Financial Reporting - Xtant Medical Holdings, Inc. reported financial results for Q4 and the full year 2024 on March 6, 2025[5]. - The financial results announcement includes a press release detailing the fourth quarter and full year 2024 performance[19]. - The report does not provide specific numerical data regarding revenue or net income/loss for the reported periods[5]. - The report was signed by Scott Neils, Chief Financial Officer, indicating formal acknowledgment of the financial disclosures[22]. Non-GAAP Measures - The company utilizes non-GAAP adjusted EBITDA to provide insights into its core operational performance, excluding items like separation-related expenses and legal settlements[7][10]. - Non-GAAP adjusted EBITDA is defined as net income/loss from operations before depreciation, amortization, interest expense, and income tax provision, adjusted for specific non-recurring items[7]. - The company believes that non-GAAP measures facilitate internal comparisons to historical results and assist in budgeting and resource allocation decisions[8]. - The company emphasizes that non-GAAP financial measures should be evaluated alongside GAAP measures for a comprehensive understanding of financial results[17]. Company Information - The company is listed on NYSE American LLC under the trading symbol XTNT[3]. - The financial results are part of the company's ongoing strategy to enhance operational transparency and investor understanding[8].

Financial Data and Key Metrics Changes - Total revenue for Q2 2024 was $29.9 million, a 48% increase from $20.2 million in Q2 2023, primarily driven by product sales from the recently acquired Surgalign Hardware and Biologics business [14] - Adjusted EBITDA for Q2 2024 was $0.5 million, compared to $0.1 million in the same period in 2023, marking the fifth consecutive quarter of positive adjusted EBITDA [5][16] - Net loss for Q2 2024 was $3.9 million or $0.03 per share, compared to a net loss of $2.2 million or $0.02 per share in Q2 2023 [16] Business Line Data and Key Metrics Changes - Organic growth for Q2 was flat compared to the prior year, mainly due to planned cannibalization of X-spine hardware and significant OEM sales in Q2 2023 [4] - The top 20 distributors grew 16.5% in revenue since the acquisition of Surgalign in Q3 2023 [6] - The company expanded its Biologics product offering from two categories to five, with the introduction of a sixth category, amniotic membrane allografts [7] Market Data and Key Metrics Changes - The distribution network now includes over 650 distributors, covering approximately 90% of all beds in the U.S. [9] - The company is focusing on increasing penetration into existing distributors rather than just adding new ones [9] Company Strategy and Development Direction - The company aims to achieve self-sustainability by controlling its supply chain and reducing reliance on external production [12] - Key growth pillars include new product introductions, distribution network expansion, adjacent market penetration, and strategic acquisitions [11] - The company is targeting undercapitalized or subscale companies for acquisitions to enhance capabilities and expand production capacity [11] Management's Comments on Operating Environment and Future Outlook - Management expects organic growth to accelerate in the second half of 2024 as supply chain challenges abate and new products are introduced [4] - The company anticipates positive operating cash flow by Q4 2024, driven by increased production of its own biologics [13][41] - Management is optimistic about the growth potential of the amniotic tissue products and the stem cell business [28][33] Other Important Information - The company entered into an agreement for a $5 million PIPE with an existing institutional investor to provide additional working capital [17] - Gross margin for Q2 2024 was 62.1%, an increase from 61.6% in Q2 2023, attributed to greater scale and improved production efficiency [14] Q&A Session Summary Question: Can you provide color on the revenue mix between orthobiologics and spinal implants? - Management noted that Surgalign hardware significantly contributed to revenue, helping to replace older X-spine hardware, and expects an increase in self-produced products in the second half of the year [18][19] Question: How does the guidance look for the balance of the year? - Management indicated an expected uptick in Q3 and a strong performance in Q4, particularly with the ramp-up of the Stem Cell business [21][22] Question: What are the expectations for gross margins moving forward? - Management expects gross margins to remain steady in Q3 and Q4, with a significant uptick anticipated in Q1 2025 as internal production increases [24] Question: Can you discuss the opportunities in the amniotic product line? - Management highlighted the OEM opportunities and the potential for high margins, noting that sourcing amniotic tissue is currently a limiting factor [28][30] Question: How quickly can the company ramp up production for stem cells? - Management indicated that production ramp-up would occur over the next three to four months, with a focus on fulfilling OEM opportunities first [34][36] Question: What is the outlook for sustainable cash flow? - Management does not expect cash flow breakeven in Q1 2025 but anticipates that it will be sustainable thereafter [39]

Financial Performance - Revenue for Q2 2024 was $29.9 million, representing a 48% increase compared to $20.2 million in Q2 2023[3] - Gross margin improved to 62.1%, up 50 basis points from 61.6% in the prior year quarter[4] - Net loss for Q2 2024 was $3.9 million, compared to a net loss of $2.2 million in the same quarter last year[4] - Adjusted EBITDA for Q2 2024 was $0.5 million, an increase from $0.1 million in Q2 2023[5] - Revenue for Q2 2024 reached $29,943,000, a 48.4% increase from $20,232,000 in Q2 2023[11] - Gross profit for Q2 2024 was $18,582,000, with a gross profit margin of 62.1%, compared to $12,459,000 and 61.6% in Q2 2023[11] - Total operating expenses increased to $21,528,000 in Q2 2024, up from $13,850,000 in Q2 2023, primarily driven by higher sales and marketing expenses[11] - Net loss for Q2 2024 was $3,861,000, compared to a net loss of $2,190,000 in Q2 2023[11] - Non-GAAP Adjusted EBITDA for Q2 2024 was $504,000, compared to $105,000 in Q2 2023[13] Cash Flow and Financing - Cash and cash equivalents as of June 30, 2024, were $5.4 million, down from $5.7 million at the end of 2023[5] - Cash used in operating activities for the first half of 2024 was $10,843,000, significantly higher than $4,766,000 in the same period of 2023[12] - The company reported a net cash provided by financing activities of $11,613,000 in the first half of 2024, compared to $6,522,000 in the same period of 2023[12] - The company had cash and cash equivalents of $5,379,000 at the end of the period, compared to $4,138,000 at the end of Q2 2023[12] - The company entered into a $5.0 million private placement on August 7, 2024[2] Product Development and Market Expansion - Two new amniotic membrane allografts products, SimpliGraft™ and SimpliMax™, were launched in Q2 2024[2] - The company signed 15 new distributors and awarded 20 IDN contracts in Q2 2024[2] Operating Expenses - Operating expenses for Q2 2024 totaled $21.5 million, up from $13.9 million in Q2 2023[4] - The company incurred $13,179,000 in sales and marketing expenses in Q2 2024, up from $8,716,000 in Q2 2023[11] - Research and development expenses increased to $636,000 in Q2 2024, compared to $180,000 in Q2 2023[11] Future Outlook - The company expects full year 2024 revenue to be between $116 million and $120 million, indicating annual growth of approximately 27% to 31% compared to 2023[6]

Xtant Medical Holdings, Inc. (NYSE:XTNT) Q1 2024 Results Conference Call May 15, 2024 4:30 PM ET Company Participants Brett Maas - Managing Partner, Hayden IR Sean Browne - President and Chief Executive Officer Scott Neils - Chief Financial Officer Conference Call Participants Ryan Zimmerman - BTIG Chase Knickerbocker - Craig-Hallum Operator Greetings. Welcome to the Xtant Medical Holdings, Inc. First Quarter 2024 Conference Call. At this time, all participants are in a listen-only mode. A question-and-answ ...

