Document:

EX-10.19

 Exhibit 10.19 
 AMENDED AND RESTATED 
 RESOURCES GROUP MANAGEMENT SERVICES AGREEMENT 

This Amended and Restated Resources Group Management Services Agreement (as amended, modified or supplemented from time to time, this
“Agreement”) is entered into as of August 8, 2013 by and among (i) K2M Group Holdings, Inc., a Delaware corporation (“Group Holdings”), (ii) K2M Holdings, Inc., a Delaware corporation
(“Holdings”), (iii) K2M, Inc., a Delaware corporation (“K2M” and together with Group Holdings and Holdings, each a “Company” and collectively, the
“Companies”), and (iv) WCAS Management Corporation, a Delaware corporation (“WCAS Management”). 
 RECITALS 
 A. On August 12, 2010 Group Holdings acquired K2M pursuant
to a merger of an indirect wholly-owned Subsidiary of Group Holdings with and into K2M pursuant to the Agreement and Plan of Merger dated as of July 2, 2010 among Group Holdings, K2M, and the other persons party thereto (the “Merger
Agreement”). The transactions contemplated by the Merger Agreement are referred to herein as the “Contemplated Transactions”. 
 B. The Indemnitees (as hereinafter defined) may have certain rights to indemnification, advancement of expenses and/or insurance provided by WCAS Management, Welsh, Carson, Anderson & Stowe XI,
L.P., a Delaware limited partnership (“WCAS XI”) or their respective Affiliates (other than the Companies) under the certificates or articles of incorporation, bylaws, agreements of limited partnership or other organizational
documents of the such entities or any management agreement, indemnification agreement or other contract, agreement or arrangement between any of WCAS XI or such Affiliates, on the one hand, and the Indemnitees party thereto, on the other hand, which
the Companies, WCAS Management and WCAS XI intend to be secondary to the primary obligation of the Companies to indemnify Indemnitees as provided under the certificates of incorporation, bylaws or other organizational documents of the Companies or
any indemnification agreement, other contract, agreement or arrangement between any of the Companies, on the one hand, and the Indemnitees party thereto, on the other hand, with the Companies’ acknowledgement of and agreement to the foregoing
being a material condition to Indemnitees’ willingness to provide services to the Companies. 
 C. The WCAS Resources Group
consists of operating executives that have been recruited and retained by WCAS Management to provide consulting services to the portfolio companies of the various investment partnerships that are from time to time managed by WCAS Management and the
services provided by the WCAS Resources Group are of a nature otherwise available to such portfolio companies from unaffiliated third parties (but not of a nature historically provided by the investment professionals of WCAS Management). 

D. On August 12, 2010, the parties hereto entered into a Management Services Agreement (the “Original
Management Services Agreement”) and such parties
desire to amend the Original Management Services Agreement on the terms and conditions set forth herein, and for administrative convenience to restate the Original Management Services Agreement as so amended. In connection therewith, the Companies
desire to continue to retain WCAS 

 
Management to make available members of the WCAS Resources Group to provide certain management, consulting, strategic, financial and other advisory services to the Companies and their respective
Subsidiaries (as hereinafter defined) and Affiliates (as hereinafter defined) and WCAS Management is willing to continue to make available the members of the WCAS Resources Group to provide such services on the terms set forth below. 

AGREEMENT 

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties hereto, intending to be legally bound, agree that
the Original Management Services Agreement is hereby amended and restated in its entirety as follows: 
 1. Resources Group
Services. WCAS Management hereby agrees that it will make available to the Companies and their Subsidiaries Dan Pelak (so long as he is a member of the WCAS Resources Group) and/or other members of the WCAS Resources Group selected by WCAS
Management to provide strategic, managerial and operational advice to the senior management of the Companies and their Subsidiaries, including, without limitation, (i) advice with respect to the development and implementation of strategies for
improving operating performance, (ii) advice in connection with product and service offering development, marketing and distribution, (iii) advice in connection with the negotiation of agreements with suppliers, customers, landlords,
licensees, licensors, strategic partners and other persons with whom the Companies and their Subsidiaries conduct business, (iv) advice in connection with intellectual property development and management and (v) advice in connection with
strategic planning and analysis, human resources, executive recruitment and other operational matters. The WCAS Resources Group will devote such time and efforts to the performance of the services contemplated hereby as WCAS Management deems
reasonably necessary or appropriate. The Companies acknowledge that the services of the WCAS Resources Group are not exclusive and that WCAS Management and its Affiliates and the WCAS Resources Group will render similar services to other persons and
entities. WCAS Management and the Companies understand that the Companies may, at times, engage one or more consultants or other advisers to provide services in addition to, but not in lieu of, services provided under this Agreement. In providing
services to the Companies and their respective Subsidiaries, WCAS Management will act as an independent contractor and it is expressly understood and agreed that this Agreement is not intended to create, and does not create, any partnership, agency,
joint venture or similar relationship and that neither WCAS Management, on the one hand, nor the Companies, on the other hand, has the right or ability to contract for or on behalf of each other or to effect any transaction for each other’s
account. 
 2. Payment of Fees. The Companies shall be jointly and severally obligated to pay to WCAS Management (or an
Affiliate of WCAS Management designated by it) a fee (the “Resources Group Fee”) equal to (i) for the period prior to the date hereof and ending on June 30, 2013, the amounts payable for such period under Section 2(a)
of the Original Management Services Agreement (i.e., SEVENTY FIVE THOUSAND DOLLARS ($75,000) per fiscal quarter) and (ii) beginning on July 1, 2013, TWO HUNDRED SIXTY TWO THOUSAND FIVE HUNDRED DOLLARS ($262,500) per fiscal quarter, or such
other amount as may be mutually agreed to from time to time by WCAS Management and the Companies in order to reflect the 

  
 -2-

 
scope of the services being provided and the costs incurred by WCAS Management (and its Affiliates) in making available its WCAS Resources Group personnel for purposes of providing such services.
For the avoidance of doubt, all accrued but unpaid Resources Group Fees under the Original Management Agreement for the period ending on June 30, 2013 shall be payable on July 1, 2013. In furtherance of the forgoing, the Resources Group
Fee may be adjusted from time to time by WCAS Management and the Companies in order for the Companies to retain unaffiliated third parties to provide services in lieu of the services of the WCAS Resources Group to be provided under this Agreement.
The Resources Group Fee shall be payable quarterly in advance on or prior to the first day of each calendar quarter beginning on each January 1, April 1, July 1 and October 1. Once paid, the Resources Group Fee shall be
non-refundable. Each payment made pursuant to this Section 2 will be paid by wire transfer of immediately available federal funds to an account specified by WCAS Management for such purposes, or by other means as WCAS Management and the
Companies may from time to time agree. 
 3. Term. This Agreement will continue in full force and effect until
December 31, 2020 (the “Initial Termination Date”); provided that (a) this Agreement shall be automatically extended for an additional one year period on the Initial Termination Date and on each
December 31 thereafter (with the next succeeding December 31 becoming an “Extended Termination Date”) unless the Companies or WCAS Management provide written notice of their or its desire not to automatically extend the
term of this Agreement to the other parties hereto at least 180 days prior to such Initial Termination Date or Extended Termination Date, as applicable, (b) WCAS Management may terminate this Agreement upon not less than 10 days written notice
to the Companies, (c) either party may terminate this Agreement following a material breach of the terms of this Agreement by the other party hereto and a failure to cure such breach within 30 days following written notice thereof, (d) the
Companies may, upon not less than 90 days prior written notice terminate Sections 1 and 2 of this Agreement in order to retain unaffiliated third parties to provide services in lieu of the Resources Group Services to be provided under
Section 1 of this Agreement, and (e) this Agreement shall terminate upon the consummation of a Qualified Public Offering or Deemed Liquidation (each as defined in the certificate of incorporation of Group Holdings) (the period on
and after the date hereof through the termination hereof being referred to herein as the “Term”); provided further, that each of (x) Sections 4, 5 and 8 of this Agreement (whether in respect of or
relating to services rendered during or after the Term) and (y) any and all accrued and unpaid obligations of the Companies owed under Section 2 will all survive any termination of this Agreement or termination of Sections 1
and 2 hereof (pursuant to clause (d) above) to the maximum extent permitted under applicable law. 

