Document:

1st Amendment to Amended Loan and Security Agreement

 Exhibit 10.9 
 FIRST AMENDMENT 
 TO 

SECOND AMENDED AND RESTATED LOAN AND SECURITY AGREEMENT 
 THIS FIRST AMENDMENT to Second Amended and Restated Loan and Security Agreement (this “Amendment”) is entered into as of January 31, 2011, by and between SILICON VALLEY BANK
(“Bank”) and ALPHATEC SPINE, INC., a California corporation (“Alphatec”) and ALPHATEC HOLDINGS, INC., a Delaware corporation (“Parent” and together with Alphatec, each a
“Borrower” and collectively, “Borrowers”) whose address is 5818 El Camino Real, Carlsbad, California 92008. 
 RECITALS 
 A. Bank and Borrowers have entered into that
certain Second Amended and Restated Loan and Security Agreement dated as of October 29, 2010 (as the same has been amended and may from time to time be further amended, modified, supplemented or restated, , the “Loan
Agreement”). 
 B. Bank has extended credit to Borrowers for the purposes permitted in the Loan Agreement. 

C. Borrowers have requested that Bank amend the Loan Agreement to make certain revisions to the Loan Agreement as more fully set forth
herein. 
 D. Bank has agreed to so amend certain provisions of the Loan Agreement, but only to the extent, in accordance with
the terms, subject to the conditions and in reliance upon the representations and warranties set forth below. 

AGREEMENT 
 NOW, THEREFORE, in consideration of the foregoing recitals and other good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, and
intending to be legally bound, the parties hereto agree as follows: 
 1. Definitions. Capitalized terms used but not
defined in this Amendment shall have the meanings given to them in the Loan Agreement. 
 2. Amendments to Loan
Agreement. 
 2.1 Section 13 (Definitions). The following terms and their respective definitions hereby are
amended in, or added to, Section 13.1 of the Loan Agreement: 
 “Cibramed Acquisition”
means the transactions effectuated by the Cibramed Acquisition Documents. 
 “Cibramed Acquisition
Agreement” means that certain Quota Purchase Agreement by and among Alphatec, Marcia De Castro Leitao, Rodrigo De Godoy, Mauro Paciello De Souza Castro, Antonia Da Graca Silva and Cibramed Produtos Medicos Descartaveis Comercio Importacao E
Exportacao Ltda. - EEP), dated as of January 3, 2011, and the schedules and exhibits thereto, if any. 

“Cibramed Acquisition Documents” means the Cibramed Acquisition Agreement and any other documents,
instruments, certificates and/or agreements necessary to, and executed in connection with, the Cibramed Acquisition Agreement; all in form and substance reasonably acceptable to Bank. 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 1 

 “First Amendment Effective Date” means January 31,
2011. 
 “Non-Formula Amount” means Revolving Advances made without regard to the Borrowing
Base, in an aggregate amount not to exceed [***]. 
 “Tier 4 AQR” is defined in
Section 6.9(a). 
 2.2 Section 2.4 (Payment of Interest on the Credit Extensions). Section 2.4(a)
of the Loan Agreement hereby is amended and restated in its entirety to read as follows: 
 “(a) Interest
Rates. Subject to Section 2.4(b), the principal amount outstanding under the Revolving Line shall accrue interest at a per annum rate equal to (i) during the period when the Tier 1 AQR is in effect, [***]; (ii) during the
period when the Tier 2 AQR is in effect, [***]; (iii) during the period when the Tier 3 AQR is in effect, [***]; and (iv) during the period when the Tier 4 AQR is in effect, the greater of (x) [***] and (y) five [***]; in each
case, which interest shall be payable monthly.” 
 2.3 Section 6.8 (Operating Accounts). Effective as of
December 13, 2010, Section 6.8(a) of the Loan Agreement hereby is amended and restated in its entirety to read as follows: 
 “(a) Maintain its primary depository, operating and securities accounts with Bank or Bank’s Affiliates, which accounts shall represent at least [***] of the dollar value of each Borrower’s
and each Borrower’s Subsidiaries’ accounts at all financial institutions. Notwithstanding the foregoing, Borrower’s shall cause multi-currency accounts with Bank to be opened no later than forty-five (45) days after the First
Amendment Effective Date.” 
 2.4 Section 6.9 (Financial Covenants). Effective as of November 30, 2010,
Section 6.9(a) of the Loan Agreement hereby is amended and restated in its entirety to read as follows: 

“(a) Adjusted Quick Ratio. An Adjusted Quick Ratio, measured monthly, of at least [***] (the “Tier 1
AQR”); (ii) [***] (the “Tier 2 AQR”); (iii) [***] (the “Tier 3 AQR”); and (iv) [***] (the “Tier 4 AQR”).” 

