UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D . C . 20549

 

FORM 10-K

 

(Mark One)

x ANNUAL REPORT PURSUANT TO SECTION 13 or 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 

For the fiscal year ended December 31, 2014

 

or

 

¨ TRANSITION REPORT PURSUANT TO SECTION 13 or 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 

Commission file number 000-51038

 

CYTOSORBENTS CORPORATION

(Exact name of registrant as specified in its charter)

 

Delaware   98-0373793
(State or other jurisdiction of incorporation or   (I.R.S. Employer Identification No.)
organization)    

 

7 Deer Park Drive, Suite K

Monmouth Junction, New Jersey 08852

(Address of principal executive offices) (Zip Code)

 

Registrant’s telephone number, including area code (732) 329-8885

 

Securities registered pursuant to Section 12(b) of the Act:

 

Title of each class:   Name of each exchange on which registered:
Common Stock, $0.001 par value   NASDAQ Stock Market LLC

 

Securities registered pursuant to Section 12(g) of the Act:

 

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. ¨ Yes þ No

 

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. ¨ Yes þ No

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.

þ Yes ¨ No

 

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).

Yes  þ    No  ¨

 

Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K (§229.405 of this chapter) is not contained herein, and will not be contained, to the best of registrant’s knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to this Form 10-K. þ

 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

 

Large Accelerated Filer ¨ Accelerated Filer ¨
   
Non-accelerated Filer ¨ (do not check if a smaller reporting company) Smaller reporting company þ

 

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act.)

¨ Yes þ No

 

The aggregate market value of the common stock of the registrant held by non-affiliates as of June 30, 2014 was approximately $72,139,000. As of March 23, 2015 there were outstanding 24,637,822 shares of common stock.

 

Documents incorporated by reference:

 

Portions of the CytoSorbents Corporation definitive proxy statement to be filed pursuant to Regulation 14A within 120 days after the end of the fiscal year are incorporated by reference into Part III of this Form 10-K and certain documents are incorporated by reference into Part IV.

 

 
 

 

CYTOSORBENTS CORPORATION

ANNUAL REPORT ON FORM 10-K

TABLE OF CONTENTS

 

    Page
     
PART I  
     
  Item 1. Business. 3
     
  Item 1A. Risk Factors. 45
     
  Item 1B. Unresolved Staff Comments. 52
     
  Item 2. Properties. 52
     
  Item 3. Legal Proceedings. 52
     
  Item 4. Mine Safety Disclosures. 52
     
PART II  
     
  Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities. 53
     
  Item 6. Selected Financial Data. 55
     
  Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations. 55
     
  Item 7A. Quantitative and Qualitative Disclosures About Market Risk. 62
     
  Item 8. Financial Statements and Supplementary Data. 62
     
  Item 9. Changes in and Disagreements With Accountants on Accounting and Financial Disclosure. 63
     
  Item 9A. Controls and Procedures. 63
     
  Item 9B. Other Information. 64
     
PART III  
     
  Item 10. Directors, Executive Officers and Corporate Governance. 64
     
  Item 11. Executive Compensation. 65
     
  Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 65
     
  Item 13. Certain Relationships, Related Transactions and Director Independence. 65
     
  Item 14. Principal Accountant Fees and Services. 65
     
Part IV  
     
  Item 15. Exhibits, Financial Statement Schedules. 66

 

2
 

 

CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS

 

This Annual Report on Form 10-K, or this Report, contains “forward-looking statements” within the meaning of Section 27A of the Securities Act, and Section 21E of the Exchange Act. Forward-looking statements discuss matters that are not historical facts. Because they discuss future events or conditions, forward-looking statements may include words such as “anticipate,” “believe,” “estimate,” “intend,” “could,” “should,” “would,” “may,” “seek,” “plan,” “might,” “will,” “expect,” “predict,” “project,” “forecast,” “potential,” “continue” negatives thereof or similar expressions. These forward-looking statements are found at various places throughout this Report and include information concerning possible or assumed future results of our operations; business strategies; future cash flows; financing plans; plans and objectives of management; any other statements regarding future operations, future cash needs, business plans and future financial results, and any other statements that are not historical facts. Unless otherwise indicated, the terms “CytoSorbents,” “Company,” “we,” “us” and “our” refer to CytoSorbents Corporation. Unless otherwise indicated, the terms “MedaSorb,” “CytoSorbents,” “we,” “us” and “our” with respect to events prior to June 30, 2006 are references to CytoSorbents Medical, Inc. and its predecessors.

