purchased by Aziyo from Cook under the Supply Agreement between Aziyo and
Cook.

 

ARTICLE 3. ENFORCEMENT

 

3.1       First
Right of Aziyo to Notify and Initiate Proceedings. Aziyo shall have the first right, but not the obligation, to notify
any infringer and/or initiate legal proceedings to abate any infringement in the Aziyo Fields of Use by a third-party product
that is the same as a Specific Licensed Product. All fees, costs and expenses incurred therein and all damages or other
monies obtained therefrom shall be the responsibility of and belong to Aziyo.

 

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3.2       Notification
regarding Infringements and Initial Consultation. Cook and Aziyo each agree to notify the other in writing in the event that
they become aware of an infringement or apparent infringement of one or more Cook Patents in the Aziyo Fields of Use by a third-party
product that is the same as a Specific Licensed Product, and to initially consult to consider what if any action should be taken.
This agreement to consult shall not in any way modify the rights of Aziyo to first initiate proceedings hereunder as per Section
3.1.

 

3.3       Additional
Rights/Obligations of the Parties

 

3.3.1       In
the event that Aziyo has not initiated legal proceedings within six (6) months after providing or receiving notice under
Section 3.2 above, for an infringement or apparent infringement of one or more Cook Patents, then Cook may initiate such
legal proceedings on its own behalf; and, reasonably promptly thereafter, Aziyo may elect to join in those legal proceedings
(in a manner other than in name only, if applicable) and upon Aziyo doing so each party shall bear its own fees, costs and
expenses incurred in the legal proceedings except that court costs and expenses for any joint filings shall be apportioned
one-half to each party, and each party will be apportioned one-half (1/2) of the damages or other monies awarded in those
legal proceedings.

 

3.3.2       If
legal proceedings are initiated under this Article 3 by any Party, each Party will be reasonably cooperative with the other
Party, whether joining or not, in the conduct of the legal proceedings (for example including, to the extent possible, having its
employees testify when requested, making available the relevant records, papers and information, samples and the like, and being
joined in name only).

 

3.3.3       If
a Party does not join in a legal proceeding initiated by the other Party under this Article 3 (in a manner other than in
name only, if applicable), then any damages or other monies awarded in the suit shall belong to, and all fees, costs and expenses
incurred in the suit shall be the responsibility of, the initiating Party.

 

3.3.4       If
a Party is joined in a legal proceeding initiated by the other Party under this Article 3 in name only (the “Necessary
Party”), and does not elect to join in any other capacity, then the initiating Party will indemnify and hold harmless
the Necessary Party from and against all damages, fees, costs and expenses which may be finally assessed against the Necessary
Party in such legal proceeding.

 

ARTICLE 4. LIMITED WARRANTY, MERCHANTABILITY

 

Cook Limited
Warranty. Cook represents and warrants to Aziyo that it has the right, power and authority to enter into this Agreement.
Cook does not warrant the validity of the patents licensed hereunder and makes no representation whatsoever with regard to
the scope or commercial potential or profitability or income of or from the patents or that such patents may be exploited by
Aziyo or its Affiliates without infringing other patents. COOK MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND WITH RESPECT
TO THE PATENTS LICENSED HEREUNDER AND EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR
PURPOSE AND ANY OTHER WARRANTIES WITH RESPECT TO THE CAPABILITIES, SAFETY, UTILITY, EFFICACY, APPROVABILITY BY REGULATORY
AUTHORITIES, TIME AND COST OF DEVELOPMENT, OR COMMERCIAL APPLICATION OF LICENSED PATENTS.

 

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4.2       Aziyo
Warranty. Aziyo represents and warrants that it has the right and authority to enter into this Agreement.

 

4.3       Survival.
The foregoing representations and warranties shall survive the execution and delivery of this Agreement and the closing of the
Sale Transaction.

 

ARTICLE 5. INDEMNIFICATION/EFFORTS

 

5.1       Aziyo
Indemnity. Aziyo shall indemnify and hold harmless Cook and its officers, directors, employees and agents from and against
all claims, demands, liabilities, damages and expenses (including reasonable attorneys’ fees) arising from or related to
Aziyo’s exercise of the License.