  
 -3-

 4. Expenses; Indemnification. 

(a) Expenses. The Companies shall jointly and severally pay on demand all expenses incurred by WCAS Management,
WCAS XI and their respective Affiliates (i) in connection with this Agreement, (ii) relating to operations of, or services provided by WCAS Management or any of its Affiliates to, the Companies or any of their respective Affiliates from
time to time and (iii) otherwise relating to the Companies or relating to, or arising out of, the Contemplated Transactions, any investment made by WCAS XI or any of its Affiliates in the Companies or any of their respective Affiliates or the
ownership or sale of all or any part of such investments by WCAS XI or its Affiliates. Without limiting the generality of the foregoing, the Companies jointly and severally agree to pay on demand all expenses incurred by WCAS Management, WCAS XI and
their respective Affiliates in connection with, or relating to, (x) the preparation, negotiation and execution of this Agreement, the Merger Agreement and the Ancillary Agreements (as defined in the Merger Agreement), any other agreement
relating to any of the foregoing, and the consummation of the Contemplated Transactions and any other transactions entered into by the Companies or any of their respective Affiliates during the Term (including any future financing transactions with
WCAS XI or any of its Affiliates, any public offering, any future acquisition or recapitalization by any of the Companies or any of their respective Affiliates or any transaction that is a Deemed Liquidation (as defined in the certificate of
incorporation of Group Holdings) or (y) any and all amendments, modifications, restructurings and waivers, and exercises and preservations of rights and remedies relating to any of the foregoing, and in each case will specifically include the
fees and disbursements of counsel, accountants, consultants or advisors retained by WCAS Management, WCAS XI or their respective Affiliates or their respective consultants or advisors, and any out-of-pocket expenses incurred by WCAS Management, WCAS
XI or their respective Affiliates in connection with the provision of services to the Companies or any of their respective Affiliates from time to time or the attendance at any meeting of the managers, officers or board of directors (or equivalent),
including any committee thereof, of any of the Companies or any of their respective Affiliates. 
 (b)
Indemnity and Liability. The Companies hereby jointly and severally indemnify and agree to exonerate and hold each of WCAS Management, WCAS XI and each of their respective partners, shareholders, members, Affiliates, directors, officers,
fiduciaries, managers, controlling persons, employees and agents and each of the partners, shareholders, members, directors, officers, fiduciaries, managers, controlling persons, employees and agents of each of the foregoing (collectively, the
“Indemnitees”), each of whom is an intended third party beneficiary of this Agreement, free and harmless from and against any and all actions, causes of action, suits, claims, liabilities, losses, damages and all costs and expenses
in connection therewith, including without limitation reasonable attorneys’ fees and expenses (collectively, the “Indemnified Liabilities”), incurred by the Indemnitees or any of them as a result of, arising out of, or in any
way relating to (i) this Agreement, Merger Agreement, the Ancillary Agreement, the Contemplated Transactions and any other transaction to which the Companies or any of their respective Affiliates are a party or any related transactions or
(ii) operations of, or services provided by WCAS Management or its Affiliates to, any of the Companies or 

  
 -4-

 
any Affiliate of any of the Companies from time to time (including but not limited to any indemnification obligations assumed or incurred by any Indemnitee to or on behalf of any of the Companies
or any of their respective accountants or other representatives, agents or Affiliates) except for any such Indemnified Liabilities arising from such Indemnitee’s willful misconduct, and if and to the extent that the foregoing undertaking may be
unavailable or unenforceable for any reason, each of the Companies hereby agrees to make the maximum contribution to the payment and satisfaction of each of the Indemnified Liabilities that is permissible under applicable law. In addition, the
Companies hereby jointly and severally agree to advance to each Indemnitee all expenses incurred in connection with any indemnifiable claim referenced in the immediately preceding sentence promptly after receipt of reasonably detailed statements
therefor. For purposes of this Section 4(b), none of the circumstances described in the limitations contained in the immediately preceding sentence shall be deemed to apply absent a final non-appealable judgment of a court of competent
jurisdiction to such effect, in which case to the extent any such limitation is so determined to apply to any Indemnitee as to any previously advanced indemnity payments made by the Companies, then such payments shall be promptly repaid by such
Indemnitee to the Companies. The rights of any Indemnitee to indemnification hereunder will be in addition to any other rights any such person may have under the Merger Agreement or any other Ancillary Agreement (as defined in the Merger Agreement)
or any other agreement or instrument to which such Indemnitee is or becomes a party or is or otherwise becomes a beneficiary or under law or regulation. The Companies hereby agree that they are the indemnitors of first resort (i.e., the
obligations of the Companies to any Indemnitee under their respective certificates of incorporation, or any other agreement that any of the Companies may have with the Indemnitees are primary and any obligation of WCAS Management or WCAS XI (or any
of their respective Affiliates other than the Companies) to provide advancement or indemnification for the same Indemnified Liabilities (including all interest, assessment and other charges paid or payable in connection with or in respect of such
Indemnified Liabilities) incurred by Indemnitee are secondary), and if WCAS Management or WCAS XI (or any Affiliate thereof other than the Companies) pays or causes to be paid, for any reason, any amounts otherwise indemnifiable hereunder or under
any other indemnification obligation (whether pursuant to any other contract, any organizational document or otherwise) with any Indemnitee, then (i) WCAS Management or WCAS XI (or such Affiliate, as the case may be) shall be fully subrogated
to all rights of the applicable Indemnitee with respect to such payment and (ii) the Companies shall reimburse WCAS Management or WCAS XI (or such Affiliate) for the payments actually made. Each of the Companies hereby unconditionally and
irrevocably waives, relinquishes and releases (and covenants and agrees not to exercise, and to cause each Affiliate of any of the Companies not to exercise), any claims or rights that any of the Companies may now have or hereafter acquire against
any Indemnitee (in any capacity) that arise from or relate to the existence, payment, performance or enforcement of one of the Companies’ obligations under this Agreement or under any indemnification obligation (whether pursuant to any other
contract, any organizational document or otherwise), including any right of subrogation, reimbursement, exoneration, contribution or indemnification and any right to participate in any claim or remedy of any Indemnitee against any other Indemnitee,
whether such claim, remedy or right arises in equity or 

  
 -5-

 
under contract, statute, common law or otherwise, including any right to claim, take or receive from any Indemnitee, directly or indirectly, in cash or other property or by set-off or in any
other manner, any payment or security or other credit support on account of such claim, remedy or right. None of the Indemnitees will be liable to the Companies or any of their respective Affiliates for any act or omission suffered or taken by such
Indemnitee that does not constitute willful misconduct. 
 5. Disclaimer and Limitation of Liability; Opportunities.

 (a) Disclaimer; Standard of Care. WCAS Management makes no representations or warranties, express or
implied, in respect of the services to be provided by it hereunder. In no event will WCAS Management or any of the Indemnitees be liable to any of the Companies or any of their respective Affiliates for any act, alleged act, omission or alleged
omission that does not constitute gross negligence or willful misconduct of WCAS Management or another Indemnitee as determined by a final, non-appealable determination of a court of competent jurisdiction. 

(b) Freedom to Pursue Opportunities. In recognition that WCAS Management, WCAS XI and their respective Affiliates
currently have, and will in the future have or will consider acquiring, investments in numerous companies with respect to which WCAS Management, WCAS XI or their respective Affiliates or the other Indemnitees may serve as an advisor, a director or
in some other capacity, and in recognition that WCAS Management, WCAS XI and their respective Affiliates and the other Indemnitees have myriad duties to various investors and partners, and in anticipation that the Companies and WCAS Management or
WCAS XI (or one or more Affiliates, associated investment funds or portfolio companies, or clients of WCAS Management or WCAS XI) may engage in the same or similar activities or lines of business and have an interest in the same areas of corporate
opportunities, and in recognition of the benefits to be derived by the Companies hereunder and in recognition of the difficulties that may confront any advisor who desires and endeavors fully to satisfy such advisor’s duties in determining the
full scope of such duties in any particular situation, the provisions of this Section 5(b) are set forth to regulate, define and guide the conduct of certain affairs of the Companies as they may involve WCAS Management, WCAS XI or their
respective Affiliates or the other Indemnitees. Except as WCAS Management may otherwise agree in writing after the date hereof: 
 (i) Each of WCAS Management, WCAS XI and their respective Affiliates and the other Indemnitees will have the right: (A) to directly or indirectly engage in any business (including, without
limitation, any business activities or lines of business that are the same as or similar to those pursued by, or competitive with, any of the Companies or their respective Subsidiaries or Affiliates, (B) to directly or indirectly do business
with any client or customer of any of the Companies or their respective Subsidiaries or Affiliates, (C) to take any other action that any of them believe in good faith is necessary to or appropriate to fulfill their obligations as described in
the first sentence of this Section 5(b), and (D) not to present 

  
 -6-

 
potential transactions, matters or business opportunities to any of the Companies or any of their respective Subsidiaries or Affiliates, and to pursue, directly or indirectly, any such
opportunity for itself, and to direct any such opportunity to another person. 
 (ii) WCAS Management, WCAS XI
and their respective Affiliates and the other Indemnitees will have no duty (contractual or otherwise) to communicate or present any corporate opportunities to any of the Companies or any of their respective Subsidiaries or Affiliates or to refrain
from any action specified in Section 5(b)(i), and the Companies on their own behalf and on behalf of their respective Subsidiaries and Affiliates, hereby renounce and waive any right to require WCAS Management, WCAS XI or their
respective Affiliates or the other Indemnitees to act in a manner inconsistent with the provisions of this Section 5(b). 
 (iii) None of WCAS Management, WCAS XI or their respective Affiliates or the other Indemnitees will be liable to the Companies or any of their respective Subsidiaries or Affiliates for breach of any duty
(contractual or otherwise) by reason of any activities or omissions of the types referred to in this Section 5(b) or of any such person’s participation therein. 