 

From time to time, forward-looking statements also are included in our other periodic reports on Forms 10-Q and 8-K, in our press releases, in our presentations, on our website and in other materials released to the public.  Any or all of the forward-looking statements included in this Report and in any other reports or public statements made by us are not guarantees of future performance and may turn out to be inaccurate. These forward-looking statements represent our intentions, plans, expectations, assumptions and beliefs about future events and are subject to risks, uncertainties and other factors.  Many of those factors are outside of our control and could cause actual results to differ materially from the results expressed or implied by those forward-looking statements. In light of these risks, uncertainties and assumptions, the events described in the forward-looking statements might not occur or might occur to a different extent or at a different time than we have described. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this Report. All subsequent written and oral forward-looking statements concerning other matters addressed in this Report and attributable to us or any person acting on our behalf are expressly qualified in their entirety by the cautionary statements contained or referred to in this Report.

 

Except to the extent required by law, we undertake no obligation to update or revise any forward-looking statements, whether as a result of new information, future events, a change in events, conditions, circumstances or assumptions underlying such statements, or otherwise.

 

For discussion of factors that we believe could cause our actual results to differ materially from expected and historical results see “Item 1A — Risk Factors” below.

 

PART I

 

Item 1. Business.

 

Overview

 

CytoSorbents is a critical care focused immunotherapy company using blood purification to modulate inflammation - with the goal of preventing or treating multiple organ failure in life-threatening illnesses and cardiac surgery. Organ failure is the cause of nearly half of all deaths in the intensive care unit, with little to improve clinical outcome. CytoSorb®, the Company’s flagship product, is approved in the European Union as a safe and effective extracorporeal cytokine filter, designed to reduce the “cytokine storm” that could otherwise cause massive inflammation, organ failure and death in common critical illnesses such as sepsis, burn injury, trauma, lung injury, and pancreatitis. These are conditions where the mortality is extremely high, yet no effective treatments exist. In addition, CytoSorb® can be used in other inflammatory conditions such as cardiac surgery, autoimmune disease flares, and potentially for cancer, cytokine release syndrome in cancer immunotherapy, and cancer cachexia where cytokines play a major role in the cause of inflammation. CytoSorbents’ purification technologies are based on biocompatible, highly porous polymer beads that can actively remove toxic substances from blood and other bodily fluids by pore capture and surface adsorption. CytoSorbents has numerous products under development based upon this unique blood purification technology, protected by 32 issued US patents and multiple applications pending, including HemoDefend™, ContrastSorb, DrugSorb, and others.

 

3
 

 

In March 2011, the Company received European Union or E.U., regulatory approval under the CE Mark and Medical Devices Directive for the Company’s flagship product, CytoSorb ®, as an extracorporeal cytokine filter indicated for use in clinical situations where cytokines are elevated. The goal of the CytoSorb® is to prevent or treat organ failure by reducing cytokine storm and the potentially deadly systemic inflammatory response syndrome in diseases such as sepsis, trauma, burn injury, acute respiratory distress syndrome, pancreatitis, liver failure, and many others. Organ failure is the leading cause of death in the intensive care unit, and remains a major unmet medical need, with little more than supportive care therapy (e.g., mechanical ventilation, dialysis, vasopressors, fluid support, etc.) as treatment options. By potentially preventing or treating organ failure, CytoSorb® may improve clinical outcome, including survival, while reducing the need for costly intensive care unit treatment, thereby potentially saving significant healthcare costs.

 

Our CE Mark enables CytoSorb ® to be sold throughout all 28 countries of the European Union. In addition, many countries outside the E.U. accept CE Mark approval for medical devices, but may also require registration with or without additional clinical studies. The broad approved indication enables CytoSorb® to be used “on-label” in diseases where cytokines are elevated including, but not limited to, critical illnesses such as those mentioned above, autoimmune disease flares, cancer cachexia, and many other conditions where cytokine-induced inflammation plays a detrimental role.