 

5.2       Aziyo
shall use commercially reasonable efforts to promote, solicit, and expand the sale of the Specific Licensed Products in the Aziyo
Fields of Use in the Territory.

 

ARTICLE 6. TERM AND TERMINATION

 

6.1       Term.
Unless sooner terminated as otherwise provided in this Agreement, the term of this Agreement shall commence on the date of the
closing of the Sale Transaction (the “Effective Date”) and shall continue until the date of expiration of the
last to expire of the Licensed Patents, including any renewals or extensions thereof. The Parties agree that if the Sale Transaction
has not occurred on or before June 15, 2017, this Agreement shall be null and void.

 

6.2       Termination
for Breach. Either Party may terminate this Agreement, by written notice to the other Party, for any material breach of
this Agreement by the other Party, if such breach is not cured within thirty (30) days after the breaching Party receives
written notice of such breach from the non-breaching Party.

 

6.3       This
Agreement will terminate automatically, without any further action taken, upon any reversal, nullification, or cancellation of
the Sale Transaction or any other event relating to the Sale Transaction by which Aziyo no longer possesses the rights transferred
from CorMatrix to Aziyo pursuant to the Sale Transaction.

 

6.4       Survival.
The provisions of Articles 4 and 5 of this Agreement shall remain in full force and effect notwithstanding the termination
of this Agreement.

 

ARTICLE 7. MANUFACTURE OF SIS MATERIALS

 

CorMatrix and Cook are parties to an
Amended and Restated SIS Material Supply Agreement, of even date herewith, whereby Cook is designated as the exclusive
supplier of SIS to CorMatrix (the “Supply Agreement”).  The parties are entering into an SIS Material Supply
Agreement, on an even date herewith, in which Cook is designated as the exclusive supplier of SIS to Aziyo for the Specific
Licensed Products and agrees that Aziyo shall have the right under the circumstances set forth therein to sell
Specific Licensed Products including SIS Material manufactured by it and to pay to Cook a royalty of three percent (3%) of
Net Sales of Specific Licensed Products sold by Aziyo that include SIS material manufactured by Aziyo under the conditions
specified therein and that fall within the scope of at least one Valid Enforceable Claim of a Cook Patent.

 

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“Net Sales”
as used in this Article 7 means gross sales on the initial sale, rent, lease or otherwise making available to third parties (that
is, arms-length sales to other than Affiliates) of the Specific Licensed Products specified in paragraphs 8.1 and 8.2 above (“the
specified Licensed Products”), less the following, to the extent the same are credited or deducted from the sales: returns,
refunds, replacement or credits allowed to purchasers for return of products or as reimbursement for damaged products, freight,
postage, insurance, and other shipping charges, sales and use taxes, customs duties, and any other governmental tax or charge (except
income taxes) imposed on or at the time of the production, importation, use, or sale of the specified Specific Licensed Products,
including any value added taxes (VAT), as adjusted for rebates and refunds. In the case of a specified product sold in combination
with one or more other products (collectively, a “Combination Product”), Net Sales shall exclude the Proportionate
Value (as defined below) of all other products included in the Combination Product. “Proportionate Value,” for purposes
of this paragraph, shall mean fair market value, as determined by the commercial sales price of the other product(s) if sold separately,
or, if not sold separately, the fair market value of such other product(s) reasonably determined by the seller with notice of such
fair market value to be given to the other party; taking into account that the sales price of the Combination Product may be less
than the sum of the value of all of the component products in which case the value of each component product shall be proportionately
reduced. No deductions shall be made for sales representations commissions, whether they be with independent agencies or regularly
employed by the seller and on its payroll.

 

ARTICLE 8. ASSIGNMENT

 

Neither party shall
grant, transfer, convey, or otherwise assign any of its rights or delegate any of its obligations under this Agreement without
the prior written consent of the other party, which consent shall not be unreasonably withheld except that either party may, without
the consent of the other, assign this Agreement to an Affiliate or a successor in interest or transferee of all or substantially
all of the portion of the assets to which this Agreement relates and (ii) Aziyo may, without the consent of Cook, grant a security
interest in its rights and interests hereunder or make a collateral assignment thereof in connection with any bank or other institutional
financing.