CAUTIONARY STATEMENT REGARDING FORWARD-LOOKING STATEMENTS [Forward-Looking Statements and Risks](index=4&type=section&id=Forward-Looking%20Statements%20and%20Risks) This section outlines forward-looking statements in the 10-Q, highlighting inherent risks and uncertainties that could materially alter actual results - Forward-looking statements are subject to **risks and uncertainties**, including **stem cell shortages** for OsteoVive, **integration challenges** for acquired products, **international operation risks**, **biologics manufacturing challenges**, **inflation**, **supply chain disruptions**, and **labor shortages**[11](index=11&type=chunk)[12](index=12&type=chunk)[14](index=14&type=chunk) PART I. FINANCIAL INFORMATION [ITEM 1. FINANCIAL STATEMENTS](index=7&type=section&id=ITEM%201.%20FINANCIAL%20STATEMENTS) This item presents unaudited condensed consolidated financial statements, including balance sheets, operations, comprehensive loss, equity, and cash flows, with detailed notes [Condensed Consolidated Balance Sheets](index=7&type=section&id=Condensed%20Consolidated%20Balance%20Sheets) The condensed consolidated balance sheets present the company's financial position as of March 31, 2024, and December 31, 2023 | Metric | March 31, 2024 (in thousands) | December 31, 2023 (in thousands) | | :-------------------------------- | :----------------------------- | :----------------------------- | | Total Assets | $93,931 | $92,612 | | Total Liabilities | $46,251 | $41,263 | | Total Stockholders' Equity | $47,680 | $51,349 | | Cash and cash equivalents | $4,547 | $5,715 | | Line of credit | $10,270 | $4,622 | [Condensed Consolidated Statements of Operations](index=8&type=section&id=Condensed%20Consolidated%20Statements%20of%20Operations) The condensed consolidated statements of operations report the company's financial performance for the three months ended March 31, 2024, and 2023 | Metric | Three Months Ended March 31, 2024 (in thousands) | Three Months Ended March 31, 2023 (in thousands) | | :----------------------------------- | :--------------------------------------- | :--------------------------------------- | | Revenue | $27,873 | $17,943 | | Cost of sales | $10,571 | $7,407 | | Gross Profit | $17,302 | $10,536 | | Loss from Operations | $(3,470) | $(1,576) | | Net Loss | $(4,400) | $(2,078) | | Basic Net Loss Per Share | $(0.03) | $(0.02) | [Condensed Consolidated Statements of Comprehensive Loss](index=9&type=section&id=Condensed%20Consolidated%20Statements%20of%20Comprehensive%20Loss) This statement details the net loss and other comprehensive loss components, specifically foreign currency translation adjustments, for the three months ended March 31, 2024, and 2023 | Metric | Three Months Ended March 31, 2024 (in thousands) | Three Months Ended March 31, 2023 (in thousands) | | :-------------------------------- | :--------------------------------------- | :--------------------------------------- | | Net Loss | $(4,400) | $(2,078) | | Foreign currency translation adjustments | $(162) | $0 | | Comprehensive Loss | $(4,562) | $(2,078) | [Condensed Consolidated Statements of Equity](index=10&type=section&id=Condensed%20Consolidated%20Statements%20of%20Equity) The condensed consolidated statements of equity show changes in stockholders' equity for the three months ended March 31, 2024, and 2023 | Metric | Balance at March 31, 2024 (in thousands) | Balance at December 31, 2023 (in thousands) | | :-------------------------------- | :--------------------------------------- | :--------------------------------------- | | Total Stockholders' Equity | $47,680 | $51,349 | | Additional Paid-In Capital | $295,223 | $294,330 | | Accumulated Deficit | $(247,410) | $(243,010) | [Condensed Consolidated Statements of Cash Flows](index=11&type=section&id=Condensed%20Consolidated%20Statements%20of%20Cash%20Flows) This statement provides a breakdown of cash flows from operating, investing, and financing activities for the three months ended March 31, 2024, and 2023 | Metric | Three Months Ended March 31, 2024 (in thousands) | Three Months Ended March 31, 2023 (in thousands) | | :----------------------------------- | :--------------------------------------- | :--------------------------------------- | | Net cash used in operating activities | $(5,755) | $(2,245) | | Net cash used in investing activities | $(674) | $(17,421) | | Net cash provided by financing activities | $5,179 | $4,569 | | Net change in cash and cash equivalents and restricted cash | $(1,299) | $(15,097) | | Cash and cash equivalents and restricted cash at end of period | $4,624 | $5,410 | [Notes to Unaudited Condensed Consolidated Financial Statements](index=12&type=section&id=Notes%20to%20Unaudited%20Condensed%20Consolidated%20Financial%20Statements) These notes provide essential details and explanations for the unaudited condensed consolidated financial statements [(1) Business Description, Basis of Presentation and Summary of Significant Accounting Policies](index=12&type=section&id=(1)%20Business%20Description,%20Basis%20of%20Presentation%20and%20Summary%20of%20Significant%20Accounting%20Policies) This note describes Xtant Medical Holdings, Inc. as a global medical technology company focused on orthobiologics and spinal implant systems - Xtant is a global medical technology company specializing in **orthobiologics** and **spinal implant systems** to facilitate spinal fusion[30](index=30&type=chunk) - For the three months ended March 31, 2024, the company incurred a **net loss of $4.4 million** and **negative cash flows from operating activities of $5.8 million**[34](index=34&type=chunk) - Management believes current cash and credit facilities, including additional term loan borrowings of **$5.0 million on May 14, 2024**, will provide sufficient liquidity through at least **May 2025**[34](index=34&type=chunk) [(2) Acquisition of Coflex and CoFix Product Lines](index=14&type=section&id=(2)%20Acquisition%20of%20Coflex%20and%20CoFix%20Product%20Lines) On February 28, 2023, Xtant acquired Surgalign SPV, Inc., including the Coflex and CoFix product lines, for $17.0 million in cash - Xtant acquired Surgalign SPV, Inc. and its Coflex and CoFix product lines on February 28, 2023, for an aggregate purchase price of **$17.0 million in cash**[43](index=43&type=chunk)[46](index=46&type=chunk) - The acquisition strengthened the Company's spine portfolio with differentiated, FDA-approved, minimally invasive motion-preserving stabilization implants, resulting in the recognition of **$3.5 million in goodwill**[44](index=44&type=chunk)[48](index=48&type=chunk) Acquired