2.5 Exhibit D attached to the Loan Agreement hereby is replaced in its entirety by Exhibit D attached hereto. 

2.6 Bank hereby consents to the Cibramed Acquisition and the execution, delivery and performance by Borrowers of the Cibramed
Acquisition Documents; and hereby waives any violation of the Loan Agreement, including the provisions of Section 7 thereof, and of any other Loan Document that might otherwise be affected by the Cibramed Acquisition. 

3. Limitation of Amendments. 
 3.1 The amendments set forth in Section 2, above, are effective for the purposes set forth herein and shall be limited precisely as written and shall not be deemed to (a) be a
consent to any amendment, waiver or modification of any other term or condition of any Loan Document, or (b) otherwise prejudice any right or remedy which Bank may now have or may have in the future under or in connection with any Loan
Document. 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 2 

 3.2 This Amendment shall be construed in connection with and as part of the Loan
Documents and all terms, conditions, representations, warranties, covenants and agreements set forth in the Loan Documents, except as herein amended, are hereby ratified and confirmed and shall remain in full force and effect. 

4. Representations and Warranties. To induce Bank to enter into this Amendment, each Borrower hereby represents and
warrants to Bank as follows: 
 4.1 Immediately after giving effect to this Amendment (a) the representations and
warranties contained in the Loan Documents are true, accurate and complete in all material respects as of the date hereof (except to the extent such representations and warranties relate to an earlier date, in which case they are true and correct as
of such date), and (b) no Event of Default has occurred and is continuing; 
 4.2 Each Borrower has the power and
authority to execute and deliver this Amendment and to perform its obligations under the Loan Agreement, as amended by this Amendment; 
 4.3 The organizational documents of each Borrower delivered to Bank on the Effective Date remain true, accurate and complete and have not been amended, supplemented or restated and are and continue
to be in full force and effect; 
 4.4 The execution and delivery by each Borrower of this Amendment and the performance
by each Borrower of its obligations under the Loan Agreement, as amended by this Amendment, have been duly authorized; 

4.5 The execution and delivery by each Borrower of this Amendment and the performance by each Borrower of its obligations under
the Loan Agreement, as amended by this Amendment, do not and will not contravene (a) any law or regulation binding on or affecting such Borrower, (b) any contractual restriction with a Person binding on such Borrower, (c) any order,
judgment or decree of any court or other governmental or public body or authority, or subdivision thereof, binding on such Borrower, or (d) the organizational documents of such Borrower; 

4.6 The execution and delivery by each Borrower of this Amendment and the performance by each Borrower of its obligations under
the Loan Agreement, as amended by this Amendment, do not require any order, consent, approval, license, authorization or validation of, or filing, recording or registration with, or exemption by any governmental or public body or authority, or
subdivision thereof, binding on either Borrower, except as already has been obtained or made; and 
 4.7 This Amendment
has been duly executed and delivered by each Borrower and is the binding obligation of each Borrower, enforceable against such Borrower in accordance with its terms, except as such enforceability may be limited by bankruptcy, insolvency,
reorganization, liquidation, moratorium or other similar laws of general application and equitable principles relating to or affecting creditors’ rights. 
 5. Counterparts. This Amendment may be executed in any number of counterparts and all of such counterparts taken together shall be deemed to constitute one and the same instrument.

 6. Effectiveness. This Amendment shall be deemed effective upon (i) the due execution and delivery to Bank
of this Amendment by each party hereto; (ii) Borrowers’ payment of an amendment fee in an amount equal to [***]; and (iii) the due execution and delivery to Bank of the First Amendment to Post Closing Letter. 