(c) Limitation of Liability. In no event will WCAS Management, WCAS XI or their respective Affiliates or the other
Indemnitees be liable to the Companies or any of their respective Subsidiaries or Affiliates for any indirect, special, incidental or consequential damages, including, without limitation, lost profits or savings, whether or not such damages are
foreseeable, or for any third party claims (whether based in contract, tort or otherwise), relating to the services to be provided hereunder. 
 6. Assignment, etc. Except as provided below, no party hereto has the right to assign this Agreement without the prior written consent of the other parties. Notwithstanding the foregoing,
(a) WCAS Management may assign all or part of its rights and obligations hereunder to any Affiliate of WCAS Management or WCAS XI that provides services similar to those called for by this Agreement, in which event WCAS Management will be
released of all of its rights and obligations hereunder and (b) the provisions hereof for the benefit of WCAS XI and the other Indemnitees other than WCAS Management shall also inure to the benefit of WCAS XI and such other Indemnitees and
their successors and assigns, each of whom is an intended third party beneficiary of their Agreement entitled to enforce its provisions as if a party hereto. 
 7. Amendments and Waivers. No amendment or waiver of any term, provision or condition of this Agreement will be effective, unless in writing and executed by each of WCAS Management and the
Companies. No waiver on any one occasion will extend to or effect or be construed as a waiver of any right or remedy on any future occasion. No course of dealing of any person nor any delay or omission in exercising any right or remedy will
constitute an amendment of this Agreement or a waiver of any right or remedy of any party hereto. 

  
 -7-

 8. Governing Law; Jurisdiction. 

(a) Choice of Law. This Agreement and all matters arising under or related to this Agreement will be governed by
and construed in accordance with the domestic substantive laws of the State of New York. 
 (b) Consent to
Jurisdiction. Each of the parties agrees that all actions, suits or proceedings arising out of, based upon or relating to this Agreement or the subject matter hereof will be brought and maintained exclusively in the federal and state courts of
the State of New York, County of New York. Each of the parties hereto by execution hereof (i) hereby irrevocably submits to the jurisdiction of the federal and state courts in the State of New York, County of New York for the purpose of any
action, suit or proceeding arising out of or based upon this Agreement or the subject matter hereof and (ii) hereby waives to the extent not prohibited by applicable law, and agrees not to assert, by way of motion, as a defense or otherwise, in
any such action, suit or proceeding, any claim that it is not subject personally to the jurisdiction of the above-named courts, that it is immune from extraterritorial injunctive relief or other injunctive relief, that its property is exempt or
immune from attachment or execution, that any such action, suit or proceeding may not be brought or maintained in one of the above-named courts, that any such action, suit or proceeding brought or maintained in one of the above-named courts should
be dismissed on grounds of forum non conveniens, should be transferred to any court other than one of the above-named courts, should be stayed by virtue of the pendency of any other action, suit or proceeding in any court other than one of
the above-named courts, or that this Agreement or the subject matter hereof may not be enforced in or by any of the above-named courts. Notwithstanding the foregoing, to the extent that any party hereto is or becomes a party in any litigation in
connection with which it may assert indemnification rights set forth in this Agreement, the court in which such litigation is being heard will be deemed to be included in clause (i). Each of the parties hereto hereby consents to service of process
in any such suit, action or proceeding in any manner permitted by the laws of the State of New York. The provisions of this Section 8 will not restrict the ability of any party to enforce in any court any judgment obtained in a federal
or state court of the State of New York. 
 (c) Waiver of Jury Trial. TO THE EXTENT NOT PROHIBITED BY
APPLICABLE LAW THAT CANNOT BE WAIVED, EACH OF THE PARTIES HERETO HEREBY WAIVES, AND COVENANTS THAT IT WILL NOT ASSERT (WHETHER AS PLAINTIFF, DEFENDANT, OR OTHERWISE), ANY RIGHT TO TRIAL BY JURY IN ANY FORUM IN RESPECT OF ANY ISSUE, CLAIM, DEMAND,
CAUSE OF ACTION, ACTION, SUIT OR PROCEEDING ARISING OUT OF, BASED UPON OR RELATING TO THIS AGREEMENT OR THE SUBJECT MATTER HEREOF, IN EACH CASE WHETHER NOW EXISTING OR HEREAFTER ARISING AND WHETHER IN CONTRACT OR TORT OR OTHERWISE. EACH OF THE
PARTIES HERETO ACKNOWLEDGES THAT IT HAS BEEN INFORMED BY EACH OTHER PARTY THAT THE PROVISIONS OF THIS SECTION 8(C) CONSTITUTE A MATERIAL INDUCEMENT UPON WHICH SUCH PARTY IS RELYING AND WILL RELY IN ENTERING INTO THIS AGREEMENT AND THE
TRANSACTIONS CONTEMPLATED HEREBY. ANY OF THE PARTIES HERETO MAY FILE AN ORIGINAL COUNTERPART OR A COPY OF THIS AGREEMENT WITH ANY COURT AS WRITTEN EVIDENCE OF THE CONSENT OF EACH OF THE PARTIES HERETO TO THE WAIVER OF ITS RIGHT TO TRIAL BY JURY.

  
 -8-

 9. Entire Agreement. This Agreement contains the entire understanding of the parties
with respect to the subject matter hereof and supersedes any prior communication or agreement with respect thereto. 
 10.
Notice. All notices, demands, and communications required or permitted under this Agreement will be in writing and will be effective if served upon such other party and such other party’s copied persons as specified below to the address
set forth for it below (or to such other address as such party will have specified by notice to each other party) if (i) delivered personally, (ii) sent and received by facsimile or (iii) sent by certified or registered mail or by
Federal Express, UPS or any other comparably reputable overnight courier service, postage prepaid, to the appropriate address as follows: 
 If to the Companies, or any of them, to them at: 
 K2M, Inc. 

751 Miller Dr., SE 
 Leesburg, VA 20175 
 Telephone number: (703) 777-3155 

Facsimile number: (703) 779-2153 
 Attention: Chief Executive Officer 
 with a copy to: 

K2M, Inc. 
 751
Miller Dr., SE 
 Leesburg, VA 20175 
 Telephone number: (703) 777-3155 
 Facsimile number: (703) 779-8136

 Attention: General Counsel 
 If to WCAS Management or WCAS XI, to it at: 
 c/o Welsh, Carson,
Anderson & Stowe 
 320 Park Avenue, Suite 2500 
 New York, New York 10022 
 Attention: Sean M. Traynor 

Facsimile: (212) 893-9566 
 with a copy to: 
 Ropes & Gray LLP 

1211 Avenue of the Americas 
 New York, New York 10036-8704 
 Attention: Christopher W. Rile, Esq. 

Facsimile: (212) 596-9090 

  
 -9-

 Unless otherwise specified herein, such notices or other communications will be deemed effective,
(a) on the date received, if personally delivered or sent by facsimile during normal business hours, (b) on the business day after being received if sent by facsimile other than during normal business hours, (c) one business day after
being sent by Federal Express, UPS or other comparably reputable delivery service and (d) five business days after being sent by registered or certified mail. Each of the parties hereto shall be entitled to specify a different address by giving
notice as aforesaid to each of the other parties hereto. 
 11. Certain Definitions. As used herein, the following terms
have the following meanings: 
 “Affiliate” means, with respect to any specified Person
at any time, each Person directly or indirectly controlling, controlled by or under direct or indirect common control with such specified Person at such time. 
 “Person” means any natural person, corporation, limited liability company, partnership, trust, joint stock company, business trust, unincorporated association, joint venture,
governmental authority or other legal entity of any nature whatsoever. 
 “Subsidiary”
means, with respect to Group Holdings or any other Person, any Person of which Group Holdings (or such other Person) owns securities having a majority of the voting power in electing the board of directors (or similar governing body) directly or
through one or more Subsidiaries (or, in the case of a partnership, limited liability company or other similar entity, securities conveying, directly or indirectly, a majority of the economic interests in such partnership or entity), including any
Person of which Group Holdings (or such other Person) or any Subsidiary serves as general partner or managing member. 
 12.
Severability. If in any judicial or arbitral proceedings a court or arbitrator refuses to enforce any provision of this Agreement, then such unenforceable provision will be deemed eliminated from this Agreement for the purpose of such
proceedings to the extent necessary to permit the remaining provisions to be enforced. To the full extent, however, that the provisions of any applicable law may be waived, they are hereby waived to the end that this Agreement be deemed to be valid
and binding agreement enforceable in accordance with its terms, and in the event that any provision hereof is found to be invalid or unenforceable, such provision will be construed by limiting it so as to be valid and enforceable to the maximum
extent consistent with and possible under applicable law. 
 13. Counterparts. This Agreement may be executed in any
number of counterparts and by each of the parties hereto in separate counterparts, each of which when so executed will be deemed to be an original and all of which together will constitute one and the same agreement. 

  
 -10-

 IN WITNESS WHEREOF, each of the parties has caused this Amended and Restated Resources Group
Management Services Agreement to be executed on its behalf as of the date first above written by a duly authorized representative thereof. 
  

							
	WCAS MANAGEMENT:	 		 	WCAS MANAGEMENT CORPORATION
				
		 		 	By:	 	/s/ Jonathan M. Rather
		 		 	Name:	 	Jonathan M. Rather
		 		 	Title:	 	Treasurer
			
	THE COMPANIES:	 		 	K2M GROUP HOLDINGS, INC.
				
		 		 	By:	 	/s/ Gregory Cole
		 		 	Name:	 	Gregory Cole
		 		 	Title:	 	CFO
			
		 		 	K2M HOLDINGS, INC.
				
		 		 	By:	 	/s/ Gregory Cole
		 		 	Name:	 	Gregory Cole
		 		 	Title:	 	CFO
			
		 		 	K2M, INC.
				