Asset Fair Value | Acquired Asset | Fair Value (in thousands) | | :------------- | :------------------------ | | Inventories | $1,589 | | Equipment | $947 | | Intangible assets | $10,940 | | Net assets acquired | $13,476 | | Goodwill | $3,524 | | Total purchase consideration | $17,000 | [(3) Acquisition of Surgalign Holdings, Inc.'s Hardware and Biologics Business](index=15&type=section&id=(3)%20Acquisition%20of%20Surgalign%20Holdings,%20Inc.'s%20Hardware%20and%20Biologics%20Business) On August 10, 2023, Xtant acquired Surgalign Holdings, Inc.'s hardware and biologics business assets for $5.0 million in cash, plus assumed liabilities - Xtant acquired the hardware and biologics business assets of Surgalign Holdings, Inc. on August 10, 2023, for **$5.0 million in cash** plus assumed liabilities, through a bankruptcy proceeding[50](index=50&type=chunk)[51](index=51&type=chunk) - The transaction resulted in an **$11.7 million gain from bargain purchase**, as the estimated fair value of the identifiable net assets acquired exceeded the purchase consideration, strengthening the company's orthobiologics and spinal fusion device portfolio[53](index=53&type=chunk)[54](index=54&type=chunk) Preliminary Allocation of Acquired Assets/Liabilities | Acquired Asset/Liability | Preliminary Allocation (in thousands) | | :----------------------- | :------------------------------------ | | Cash | $1,087 | | Accounts receivable | $1,627 | | Inventories | $15,300 | | Prepaids and other current assets | $825 | | Equipment | $2,067 | | Right-of-use asset | $576 | | Accounts payable | $(530) | | Accrued liabilities | $(1,170) | | Current portion of lease liability | $(238) | | Lease liability, less current portion | $(338) | | Net assets acquired | $19,206 | | Bargain purchase gain | $(11,694) | | Deferred tax liability | $(1,922) | | Total purchase consideration | $5,590 | [(4) Acquisition of NanOss Production Operations](index=16&type=section&id=(4)%20Acquisition%20of%20NanOss%20Production

Exhibit 99.1 Xtant Medical Reports First Quarter 2024 Revenue Growth of 55% and Raises Full Year 2024 Revenue Guidance ● Revenue of $27.9 million, up 55%, compared to the prior year quarter ● Gross margin of 62.1%, up 340 basis points, compared to the prior year quarter ● Net loss of $4.4 million compared to $2.1 million in the year ago quarter ● Positive Adjusted EBITDA; Adjusted EBITDA of $0.1 million compared to an Adjusted EBITDA loss of $0.3 million in the prior year quarter ● Launched two amniotic mem ...

Financial Data and Key Metrics Changes - For Q4 2023, the company generated revenue of $28.1 million, an increase of 84% year-over-year, with full-year revenue of $91.3 million, exceeding guidance [9][30] - The organic revenue growth for Q4 2023 was 9%, with full-year adjusted organic growth of 17% compared to 2022 [10][11] - Gross margin for Q4 2023 was 61%, up from 54.4% in the same period of 2022, attributed to production efficiencies and favorable product mix [32] - The net loss for Q4 2023 was $4.3 million, or $0.03 per share, compared to a net loss of $2.2 million, or $0.02 per share in Q4 2022 [34] Business Line Data and Key Metrics Changes - The company expanded its biologics product offering from two categories to five, enhancing profitability [14] - The acquisition of Surgalign significantly changed the product offering to approximately two-thirds biologics and one-third fixation and hardware [16] Market Data and Key Metrics Changes - The company has access to over 450 Integrated Delivery Networks (IDNs) and every major Group Purchasing Organization (GPO), covering about 90% of all beds in the U.S. [17] - The company is building a presence in adjacent markets such as foot and ankle, trauma, and orthopedic implants [18] Company Strategy and Development Direction - The company focuses on four key growth pillars: new product introductions, distribution network expansion, adjacent market penetration, and strategic acquisitions [13] - The company aims to achieve self-sustainability in its supply chain to reduce reliance on external production [28] - Full-year 2024 revenue guidance is set between $112 million and $116 million, representing a growth of approximately 23% to 27% compared to 2023 [25] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving sustainable long-term growth and maximizing shareholder value, with expectations for accelerated growth starting in Q2 2024 [26][64] - The company anticipates improved gross margins driven by internal production and a favorable product mix [45][56] Other Important Information - The company increased its revolving credit facility from $8 million to $17 million to support growth initiatives [24] - The company completed the acquisition of NanOss Production Operations to enhance in-house biologics production capabilities [23] Q&A Session Summary Question: 2024 guidance and growth drivers - Management discussed contributions from Surgalign and expected growth from new product lines and OEM production, particularly in the second half of 2024 [39][40][42] Question: OEM business environment - Management indicated that while initial contributions from the OEM side may be quieter, opportunities are expected to arise in the latter half of the year [43][44] Question: Gross margin expectations - Management expects gross margins to improve throughout 2024, influenced by internal production and product mix [45] Question: General and administrative expenses - Management explained that elevated GA expenses were driven by acquisition-related costs, commissions, and compensation, which are expected to normalize [49][50] Question: Stem cell inventory and supply constraints - Management confirmed improved inventory levels and a positive outlook for the stem cell business, with expectations for continued inventory availability throughout the year [53][56] Question: Coflex product performance and reimbursement updates - Management reported positive developments in the Coflex business, including new coverage in New York, and expressed optimism for future growth [57] Question: Adjusted EBITDA margin improvement - Management expressed confidence in improving adjusted EBITDA margins through product offering enhancements and operational efficiencies [59]

