Xtant Medical Holdings, Inc. (XTNT)
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Canaccord Genuity’s 45th Annual Growth Conference

Aug 12, 2025

Caitlin Cronin
Director of MedTech Equity Reserach, Canaccord Genuity

Good afternoon, everyone. Thank you for joining us at this year's Canaccord Genuity Global Growth Conference. My name is Caitlin Cronin, and I'm on the MedT ech team here at Canaccord Genuity. I'm joined today by Xtant Medical Holdings Inc., a medical device company developing regenerative products for orthopedic and spine procedures. With me today is Sean Browne, CEO. Before we begin, I want to remind everyone of any relevant disclosures, which can be found on our conference and our firm website. With that, I'm going to hand it over to Sean.

Sean Browne
CEO, Xtant Medical Holdings Inc

Thank you, Caitlin. I will go through the, okay, here we go. Xtant Medical. Who are we? Xtant Medical is a global technology company focused on the design, manufacture, and commercialization of regenerative biologics and spinal implant systems, and quite frankly, in that order. More importantly, when you think about who we are as a compelling investment, there's kind of six big areas that I look to. First and foremost, we serve a large market opportunity. Just the orthobiologics business alone, we estimate to be about $2.5 billion. When you look at some of the adjacent markets that we touch on, such as advanced wound care and surgical repair, these things get over into the $10 billion market cap, or at least addressable market out there. When you look at the business itself, we're a high growth and profitable business. This morning, we announced our second quarter results.

We're up 18% year- over- year, very profitable, cash flowing, all the arrows going in the direction that we really wanted to go, especially given where we've been in the years past. The balance sheet for us has gotten significantly more strengthened, not just because of what we've been doing from an operating perspective, but also when you look at, we announced earlier this year, or earlier this month, I should say, all right, I should say early July, we announced the divestiture of some non-core assets. By doing that, those non-core businesses will be adding significant dollars onto our balance sheet in way of cash, but also at the same time, significantly reducing our long-term debt. We're vertically integrated, so one of the things that we've been working on is trying to make sure that we sell everything we, or we make everything we sell.

This has helped us in a number of different ways. One, in way of helping us at least be able to make sure that we've got the supply that we need. Secondarily, the margin that comes along with making your own products. Not to mention the fact that we get to put our own twist on the different products. We get to make sure we add our quality to it. All the elements of being vertically integrated have come to bear here. The other piece that we offer as an investment vehicle is we have a very broad commercial reach, especially for a relatively small company. We have over 450 IDN agreements. We've got every major GPO, as well as over 650 or 670 independent agent agreements. Last but not least, the innovative part of what we do.

If you looked at our long-term pipeline, we've got a very, very diverse product profile or product pipeline that we'll talk a little bit in the slides ahead, but it's something we're really, really excited about as time progresses. First and foremost, the sale of the non-core assets, selling the Paradigm and Coflex businesses really back to the Viscogliosi Brothers. They're the ones who originally sold these things as Paradigm Spine, quite frankly, to RTI back in 2019. As we were working with these businesses, these businesses made up about 16% of our sales over the course of time, but they took up about 50%- 60% of our sales guys' time. Never mind finance, never mind other parts of the organization. At the end of it, they didn't necessarily contribute a lot from a profitability perspective. Actually, by spinning these off, we are slightly more positive.

In general, really, really great technologies, just in better, they're now going to be in better hands than with us. Talking more about our referral service offering. Today we do both the fixation and the biologics offering. Clearly, you know, biologics is what we lean on. Biologics is our future. It's not to say that our hardware business doesn't have, you know, some really wonderful pieces to it. It's just that over the course of time, this is something that at least from our end, you'll hear more and more about what we're doing on the biologic side than necessarily what you'll hear on the hardware side. The market opportunity, as I mentioned before, is about a $2.5 billion opportunity in the orthobiologic space, another $5.6 billion in the hardware space.

In particular, one of the things that we're really excited about is that we're able to touch all five of these markets. More importantly, we're now manufacturing products for all five of these categories. This is something, at least from our side, was a real goal for where we wanted to be. I'll talk a little bit more about that in the following slides. From a robust revenue growth over the course of the last four years, we've seen some really nice growth year-over-year. Some of this back in 2023 was through an acquisition. As we start looking at what we've been able to do since then, and with our new guidance that we laid out this morning, from $127 million- $131 million, we've now gone to $131 million- $135 million. Now, this is assuming the Paradigm and Coflex businesses are still within our business.