 

Cytokines are small proteins that normally stimulate and regulate the immune response. However, in certain diseases, particularly life-threatening conditions commonly seen in the intensive care unit, or ICU, such as sepsis and infection, trauma, acute respiratory distress syndrome (ARDS), severe burn injury, liver failure, and acute pancreatitis, cytokines are often produced in vast excess – a condition often called cytokine storm. Left unchecked, this cytokine storm can lead to a severe maladaptive systemic inflammatory response syndrome, or SIRS, that can then cause cell death, multiple organ dysfunction syndrome or MODS, and multiple organ failure, MOF. Failure of vital organs such as the heart, lungs, and kidneys, accounts for nearly half of all deaths in the intensive care unit. This is despite the wide availability of supportive care therapies, or “life support”, such as dialysis, mechanical ventilation, extracorporeal membrane oxygenation, and vasopressors. By replacing the function of failed organs, these supportive care therapies can initially help to keep patients alive, but do not help patients recover faster, and in many cases can increase the risk of dangerous complications. Unlike these supportive care therapies, the goal of the CytoSorb® cytokine filter is to pro-actively prevent or treat organ failure by reducing cytokine storm and reducing the maladaptive SIRS response. In doing so, CytoSorb® targets the reduction in the severity of patient illness and the need for intensive care, while potentially improving clinical outcome and saving healthcare costs.

 

As part of the CE Mark approval process, we completed our randomized, controlled, European Sepsis Trial amongst fourteen trial sites in Germany in 2011, with enrollment of one hundred (100) patients with sepsis and respiratory failure. The trial established that CytoSorb® was safe in this critically-ill population. Taking into account all 100 patients, the treatment was well-tolerated with no serious device related adverse events reported in more than 300 human treatments in the trial. Although the trial was not powered to demonstrate significant reduction in other clinical endpoints such as mortality, these were also included as secondary and exploratory endpoints in the trial.

 

The first 22 patients in the study represented a sepsis pilot study. In the next 31 patients, a compromise of the manual randomization schedule at two trial sites led to an imbalance in the severity of illness between the control and treatment patient groups of the study. After a thorough review, the Scientific Advisory Board (SAB) and the independent Data Safety Monitoring Board, or DSMB, both recommended that due to this enrollment bias, these 31 patients should only be used for safety evaluation purposes and that new patients should be enrolled into the trial using electronic web-based randomization to randomly assign patients into either the control or treatment arms.

 

Excluding four patients that withdrew, the remaining forty three (43) patients enrolled under electronic randomization were relatively balanced in terms of the severity of illness in treatment and control patients, confirming the findings of the SAB and DSMB. An independent CRO,RCRI, Inc., analyzed these forty three (43) patients the European Sepsis Trial and showed on a statistically significant basis (p<0.05), CytoSorb®’s ability to reduce circulating levels of key cytokines from whole blood in treated patients on the average of 30-50% over the 7 day treatment period. Additionally, post-hoc subgroup analyses of the clinical outcome data from patients enrolled under electronic randomization demonstrated statistically significant reduction in mortality in patients at high risk of death in sepsis, specifically in patients with:

 

4
 

 

· Very high cytokine levels (IL-6 ≥ 1,000 pg/mL and/or IL-1ra ≥ 16,000 pg/mL) where 28-day mortality was 0% treated vs 63% control, p=0.03, n=14; and

 

· Age ≥ 65 (14-day mortality: 0% treated vs 36% control, p=0.04, n=21).

 

The Company plans to do larger, prospective studies in septic patients in the future to confirm these findings. According to a recent study by the U.S. Centers for Disease Control and Prevention (CDC), those older than age 65 account for approximately two-thirds of patients hospitalized in the US for sepsis, and were responsible for the doubling in the incidence of sepsis over the past decade. Without effective therapies to treat sepsis, the incidence of sepsis and sepsis-related deaths are expected to continue to increase significantly over the course of the next decade, particularly as the baby boomer generation, which began turning 65 in 2011, continues to get older.

 

In addition to CE Mark approval, CytoSorbents also achieved ISO 13485:2003 Full Quality Systems certification, an internationally recognized quality standard designed to ensure that medical device manufacturers have the necessary comprehensive management systems in place to safely design, develop, manufacture and distribute medical devices in the European Union. CytoSorbents manufactures CytoSorb® at its manufacturing facilities in New Jersey for commercial sales abroad and for additional clinical studies. In September 2013, the Company was granted a two-year renewal for the CytoSorb® CE Mark. The Company also established a reimbursement path for CytoSorb® in Germany and Austria.