PART I [Business Overview](index=5&type=section&id=Item%201.%20Business) Xtant Medical is a global medical technology company specializing in orthobiologics and spinal implant systems, expanding through strategic acquisitions - Xtant Medical focuses on **orthobiologics and spinal implant fixation systems** for spinal fusion procedures[16](index=16&type=chunk) - Distribution channels include **U.S. independent distributors** and **international partners** across multiple regions[17](index=17&type=chunk)[39](index=39&type=chunk) - Key growth initiatives involve **new product introductions**, **distribution network expansion**, **adjacent market penetration**, and **strategic acquisitions**[18](index=18&type=chunk) - In **2023**, the company completed **three significant acquisitions** (Coflex/CoFix for **$17.0 million**, Surgalign hardware/biologics for **$5 million**, nanOss operations for **$2 million** plus royalties), expanding its portfolio and international footprint[19](index=19&type=chunk)[20](index=20&type=chunk)[22](index=22&type=chunk) [Risk Factors](index=20&type=section&id=Item%201A.%20Risk%20Factors) Risks include supplier dependence, acquisition integration, international operations, regulations, and controlled company status - Dependence on **key suppliers**, particularly for **stem cells** used in **OsteoVive**, poses a significant risk due to current shortages impacting **Q3** and **Q4** **2023** revenues and future projections[110](index=110&type=chunk)[111](index=111&type=chunk) - Recent **2023 acquisitions** (Surgalign SPV, Surgalign Holdings' hardware/biologics, **RTI's nanOss operations**) introduce risks including management distraction, operational disruption, integration challenges, and potential **impairment charges** for goodwill and intangible assets[113](index=113&type=chunk)[114](index=114&type=chunk)[116](index=116&type=chunk) - Growing **international operations** expose the company to political, economic, social, and **currency risks**, along with complex regulatory compliance[117](index=117&type=chunk)[118](index=118&type=chunk)[119](index=119&type=chunk)[120](index=120&type=chunk)[121](index=121&type=chunk) - Two **material weaknesses** in internal control over financial reporting were identified: **inventory fair value completeness/accuracy** and **acquired consigned inventory confirmation** procedures[124](index=124&type=chunk)[125](index=125&type=chunk) - **Extensive governmental regulation**, including **FDA clearances**, **healthcare fraud and abuse laws** (Anti-Kickback Statute, False Claims Act, Sunshine Act), and international regulations, can lead to substantial penalties, market restrictions, and increased costs if not complied with[151](index=151&type=chunk)[152](index=152&type=chunk)[157](index=157&type=chunk)[158](index=158&type=chunk)[159](index=159&type=chunk)[160](index=160&type=chunk)[161](index=161&type=chunk)[162](index=162&type=chunk)[163](index=163&type=chunk)[164](index=164&type=chunk)[167](index=167&type=chunk)[168](index=168&type=chunk)[169](index=169&type=chunk)[170](index=170&type=chunk)[171](index=171&type=chunk)[172](index=172&type=chunk)[173](index=173&type=chunk) - **OrbiMed funds** collectively own approximately **56.2%** of outstanding **common stock**, granting them significant control over corporate decisions and director nominations[99](index=99&type=chunk)[108](index=108&type=chunk)[224](index=224&type=chunk)[225](index=225&type=chunk)[227](index=227&type=chunk) [Unresolved Staff Comments](index=62&type=section&id=Item%201B.%20Unresolved%20Staff%20Comments) There are no unresolved staff comments from the SEC - No unresolved staff comments were reported[257](index=257&type=chunk) [Cybersecurity](index=63&type=section&id=Item%201C.%20Cybersecurity) Xtant Medical prioritizes cybersecurity, integrating risk management into overall operations with Board oversight - **Cybersecurity**, **data privacy**, and **data protection** are critical to Xtant's business, with processes in place for assessing, identifying, and managing material risks[259](index=259&type=chunk) - Recent **cybersecurity** enhancements include a **new firewall**, a **Network and Security Administrator**, **internal penetration testing**, **always-on VPN**, and **hardened cloud computing security**[259](index=259&type=chunk) - Management, led by the **Director of Information Technology**, is responsible for day-to-day **cybersecurity** risk management, with oversight from the **Audit Committee** and **Board of Directors**[262](index=262&type=chunk)[264](index=264&type=chunk) - The company engages **third-party cybersecurity service providers** for assessments, protection, and monitoring of its systems[263](index=263&type=chunk) - As of the filing date, no **cybersecurity** threats have **materially affected** or are reasonably anticipated to have a material effect on the business strategy, results of operations, or financial condition, despite past cyberattacks[267](index=267&type=chunk) [Properties](index=64&type=section&id=Item%202.%20Properties) Xtant Medical's headquarters and primary manufacturing facilities are in Belgrade, Montana, with additional leased facilities globally - Headquarters and manufacturing facilities are located in **Belgrade, Montana**, across three **leased buildings** (664, 600, and 732 Cruiser Lane), with leases expiring in **October 2025**[268](index=268&type=chunk)[270](index=270&type=chunk) - The **Belgrade facilities** include **FDA registered areas** with **Class 10,000 (ISO 7)** and **Class 100 (ISO 5) clean rooms**, and a **Class 1,000 (ISO 6) clean room**, used for device design, manufacture, and tissue processing[270](index=270&type=chunk) - Additional **leased facilities** include a **2,000 sq ft facility** in **San Diego, California** (expires **Dec 2026**) for innovation/design, a **13,000 sq ft facility** in **Wurmlingen, Germany** (expires **Feb 2025**) for international operations, and a **15,000 sq ft nanOss production facility** in **Greenville, North Carolina** (expires **June 2024**)[270](index=270&type=chunk)[271](index=271&type=chunk)[272](index=272&type=chunk) [Legal Proceedings](index=65&type=section&id=Item%203.%20Legal%20Proceedings) Legal proceedings are detailed in Note 14 – Commitments and Contingencies within the financial statements - **Legal proceedings** are discussed in **Note 14 – Commitments and Contingencies** in the notes to the consolidated financial statements[273](index=273&type=chunk) [Mine Safety Disclosures](index=65&type=section&id=Item%204.%20Mine%20Safety%20Disclosures) This item is not applicable to Xtant Medical Holdings, Inc - **Mine Safety Disclosures** are not applicable[274](index=274&type=chunk) PART II [Market for Common Equity and Stockholder Matters](index=66&type=section&id=Item%205.