[Balance of Page Intentionally Left Blank] 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 3 

 IN WITNESS WHEREOF, the parties hereto
have caused this Amendment to be duly executed and delivered as of the date first written above. 
  

									
	BANK:	 		 	BORROWERS:
			
	Silicon Valley Bank	 		 	Alphatec Spine, Inc.
					
	By:	 	 /s/ Derek Brunelle
	 		 	By:	 	 /s/ Michael O’Neill

	Name:	 	 Derek Brunelle
	 		 	Name:	 	 Michael O’Neill

	Title:	 	 Deal Team Leader
	 		 	Title:	 	 CFO and VP

				
		 		 		 	Alphatec Holdings, Inc.
					
		 		 		 	By:	 	 /s/ Michael O’Neill

		 		 		 	Name:	 	 Michael O’Neill

		 		 		 	Title:	 	 CFO and VP

 [Signature Page to First Amendment 
 to Second Amended and
Restated Loan and Security Agreement] 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 

 EXHIBIT D 

COMPLIANCE CERTIFICATE 
  

			
	TO:	  	SILICON VALLEY BANK,
	Date:	  	                    
	FROM:	  	ALPHATEC SPINE, INC. and ALPHATEC HOLDINGS, INC.

 The undersigned authorized officer of ALPHATEC SPINE, INC. (“Alphatec”) certifies on behalf of Alphatec and ALPHATEC HOLDINGS, INC. (“Parent” and together with Alphatec each a
“Borrower” and collectively, “Borrowers”) that under the terms and conditions of the Second Amended and Restated Loan and Security Agreement between Borrowers, Bank (the “Agreement”), (1) Each Borrower is in
complete compliance for the period ending                      with all required covenants except as noted below, (2) there are no Events
of Default, (3) all representations and warranties in the Agreement are true and correct in all material respects on this date except as noted below; provided, however, that such materiality qualifier shall not be applicable to any
representations and warranties that already are qualified or modified by materiality in the text thereof; and provided, further that those representations and warranties expressly referring to a specific date shall be true, accurate and complete in
all material respects as of such date, (4) Each Borrower, and each of its Subsidiaries, has timely filed all required tax returns and reports, and each Borrower has timely paid all foreign, federal, state and local taxes, assessments, deposits
and contributions owed by such Borrower except as otherwise permitted pursuant to the terms of Section 5.8 of the Agreement, and (5) no Liens have been levied or claims made against either Borrower or any of their Subsidiaries
relating to unpaid employee payroll or benefits of which such Borrower has not previously provided written notification to Bank’s. Attached are the required documents supporting the certification. The undersigned certifies that these are
prepared in accordance with generally GAAP consistently applied from one period to the next except as explained in an accompanying letter or footnotes. The undersigned acknowledges that no borrowings may be requested at any time or date of
determination that Borrowers are not in material compliance with any of the terms of the Agreement, and that compliance is determined not just at the date this certificate is delivered. Capitalized terms used but not otherwise defined herein shall
have the meanings given them in the Agreement. 
 Please indicate compliance status by circling Yes/No under “Complies” column.

  

													
	 Reporting Covenant
	  	Required	  	Complies	 
	 [***]
	  	[***]	  	 	y/n	  

  

															
	 Financial Covenant
	  	Required	 	  	Actual	 	  	Complies
	 [***]
	  	 	[***]	  	  	 	[***]	  	  	y/n

 The following are the
exceptions with respect to the certification above: (If no exceptions exist, state “No exceptions to note.”) 
 The following analysis
and information set forth in Schedule 1 attached hereto are true and accurate as of the date of this Certificate. 
  

	
	  

	  

	  

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 

									
	ALPHATEC SPINE, INC.	 		 	LENDERS’ USE ONLY
					
	 By:
	 	  
	 		 	Received by:	 	  

	 Name:
	 	  
	 		 		 	AUTHORIZED SIGNER
	Title:	 	  
	 		 	Date:	 	  

					
		 		 		 	Verified:	 	  

		 		 		 		 	AUTHORIZED SIGNER
		 		 		 	Date:	 	  

				
		 		 		 	Compliance Status:          Yes          No

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended.5th Amendment to Exclusive License Agreement