 

From September 2011 through June 2012, the Company began a controlled market release of CytoSorb® in select geographic territories in Germany. The purpose of this program was to prepare the Company for commercialization of CytoSorb® in Germany in terms of manufacturing, reimbursement, logistics, infrastructure, marketing, contacts, and other key issues.

 

In late June 2012, following the establishment of our European subsidiary, CytoSorbents Europe GmbH, a wholly-owned operating subsidiary of CytoSorbents Corporation, the Company began the commercial launch of CytoSorb® in Germany with the hiring of Dr. Christian Steiner as Vice President of Sales and Marketing and three additional sales representatives who joined the Company and completed their sales training in Q3 2012. The fourth quarter of 2012 represented the first quarter of direct sales with the full sales team in place. During this period, we expanded our direct sales efforts to include both Austria and Switzerland.

 

Fiscal 2013 represented the first full year of CytoSorb® commercialization. We focused our direct sales efforts in Germany, Austria and Switzerland with 4 sales representatives. The focus of the team was to encourage acceptance and usage by key opinion leaders throughout these countries. By the end of 2014, we had more than 150 key opinion leaders (KOLs) in critical care, cardiac surgery, and blood purification who were either using CytoSorb® or committed to using CytoSorb® in the near future. We believe these KOL relationships will be essential to drive adoption and recurrent usage of CytoSorb by the department, facilitate purchases by the hospital administration, arrange reimbursement, and generate data for papers and presentations. In addition, we now currently have more than 40 investigator initiated studies being planned in Germany, Austria, and the United Kingdom in multiple applications including sepsis, cardiac surgery, lung injury, trauma, pancreatitis, liver failure, kidney failure, and others, with many already enrolling patients. These studies are being supported by our European Director of Scientific Affairs. As of March 1, 2015, we have increased our sales force to include seven direct sales people, two contract sales people, and seven sales and distributor support staff.

 

The Company has complemented our direct sales efforts with sales to distributors and/or corporate partners. In 2013, we reached agreement with distributors in the United Kingdom, Ireland, the Netherlands, Russia and Turkey. In April 2014, the Company announced distribution of CytoSorb® in the Middle East, including Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman (the Gulf Cooperative Council, or GCC) and Yemen, Iraq, and Jordan through an exclusive agreement with TechnoOrbits. In December 2014, the Company entered into an exclusive agreement with Smart Medical Solutions S.R.L., to distribute CytoSorb® for critical care applications in Romania and the neighboring Republic of Moldova. In January 2015, the Company announced its exclusive distribution agreement with Aferetica SRL to distribute CytoSorb® in Italy for critical care applications.

 

5
 

 

The Company has been expanding the number and scope of its strategic partnerships. In September 2013, we entered into a strategic partnership with Biocon Ltd., Asia’s largest biotech company, with an initial distribution agreement for India and select emerging markets, under which Biocon has the exclusive commercialization rights for CytoSorb® initially focused on sepsis. In September 2014, the Biocon partnership was expanded to include all critical care applications and cardiac surgery. In addition, Biocon committed to higher annual minimum purchases of CytoSorb® to maintain distribution exclusivity and committed to conduct and publish results from multiple investigator initiated studies and patient case studies.

 

In addition, in November 2014, the Company entered into an initial partnership agreement with a leading global medical device company in cardiac surgery and other cardiovascular diseases, to use CytoSorb® intra-operatively during cardiac surgery in France. Under the terms of the agreement, the partnership will commence with an initial six-month market evaluation period to determine various market parameters, to obtain clinical data, and to build key opinion leader support in France. Following a successful evaluation, the parties plan to jointly determine how to expand upon both the size and geographic footprint of its partnership.

 

In February 2015, we entered into a multi-country strategic partnership with Fresenius Medical Care AG & Co KGaA, or Fresenius, to commercialize the CytoSorb® therapy. Under the terms of this agreement, Fresenius has exclusive rights to distribute CytoSorb® for critical care applications in France, Poland, Sweden, Denmark, Norway, and Finland. The partnership will allow Fresenius to offer an innovative and easy way to use blood purification therapy for removing cytokines in patients that are treated in the intensive care unit. To promote the success of CytoSorb®, Fresenius will also engage in the ongoing clinical development of the product. This includes the support and publication of a number of small case series and patient case reports as well as the potential for future larger, clinical collaborations.