%20Market%20for%20Registrant%27s%20Common%20Equity%2C%20Related%20Stockholder%20Matters%20and%20Issuer%20Purchases%20of%20Equity%20Securities) Xtant Medical's common stock is listed on NYSE American, with no cash dividends expected due to credit agreements - **Common stock** is listed on the **NYSE American** under the ticker symbol '**XTNT**'[277](index=277&type=chunk) - As of **March 25, 2024**, there were **166 holders of record** and **130,216,541 shares of common stock outstanding**[5](index=5&type=chunk)[278](index=278&type=chunk) - The company has not paid **cash dividends** and does not expect to in the foreseeable future, as **credit agreements** preclude such payments[279](index=279&type=chunk) - No **unregistered equity securities** were sold, and no **equity securities** were purchased by the issuer during the **Q4 2023**[280](index=280&type=chunk)[281](index=281&type=chunk) [Reserved](index=66&type=section&id=Item%206.%20Reserved) This item is reserved and contains no information [Management's Discussion and Analysis of Financial Condition and Results of Operations](index=67&type=section&id=Item%207.%20Management%27s%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations) Xtant Medical achieved significant revenue growth and net income in 2023, driven by acquisitions and managed liquidity - **Total revenue** for the year ended **December 31, 2023**, increased by **58%** to **$91.3 million**, up from **$58.0 million** in **2022**, primarily due to additional sales from acquisitions and increased independent agent sales[291](index=291&type=chunk) - **Gross profit** as a percentage of revenue increased to **60.8%** in **2023** from **55.4%** in **2022**, driven by greater scale and improved production efficiency (**620 basis points**) and sales mix (**290 basis points**), partially offset by higher production costs (**340 basis points**)[293](index=293&type=chunk) - **Net income** for **2023** was **$660 thousand**, a significant improvement from a **net loss** of **$8.5 million** in **2022**, primarily due to an **$11.7 million gain on bargain purchase** from the Surgalign Holdings acquisition[298](index=298&type=chunk)[299](index=299&type=chunk) - **Net cash used in operating activities** increased to **$9.5 million** in **2023** from **$5.3 million** provided in **2022**, mainly due to an increase in accounts receivable[301](index=301&type=chunk) - **Net cash used in investing activities** significantly increased to **$24.8 million** in **2023** from **$1.6 million** in **2022**, primarily due to cash used for the **three major acquisitions**[302](index=302&type=chunk) - The company believes its **cash and credit facilities** will meet anticipated cash requirements through at least **March 2025**, but may seek additional financing[309](index=309&type=chunk) [Quantitative and Qualitative Disclosures About Market Risk](index=74&type=section&id=Item%207A.%20Quantitative%20and%20Qualitative%20Disclosures%20About%20Market%20Risk) This section is inapplicable to Xtant Medical Holdings, Inc. as it is a smaller reporting company - This item is inapplicable to Xtant as a **smaller reporting company**[322](index=322&type=chunk) [Financial Statements and Supplementary Data](index=75&type=section&id=Item%208.%20Financial%20Statements%20and%20Supplementary%20Data) This section presents audited consolidated financial statements for 2023 and 2022, prepared in conformity with U.S. GAAP Consolidated Statements of Operations (in thousands) | | Year Ended December 31, 2023 | Year Ended December 31, 2022 | |:---|:---|:---| | Total Revenue | $91,303 | $57,969 | | Cost of Sales | $35,836 | $25,832 | | Gross Profit | $55,467 | $32,137 | | Operating Expenses | $65,625 | $38,892 | | Loss from Operations | $(10,158) | $(6,755) | | Total Other Income (Expense) | $9,121 | $(1,661) | | Net Loss from Operations Before Provision for Income Taxes | $(1,037) | $(8,416) | | Benefit (Provision) for Income Taxes Current and Deferred | $1,697 | $(69) | | Net Income (Loss) | $660 | $(8,485) | Consolidated Balance Sheets (in thousands) | ASSETS | As of December 31, 2023 | As of December 31, 2022 | |:---|:---|:---| | Cash and cash-equivalents | $5,715 | $20,298 | | Restricted cash | $208 | $209 | | Trade accounts receivable, net | $20,731 | $10,853 | | Inventories | $36,885 | $17,285 | | Prepaid and other current assets | $1,330 | $673 | | Total current assets | $64,869 | $49,318 | | Property and equipment, net | $8,692 | $5,785 | | Right of use asset, net | $1,523 | $1,380 | | Goodwill | $7,302 | $3,205 | | Intangible assets, net | $10,085 | $344 | | Other assets | $141 | $197 | | Total Assets | $92,612 | $60,229 | | LIABILITIES & STOCKHOLDERS' EQUITY | | | | Accounts payable | $7,054 | $3,490 | | Accrued liabilities | $10,419 | $5,496 | | Current portion of lease liability | $830 | $458 | | Current portion of finance lease obligations | $65 | $62 | | Line of credit | $4,622 | $3,379 | | Current portion of long-term debt | $— | $2,333 | | Total current liabilities | $22,990 | $15,218 | | Long-term Liabilities: | | | | Lease liability, net | $759 | $972 | | Financing lease obligations, net | $116 | $181 | | Long-term debt, plus premium and less issuance costs | $17,167 | $9,687 | | Accrued earnout liabilities | $210 | $— | | Deferred tax liability | $21 | $— | | Total Liabilities | $41,263 | $26,058 | | Total Stockholders' Equity | $51,349 | $34,171 | | Total Liabilities & Stockholders' Equity | $92,612 | $60,229 | Consolidated Statements of Cash Flows (in thousands) | | Year Ended December 31, 2023 | Year Ended December 31, 2022 | |:---|:---|:---|\n| Net cash used in operating activities | $(9,515) | $(5,341) | | Net cash used in investing activities | $(24,784) | $(1,559) | | Net cash provided by financing activities | $19,691 | $9,020 | | Effect of exchange rate changes on cash and cash equivalents and restricted cash | $24 | $— | | Net change in cash and cash equivalents and restricted cash | $(14,584) | $2,120 | | Cash and cash equivalents and restricted cash at beginning of year | $20,507 | $18,387 | | Cash and cash equivalents and restricted cash at end of year | $5,923 | $20,507 | - The company recognized a **$11.7 million gain on bargain purchase** in **2023** due to the acquisition of Surgalign Holdings' hardware and biologics business as part of bankruptcy proceedings[288](index=288&type=chunk)[400](index=400&type=chunk) - **Orthobiologics revenue** was **$58.6 million** (**64%** of total) in **2023**, down from **81%** in **2022**, while **spinal implant revenue** increased to **$32.7 million** (**36%** of total) in **2023** from **$10.8 million** (**19%** of total) in **2022**, reflecting a shift in product mix[380](index=380&type=chunk) - The company corrected an **immaterial misstatement** in prior period financial statements, prospectively reducing **revenue and sales and marketing expense** by **$1.0 million** for the year ended **December 31, 2022**, related to **GPO fees**[457](index=457&type=chunk)[458](index=458&type=chunk)[459](index=459&type=chunk) [Changes in and Disagreements with Accountants](index=103&type=section&id=Item%209.