		 		 	By:	 	/s/ Gregory Cole
		 		 	Name:	 	Gregory Cole
		 		 	Title:	 	CFO

  

  

Signature Page to Amended and Restated 
 Resources Group Management Services AgreementEX-10.20

 Exhibit 10.20 

EXCLUSIVE LICENSE AGREEMENT 

This Agreement is entered into as of the 2 day of Sep, 2004 (“Effective Date”) by and between Spinal LLC (hereafter
“SPINAL”), a Florida Limited Liability Company with its principal place of business located at 1517 Coining Drive, Toledo, Ohio, 43612, and K2M, LLC. (hereafter “K2M”), a Delaware Limited Liability Company, with its principal
place of business located at 751 Miller Road Lccsburg, VA 20175. 
 WHEREAS, SPINAL is the owner of certain inventory, and Trademarks,
Patents, patent applications, technology, and related Know-How pertaining to spinal fixation devices; 
 WHEREAS, K2M wishes to obtain the
inventory and an exclusive license to the Licensed Technology; and 
 WHEREAS, SPINAL desires to grant K2M an exclusive license and certain
other rights to the Inventory, and Licensed Technology; 
 WHEREAS SPINAL owns certain inventories of product using the Licensed Technology
and wishes to transfer ownership of said inventories to K2M 
 NOW THEREFORE, in consideration of the mutual covenants contained herein, the
parties agree as follows: 
 1. DEFINITIONS 

For purposes of this Agreement, the following definitions apply: 

1.1 “Affiliate” means an entity that controls, is controlled by, or is under common control with a Party or its Permitted Successor.
For purposes of this definition, “control” shall mean the possession, directly or indirectly, of a majority of the voting power of such entity (whether through ownership of securities or partnership or other ownership interests, by
contract or otherwise); provided that, such entity shall be deemed an Affiliate only so long as such control continues. 
 1.2 “Calendar
Quarter” means one of the four periods of three consecutive calendar months that together constitute a calendar year, namely the three month period beginning April, July, October, and January. 

1.3 “Commercialization of a Royalty Bearing Device” means the spinal fixation Device is being commercially sold or offered for sale
in the Territory following regulatory approval for that Territory. 

  
 1 

 1.4 “Confidential Information” means any information in written, graphic, electronic or
other tangible form, which is designated as confidential at the time of disclosure, identified and/or labeled as “Confidential” or “Proprietary” information or similar designation of the disclosing Party, and any information in
oral, audible, visual, or other non-tangible form unless one or more of the exceptions to the restrictions on use and disclosure specified in Article 12 applies. 

1.5 “K2M” means K2 Medical, LLC and any and all Affiliates and Permitted Successors of K2M, LLC. 

1.6 “Field of Use” means spine fixation devices to treat diseases of or injuries to the spine. 

1.7 “Improvements” means all improvements, changes, modifications, revisions, new generations or models of the Licensed Technology
which may be developed, created or acquired by SPINAL during the term of this Agreement, whether or not patentable, which are necessary or useful to the development, manufacture or commercialization of a Royalty Bearing Device. 

1.8 “Inventory” means SPINAL’s inventories of the Royalty Bearing Device(s), including but not limited to the finished goods,
instrument sets and samples which are set forth in the attached Exhibit C (the “Inventory”); 
 1.9
“Know-How” means all information and inventions or discoveries, whether or not patentable, including Confidential Information, formulas, designs, data, processes, prototypes, or specifications, that relate to the Licensed Technology and
are owned, possessed, licensed, or otherwise controlled by SPINAL. 
 1.10 “Licensee” means K2M. 

1.11 “Licensor” means SPINAL. 

1.12 “Mark” shall mean the trademarks in block letter form and any United States or other national or regional registration therefore
listed on Exhibit B attached hereto, which Exhibit B may be amended from time to time as mutually agreed upon by the Parties or as required by law or regulation. 

1.13 “Net Sales” means the total invoice price payable to K2M for any sale of a Royalty Bearing Device, less the following items: (i)
returns and allowances; (ii) freight; (iii) sale and use taxes; (iv) import or export taxes; or (v) reasonable third party commissions paid in connection with a sale. If any Royalty Bearing Device is sold by K2M through a sales organization which is
directly or indirectly controlling, controlled by, or under direct or indirect common control of K2M (as such terms are used to describe an affiliate under United States Securities and Exchange Commission Rule 17 CFR 240.12b-2, the amount used for
the purpose of calculating the Net Sales shall be the total invoice price payable to such sales organization for any sale of a Royalty Bearing Device, less the following items: (i) returns and allowances; (ii) freight; (iii) sale and use taxes; (iv)
import or export taxes; or (v) reasonable third party 

  
 2 

 
commissions paid in connection with a sale. Royalty Bearing Devices shall be deemed “sold” when invoiced with the exception of shipment of Royalty Bearing Devices to be sold on
consignment, which shall be deemed sold only upon actual transfer of title of such Royalty Bearing Devices. For purposes of this Agreement, a “sale” shall include a sale or other transfer of title of Royally Bearing Device(s), and the
purchase price or other payments from the sale or other transfer of Royalty Bearing Device(s) shall be deemed fully received by K2M immediately upon the execution of or entry into a sale regardless of the term or manner of the transaction. 

1.14 “Party” means K2M or SPINAL; “Parties” means K2M and SPINAL. 

1.15 “Patents and Patent Applications” means all patents and patent applications assigned to, issued to, owned by, licensed to or
capable of being licensed by SPINAL relating to the Licensed Technology, and the patents and patent applications identified in Exhibit A, as well as all continuations, continuations-in-part, and divisional applications, and all patents issuing
therefrom, together with all reissues, re-examinations, requests for continued examination, and extensions, and all corresponding foreign patent applications and patents based thereon in any and all countries in the Territory. 

1.16 “Permitted Successor” shall mean any individual, corporation, partnership, joint venture, association, trust, or any other
entity or organization of any kind or character that assumes the obligations of a party under this Agreement as permitted according to the terms of this Agreement. 

1.17 “SPINAL” means Spinal LLC and any and all Affiliates or Permitted Successors of Spinal LLC. 

1.18 “ Royalty Bearing Device” means any product manufactured by or for K2M that includes the Licensed Technology, is covered by at
least one Valid Claim of a patent issued or issuing from any of the Patents and Patent Applications, and is listed on Exhibit A. Notwithstanding the foregoing, devices or components of systems, which are in the public domain arc not Royalty Bearing
Devices. 
 1.19 “Licensed Technology” means the spinal fixation systems owned, possessed, licensed to, capable of being licensed
to or otherwise controlled by SPINAL and all related technology instruments, methods, Know-How and Trademarks related to low profile spinal fixation systems. 

1.20 “Territory” means all countries of the world. 

1.21 “Valid Claim” means any claim in an issued, unexpired patent which has not been held unenforceable or invalid by a court or
other governmental agency of competent jurisdiction, in a decision that is unappealable or unappealed, within the time allowed for appeal, and which has not been irrevocably abandoned or admitted to be invalid or unenforceable through reissue or
disclaimer. If there should be two or more such decisions conflicting with respect to the validity of the same claims, the decision of the higher or highest tribunal shall thereafter control. However, should the tribunals be of equal rank, then the
decision or decisions upholding the claims will prevail when the conflicting decisions are equal in number, and the majority of decisions will prevail when conflicting decisions are unequal in number. 

  
 3 

 2. GRANT OF LICENSE 

2.1 Grant. 

2.1.1 License of Patents and Technology. SPINAL hereby grants an exclusive license, including the right to grant
sublicenses, to make, have made, use, import, export, offer to sell, sell or otherwise dispose of products based on the Licensed Technology, Improvements thereto, or the subject matter shown, described or claimed in the Patents and Patent
Applications for the Term of this Agreement and subject to the terms and conditions of this Agreement, but for no other purpose, use and with respect to no other product(s). 

2.1.2 License of Marks and Know-How. Subject to the terms and conditions of this Agreement, SPINAL hereby grants to K2M
an exclusive, royalty-free license, including the right to grant sublicenses, within the Field of Use and during the Term of this Agreement to reproduce, display, broadcast, publish and otherwise use the Mark(s) and to utilize the Know-How in
connection with Royalty Bearing Device(s) by K2M throughout the Territory. K2M shall disclose the names, addresses and contact information for all sublicensees to SPINAL. All sublicenses granted by K2M shall include provisions granting SPINAL the
right to inspect all sublicensees’ books and records relating to the sublicensed Royalty Bearing Device(s). Each such sublicense provision shall include inspection cost reimbursement provisions consistent with Section 3.5 herein below.

 2.1.3 SPINAL and K2M shall execute license documents in such other form or forms not inconsistent with this Agreement in
any country where such is required to conform with the patent laws of any such country in respect of the Patents, and such licenses shall be subject to all the terms and conditions of this Agreement. 

2.2 Release. While this Agreement is in effect or while K2M is disposing of Royalty Bearing Device(s) pursuant to Section 11.4 of
this Agreement, the grants made in this section fully release K2M, and any and all manufacturers, suppliers, distributors, sellers, purchasers, or users of a Royalty Bearing Device(s) for or from K2M, from any and all claims within the Field of Use
involving the Patents, Know-How, and the Marks, including claims for patent and trademark infringement, and product liability claims stemming from sales of Royalty Bearing Devices made prior to the effective date of this Agreement. 