 

Overall, we have established either direct sales (as above) or distribution (via distributors or strategic partners) of CytoSorb in 29 countries worldwide. Registration of CytoSorb is typically required in each of these countries prior to active commercialization. With CE Mark approval, this can be typically achieved within several months in E.U. countries. Outside of the E.U., the process is more variable and can take months to more than a year due to different requirements for documentation and clinical data. Variability in the timing of registration affects the initiation of active commercialization in these countries, which affects the timing of expected CytoSorb sales. We actively support all of our distributors and strategic partners in the product registration process. Outside of the E.U., CytoSorb is actively being commercialized in Turkey and India. CytoSorb is registered in Saudi Arabia, but is currently awaiting Saudi FDA approval, a proxy for the rest of the Gulf Cooperation Council (GCC) countries. CytoSorb and its distribution partner in Russia have submitted all requested documentation for registration, and await a response from the Russian authorities. We cannot generally predict the timing of these registrations, and there can be no guarantee that we will ultimately achieve registration in countries where we have established distribution. For example, in August 2014 we announced exclusive distribution of CytoSorb® in Taiwan with Hemoscien Corporation. However, in March 2015, due to the complexity we encountered with Taiwanese product registration, we elected to terminate our agreement with Hemoscien. We also cannot guarantee that we will generate meaningful sales in the countries where we have established registration, due to other factors such as market adoption and reimbursement. We are currently actively evaluating other potential distributor and strategic partner networks in other major countries that accept CE Mark approval.

 

The market focus for CytoSorb ® is the prevention or treatment of organ failure in life-threatening conditions, including commonly seen illnesses in the intensive care unit such as infection and sepsis, trauma, burn injury, ARDS, and others. Severe sepsis and septic shock, a potentially life-threatening systemic inflammatory response to a serious infection, accounts for approximately 10-20% of all ICU admissions and is one of the largest target markets for CytoSorb®. Sepsis is a major unmet medical need with no approved products in the U.S. or Europe to treat it. As with other critical care illnesses, multiple organ failure is the primary cause of death in sepsis. When used with standard of care therapy, that includes antibiotics, the goal of CytoSorb ® in sepsis is to reduce excessive levels of cytokines and other inflammatory toxins, to help reduce the SIRS response and either prevent or treat organ failure.

 

6
 

 

In addition to the sepsis indication, the Company intends to conduct or support additional clinical studies in sepsis, cardiac surgery, and other critical care diseases where CytoSorb ® could be used, such as ARDS, trauma, severe burn injury, acute pancreatitis, and in other acute conditions that may benefit by the reduction of cytokines in the bloodstream. Some examples include the prevention of post-operative complications of cardiac surgery (cardiopulmonary bypass surgery) and damage to organs donated for transplant prior to organ harvest. The Company intends to generate additional clinical data to expand the scope of clinical experience for marketing purposes, to increase the number of treated patients, and to support potential future publications.

 

We are currently conducting a matched pairs analysis, dose ranging trial in Germany amongst eight clinical rial sites to evaluate the safety and efficacy of CytoSorb® when used continuously for 7 days, each day with a new divice. Data from this dosing study are intended to help clinicians with additional treatment options for CytoSorb®, help support the positive clinical data from the Company’s first European Sepsis Trial, and help shape the trial protocol for a pivotal sepsis study.

 

In addition to the dosing study, the Company will rely on data generated in the more than 40 ongoing investigator initiated studies and company sponsored trials currently planned or enrolling in Germany, Austria and the United Kingdom, India, and the U.S. Approximately 12 of these studies are currently enrolling patients. These trials, which are funded and supported by well-known university hospitals and key opinion leaders, are the equivalent of Phase 2 clinical studies. They will provide invaluable information regarding the success of the device in the treatment of sepsis, cardio-pulmonary bypass surgery, trauma, and many other indications, and if successful, will be integral in helping to drive additional usage and adoption of CytoSorb®.

 

In addition to sepsis and other critical care applications, cardiac surgery is emerging as an important potential application for CytoSorb® in the European market. There are approximately one million cardiac surgery procedures performed annually in the U.S. and E.U. including, for example, coronary artery bypass graft surgery, valve replacement surgery, heart and lung transplant, congenital heart defect repair, and left ventricular assist device (LVAD) implantation. Cardiac surgery can result in inflammation and the production of high levels of inflammatory cytokines, as well as hemolysis, causing the release of free hemoglobin. These can lead to post-operative complications such as respiratory failure and acute kidney injury. CytoSorb® has a unique competitive advantage as the only cytokine and free hemoglobin removal technology that can be used during the operative procedure and can be easily installed in a bypass circuit in a heart-lung machine without the need for an additional pump. Direct cytokine and hemoglobin removal with CytoSorb® enables it to replace the existing market for leukoreduction filters in cardiac surgery that attempt to indirectly reduce cytokines by capturing cytokine-producing leukocytes – an inefficient and suboptimal approach.