%20Changes%20in%20and%20Disagreements%20with%20Accountants%20on%20Accounting%20and%20Financial%20Disclosure) Xtant Medical appointed Grant Thornton LLP as its new auditor in 2023, with no disagreements reported - On **August 15, 2023**, **Grant Thornton LLP** was appointed as the **independent registered public accounting firm**, replacing **Plante & Moran, PLLC**[460](index=460&type=chunk) - No **disagreements on accounting or financial disclosure matters** occurred with either firm during the fiscal years ended **December 31, 2022** and **2021**, or the subsequent interim period[460](index=460&type=chunk)[571](index=571&type=chunk) [Controls and Procedures](index=103&type=section&id=Item%209A.%20Controls%20and%20Procedures) Disclosure controls were ineffective due to material weaknesses in inventory valuation and acquired consigned inventory procedures - **Disclosure controls and procedures** were not effective as of **December 31, 2023**, due to identified **material weaknesses** in internal control over financial reporting[461](index=461&type=chunk)[469](index=469&type=chunk) - Two **material weaknesses** were identified: (1) insufficient controls over the completeness and accuracy of information for determining the **fair value of acquired inventory**, and (2) inadequate procedures to verify the existence of **acquired consigned inventory**[463](index=463&type=chunk)[464](index=464&type=chunk) - Remediation plans include correcting inputs and assumptions for **inventory valuation**, adding **accounting personnel** by end of fiscal **2024**, and integrating acquired consigned inventory into ongoing **field audits**[466](index=466&type=chunk)[467](index=467&type=chunk) - Management's evaluation of internal control over financial reporting excluded the internal control activities of **Surgalign SPV, Inc.**, Surgalign Holdings' hardware and biologics business, and **nanOss production operations** due to their recent acquisition in **2023**[468](index=468&type=chunk) [Other Information](index=105&type=section&id=Item%209B.%20Other%20Information) No Rule 10b5-1 or non-Rule 10b5-1 trading arrangements were adopted or terminated by directors or officers in Q4 2023 - No **Rule 10b5-1** or **non-Rule 10b5-1 trading arrangements** were adopted or terminated by **directors or officers** during **Q4 2023**[472](index=472&type=chunk) [Disclosure Regarding Foreign Jurisdictions that Prevent Inspections](index=105&type=section&id=Item%209C.%20Disclosure%20Regarding%20Foreign%20Jurisdictions%20that%20Prevent%20Inspections) This item is not applicable to Xtant Medical Holdings, Inc - **Disclosure regarding foreign jurisdictions that prevent inspections** is not applicable[473](index=473&type=chunk) PART III [Directors, Executive Officers and Corporate Governance](index=106&type=section&id=Item%2010.%20Directors%2C%20Executive%20Officers%20and%20Corporate%20Governance) This section outlines Board composition, executive officers, controlled company status, and governance committees Directors and Executive Officers as of March 25, 2024 | Name | Age | Position | Director/Officer Since | |:---|:---|:---|:---|\n| Stavros G. Vizirgianakis | 53 | Chair of the Board and Director | 2022 | | Sean E. Browne | 58 | President and Chief Executive Officer and Director | 2019 | | John K. Bakewell | 62 | Director | 2018 | | Jonn R. Beeson | 55 | Director | 2023 | | Robert E. McNamara | 67 | Director | 2018 | | Lori D. Mitchell-Keller | 57 | Director | 2023 | | Kevin D. Brandt | 58 | Chief Commercial Officer | 2018 | | Scott C. Neils | 40 | Chief Financial Officer | 2022 | | Mark A. Schallenberger | 38 | Chief Operations Officer | 2023 | - Xtant is a '**controlled company**' as **OrbiMed Advisors LLC affiliates** beneficially own approximately **56.2%** of its **common stock**, granting them the right to nominate a **majority of directors** and approve **significant corporate actions**[487](index=487&type=chunk)[488](index=488&type=chunk)[490](index=490&type=chunk) - The **Board of Directors** has a **majority of independent directors** (John K. Bakewell, Jonn R. Beeson, Robert E. McNamara, Lori D. Mitchell-Keller, Stavros G. Vizirgianakis) and maintains independent **Audit, Compensation, and Nominating and Corporate Governance Committees**[487](index=487&type=chunk)[491](index=491&type=chunk)[495](index=495&type=chunk)[497](index=497&type=chunk) - **Stavros G. Vizirgianakis** serves as **Chair of the Board**, while **Sean E. Browne** is **President and CEO**, a structure believed to balance strategic direction and day-to-day operations[492](index=492&type=chunk) [Executive Compensation](index=114&type=section&id=Item%2011.%20Executive%20Compensation) Executive compensation for 2023 included base salary, short-term, and long-term incentives, targeting the 50th percentile of a peer group - **Executive compensation** targets the **50th percentile** of a **peer group**, with **Mercer (US) Inc.** engaged as an independent compensation consultant[511](index=511&type=chunk)[512](index=512&type=chunk)[514](index=514&type=chunk) - The **2023 executive compensation program** included **base salary**, **short-term incentives** (**cash bonuses** based on **Xtant revenue**, **Coflex revenue**, **total revenue**, **gross margin**, and **adjusted EBITDA**), and **long-term incentives** (**time-vested stock options** and **restricted stock units**)[515](index=515&type=chunk)[516](index=516&type=chunk) Summary Compensation Table for Named Executive Officers (2023) | Name | Salary | Stock Awards | Option Awards | Non-Equity Incentive Plan Compensation | All Other Compensation | Total | |:---|:---|:---|:---|:---|:---|:---|\n| Sean E. Browne | $600,000 | $209,059 | $209,266 | $664,560 | $29,273 | $1,712,158 | | Kevin D. Brandt | $415,000 | $144,599 | $144,743 | $229,827 | $13,200 | $947,369 | | Mark A. Schallenberger | $400,000 | $205,144 | $208,263 | $221,520 | $139,696 | $1,174,623 | - **Director compensation** was revised in **2023** to include **annual cash retainers** for **Board Committee members** and a **director education reimbursement policy**[536](index=536&type=chunk)[539](index=539&type=chunk)[541](index=541&type=chunk) Director Compensation Table for Fiscal 2023 | Name | Fees Earned or Paid in Cash | Stock Awards | Option Awards | All Other Compensation | Total | |:---|:---|:---|:---|:---|:---|\n| John K. Bakewell | $82,500 | $174,216 | $27,594 | $— | $284,310 | | Jonn R. Beeson | $53,229 | $205,966 | $27,594 | $— | $286,789 | | Michael J. Eggenberg | $16,801 | $— | $— | $— | $16,801 | | Robert E. McNamara | $82,500 | $174,216 | $27,594 | $— | $284,310 | | Lori D. Mitchell-Keller | $43,505 | $205,806 | $27,594 | $— | $276,905 | | Matthew S. Rizzo | $16,801 | $— | $— | $— | $16,801 | | Stavros G. Vizirgianakis | $98,750 | $261,324 | $41,390 | $— | $401,464 | [Security Ownership](index=124&type=section&id=Item%2012.