 

ARTICLE 9. NOTICES

 

All notices and other
communications shall be hand delivered, sent by private overnight delivery service, or sent by registered or certified U.S. mail,
postage prepaid, return receipt requested, and addressed to the party to receive such notice or other communication at the address
given below, or such other address as may hereafter be designated by notice in writing:

 

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	 	If to Cook, at:	Cook Biotech Incorporated
	 	 	1425 Innovation Place
	 	 	West Lafayette, IN 47906
	 	 	Attn: President
	 	 	 
	 	If to Aziyo, at:	Aziyo Med, LLC
	 	 	12510 Prosperity Drive, Suite 370
	 	 	Silver Spring, MD 20904
	 	 	Attn: [XXX]
	 	 	Email: [XXX]
	 	 	 
	 	With a copy to:	Winston & Strawn LLP
	 	 	200 Park Avenue
	 	 	New York, NY 10166
	 	 	Attn: [XXX]
	 	 	Email: [XXX]

 

Such notices or other communications shall
be effective upon receipt by an employee, agent or representative of the receiving party authorized to receive notices or other
communications sent or delivered in the manner set forth above.

 

ARTICLE 10. MISCELLANEOUS

 

10.1       Legal
Compliance. The parties shall comply with all laws and regulations relating to the manufacture, processing, producing, use,
selling, or distributing of Specific Licensed Products. Neither party shall take any action which would cause the other party to
violate any laws or regulations or to breech any written agreement with a third party.

 

10.2 No Other
Licenses.Only the licenses granted pursuant to the express terms of this Agreement shall be of any legal force and effect
as between Cook and Aziyo. No license rights are created by implication or estoppel. In addition, nothing contained in this Agreement
shall be construed as requiring Cook or Aziyo to file or maintain any patent application, to secure any patent or to maintain any
patent in force, or as requiring Cook or Aziyo to bring or prosecute actions or suits against third parties for infringement, or
as conferring any right to use, in advertising, publicity or otherwise, any name, trade name or trademark, or any contraction,
abbreviation, or simulation thereof.

 

10.3       Entire
Agreement. This Agreement constitutes the entire agreement between Cook and Aziyo with respect to the subject matter hereof
and shall not be modified, amended or terminated except as herein provided or except by another agreement in writing executed by
the parties hereto.

 

10.4       Severability.
All rights and restrictions contained herein may be exercised and shall be applicable and binding only to the extent that
they do not violate any applicable laws and are intended to be limited to the extent necessary so that they will not render
this Agreement illegal, invalid or unenforceable. If any provision or portion of any provision of this Agreement not
essential to the commercial purpose of this Agreement shall be held to be illegal, invalid or unenforceable by a court of
competent jurisdiction, it is the intention of the parties that the remaining provisions or portions thereof shall constitute
their agreement with respect to the subject matter hereof, and all such remaining provisions or portions thereof shall remain
in full force and effect. To the extent legally permissible, any illegal, invalid or unenforceable provision of this
Agreement shall be replaced by a valid provision which will implement the commercial purpose of the illegal, invalid or
unenforceable provision. In the event that any provision essential to the commercial purpose of this Agreement is held to be
illegal, invalid or unenforceable and cannot be replaced by a valid provision which will implement the commercial purpose of
this Agreement, this Agreement and the rights granted herein shall terminate.

 

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10.5       Force
Majeure. Any delays in, or failure of, performance of any party to this Agreement shall not constitute default hereunder, or
give rise to any claim for damages, if and to the extent caused by occurrences beyond the control of the party affected, including,
but not limited to, acts of God, strikes or other work stoppages; civil disturbances, fires, floods, explosions, riots, war, rebellion,
sabotage, acts of governmental authority or failure of governmental authority to issue licenses or approvals which may be required.