2.3 Documents to Effect Grant of Rights. The parties shall execute any documents required to validate or give effect to the grant
in Article 2 of this Agreement in any country in the Territory. 

  
 4 

 2.4 Rights Outside Field of Use. This Agreement is not to be construed as a license to
make, have made, use, import, export, offer to sell, sell or otherwise dispose of products covered by the Patents within the Territory but outside the Field of Use nor shall anything contained herein constitute any assignment of Licensed Technology.

 3. COMPENSATION - LICENSE FEES, ROYALTIES AND MILESTONES 

3.1 Compensation - License Fees: 
  

	 	(A)	As consideration for the license granted herein, SPINAL shall be paid a license fee and royalties pursuant to the following payment terms, schedule and milestones: 

 

	 	i.	K2M has paid SPINAL $100,000.00 cash, the receipt and sufficiency of which SPINAL hereby acknowledged, with the signed Letter of Intent sheet, on or about August 4, 2004. 

 

	 	ii.	K2M shall have paid an additional $100,000.00 cash upon execution of this Agreement. 

  

	 	iii.	K2M shall pay to SPINAL an additional monthly license fee (“Monthly License Fee”) of $20,000.00 for 24 consecutive months, commencing with the second month subsequent to payment by K2M to SPINAL of the payment
pursuant Section 3.1(B) after completion of all Due Diligence Milestones. Thereafter, the Monthly License Fee shall be due on the first day of each calendar month during the period that Monthly License Fees are Payable. 

 

	 	(B)	Upon conclusion of the Due Diligence Period, if K2M has not terminated this Agreement pursuant to Section 9, K2M shall pay SPINAL an additional $1,800,000.00 as follows: 

 

	 	(i)	$800,000.00 in cash upon the conclusion of the Due Diligence Period. 

  

	 	(ii)	$1,000,000.00 to be paid to SPINAL by means of a six percent (6%) License Fee payable on Net Sales for so long as and until the six percent (6%) License Fee paid to SPINAL cumulatively totals $1,000,000.00.

  

	 	(iii)	$250,000.00 upon receipt of U.S. Food and Drug Administration Approval of a 510(k) application for the Royalty Bearing Device shown in U.S. Patent Application Number 11/701,349, payable to SPINAL by means of an
extension of the six percent (6%) License Fee until the cumulative total six percent (6%) License Fee paid to SPINAL totals $ 1,250,000. 

  
 5 

	 	(iv)	$250,000.00 for issuance of a U.S. Patent based on U.S. Patent Application Serial Number 11/701,349, payable to SPINAL by means of an extension of the six percent (6%) License Fee until the cumulative total six
percent (6%) License Fee paid to SPINAL totals $1,500,000. 

 Payments pursuant to this Section 3.1 are License Fees
in addition to and shall not be credited toward Royalties or Minimum Annual Royalties as defined in Sections 3.2 and 3.3 below. 
 3.2
Royalties 
  

	 	(a)	K2M shall pay SPINAL a Royalty in the amount of 6% of the Net Sales of Royalty Bearing Devices. The 6% Royalty shall be payable quarterly in arrears within forty five (45) days of the close of each calendar quarter
for which such Royalty is due. 

 3.3 Minimum Annual Royalties: K2M agrees to pay SPINAL the following Minimum Annual
Royalties which shall be payable in equal quarterly installments in accordance with Section 3.4, below: 
 For the calendar years: 

2006 - $300,000.00 Minimum Annual Royalty 

2007 - $350,000.00 Minimum Annual Royalty 

2008 through the expiration of this Agreement - $400,000.00 

3.4 Minimum Annual Royalties Payment Policy 

Minimum Annual Royalties payable to SPINAL by K2M pursuant to Sections 3.3 above shall be payable in quarterly installments as follows: 

For the calendar years: 
 2006 -
$75,000.00 per Calendar Quarter 
 2007 - $87,500.00 per Calendar Quarter 

2008 through the expiration of this Agreement - $ 100,000.00 per Calendar Quarter 

If the six percent (6%) Royalty on K2M’s actual Net Sales paid by K2M to SPINAL pursuant to Section 3.2 (a), above, in any
Calendar Quarter of any year for which Minimum Annual Royalties Apply does not equal or exceed the applicable quarterly installment of the Minimum Annual Royalties for such Calendar Quarter as set forth in Sections 3.3 and 3.4 hereof, then together
with remittance of the payment to SPINAL of the six percent (6%) Royalty pursuant to Section 3.2 (a), above, K2M shall pay such additional funds to SPINAL (“Makeup Royalties”) as required to satisfy the then

  
 6 

 
applicable quarterly installment of the Minimum Annual Royalty. Any Makeup Royalties may be offset in any subsequent Calendar Quarter quarter-year in which the six (6%) percent Royalty of
K2M’s actual Net Sales pursuant to Section 3.2(a) exceeds the then applicable payment of Minimum Annual Royalties or any quarterly installment thereof. 

The payment of Royalties pursuant to Sections 3.2, 3.3 and 3.4 as due and payable from K2M to SPINAL, shall be deemed Royalty payments which
are payable to SPINAL in addition to and without regard to the License Fees set forth in Section 3.1 above. 
 3.5 Records of Royalties
K2M shall maintain sufficient and accurate books and records with respect to the Royalty Bearing Devices such that the payments due and payable set forth herein, can be easily ascertained. Such books and records shall be maintained at K2M’s
principal place of business and, such portions as are relevant to the subject matter of this Agreement shall be available for inspection by SPINAL or its representatives during the normal business day upon not less than ten (10) days prior
written notice, provided that SPINAL or its representatives agree to protect any confidential information of K2M and not unduly interfere with K2M’s business. In the event that such inspection reveals that the amount of payments paid to SPINAL
was in error by more than ten percent (10%), K2M shall pay the costs of the inspection. 
 3.6 In the event a court directed preliminary
injunction or other judicial or regulatory action requires sales of Royalty Bearing Devices to be held in abeyance all royalty payments will be likewise held in abeyance. 

4. DUE DILIGENCE 
 4.1 Due Diligence
Period. K2M shall have one-hundred-eighty (180) days from the date of execution of this Agreement, subject to the completion of the steps listed to conduct all appropriate and necessary due diligence (the “Due Diligence Period”).

 4.2 Due Diligence Obligations: 
  

	 	(a)	SPINAL shall demonstrate to K2M’s satisfaction as a precedent to K2M’s obligations to complete Due Diligence, the following: 

 

	 	(i)	SPINAL shall finalize the design for, and manufacture test quantities of the Implant (as generally defined on Exhibit D) for the testing described in Section 4.2(b)(i). 

 

	 	(ii)	SPINAL shall produce, test, and demonstrate a working prototype of screw locking and unlocking instruments. 

  

	 	(iii)	SPINAL shall prove to K2M’s satisfaction its ownership of all intellectual property and inventories subject of this Agreement. 

  
 7 

	 	(b)	K2M shall be satisfied based on K2M’s own work that: 

  

	 	(i)	The products provided by Spinal meet static compression bending and static torsion testing and all additional testing required by ASTM F 1717, as described in Exhibit E. 

 

	 	(ii)	All intellectual property including ownership matters are satisfactory. 

  

	 	(iii)	K2M’s scientific advisory board is satisfied with its evaluation of the final implant and instrument. 

(c) In the event K2M is, in good faith, not satisfied as to the results of the Due Diligence, K2M may terminate this Agreement
pursuant to Section 9. and SPINAL shall retain the initial $100,000.00 paid by K2M to SPINAL as consideration for the “stand-still” agreement included in the Letter of Intent dated August 3, 2004. In the event that SPINAL fails
to timely complete its obligations as listed in 4.2(a), then K2M may extend the Due Diligence Period until SPINAL satisfies said obligations, or for a period of up to an additional 180 days, whichever expires first. Notwithstanding the foregoing, in
the event SPINAL is unable to obtain ownership to the intellectual property described in Exhibit A, K2M may recover all monies paid by K2M to SPINAL to that date. 

(d) Upon satisfaction of the Due Diligence Milestones, SPINAL shall transfer the existing Inventory of Royalty Bearing Devices,
(as set forth in the attached Schedule C), and all supporting documentation and regulatory approvals. 
 5. PROSECUTION AND MAINTENANCE 

5.1 Notwithstanding any other provisions of this Agreement, SPINAL and K2M agree not to abandon any pending patent application, any Patent, or
the maintenance of any Patent related to the Licensed Technology without a minimum of sixty (60) days prior written notice to the other Party. 

5.2 SPINAL will prosecute pending United States patent applications included within the Patents and Patent Applications. SPINAL shall pay all
of the reasonable expenses of filing and prosecuting said United States patent applications. K2M shall assume the maintenance of Patent registrations and any future United States patent registrations in connection with the Licensed Technology in the
Field of Use. SPINAL agrees to routinely advise K2M regarding the status of said United States patent applications. K2M agrees to routinely advise SPINAL regarding the status of all maintenance of said patent registrations, including payment of
maintenance fees renewals. K2M shall provide copies of all correspondence to and from the responsible foreign examining authority for all Patents and Patent Applications. 