%20Security%20Ownership%20of%20Certain%20Beneficial%20Owners%20and%20Management%20and%20Related%20Stockholder%20Matters) This section details beneficial ownership by significant shareholders and management, including equity compensation plan information Significant Beneficial Owners (>5%) as of March 25, 2024 | Name of Beneficial Owner | Amount and Nature of Beneficial Ownership | Percent of Class | |:---|:---|:---|\n| OrbiMed Advisors LLC | 73,114,592 | 56.1% | | Altium Capital Management, LP | 14,525,511 | 10.6% | | Stavros G. Vizirgianakis | 7,440,339 | 5.7% | Security Ownership of Management as of March 25, 2024 | Name of Beneficial Owner | Amount and Nature of Beneficial Ownership | Percent of Class | |:---|:---|:---|\n| John K. Bakewell | 448,546 | * | | Jonn R. Beeson | 1,321,139 | 1.0% | | Sean E. Browne | 2,332,997 | 1.8% | | Robert E. McNamara | 446,809 | * | | Lori D. Mitchell-Keller | — | — | | Stavros G. Vizirgianakis | 7,440,339 | 5.7% | | Kevin D. Brandt | 581,372 | * | | Mark A. Schallenberger | 55,062 | * | | All current executive officers and directors as a group (9 persons) | 12,919,615 | 9.7% | Securities Authorized for Issuance under Equity Compensation Plans as of December 31, 2023 | Plan Category | Number of Securities to Be Issued upon Exercise of Outstanding Options, Warrants and Rights (a) | Weighted Average Exercise Price of Outstanding Options, Warrants and Rights (b) | Number of Securities Remaining Available for Future Issuance under Equity Compensation Plans | |:---|:---|:---|:---|\n| Equity compensation plans approved by security holders | 8,400,503 | $1.31 | 9,968,016 | | Equity compensation plans not approved by security holders | — | — | — | | Total | 8,400,503 | $1.31 | 9,968,016 | [Certain Relationships and Related Transactions, and Director Independence](index=126&type=section&id=Item%2013.%20Certain%20Relationships%20and%20Related%20Transactions%2C%20and%20Director%20Independence) The Audit Committee reviews related party transactions, including the Investor Rights Agreement with OrbiMed affiliates - The **Audit Committee** is responsible for reviewing and approving all **related party transactions**[556](index=556&type=chunk) - The **Investor Rights Agreement** with **OrbiMed affiliates** grants them the right to nominate a **majority of directors** and requires their approval for **significant corporate actions**, as long as they maintain at least **40%** ownership[558](index=558&type=chunk) - The **2022 Private Placement** involved the issuance of **common stock** and warrants to **accredited investors**, including **Stavros G. Vizirgianakis** and his brother, and **Jonn R. Beeson**, for an aggregate purchase price of approximately **$9.75 million**[560](index=560&type=chunk)[561](index=561&type=chunk)[562](index=562&type=chunk) - Associated agreements from the **2022 Private Placement** included **lock-up agreements** (**12-month** for **Stavros G. Vizirgianakis**) and a **registration rights agreement**[563](index=563&type=chunk)[565](index=565&type=chunk) - The Board has affirmatively determined that John K. Bakewell, Jonn R. Beeson, Robert E. McNamara, Lori D. Mitchell-Keller, and **Stavros G. Vizirgianakis** are '**independent directors**' under **NYSE American standards**[567](index=567&type=chunk) [Principal Accountant Fees and Services](index=129&type=section&id=Item%2014.%20Principal%20Accountant%20Fees%20and%20Services) Xtant Medical changed auditors to Grant Thornton LLP in 2023, with increased audit fees and a pre-approval policy - **Xtant Medical** changed its **independent registered public accounting firm** from **Plante & Moran, PLLC** to **Grant Thornton LLP** on **August 15, 2023**[568](index=568&type=chunk) Aggregate Fees Billed by Independent Registered Accounting Firms (in thousands) | Category | 2023 | 2022 | |:---|:---|:---|\n| Audit fees | $840 | $320 | | Audit-related fees | $45 | $7 | | Tax fees | $— | $— | | All other fees | $— | $— | | Total fees | $885 | $327 | - The **Audit Committee** has a policy to **pre-approve** all **audit, audit-related, tax, and other services**, with the **Chair delegated authority** for pre-approvals up to **$25,000**[576](index=576&type=chunk) PART IV [Exhibit and Financial Statement Schedules](index=131&type=section&id=Item%2015.%20Exhibit%20and%20Financial%20Statement%20Schedules) This section lists all financial statements and exhibits filed with the 10-K report, omitting schedules for smaller reporting companies - **Consolidated financial statements** are included in **Part II, Item 8**[579](index=579&type=chunk) - **Financial statement schedules** are omitted because the company is a **smaller reporting company**[579](index=579&type=chunk) - **Exhibits** include various agreements such as **equity purchase**, **asset purchase**, **credit**, **investor rights**, and **equity incentive plans**[580](index=580&type=chunk)[582](index=582&type=chunk)[583](index=583&type=chunk)[584](index=584&type=chunk)[585](index=585&type=chunk)[586](index=586&type=chunk)[587](index=587&type=chunk) [Form 10-K Summary](index=136&type=section&id=Item%2016.%20Form%2010-K%20Summary) This is an optional disclosure item and is not included in this Annual Report on Form 10-K - **Form 10-K Summary** is an **optional disclosure** and is not included in this report[588](index=588&type=chunk)

Exhibit 99.1 Xtant Medical Announces Record Full Year 2023 Revenue of $91.3 Million Establishes Full Year 2024 Revenue Guidance of $112 Million - $116 Million BELGRADE, MT, April 1, 2024 – Xtant Medical Holdings, Inc. (NYSE American: XTNT), a global medical technology company focused on surgical solutions for the treatment of spinal disorders, today reported financial and operating results for the fourth quarter and year ended December 31, 2023. "2023 was a transformative year for Xtant Medical. We achieved ...