 

10.6       Amendment
of the CorMatrix Agreement; No Assumption by Aziyo of CorMatrix Liabilities. Cook hereby consents and agrees to the assignment
by CorMatrix of all of its right, title and interest under the CorMatrix Agreement to the Specific Licensed Products and the Patent
Rights relating to such Products, and an amendment of the CorMatrix Agreement is being executed, on an even date herewith, to terminate
the rights of CorMatrix thereunder with respect to the Specific Licensed Products and Patent Rights at the Effective Date. Cook
acknowledges that Aziyo is not assuming any of the liabilities or other obligations of CorMatrix under the CorMatrix Agreement,
all of which shall be retained by CorMatrix.

 

(signature page follows)

 

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IN WITNESS WHEREOF,
Cook and Aziyo have caused this License Agreement to be signed by their duly authorized representatives, under seal, to be effective
on the Effective Date.

 

	Cook:	 	Aziyo:
	 	 	 
	COOK BIOTECH INCORPORATED	 	AZIYO MED, LLC
	 	 	 
	By:	/s/ Umesh Patel	 	By:	/s/ Jeffrey D. Hamet
	 	 	 
	Name:	Umesh Patel	 	Name:	Jeffrey D. Hamet
	 	 	 
	Title:	President	 	Title:	VP, Finance and Treasurer
	 	 	 
	CorMatrix hereby consents and agrees to the foregoing.	 	 
	 	 	 
	CORMATRIX CARDIOVASCULAR, INC.	 	 
	 	 	 
	By:	/s/ John C. Thomas	 	 
	 	 	 
	Name:	John C. Thomas	 	 
	 	 	 
	Title:	CFO	 	 

 

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EXHIBIT A

 

Cook Patents and Patent Applications

 

     

     

    

 

EXHIBIT B

 

SPECIFIC LICENSED PRODUCTS

 

	Products/Applications	Reference to Cross License Agreement	Relevant Fields of Use from Cross License Agreement
	CorMatrix® ECM® for Pericardial Closure	Paragraph 1.3 of Article 1	
        SIS for the repair of the pericardial sac

         

	CorMatrix® ECM® for Cardiac Tissue Repair	Paragraph 1.3 of Article 1	
        SIS for repair of myocardial tissue

         

	
        CorMatrix® ECM® for Carotid Repair

         
	Amendment 1 Paragraph 1	SIS to repair Carotid Arteries
	CorMatrix® ECM® for Vascular Repair	Amendment 5 Paragraph 1	Co-Exclusive Vascular Patch using SIS to repair the wall of peripheral veins and arteries
	
        CorMatrix® TYKE® Patch, Pledget
        and Intracardiac or TYKE® Patch, Pledget and Intracardiac

         
	Paragraph 1.3 of Article 1	SIS for repair of myocardial tissue
	CorMatrix® CanGaroo®  ECM® Envelope or CanGaroo® ECM® Envelope	Amendment 3 Paragraph 1	SIS pouch devices into which implantable cardiac pacemaker or defibrillator devices are insertedExhibit 10.17

 

DECEMBER 2017 AMENDMENT TO LICENSE AGREEMENT

 

This is an amendment (this “Amendment”),
effective as of December 21st, 2017, to that certain LICENSE AGREEMENT (the “License Agreement”)
dated May 31, 2017, by and between COOK BIOTECH INCORPORATED, an Indiana corporation with its principal office at 1425 Innovation
Place, West Lafayette, Indiana 47906 (“Cook”), and AZIYO MED, LLC, a Delaware limited liability company with
its principal office at 12510 Prosperity Drive, Suite 370, Silver Spring, Maryland 20904 (“Aziyo”).

 

WHEREAS, Cook and Aziyo entered into the
License Agreement, by which Cook granted to Aziyo a license relating to certain defined Specified Licensed Products in certain
defined Aziyo Fields of Use;

 

WHEREAS, Aziyo desires to add to the defined
Aziyo Fields of Use certain fields relating to SIS pouch devices into which certain implantable electronic medical devices are
to be inserted at the point of care for subcutaneous implantation in human patients;

 

WHEREAS, Cook is willing to grant to Aziyo
additions to the defined Aziyo Fields of Use, on the terms and conditions herein;

 

NOW, THEREFORE, Cook and Aziyo agree as
follows:

 