5.3 K2M may prosecute and maintain foreign patents based upon the licensed subject matter, at K2M’s sole discretion and expense. K2M shall
routinely advise SPINAL regarding the status of the foreign patent applications, patent registrations, and payment of annuities thereon. 

  
 8 

 5.4 In the event that a Party provides notice to the other Party that it will not continue to
prosecute, maintain or pay costs for any Patent, or any pending United States or foreign patent applications as described in this Article 5, the other party may assume prosecution and maintenance of same and the noticing party shall cooperate and
assist the other party in its efforts. 
 6. PROTECTION AND ENFORCEMENT 

6.1 Protection Notice. Each of the parties shall promptly notify the other in writing if it (i) receives any notice or becomes
aware of any information that in any way adversely affects the other Party’s rights under this Agreement, or (ii) becomes aware of any actual or suspected infringement, misappropriation, or misuse by a third party of the Licensed
Technology in the Field of Use. 
 6.2 Enforcing Patents, Know-How. K2M shall have the right, in its sole discretion, to take action
at its own expense against any actual or suspected infringement, misappropriation, or misuse by a third party of Licensed Technology Patents or Know-How within the Field of Use. SPINAL shall provide any materials, cooperation and assistance as may
be reasonably required to assist K2M in connection with any enforcement action. SPINAL may participate in such suit at its own expense as represented by counsel of its own choice. SPINAL shall have the right, in its sole discretion, to take action
at its own expense against any actual or suspected infringement, misappropriation, or misuse by a third party of Licensed Technology outside the Field of Use. K2M may provide any materials, cooperation and assistance as may be reasonably required to
assist SPINAL in connection with any enforcement action. K2M may participate in such suit at its own expense as represented by counsel of its own choice. 

6.2.1 In the case where any action is taken by K2M as to any infringement, misappropriation, or misuse within the Field of Use, any recovery of
damages in, or sums in settlement of, such action(s) (suits, mediation, arbitration, and other dispute resolution processes) shall be split between the Parties after accounting for each party’s fees and expenses with seventy-five percent
(75%) going to K2M and the remaining twenty-five (25%) going to SPINAL. In the case where any action is taken by SPINAL as to any infringement, misappropriation, or misuse outside the Field of Use, any recovery of damages in, or sums in
settlement of, such action(s) (suits, mediation, arbitration, and other dispute resolution processes) shall be split between the Parties after accounting for each party’s fees and expenses with seventy-five percent (75%) going to SPINAL
and the remaining twenty-five (25%) going to K2M. 

  
 9 

 7. TRADEMARKS 

7.1 Use and Ownership. 

7.1.1 K2M may use any licensed Mark only in the form and manner with appropriate legends as prescribed from time to time by
SPINAL. K2M agrees it will not alter or modify, any Mark. 
 7.1.2 Subject to SPINAL’s representations and warranties as
set forth in Section 8, K2M acknowledges and agrees that SPINAL is the owner of all rights in and to any Mark and that K2M will not during the Term of this Agreement use any Mark or any element thereof in any form and for any goods or services
or challenge the use or registration thereof except as permitted under this Agreement without the prior written permission of SPINAL. 

7.1.3 Subject to SPINAL’s representations and warranties as set forth in Section 8, K2M recognizes the goodwill
associated with any Mark and acknowledges that said goodwill belongs exclusively to SPINAL and that any use of any Mark by K2M during the term of this Agreement will inure solely to the benefit of SPINAL, and K2M hereby assigns any such goodwill in
its entirety to SPINAL. 
 7.1.4 Notwithstanding the foregoing, K2M shall not be obligated to use any Mark in connection with
the manufacture, use or sale of any product. K2M shall be solely responsible for and shall have control in its sole discretion of all decisions relating to the marketing, sale, promotion and distribution of any Royalty Bearing Products developed
utilizing Licensed Technology. 
 8. WARRANTIES AND REPRESENTATIONS 

8.1 SPINAL Representations and Warranties. SPINAL hereby represents, warrants and covenants to K2M as follows: 

8.1.1 Spinal, LLC is a limited liability company duly organized, validly existing and in good standing under the laws of the
State of Florida. 
 8.1.2 SPINAL has the corporate power and authority to execute and deliver this Agreement and to perform
its obligations hereunder. 
 8.1.3 SPINAL has full and complete legal right, title and interest in and to the Patents, and
Patent Applications, Licensed Technology, Know-How and Marks. 
 8.1.4 No other person or entity has any proprietary interest
in the Licensed Technology, Know-How or Marks. 
 8.1.5 SPINAL has the power and authority to grant the rights and licenses
granted to K2M in this Agreement without the consent of any other entity. 

  
 10 

 8.1.6 There are no outstanding assignments, grants, licenses, contracts or
encumbrances that are inconsistent or conflict with the obligations undertaken and rights and licenses granted in this Agreement. 

8.1.7 Except as otherwise expressly provided by this Agreement, SPINAL will not, during the term of this Agreement, enter into
or agree to enter into any agreements with any person or entity other than K2M granting rights to the Patents, and Patent Applications, Licensed Technology, Know-How or Marks without K2M’s prior written consent. 

8.1.8 SPINAL nor any of its principals, legal and professional advisors, is aware, having done reasonable review, of no legal
claim by a third party, including any claim for infringement or misappropriation of intellectual property rights, that may arise as a result of K2M’s exercise of the rights and licenses granted in this Agreement, including the manufacture, use,
importation, exportation, offering to sell, sale or other activities involving Royalty Bearing Device(s) or Licensed Technology. 

8.1.9 No claim by any third party contesting the validity, enforceability, use or ownership of any of the Patents and Patent
Applications or Licensed Technology has been made, is currently outstanding or is threatened, and there are no grounds for the same. SPINAL has disclosed to K2M all prior art, search results, or other information known to SPINAL that may be relevant
to the patentability/validity of any claim in any of the Patents. 
 8.1.10 There are no pending or threatened claims,
disputes, litigation or proceedings challenging SPINAL’s rights, title or interest in, or the use of, the Patents, and Patent Applications, Know-How, Marks, Royalty Bearing Device(s), or Licensed Technology. 

8.2 K2M Representations and Warranties. K2M hereby represents and warrants to SPINAL as follows: 

8.2.1 K2 Medical, LLC is a corporation duly organized, validly existing and in good standing under the laws of the State of
Delaware. 
 8.2.2 K2M has the corporate power and authority to execute and deliver this Agreement, and perform its
obligations under this Agreement. 
 8.2.3 K2M shall be responsible for and will use commercially reasonable efforts
regarding the marketing, sales, and distribution of any Royalty Bearing Device(s) developed utilizing the Patents or Technology. Any manufacture of Royalty Bearing Device(s) by K2M, its vendor(s), suppliers agents or contractors, shall comply with
and conform to all applicable specifications required by any regulatory approval. 

  
 11 

 8.2.4 Subject to SPINAL’s being in full compliance with its obligations, K2M
shall timely make all payments to SPINAL required by this Agreement. 
 8.2.5 All design, development, validation, testing
and production of Royalty Bearing Device(s) shall be performed in compliance with all applicable regulations established by the United States Food and Drug Administration (“FDA”), or any other governmental or regulatory authority having
jurisdiction over any particular activity or Royalty Bearing Device. 
 8.2.6 To the extent, if any, permitted under this
Agreement or any subsequent agreement between the parties, any manufacture of Royalty Bearing Device(s) by K2M, its vendor(s), agents or contractors, shall comply with and conform to all applicable specifications required by any applicable
regulatory laws. 
 9. AGREEMENT CONTINGENT UPON PROOF OF OWNERSHIP. 

9.1 Execution, delivery, and enforcement of this Agreement are contingent upon the SPINAL providing proof of ownership of Licensed Technology
and Patents and Patent Applications subject of this Agreement to the satisfaction of K2M. 
 10. TERM AND TERMINATION 

10.1 Term. This Agreement shall be effective on the Effective Date and shall remain in effect for the life of the last issued Patent,
unless sooner terminated according to the terms set forth in this Agreement. Notwithstanding the previous sentence, Sections 7.1.3 and 9.6.1 ??and Articles 8, 11 and 13 shall survive termination of this Agreement. 

10.2 Termination for Breach. In the event that a Party (the “Aggrieved Party”) believes that the other Party (the
“Breaching Party”) is in breach of any provision or term of this Agreement, including breach by K2M for failure to make timely payments, the Aggrieved Party shall give the Breaching Party written notice of breach specifying in reasonable
detail the nature and extent of the breach. For thirty (30) days following receipt of written notice from the Aggrieved Party, the Breaching Party shall have an opportunity to cure the alleged breach. If, thirty (30) days following receipt
of written notice, the Breaching Party maintains that no breach has occurred or that the breach has been cured, and the Aggrieved Party disputes the position of the Breaching Party, either Party may invoke the process for resolving disputes under
Article 13 of this Agreement. The Aggrieved Party may terminate the Agreement only if: (i) thirty (30) days have passed since the Breaching Party received the written notice and there is no disagreement among the Parties that the Breaching
Party breached the Agreement and did not cure the breach within thirty (30) days of receiving written notice; or (ii) the dispute resolution process results in an arbitration decision finding that the Breaching Party breached the Agreement
and did not cure the breach within thirty (30) days. 