CAUTIONARY STATEMENT REGARDING FORWARD-LOOKING STATEMENTS The report contains forward-looking statements subject to risks from acquisitions, supply chain, economic conditions, and regulatory approvals - The report contains forward-looking statements **subject to risks and uncertainties**, including those related to product integration from acquisitions, stem cell shortages for OsteoVive, inflation, supply chain disruptions, economic slowdowns, labor shortages, debt servicing, liquidity, COVID-19 impacts, sales performance, new product development, third-party reliance, personnel retention, GPO/IDN agreements, growth initiatives, OEM business, reimbursement, regulatory approvals, international operations, business combinations, product liability, AATB accreditation, intellectual property, and stock listing[11](index=11&type=chunk)[12](index=12&type=chunk)[13](index=13&type=chunk)[14](index=14&type=chunk) PART I. FINANCIAL INFORMATION This part presents the company's unaudited condensed consolidated financial information and related disclosures [ITEM 1. FINANCIAL STATEMENTS](index=6&type=section&id=Item%201.%20Financial%20Statements) This section presents the unaudited condensed consolidated financial statements for Xtant Medical Holdings, Inc. and its subsidiaries, including balance sheets, statements of operations, comprehensive income (loss), equity, and cash flows, along with detailed notes explaining business description, significant accounting policies, recent acquisitions, revenue breakdown, and other financial details [Condensed Consolidated Balance Sheets](index=6&type=section&id=Condensed%20Consolidated%20Balance%20Sheets) This section presents the company's financial position, detailing assets, liabilities, and equity at specific points in time Condensed Consolidated Balance Sheets (in thousands) | ASSETS | Sep 30, 2023 | Dec 31, 2022 | Change | | :----------------------------------- | :----------- | :----------- | :----- | | Cash and cash equivalents | $8,664 | $20,298 | $(11,634) | | Trade accounts receivable, net | $19,150 | $10,853 | $8,297 | | Inventories | $34,334 | $17,285 | $17,049 | | Total current assets | $64,107 | $49,318 | $14,789 | | Property and equipment, net | $9,097 | $5,785 | $3,312 | | Goodwill | $6,514 | $3,205 | $3,309 | | Intangible assets, net | $10,492 | $344 | $10,148 | | Total Assets | $92,003 | $60,229 | $31,774 | | **LIABILITIES & STOCKHOLDERS' EQUITY** | | | | | Accounts payable | $5,358 | $3,490 | $1,868 | | Accrued liabilities | $8,934 | $5,496 | $3,438 | | Line of credit | $3,999 | $3,379 | $620 | | Current portion of long-term debt | $2,833 | $2,333 | $500 | | Total current liabilities | $21,921 | $15,218 | $6,703 | | Long-term debt, plus premium and less issuance costs | $14,352 | $9,687 | $4,665 | | Total Liabilities | $37,322 | $26,058 | $11,264 | | Total Stockholders' Equity | $54,681 | $34,171 | $20,510 | | Total Liabilities & Stockholders' Equity | $92,003 | $60,229 | $31,774 | [Condensed Consolidated Statements of Operations](index=7&type=section&id=Condensed%20Consolidated%20Statements%20of%20Operations) This section outlines the company's financial performance, including revenue, cost of sales, gross profit, and net income or loss Condensed Consolidated Statements of Operations (in thousands, except per share amounts) | Metric | 3 Months Ended Sep 30, 2023 | 3 Months Ended Sep 30, 2022 | 9 Months Ended Sep 30, 2023 | 9 Months Ended Sep 30, 2022 | | :----------------------------------- | :-------------------------- | :-------------------------- | :-------------------------- | :-------------------------- | | Total Revenue | $25,019 | $14,462 | $63,195 | $42,699 | | Cost of Sales | $9,685 | $6,566 | $24,865 | $18,868 | | Gross Profit | $15,334 | $7,896 | $38,330 | $23,831 | | Loss from Operations | $(3,385) | $(1,900) | $(6,352) | $(5,031) | | Bargain purchase gain | $11,028 | $0 | $11,028 | $0 | | Net Income (Loss) | $9,231 | $(2,353) | $4,963 | $(6,276) | | Basic Net Income (Loss) Per Share | $0.07 | $(0.03) | $0.04 | $(0.07) | | Diluted Net Income (Loss) Per Share | $0.07 | $(0.03) | $0.04 | $(0.07) | [Condensed Consolidated Statements of Comprehensive Income (Loss)](index=8&type=section&id=Condensed%20Consolidated%20Statements%20of%20Comprehensive%20Income%20(Loss)) This section reports total comprehensive income or loss, including net income and other comprehensive income items Condensed Consolidated Statements of Comprehensive Income (Loss) (in thousands) | Metric | 3 Months Ended Sep 30, 2023 | 3 Months Ended Sep 30, 2022 | 9 Months Ended Sep 30, 2023 | 9 Months Ended Sep 30, 2022 | | :-------------------------- | :-------------------------- | :-------------------------- | :-------------------------- | :-------------------------- | | Net Income (Loss) | $9,231 | $(2,353) | $4,963 | $(6,276) | | Foreign currency translation adjustments | $(146) | $0 | $(146) | $0 | | Comprehensive Income (Loss) | $9,085 | $(2,353) | $4,817 | $(6,276) | [Condensed Consolidated Statements of Equity](index=9&type=section&id=Condensed%20Consolidated%20Statements%20of%20Equity) This section details changes in stockholders' equity, including common stock, paid-in capital, and accumulated deficit Condensed Consolidated Statements of Equity (in thousands, except number of shares) | Metric | Dec 31, 2022 | Sep 30, 2023 | | :----------------------------------- | :----------- | :----------- | | Common Stock Shares | 108,874,803 | 129,788,947 | | Additional Paid-In Capital | $277,841 | $293,534 | | Accumulated Other Comprehensive Loss | $0 | $(146) | | Accumulated Deficit | $(243,670) | $(238,707) | | Total Stockholders' Equity | $34,171 | $54,681 | - **Stockholders' Equity increased by $20.5 million** from December 31, 2022, to September 30, 2023, **primarily due to a $14.0 million private placement** of common stock and **net income of $9.2 million** in Q3 2023[24](index=24&type=chunk) [Condensed Consolidated Statements of Cash Flows](index=10&type=section&id=Condensed%20Consolidated%20Statements%20of%20Cash%20Flows) This section summarizes cash flows from operating, investing, and financing activities over specific periods Condensed Consolidated Statements of Cash Flows (in thousands) | Cash Flow Activity (9 Months Ended Sep 30) | 2023 | 2022 | | :----------------------------------------- | :----- | :----- | | Net cash used in operating activities | $(8,600) | $(3,053) | | Net cash used in investing activities | $(22,471) | $(1,137) | | Net cash provided by financing activities | $19,366 | $3,406 | | Net change in cash and cash equivalents and restricted cash | $(11,758) | $(784) | | Cash and cash equivalents and restricted cash at end of period | $8,749 | $17,603 | [Notes to Unaudited Condensed Consolidated Financial Statements](index=11&type=section&id=Notes%20to%20Unaudited%20Condensed%20Consolidated%20Financial%20Statements) These notes provide detailed explanations and breakdowns for the financial statements, covering business operations, accounting policies, recent acquisitions, revenue segmentation, asset and liability specifics, debt structure, equity compensation, and other significant financial and operational disclosures [Business Description, Basis of Presentation and Summary of Significant Accounting Policies](index=11&type=section&id=Business%20Description,%20Basis%20of%20Presentation%20and%20Summary%20of%20Significant%20Accounting%20Policies) This section describes the company's business, the basis of financial statement presentation, and key accounting policies applied - Xtant Medical Holdings, Inc. is a **global medical technology company focused on orthobiologics and spinal implant systems** for spinal fusion procedures[28](index=28&type=chunk) - On July 3, 2023, the company completed a private placement of **20,000,000 common shares at $0.75 per share, generating $15.0 million in gross proceeds** for working capital and general corporate purposes[32](index=32&type=chunk) - **Goodwill increased from $3,205 thousand** at January 1, 2023, **to $6,514 thousand** at September 30, 2023, **primarily due to the acquisition of Surgalign SPV, Inc.**[