 

In February 2015, the U.S. Food and Drug Administration, or FDA, approved the Company’s Investigational Device Exemption, or IDE, application to commence a planned U.S. cardiac surgery feasibility study.  This single-arm study in 20 patients and three U.S. clinical sites represents the first part of a larger clinical trial strategy intended to support the U.S. approval of CytoSorb® for intra-operative use during cardiac surgery. The study is designed to evaluate the safety of CytoSorb® when used intra-operatively in a heart-lung machine to reduce plasma free hemoglobin and cytokines in patients undergoing complex cardiac surgery.  The length, complexity and invasiveness of these procedures cause hemolysis and inflammation, leading to high levels of plasma free hemoglobin, cytokines, activated complement, and other substances.  These inflammatory mediators directly correlate with the incidence of serious post-operative complications such as kidney injury and failure.  The goal of CytoSorb® is to actively remove these inflammatory and toxic substances as they are being generated during the surgery and reduce complications.

 

Concurrently, the Company is funding a non-interventional study amongst a broader array of U.S. cardiac surgery centers that will assess adverse event rates (e.g., incidence of acute kidney injury and respiratory failure) and levels of free hemoglobin and other inflammatory mediators in patients undergoing complex cardiac surgery.  These patients will be selected using similar inclusion and exclusion criteria to the feasibility study.  The data from these two studies will help to rapidly validate assumptions in this surgical patient population and help to appropriately power a U.S. pivotal cardiac surgery trial.

 

Even though we have obtained CE Mark approval, no guarantee or assurance can be given that our CytoSorb ® product will work as intended or that we will be able to obtain FDA approval to sell CytoSorb ® in the United States or approval in any other country or jurisdiction. Because of the limited studies we have conducted, we are subject to substantial risk that our technology will have little or no effect on the treatment of any indications that we have targeted.

 

7
 

 

The Company has been successful in obtaining technology development contracts from agencies in the U.S. Department of Defense, including DARPA, the U.S. Army, and the U.S. Air Force.

 

In June 2013, we announced that the U.S. Air Force will fund a 30 patient, single site, randomized controlled human pilot study in the United States amongst trauma patients with rhabdomyolysis. The primary endpoint is myoglobin removal. The FDA approved our Investigational Device Exemption (IDE) application for this study and we also received ethics committee approval, allowing the study to commence. However, because of the stringency of our inclusion criteria, and because of the patient mix seen at our single center, we have experienced difficulty in enrolling patients. We have subsequently modified one of the key inclusion criteria and have expanded the number of clinical trial sites to three in a revised protocol which has been submitted to the FDA. Though CytoSorbents does not expect to receive material direct funding from this $3 million budgeted program, the study may generate valuable data that can be used commercially or in future trauma studies.

  

In September 2012 CytoSorbents was awarded a Phase II SBIR (Small Business Innovation Research) contract by the US Army Medical Research and Materiel Command to evaluate our technology for the treatment of trauma and burn injury in large animal models. In 2013, we finalized the Phase II SBIR contract whjch provided for a maximum funding of approximately $753,000 with the granting agency. This work is supported by the U.S. Army Medical Research and Material Command under an amendment to Contract W81XWH-12-C-0038. As of December 31, 2014, the Company received approximately $649,000 in funding under this contract and no further amounts are expected from this contract.

 

In August 2012, the Company was awarded a $3.8 million, five-year contract by the Defense Advanced Research Projects Agency, or DARPA, for its “Dialysis-Like Therapeutics” program to treat sepsis. DARPA has been instrumental in funding many of the major technological and medical advances since its inception in 1958, including development of the Internet, the global positioning system, or GPS, and robotic surgery. The DLT program in sepsis seeks to develop a therapeutic blood purification device that is capable of identifying the cause of sepsis (e.g. cytokines, toxins, pathogens, activated cells) and remove these substances in an intelligent, automated, and efficient manner. CytoSorbents’ contract is for advanced technology development of its hemocompatible porous polymer technologies to remove cytokines and a number of pathogen and biowarfare toxins from blood. CytoSorbents is in Year 3 of the program and is currently working with the systems integrator, Battelle Laboratories, and its subcontractor NxStage Medical, who are responsible for integrating the technology developed by CytoSorbents and others into a final medical device design prototype, and evaluating this device in septic animals and eventually in human clinical trials in sepsis. CytoSorbents’ work is supported by DARPA and SSC Pacific under Contract No. N66001-12-C-4199. As of December 31, 2014, we have received approximately $2,818,000 to date and have approximately $1,007,000 not yet billed under this contract.