  
 12 

 10.3 Termination for Cause. Either Party may terminate this Agreement immediately by
giving written notice to the other Party if the other Party: (i) declares bankruptcy, or institutes bankruptcy, insolvency or other proceedings for the settlement of the Party’s debts; (ii) has insolvency, bankruptcy, or receivership
proceedings, or any other proceedings for the settlement of the Party’s debts, filed against it and the proceedings are not dismissed within 120 days; (iii) is appointed a receiver by a court of competent jurisdiction and the receiver is
not discharged within 30 days; (iv) makes an assignment for the benefit of creditors; (v) is the subject of a levy of execution that involves substantially all of the Party’s assets; or (vi) upon the other Party’s
dissolution or ceasing to do business. K2M may terminate this agreement immediately by giving written notice to SPINAL of a third-party claim made that Royalty Bearing Devices made or sold by K2M infringe a third-party patent or other third-party
rights. K2M may terminate this agreement immediately by giving written notice to SPINAL that K2M has become aware of third-party intellectual property that negatively affects K2M’s ability to practice the Licensed Technology, or negatively
affects K2M’s ability to protect the Licensed Technology. 
 10.4 Fee Obligation. Notwithstanding termination of this Agreement
pursuant to any of Sections 10.1- 10.3, K2M shall be responsible for all fee payments due under Article 3 of this Agreement until the date the termination takes effect. SPINAL shall retain all payments made by K2M prior to termination pursuant to
Sections 10.1-10.3. After receipt of termination notification, K2M is not obligated to make any additional payments except K2M shall have one year to dispose of any Royalty Bearing Device it currently has in inventory or on order as of
the date of termination, and shall pay royalty fee payments as defined in Sections 3.2(a) for all of said Royalty Bearing Devices disposed of after the termination. However, no royalty payments or any other payments shall be owed to SPINAL if
termination of this Agreement occurs for breach of the Agreement by SPINAL. 
 10.5 Rights after Termination. If termination of this
Agreement occurs for breach of the Agreement by SPINAL, the rights and licenses granted from SPINAL to K2M shall not be revoked and shall continue to be held by K2M after termination of the Agreement. If termination of this Agreement occurs and
termination is not because of a breach by SPINAL, all rights and licenses granted by SPINAL to K2M shall be revoked subject however to the provisions of Section 10.4. If termination of this Agreement occurs for any reason other than a breach of
the Agreement by SPINAL, SPINAL may purchase clinical data and approvals from K2M. 
 10.6 Other Termination Obligations. Upon
termination or expiration of this Agreement for any reason: 
 10.6.1 unless otherwise agreed, the receiving Party’s
right to use and disclose Confidential Information under this Agreement shall terminate. Each Party shall, within thirty (30) days after termination or expiration, return all Confidential Information of the other Party, including all electronic
records and files or other information that may be used by or with the aid of a machine. Each Party may keep a copy of the Confidential Information for their legal files; and 

  
 13 

 10.6.2 except as otherwise provided in this Agreement, neither Party shall have
any further obligations under this Agreement. 
 10.7 K2M Right to Terminate During Due Diligence. Upon completion of Due Diligence as
contemplated in Section 4, K2M may terminate this Agreement at any time during the immediately subsequent thirty (30) day period as follows: 

10.7.1 If K2M is not satisfied with respect to the Due Diligence concerning the ownership of the intellectual property and inventory subject of
this Agreement by SPINAL, K2M may terminate this Agreement and SPINAL shall promptly return to K2M all payments made to SPINAL prior to such termination. 

10.7.2 If K2M is not satisfied with Due Diligence in any respect other than the ownership of K2M may terminate this Agreement, and SPINAL shall
be entitled to keep for its sole benefit any payments made by K2M to SPINAL prior to such termination. 
 10.8 K2M may terminate this
Agreement at any time upon thirty (30) days notice to SPINAL, provided that SPINAL shall be entitled to keep any payments made by K2M to SPINAL prior to such termination, if such termination is not due to breach of this Agreement by SPINAL
shall recover all rights of granted under this Agreement. 
 11. CONFIDENTIALITY 

11.1 Use and Disclosure of Confidential Information. Pursuant to this Agreement, each Party may disclose to the other Confidential
Information. Each Party agrees: 
 11.1.1 That it will not disclose the Confidential Information acquired from the other
Party in whole or in part to any third party, and that it will not use any Confidential Information of the other Party except for purposes of this Agreement; 

11.1.2 Not to disclose any Confidential Information except in connection with the exercise of rights granted by this Agreement
to those employees or consultants of the recipient Party who have agreed in writing, under the recipient Party’s own blanket or specific agreement form, to protect and preserve the confidentiality of such information; 

11.1.3 Without affecting the generality of the foregoing subparagraphs, to exercise no less care to safeguard the Confidential
Information acquired than the Party exercises in safeguarding its own confidential or proprietary information; provided that in no event will less than reasonable care be exercised to safeguard Confidential Information of the other Party. 

11.2 The restrictions in this Agreement on use and disclosure of Confidential Information will not apply to information: 

  
 14 

 a. that becomes lawfully known or available to the receiving Party from a source
other than the disclosing Party without breach of this Agreement; 
 b. that was already known to the receiving Party, as
shown by written records, before its disclosure by the disclosing Party; 
 c. that is within, or falls within, the public
domain without breach of this Agreement; 
 d. that is rightfully acquired by, or received by, the receiving Party from a
third party without restriction on disclosure or use; 
 e. that is developed independently by the receiving Party without
the use or consideration of, or reference to, Confidential Information; or 
 f. that is disclosed pursuant to the
requirement or demand of a lawful governmental or judicial authority, but only to the extent required by operation of law, regulation or court order, and provided that the receiving Party gives written notice to the disclosing Party reasonably in
advance of any disclosure to allow sufficient opportunity for the disclosing Party to object to and/or prevent such disclosure. 
 The
receiving Party will have the burden of proof respecting any of the aforementioned events on which the receiving Party may rely as relieving it from the restrictions on disclosure or use of Confidential Information. 

11.3 Confidential Agreement. The existence of this Agreement is considered strictly confidential. The specific terms of this Agreement,
including the Patents and Licensed Technology involved and terms of the grant of license are confidential, and neither Party will disclose any specific terms of this Agreement to any third party without the express written consent of the other
Party. SPINAL consents to the disclosure of this Agreement in matters related to K2M’s efforts to obtain financing. 
 11.4 Public
Announcements. No publicity or public announcements concerning the existence of this Agreement, its terms, or the transactions it authorizes may be made except as mutually agreed by both Parties. 

11.5 Injunctive Relief. If a Party breaches any of its obligations respecting confidentiality in Article 10, notwithstanding the dispute
resolution process set out in Article 13 of this Agreement, without prior notice the other Party shall be entitled to seek equitable relief to protect its interests, including but not limited to injunctive relief, in any court of competent
jurisdiction. 

  
 15 

 11.6 Survival of Confidentiality Obligations. The obligations respecting disclosure and
use of Confidential Information will survive expiration or termination of this Agreement and will continue for a period of two (2) years after the date of expiration or termination, or the occurrence of any of the events recited in
Section 10.2, whichever occurs first. After such time, the receiving Party will be relieved of all confidentiality obligations. 
 11.7
Prior Confidentiality Agreements. The obligations regarding the disclosure and use of Confidential Information recited herein apply to disclosures made after the execution date of this Agreement, and replace any previous agreements between
the Parties with regard to the handling of Confidential Information. 
 12. DISPUTE RESOLUTION 

12.1 Either Party may initiate the dispute resolution process of this section at any time by giving written notice to the other Party. The
written notice shall: (i) describe the nature of the dispute, including if applicable any device and or patent(s) that are involved in the dispute, (ii) describe the initiating Party’s claim for relief, and (iii) provide the
name, address, telephone, and fax numbers of one or more individuals with authority to settle the dispute on the initiating Party’s behalf. 

12.2 Within thirty (30) days of receipt of a written notice of dispute, the parties shall meet and attempt to amicably resolve the
dispute. One or more individuals of each Party with authority to settle the entirety of the dispute shall attend the initial meeting. 
 13.
MISCELLANEOUS PROVISIONS 
 13.1 Governing Law. This Agreement shall be governed by, and construed and enforced in accordance
with the laws of the Commonwealth of Virginia, United States of America, without regard to conflict of law principles. Any controversy or dispute arising under this Agreement shall be subject to the exclusive jurisdiction and venue of a United
States District Court within the Commonwealth of Virginia. Each of the Parties also submits itself to the exclusive jurisdiction and venue of such courts for the purpose of any such action. Each of the Parties also waives any defense of inconvenient
forum to any action or proceeding so brought. Nothing in this Section 13.1 shall affect the right of any Party to serve legal process in any other manner permitted by law or in equity. The Parties specifically disclaim the UN Convention on
Contracts for the International Sale of Goods. The prevailing Party in any action to enforce the terms of this Agreement shall be entitled to recover its reasonable attorney fees and costs. 