Once those businesses are officially sold, which we expect to happen in the third quarter here, we're going to reissue our guidance from there. When you think about our focus, really our focus comes down to these three things. First and foremost, biologics, two, diversification, and three, profitability. When you think about number one, biologics, it's who we are. It's our knitting. This is the stuff that we do, trying to do as best as we can, and I think we've been successful at vertically integrating these businesses, but then also trying to emphasize that next generation of the biologics that we're working on. Last but not least, one of the things we'll be working on over the course of time is creating both a clinical and a regulatory moat. We're blessed with being an ISO 13485 facility.

Matter of fact, one of the products we sell as a biologic is a 510(k) product. This is an area for us that we think that we can start driving not only higher clinical outcomes, but also with a 510(k) regulatory pathway for some of our biologics. We hope to actually also increase our ASPs. Secondly, from a diversification perspective, when I first got to Xtant, over 90% of our revenues were coming from just the spine space. Today, that number is somewhere in the mid 70%s. It's still very big, but it's not as reliant on the spine world. Especially when you start looking at the product lines, such as our amniotic and soon to be released collagen-based product lines, these are things that get us into the wound care and the surgical repair side.

These areas help us, at least as a shareholder, know that we're not completely dependent upon just one specialty for where our dollars are coming from. The other piece of this too is that when you think about leveraging our strengths, this is really the stuff that when you think about a biologics business over the course of time, from a shareholder, greater shareholder value, this kind of diversification is going to be important, especially when you think about regenerative biologics. Last but not least, from a profitability perspective, recognizing operating leverage as the business scales. One of the things that we've been very, very in tune or really been focused on over the course of the last year, and you'll see it in our results this past quarter, is how much we've been able to drive out cost. As we've been growing, we're getting greater leverage.

Of course, as the great driving the greater penetration, you know, today we have all of these IDN agreements and independent agent agreements. Today we don't do as good a job as we need to in way of driving the kind of penetration that we should. This is going to be a real focus for us in the months and years ahead. The other big thing too is that when you look at our Xtant branded products, when we sell an Xtant branded product that we manufacture, we do very, very well. The actual gross profit dollars are significantly higher. I'm telling you something I guess you should probably already know, but it also, there's an opportunity for us, and we've been able to take advantage of that, especially on our higher margin products, is monetizing our excess capacity through OEM opportunities.

This is something that, again, helps drive nice contribution dollars to the bottom line, not so much on the gross profit side. Vertical integration, what does it mean to us? Over the course of time, we were a business that only did demineralized bones and basically allograft, and that made up a little over 60% of our total biologics business. Our goal over the course of what would be about 18 months was to be able to start making our own viable bone matrix, growth factor, amnion, and synthetics. I'm happy to say that now we're at a point today where all of these products today are being manufactured internally. More importantly, here we had 60% of our business tied into demineralized bone.

Now, if we can make something that, again, could drive higher average, well, first of all, a better product that's sold at a higher price, that gets higher margins, and from a production perspective, is really, really extraordinarily efficient for us to make. That's what we've been able to do with our enhanced DBM. That's this new product that we just started called Trivium. Trivium is something I'm really, really excited about because even if we are able to never even grow anything on Trivium by itself, but even start just converting 20%, 30%, 40% of our DBM business, that would be something that would be extraordinarily profitable and very accretive from a top line perspective too. Last but not least is getting into the recent innovations that we've had. I'll talk a little bit about what we're doing from a longer term perspective.

From the recent innovations, if you look at the things that we are aiming for, first and foremost, we want to develop best in class products, expand margins through vertical integration where possible. Also, make sure that we can control the supply chain because this, again, is something that, at least from our side, we had some of our fastest growing products being held back because we were just third or fourth or fifth in line. Last but not least, selectively expand distribution network where possible. If you look at over the course of the last year and a half, from Q1 of 2024 to where we are today, in Q1 of 2024, we rolled out our first amniotic products. In Q3, we rolled out our viable bone matrix product. In Q1 and Q2 of this year, we rolled out Trivium, OsteoFactor Pro, and FiberX.

FiberX was a product that we used to get made. It's a product about a $2 million product line for us. It was a product line that was already done for or sold by the old Surgiline business. We've taken it on, been able to increase the margins. It's a nice product, but not new. It's really replacing something old. When we look at Trivium, as I mentioned before, this great new product line and our OsteoFactor Pro, which is a growth factor product, we're really, really excited about how we've positioned and, quite frankly, building the muscle within our organization to be an organization that's knocking out new product quarter after quarter after quarter. Again, expanding our footprint within the regenerative biologics world. When we think about our pipeline, you know, we laid out before you, you know, what we've been able to do over the course of time.