		1.	In Article 1 of the License Agreement, the definition of “Aziyo Fields of Use” is removed and replaced in its entirety
with the following:

 

“Aziyo Fields of Use” means:

 

(a)       the
use of SIS for the repair of myocardial tissue, and for the repair of the pericardial sac. By way of clarification, the Aziyo Fields
of Use do include placing the SIS patch material directly into or onto myocardial tissue but do not include the use of SIS for
the repair or replacement of the coronary arteries, or for epicardial infarct repair;

 

(b)       the
use of SIS for all Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) repair, except for the transvascular approach
to ASD and VSD repair;

 

(c)       the
use of SIS to repair carotid arteries in an open surgery but not the use of SIS in conjunction with a stent or other frame; and
for clarity, “open surgery” for purposes of this subparagraph (c) does not include (i) any form of percutaneous access
(using a cut down or not) to or through a carotid artery using SIS, including but not limited to any vascular patching via percutaneous
delivery (e.g. as in the repair of punctures created by percutaneous access devices), (ii) any form of indirect access to the carotid
artery through a vascular vessel using SIS, or (iii) any form of access to or through a carotid artery over or through a device
using SIS (e.g. transcatheter access);

 

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(d)       the
use of SIS to patch repair the wall of peripheral veins and arteries, other than carotid arteries, using a sheet form patch product
in open surgery and where a surface of the implanted patch forms part of the blood contacting lumen of the vein or artery, but
not including the use of SIS in conjunction is with a stent or other frame; and for clarity, (i) “open surgery” for
purposes of this subparagraph (d) does not include (a) any form of percutaneous access (using a cut-down or not) to or through
a vein or artery using SIS, including but not limited to any vascular patching via percutaneous delivery (e.g. as in the repair
of punctures created by percutaneous access devices), (b) any form of indirect access to the vein or artery through a vascular
vessel using SIS, or (c) any form of access to or through a vein or artery over or through a device using SIS (e.g. transcatheter
access), and (ii) patch repair shall be limited to patch repair as specified above only and does not include the creation or use
of a vessel or conduit made out of SIS and does not include any use of SIS to replace or repair any valve;

 

(e)       SIS
pouch devices into which implantable cardiac pacemaker or defibrillator devices are to be inserted at the point of care for subcutaneous
implantation in human patients;

 

(f)       SIS
pouch devices into which implantable electronic cardiac stimulation devices, other than cardiac pacemaker or defibrillator devices,
are to be inserted at the point of care for subcutaneous implantation in human patients (hereafter the “Other ECSD SubField”);
and

 

(g)       SIS
pouch devices into which implantable electronic neurostimulation devices for deep brain stimulation, spinal nerve and sacral nerve
stimulation to relieve chronic pain, and nerve stimulation to help control bladder, digestive, abdomen, and bowel movements, are
to be inserted at the point of care for subcutaneous implantation in human patients (hereafter the “ENSD SubField”).”.

 

		2.	The following paragraphs are added at the end of Article
5:

 

5.3.       Minimum
Requirements for SIS Pouch Devices. If, during the term of this Agreement, Aziyo fails in any calendar year to order and pay
Cook Biotech for a minimum of five hundred thousand dollars ($500,000.00) of SIS Material pursuant to the Supply Agreement for
use in SIS pouch devices SubFields emcompassed in 1 (e) through (g) as demonstrated by corporate records of Aziyo, Cook may, in
its sole discretion, terminate the license to SIS pouch devices for the Other ECSD SubField and the ENSD SubField or convert such
licenses to non-exclusive licenses unless Aziyo remits to Cook a non-refundable, non-creditable payment equal to any shortfall
in purchasing such minimum amount of SIS Material pursuant to this Agreement within 45 days after such calendar year end.

 

5.4.       Diligence
for SIS Pouch Devices. If, within eighteen (18) months after execution of this Amendment, Aziyo has not commenced
commercial sales of SIS pouch devices in the Other ECSD SubField under a U.S. regulatory approval for the Other ECSD
SubField, Cook may, in its sole discretion, terminate the licenses to SIS pouch devices in the Other ECSD SubField under this
Agreement or convert such license to a non-exclusive license. If, within eighteen (18) months after execution of this
Amendment, Aziyo has not commenced commercial sales of SIS pouch devices in the ENSD SubField under a U.S. regulatory
approval for the ENSD SubField, Cook may, in its sole discretion, terminate the license to SIS pouch devices in the ENSD
SubField under this Agreement or convert such license to a non-exclusive license.