 Exhibit 10.22 
 FIFTH AMENDMENT TO 
 EXCLUSIVE LICENSE AGREEMENT 

This Fifth Amendment to Exclusive License Agreement (this “Fifth Amendment”) is made as of November 30, 2010 by and among
Alphatec Spine, Inc., a Delaware corporation with a principal place of business at 5818 El Camino Real, Carlsbad, California 92008 (“Licensee”), Progressive Spinal Technologies LLC, a limited liability company organized under the laws of
the state of Delaware, with an address at 410 East Walnut Street, Suite #8, Perkasie, Pennsylvania 18944 (“Licensor”) and for purposes of Section 7.2 and Section 11.15 thereof only Alphatec Holdings, Inc., a Delaware corporation
with a principal place of business at 2051 Palomar Airport Road, Suite 100, Carlsbad, California 92008 (“Holdings”). Capitalized terms undefined herein shall have the meaning ascribed them in the Agreement (as hereinafter defined).

 RECITALS 
 Reference is made to that certain Exclusive License Agreement dated December 18, 2007, as amended, between the parties to this Fifth Amendment (the “Agreement”). 

The Parties desire to amend the Agreement as set forth herein. 
 Now, therefore, in consideration of the mutual promises set forth herein and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged by the Parties hereto, the
Parties hereto agree as follows: 
  

	1.	AMENDMENTS 

 1.1
Deletion of Portion of Subsection 4.1.2 with respect to the Event titled [***]. 
 The portions of the table in
Subsection 4.1.2 with respect to the event titled [***] and the associated “Milestone Payment” are hereby deleted. 

1.2 Addition to Subsection 4.1.2. 
 A new paragraph is added immediately after the table in Subsection 4.1.2, reading as follows: 
 “In addition to the foregoing, on the date hereof, Licensee shall, as a payment for the achievement of [***]: 
  

	 	(i)	Pay to Licensor one million five-hundred thousand dollars ($1,500,000) in cash; and 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 

	 	(ii)	Cause Holdings to issue (and Holdings by its signature hereof agrees to issue) to (i) [***] five hundred thousand dollars ($500,000) in shares of Common Stock; and
(ii) [***] five-hundred thousand dollars ($500,000) in shares of Common Stock; the price of a share of Common Stock for such purpose equal to the average per share NASDAQ Close/NASDAQ Official Closing Price (as defined by NASDAQ) or a defined
successor closing price (designated by NASDAQ) on the fifteen (15) business days prior to the date of issuance; provided that if on any such business day the Common Stock shall not be listed on the NASDAQ national exchange, then Licensor shall
receive One million dollars ($1,000,000) in cash in lieu of such shares of Common Stock.” 

 1.3
Amendment and Restatement of Subsection 4.1.3. 
 Subsection 4.1.3 of the Agreement is deleted in its entirety and
replaced with the following: 
 “4.1.3 Royalty Payments. 

4.1.3.1 Royalty Payments if Subsection 4.1.3.2 Does Not Apply, i.e. no Clinical Trial Required. If Subsection 4.1.3.2 does not
apply, Licensee shall pay to Licensor within thirty (30) days of the end of each calendar quarter earned royalties of [***] of Net Sales during such calendar quarter. 
 4.1.3.2 Royalty Payments if a Clinical Trial is Required. Notwithstanding Subsection 4.1.3.1, if the FDA notifies Licensee on or before [***] that approval of the current design of a Licensed
Product will require a clinical trial to obtain approval to market such Licensed Product in the U.S., then in lieu of royalties payable as described in Subsection 4.1.3.1, Licensee shall pay to Licensor within thirty (30) days of the end of
(i) the three (3)-month period beginning on the first day of the calendar month following the date on which FDA clearance to market and sell a Licensed Product is received and (ii) each of the consecutive three (3)-month period thereafter
(the date upon which FDA clearance is received shall be referred to as the “Minimum Trigger Date” and each three (3)-month period described in (i) or (ii) shall be referred to as a “Royalty Quarter”) earned royalties of
[***] of Net Sales during such Royalty Quarter, except that the first payment shall include Net Sales from the Minimum Trigger Date through the end of the first Royalty Quarter. By way of illustration of the foregoing, in the event that the FDA
grants clearance to market and sell a Licensed Product on April 3, 2012, that date shall be the Minimum Trigger date and Royalty Quarters shall begin on May 1, August 1, November 1 and February 1 with the first
Royalty Quarter commencing with May 1, 2012. 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 2 