As we start to look at some of the other things, when we get into things like the collagen-based products, which we will be rolling out here in the second half of 2025, and then getting into even greater eMatrix wound care, eMatrix is a technology that we acquired in the Surgiline acquisition. It was actually the base collagen that had its own 510(k), by the way, that's tied to nanos. This product by itself has already done a fair amount of the regulatory work to become a surgical repair wound care product. The other part about this thing too is it's also the core, as I mentioned, the nanos. We are looking to be rolling out a new synthetic that's going to have more bioactive activity. Therefore, we'll be able to get higher reimbursement over the course of time. Here is a list of some of the things.

There's a number of other things over the course of the next few years that we'll be working on as well. Here are the big ones. When we think about diversifying, what diversification means to me is that there are opportunities and there are things that we make today. For instance, our amniotic and collagen-based product lines today, there are things that we sell with our own Xtant branded product that's sold into our spine procedures, things that are basically created as a barrier for tricky cases. Our amnion is also sold into wound care, which is a big part of the success we had these past two quarters. In the near future, we could be seeing this product being sold into sports medicine and potentially one day in the nerve regeneration world.

When we think about how we diversify where our income or where our revenue is coming from, there are these opportunities. Many of them are on OEM opportunities, but some of them may be able to even leverage some of the national contracting that we do today. Last but not least, when we talk about the three parts to our business, it's the profitability. Like I said earlier, generating operation, or at least getting operating leverage as the business scales has always been a high, high, especially for a company that has been capital constrained. You don't lose those types of lessons. Second, driving greater penetration of distributor and IDN agreements.

Big, big focus for us, especially given the fact that over the course of the last year, or actually over the course of the last two years, when we basically doubled the number of IDN, or I should say doubled the number of IA or independent agent agreements because of the Surgiline acquisition, we've not done a great job of getting greater penetration. There's a real, real opportunity for us to get more of their spend than we have today. Driving sales of Xtant branded products, as I mentioned before, is very, very profitable for us. Also, something, needless to say, drives the brand. Last but not least, where possible, we want to monetize that excess capacity through this OEM and contract manufacturing.

One of the things I should note about this is that even though the gross profit margins when you sell the product isn't great, our contribution margins, especially on the higher end stuff, get in the 50%- 60% range. It's actually, from a contribution margin, something very, very good without having to pay a rep's commission, so to speak. When you look at our improving financial profile, as I mentioned, we just laid these out for this second quarter of 2025. We're extraordinarily happy with how we've come out, especially when you look at the cash that we've been generating. When you look at things such as, you know, one of the things that's not listed here is the fact that at the end of Q2, we had $7 million of cash on our balance sheet, but what it didn't count is the royalty dollars that were coming in.

That was roughly another $4 million- $5 million. On top of that, when you throw on the $9 million plus that we'll be adding from a cash perspective in the near future, we'll be over $20 million of cash on the balance sheet. One of the things that was a knock against our business in years past is not having enough cash. I think we've been able to answer that. Moreover, I do believe that as we generate more cash from the business, because that's where we are today, that number will continue to grow. To summarize things, again, I think this is very compelling, especially where we are in our business, or at least in our company's history. We've got a large market opportunity. We've got a high growth and profitable business.

We've strengthened our balance sheet with the moves that we've made to reduce, or at least to refocus the business on our core business. We are fully vertically integrated today, which is again something that's helping us at least from driving higher margins and really controlling our own destiny. When you look at our broad commercial reach, it's a great, great, great, great opportunity that we're just really scratching the surface on what we could be doing there. Last but not least, the innovation that we've been driving, especially when you start looking at not only the products that we've made within our own orthobiologic space, but also as we've expanded beyond just the orthobiologics world. With that said, I will open the floor for any questions. Yes, Ms. Caitlin.

Caitlin Cronin
Director of MedTech Equity Reserach, Canaccord Genuity

The evolution of your business, the strategy you use to leverage the business to launch orthobiologics.

Sean Browne
CEO, Xtant Medical Holdings Inc

The commercial, as I look at it, it's kind of twofold, right? When you think about the world of spine, let's break it out that way. From a spine perspective, so many of the independent agents that we work with think hardware, hardware, hardware, hardware, biologics, right? We still carry hardware, we still have some of that as well within our own business. I think over the course of time, as our biologics space or biologics business continues to grow the way it is, I hope that we can get more mind share of my own guys, first and foremost, and then be able to therefore get greater mind share of our independent agents. Hardware is a very, very alluring thing because, you know, you think about it, an average case is probably 75%- 80% of the cost is in the hardware.

From a rep's perspective, they look at it and say, voila, I can meet my quota in one guy here versus having to go out and get the four or five guys that you need to get. That is what's going to evolve over time. It's just that our broader and more, no, I should say broader, our focused, you know, attention to those biologic cases. Yes, sir. We have about, it'll be about $23 million of existing hardware-based adult degenerative bread and butter type of product lines. It still serves a nice role for us, but, you know, the question is how long do we have it, right? That's still out there.

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