 

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5.6.       Regulatory/Pouches
in the Other ECSD SubField. Aziyo shall obtain and be responsible for the costs associated with obtaining regulatory approval
of the SIS pouch devices for the Other ECSD SubField. Aziyo shall also be responsible for pre-clinical development, pre-clinical
studies and post-market clinical studies as may be required by regulatory bodies for regulatory approval.

 

5.7.       Regulatory/Pouches
in the ENSD SubField. Aziyo shall obtain and be responsible for the costs associated with obtaining regulatory approval of
the SIS pouch devices for the ENSD SubField. Aziyo shall also be responsible for pre-clinical development, pre-clinical studies
and post-market clinical studies as may be required by regulatory bodies for regulatory approval.

 

5.8.       License
Fee Payments. Aziyo shall make the following License Fee Payments to Cook, on or before the specified Payment Due Date. These
License Fee Payments shall be nonrefundable and noncreditable by Aziyo against any other amounts due under this Agreement:

 

	License Fee Payment	Payment Due Date
	 	 
	$200,000	October 20, 2018
	 	 
	$100,000	October 20, 2019
	 	 
	$100,000	October 20, 2020
	 	 
	$100,000	October 20, 2021
	 	 
	$100,000	October 20, 2022
	 	 
	$100,000	October 20, 2023
	 	 
	$100,000	October 20, 2024
	 	 
	$100,000	October 20, 2025
	 	 
	$100,000	October 20, 2026

 

5.9       Acceleration
of License Fee Payments. If, as and to the extent permitted by the License Agreement, Aziyo consummates a Change in
Control (as defined below), then Aziyo shall pay to Cook the total of all License Fee Payments under Section 5.8 that have
not yet been paid within fifteen (15) days after the consummation of such Change in Control. “Change in Control”
shall mean the acquisition by any individual, entity or group of beneficial ownership of 50% or more of the then outstanding
shares of voting capital stock of Aziyo solely in exchange for cash or other liquid asset consideration, payable by such
individual, entity or group to the holders of such outstanding shares of voting capital stock. For avoidance of doubt, the
Parties acknowledge that the terms of this Amendment, including but not limited to this Section 5.9, shall be binding upon
any permitted assignee or successor in interest of Aziyo in the License Agreement.

 

    3

     

    

 

5.10       Cook
Rights Upon Any Nonpayment of License Fee Payments. Upon any failure by Aziyo to make any License Fee Payment when due pursuant
to Section 5.8 or Section 5.9, in addition to any and all other equitable or legal remedies that may be available to Cook under
the License Agreement, Aziyo agrees that Cook shall be entitled, at Cook’s discretion and election, to terminate the License
Agreement in its entirety, to terminate or convert to a non-exclusive license all or any portion of the Aziyo Fields of Use, and/or
to an injunction or injunctions to enforce specifically the provisions of Section 5.8 and/or Section 5.9 in any court of the United
States or any state having jurisdiction. For clarity, Aziyo acknowledges that all of its payment obligations under the License
Agreement, including but not limited to those under Sections 5.8 and 5.9, are material obligations, and that failure to make such
payments would constitute a material breach of the License Agreement.

 

Except as amended hereby, the License Agreement is ratified
and confirmed in all respects.

 

	COOK BIOTECH INCORPORATED	 	AZIYO MED, LLC
	 	 	 	 	 
	BY:	/s/ Umesh Patel	 	BY:	/s/ Jeffrey D. Hamet
	 	Umesh Patel	 	 	Jeffrey D. Hamet
	 	 	 	 	 
	TITLE:	President	 	TITLE:	Vice President of Finance
	 	 	 	 	 
	DATE:	21 Dec 17	 	DATE:	12/21/17
	 	 	 	 	 

  

    4

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