 4.1.3.3 Additional Covenants Related to Royalty Payments. Each royalty payment made
pursuant to this Subsection 4.1.3 shall (i) be accompanied by a report specifying: the Net Sales (including an accounting of deductions taken in the calculation of Net Sales) and (ii) state the applicable exchange rate used in conversion
from any foreign country’s currency to United States Dollars (which conversion shall be determined in accordance with Subsection 4.2.2). Earned royalties described in this Subsection 4.1.3 shall only be credited against minimum royalties which
would otherwise be due as contemplated by Subsection 4.1.4 and shall not be credited against or otherwise reduce any other amounts payable hereunder.” 
 1.4 Amendment and Restatement of Subsection 4.1.4. Subsection 4.1.4 of the Agreement is deleted in its entirety and replaced with the following: 

“4.1.4 Minimum Royalties. 
 4.1.4.1 Minimum Royalties if Subsection 4.1.4.2 Does Not Apply, i.e. no Clinical Trial Required. If Subsection 4.1.4.2 does not apply, Licensee shall pay Licensor the following minimum annual
royalty amounts in each calendar year listed next to such amount. For a particular calendar year, in the event that the sum of the earned royalties on Net Sales timely paid in accordance with Subsection 4.1.3 above with respect to the four
calendar quarters of such calendar year are less than the minimum annual royalty for such year designated below, the obligation to pay the difference to Licensor shall accrue on the last day of such calendar year and be payable by Licensee no later
than forty-five (45) days following the end of such calendar year: 
  

			
	 Twelve (12) Months Ending
	 	 Minimum Annual Royalty

	[***]	 	[***]
	[***]	 	[***]

 4.1.4.2 Minimum Royalties if a
Clinical Trial is Required. Notwithstanding Subsection 4.1.4.1, if the FDA notifies Licensee on or before [***] that approval of the current design of a Licensed Product will require a clinical trial to obtain approval to market such Licensed
Product, then in lieu of minimum royalties payable as described in Subsection 4.1.4.1, Licensee shall pay Licensor a minimum annual royalty of [***] with respect to each twelve (12)-month period comprised of four (4) Royalty Quarters, the first
of which will commence on the first day of the first Royalty Quarter (each a “Royalty Year”). By way of illustration of the foregoing, if the first Royalty Quarter shall commence on May 1, 2012, the first Royalty Year shall commence
on that date and end on April 30, 2013, the second Royalty Year shall commence on May 1, 2013 and end on April 30, 2014, etc. In the event that aggregate earned royalties on Net Sales timely paid in accordance with Subsection 4.1.3.2
with respect to a Royalty Year are less than [***], the obligation to pay the difference to Licensor shall accrue on the last day of such Royalty Year and shall be payable by Licensee no later than forty-five (45) days following the end of such
Royalty Year; provided that with respect to the first Royalty Year: (i) within thirty (30) days of the end of each Royalty Quarter during the first Royalty Year, the Licensee shall make a payment (which payment obligations shall accrue on
the last day of such Royalty Quarter and shall be due and payable thirty (30) days thereafter) to the Licensor (each a “First Year Minimum Payment”) equal to 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 3 

 
greater of (A) [***] and (B) earned royalties on Net Sales payable to Licensor pursuant to Subsection 4.1.3.2 with respect to such Royalty Quarter and (ii) if the aggregate amount
of the four First Year Minimum Payments calculated as described in clause (i) would be more than both (y) earned royalties on Net Sales payable to Licensor pursuant to Subsection 4.1.3.2 with respect to the first Royalty Year, and
(z) [***] (such greater amount the “First Year Maximum’), then Licensee may reduce the amount of the final First Year Minimum Payment such that the aggregate of the four First Year Minimum Payments would equal the First Year Maximum.
If the aggregate amount of the three First Year Minimum Payments calculated as described in clause (i) is more than the First Year Maximum, then no fourth First Year Minimum Payment from Licensee is due and Licensor shall pay Licensee no later
than thirty (30) days following the end of such Royalty Year an amount equal to the difference. 
 4.1.4.3 No Credits. No minimum
annual royalty described in this Subsection 4.1.4 shall be credited against or otherwise reduce any other amounts payable hereunder.
 1.5 Amendment and Restatement of to Subsection 4.2.2. Subsection 4.2.2 of the Agreement is deleted in its entirety and replaced with the following: 