13.2 Indemnity. SPINAL shall indemnify, defend and hold harmless K2M and each of its officers, directors, employees, and shareholders
from any and all demands, claims, actions or causes of action, assessments, judgments, losses, damages, liabilities, fines or levies, interest and penalties, costs and expenses, resulting from or arising out of any and all acts or omissions of
SPINAL, or anyone directly or indirectly employed by, associated with, or acting on behalf of SPINAL, related to: (a) SPINAL’s breach of, or performance or non-performance under, this Agreement; (b) activities that involve or relate
to the exercise of any rights granted by SPINAL under this Agreement; (c) any use or sale of Royalty Bearing Devices prior to the existence of 

  
 16 

 
this Agreement; or (d) other gross negligence or intentional misconduct of SPINAL. In the event that SPINAL assumes the defense of K2M in accordance with this section, K2M is entitled to
participate in the defense of its interests, including participation in any proceeding or settlement discussions. K2M agrees that it will not settle any action commenced against it related to the Patents in a manner that is prejudicial to any of
SPINAL’s rights related to the Patents without the SPINAL’s prior written consent. 
 13.3 K2M shall indemnify, defend and hold
harmless SPINAL and each of its officers, directors, employees, and shareholders from any and all demands, claims, actions or causes of action, assessments, judgments, losses, damages, liabilities, fines or levies, interest and penalties, costs and
expenses (“Indemnifiable Losses”), resulting from or arising out of any and all acts or omissions of K2M, or anyone directly or indirectly employed by, associated with, or acting on behalf of K2M, related to: (a) the use of any
Royalty Bearing Device(s) in a manner for which it was not designed or intended to be used; or (b) other gross negligence or intentional misconduct of K2M, except to the extent in any of the foregoing cases that the Indemnifiable Losses are
caused in whole or in part by the gross negligence or intentional misconduct of SPINAL. SPINAL agrees that it will not settle any action commenced by or against it related to the Patents, the Royalty Bearing Devices or the Technology in a manner
that is prejudicial to any of the rights related to the Patents, the Royalty Bearing Devices or the Technology without the K2M’s prior written consent. 

13.4 Limitation of Liability. EXCEPT AS PROVIDED OTHERWISE HEREIN, NEITHER PARTY SHALL BE LIABLE TO THE OTHER PARTY OR ANY THIRD PARTY
FOR ANY SPECIAL, CONSEQUENTIAL, EXEMPLARY OR INCIDENTAL DAMAGES (INCLUDING LOST OR ANTICIPATED REVENUES OR PROFITS RELATING TO THE SAME), ARISING FROM ANY CLAIM RELATING TO THIS AGREEMENT, THE PATENTS, THE KNOW-HOW, THE TECHNOLOGY, THE MARKS, THE
ROYALTY BEARING DEVICE(S), WHETHER SUCH CLAIM IS BASED ON WARRANTY, CONTRACT, TORT (INCLUDING NEGLIGENCE OR STRICT LIABILITY) OR OTHERWISE, EVEN IF AN AUTHORIZED REPRESENTATIVE OF SUCH PARTY IS ADVISED OF THE POSSIBILITY OR LIKELIHOOD OF SAME. 

13.5 Insurance. K2M agrees to maintain product liability and commercial general liability insurance, if any, at such amounts and with
such carriers as it deems commercially reasonable. 
 13.6 Relationship of the Parties. Except as specifically provided herein,
neither Party shall act or represent or hold itself out as having authority to act as an agent or partner of the other Party, or in any way bind or commit the other Party to any obligations. Any such act will create separate liability in the Party
so acting to any and all third parties affected thereby. Except where specifically provided in this Agreement, the rights, duties, obligations and liabilities of the Parties shall be several and not joint or collective, and nothing contained in this
Agreement shall be construed as creating a partnership, joint venture, agency, trust or other association of any kind, each Party being individually responsible only for its obligations as set forth in this Agreement. 

  
 17 

 13.7 Currency. All payments required by this Agreement shall be remitted in United States
currency. 
 13.8 Force Majeure. No Party shall be liable to the other for any failure or delay in performing obligations set forth in
this Agreement, and no Party shall be deemed in breach of its obligations, if such failure or delay is caused by events, occurrences or causes beyond the reasonable control of the Party. Such events include national disasters, acts of God, strikes,
lockouts, riots, acts of war, earthquakes, floods, and fire. The inability to meet financial obligations is expressly excluded. 
 13.9
Assignment. SPINAL shall not divest itself of ownership of the Patents and Patent Application without prior written notice to K2M and subsequent approval by K2M of such divestiture; such approval by K2M not being unreasonably withheld.
Neither this Agreement nor any of the rights, privileges, obligations, or benefits conferred by this Agreement are assignable or transferable, except: (i) where prior written consent of the other Party is obtained, or (ii) the assignment
or transfer is part of the acquisition, whether by purchase, merger, or operation of law, of substantially all of the assets of the Party or any entity that owns or controls the Party, on condition that the assignee or transferee has executed and
delivered a written agreement undertaking all of the duties and obligations of the assignor or transferor under this Agreement or (iii) where the assignment is to an Affiliate of either SPINAL or K2M, or (iv) where the assignment is due to
operation of law. 
 13.10 Notice. All communications, notices and exchanges of information shall be in writing and shall be deemed
properly given: (i) when personally delivered, (ii) three (3) calendar days after a Party delivers it to an established courier service, with fees prepaid, addressed to the other Party at the address set forth in this section, or
(iii) twenty-four (24) hours after a Party transmits it by facsimile, to the fax number and address of the other Party set forth in this section: 
  

			
	 SPINAL:
	  	 Spinal LLC
 1517 Coining Drive

Toledo, Ohio 43612

		
		  	 Attention: John Hammill
 Fax: (419)
720-3600

		
	 K2M:
	  	 K2M, LLC
 751 Miller Road

Leesburg, VA 20175
 Attn: President

Fax:
                                        

  
 18 

 Each Party will have the right to change its address by giving at least eleven
(11) days’ prior written notice of its new address to the other Party. 
 13.11 Entire Agreement. This Agreement constitutes
the entire Agreement of the Parties with regard to its subject matter, and supersedes all previous written or oral representations, agreements or understandings between SPINAL and K2M. 

13.12 No Modification. This Agreement may be changed only by a writing signed by each Party. 

13.13 Severability. In the event that any one or more of the provisions contained in this Agreement shall, for any reason, be held to be
invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect the other provisions of this Agreement and all other provisions shall remain in full force and effect. 

13.14 Headings. Headings in this Agreement are included for ease of reference only and have no legal effect. 

13.15 No Strict Construction. The language used in this Agreement is the language chosen by the Parties to express their mutual intent,
and no rule of strict construction against either Party shall apply to any term or condition of this Agreement. 
 13.16 Export
Restrictions. This Agreement is subject to any law, regulation, order or other restriction on the export or re-export of any Royalty Bearing Device(s) or Technology that is the subject matter of this Agreement as may be imposed from time to time
by governments of the United States or any other country, or any agency thereof. Neither Party shall knowingly export or re-export or cause to be exported or re-exported, directly or indirectly, any Royalty Bearing Device(s) or Technology under this
Agreement to any country for which the United States government or any other government, or any agency thereof, requires an export license or other government approval at the time of such export without first obtaining any required license or
approval. 
 13.17 Waiver and Survival. In the event that either Party, on any occasion, fails to enforce any provision of this
Agreement, including those affecting termination, that failure shall not be deemed a waiver of that Party’s right to enforce its rights at any later time and shall not prevent enforcement of any of that Party’s other rights on any other
occasion. 
 13.18 K2M’s Retained Rights. The license and rights granted under Article 2 shall be deemed licenses of
“intellectual property” for purposes of United States Code, Title 11, Section 365(n). In the event of SPINAL’s bankruptcy and a subsequent rejection or disclaimer of this Agreement by a bankruptcy trustee or by SPINAL as a
debtor-in-possession, whether under the laws of the United States or elsewhere, or in the event of a similar action under applicable law, K2M may elect to retain its license rights, subject to and in accordance with the provisions of the United
States Code, Title 11, Section 365(n) or other applicable law. 

  
 19 

 13.19 Further Assurance. Bach of the parties will execute such documents and other papers
and take such further actions as may be reasonably required or desirable to carry out the provisions of and the transactions contemplated by this Agreement. 

13.20 Authority of Signatories. Each person executing this Agreement individually and personally represents and warrants that he
is duly authorized to execute and deliver this Agreement on behalf of the entity for which he or she is signing, and that this Agreement is binding upon the entity in accordance with its terms. 

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized officers. 

 

					
	SPINAL, LLC	  	K2 MEDICAL, LLC
			
		 	 /s/ John E Hammill Sr
	  	 /s/ Eric Major

		 	By	  	By
			
		 	 John E Hammill Sr
	  	 Eric Major

		 	Printed Name	  	Printed Name
			
		 	 CEO
	  	 CEO

		 	Title, Duly Authorized	  	Title, Duly Authorized

  
 20 

 EXHIBIT A 

PATENTS 
 U.S. Patent Registration Number 5,683,392,
Entitled “Multiplanar Locking Mechanism for Bone Fixation”, issued November 4, 1997; 
 U.S. Patent Registration Number 6,413,258, Entitled
“Rod to Rod Coupler”, issued July 2, 2002; and 
 U.S. Patent Application Number 11/701,349, Entitled “Bone Fixation System with Low
Profile Fastener”, filed November 3, 2003. 

  
 21 

 EXHIBIT B 

TRADEMARKS 
 OVATIONTM 

VERSALINKTM 

  
 22 

 EXHIBIT C — INVENTORY 

  
 23

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00229-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00229-of-00352.parquet"}]]