“4.2.2 Conversion. Conversion of funds from foreign currency to United States dollars shall be made at the conversion rate
existing in the United States (as reported in The Wall Street Journal) on the last business day of the quarter immediately preceding the calendar quarter or Royalty Quarter, as applicable. If The Wall Street Journal ceases to be
published, then the rate of exchange to be used shall be that reported in such other business publication of national circulation in the United States as the Parties reasonably agree. 

1.6 Amendment to Section 9.2. 
 Section 9.2 is hereby amended by changing its title to “Termination Rights for Breach, Voluntary Termination and Non-Pursuit” and a new Subsection 9.2.3 is hereby added as follows:

 9.2.3 Licensor’s Termination Rights Based on Non-pursuit of FDA Approval. Licensor shall be entitled to
terminate the Agreement by giving Licensee sixty (60) days written notice (i) if Licensee is at anytime failing to use commercially reasonable efforts to obtain approval by the FDA of a Licensed Product, or (ii) if following [***] the
Licensee terminates or permits to lapse a 510(k) application or Investigational Device Exemption (“IDE”) with the FDA to obtain approval of a Licensed Product (any 510(k) application or IDE with respect to a Licensed Product a
“Regulatory Filing”); provided that if during such sixty (60) day notice period Licensee (i) cures the grounds upon which termination was based, or (ii) delivers to Licensor written notice that it desires to continue this
license (the “Continuation Notice”) such termination shall be ineffective and void ab initio. In the event Licensee timely delivers the Continuation Notice, Licensee hereby agrees to make the following payments to Licensor (each of
which shall be credited against any amounts due to the Licensor pursuant to Subsection 4.1.4 as modified hereby): 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 4 

	 	(i)	[***] not later than one hundred twenty (120) days following delivery of the Continuation Notice; 

 

	 	(ii)	An additional [***] not later than two hundred ten (210) days following delivery of the Continuation Notice; 

 

	 	(iii)	An additional [***] not later than three hundred (300) days following delivery of the Continuation Notice; and 

 

	 	(iv)	An additional [***] not later than three hundred sixty (360) days following delivery of the Continuation Notice. 

If during the period following the delivery of the Continuation Notice, the Licensee makes a Regulatory Filing, Licensee shall not be
obligated to make payment thereafter of amounts set forth in (i)-(iv), without prejudice to the right of Licensor to again terminate this Agreement pursuant to this Subsection 9.2.3. If within [***] after the date of the Continuation Notice, the
Company has not made a Regulatory Filing, the termination of this Agreement shall be effective without further action by the Parties as of the end of such [***] period. 

 

	2.	MISCELLANEOUS 

 In the
event of any conflict between the provisions of this Fifth Amendment and the Agreement, the provisions of this Fifth Amendment shall prevail. Other than as set forth in this Fourth Amendment, the remainder of the Agreement shall remain in full force
and effect. 
 [Signature Page Follows] 

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 5 

 IN WITNESS WHEREOF, the Parties and Holdings have caused this Fifth Amendment to be
executed by their duly authorized representative. 
  

									
	ALPHATEC SPINE, INC.	 		 	 PROGRESSIVE SPINAL
 TECHNOLOGIES LLC:

					
	By:	 	 /s/ Dirk Kuyper
	 		 	By:	 	 /s/ E. Skott Greenhalgh

		 	Name: Dirk Kuyper	 		 		 	Name: E. Skott Greenhalgh
		 	Title: President and CEO	 		 		 	Title: CEO

  

			
	ALPHATEC HOLDINGS, INC.
		
	By:	 	 /s/ Dirk Kuyper

		 	Name: Dirk Kuyper
		 	Title: President and CEO

  
 Portions of
this Exhibit were omitted, as indicated by [***], and have been filed separately with the Secretary 
 of the Commission
pursuant to the Registrant’s application requesting confidential treatment under 
 Rule 24b-2 of the Securities
Exchange Act of 1934, as amended. 
 6

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