 

In September 2013, the National Heart, Lung, and Blood Institute, or NHLBI, a division of the National Institutes of Health (“NIH”), awarded the Company a Phase I SBIR (Small Business Innovation Research) contract valued at $203,351 to further advance its HemoDefend™ blood purification technology for packed red blood cell, or pRBC, transfusions. The University of Dartmouth collaborated with us as a subcontractor on the project, entitled “Elimination of blood contaminants from pRBCs using HemoDefend™ hemocompatible porous polymer beads. The overall goal of this program is to reduce the risk of potential side effects of blood transfusions, and help to extend the useful life of pRBCs. As of December 31, 2014, we completed the Phase I program and have been invited to apply for the Phase II SBIR, which has now been submitted.

 

The Company is also exploring potential eligibility in several other government sponsored grant programs which could, if approved, represent a substantial future source of non-dilutive funds for our research programs.

 

8
 

 

In addition to CytoSorb®, we are developing other products utilizing our adsorbent polymer technology that have not yet received regulatory approval including HemoDefend™, ContrastSorb, DrugSorb, BetaSorb™, and others. The HemoDefend™ technology platform is a development-stage blood purification system that can remove contaminants in transfused blood products, with the goal of reducing potentially fatal transfusion reactions and improving the quality of blood. ContrastSorb is designed to remove intravenous radiocontrast, or “IV contrast”, that is administered during interventional radiology procedures (e.g., coronary angiograms for heart disease) and computed tomography or computer axial tomography imaging (i.e., CT or “CAT” scans) that can cause kidney failure in high risk patients (e.g. those with pre-existing kidney disease, diabetes, hypertension, congestive heart failure, and old age). DrugSorb is designed to remove toxic drugs from blood, as in drug overdose. The BetaSorb™ filter was designed for use with renal replacement therapy in end-stage renal disease patients, to remove mid-molecular weight toxins that are not adequately removed by hemodialysis or hemofiltration. BetaSorb™ is not the current focus of our near term commercialization plans. With the exception of HemoDefend™, all of these products are known medically as hemoperfusion devices. Hemoperfusion, along with hemodialysis and hemofiltration, are the three major forms of blood purification. During hemoperfusion, blood is removed from the body via a catheter or other blood access device, perfused through a filter medium where toxic compounds are removed, and returned to the body.

 

HemoDefend™ is a development-stage blood purification technology platform designed to safeguard and protect the blood supply. The Company seeks to license the HemoDefend™ platform and has not yet received regulatory approval in any markets. HemoDefend™ consists of a mixture of proprietary porous polymer beads that target the removal of contaminants that can cause transfusion reactions or cause disease in patients receiving the tens of millions of transfused blood products administered worldwide each year. These contaminants include, for example, foreign antibodies, antigens, cytokines, free hemoglobin, bioactive lipids, toxins, drugs, and other inflammatory mediators that either were from the donor or accumulated during blood storage. The goal of the HemoDefend™ technology is to reduce these contaminants in transfused blood products to reduce transfusion reactions, to keep new blood fresh, and to improve the quality and safety of blood.

 

The HemoDefend™ beads are intended to be used in multiple configurations, including as a common in-line filter between the blood bag and the patient as well as a patent-pending “Beads in a Bag” treatment configuration, where the beads are placed directly into a blood storage bag. Once blood is put into this bag, the beads begin to automatically remove contaminants from the blood, and are designed to continue purifying blood throughout the entire blood storage period. The use of neutrally buoyant beads eliminates the need for mixing and is compatible with current blood storage conditions. Integrated filters in the bag prevent beads from leaving the bag during the transfusion process. The base polymer meets ISO 10993 standards for biocompatibility, hemocompatibility, genotoxicity, cytotoxicity, acute sensitivity and complement activation and can therefore directly contact blood for extended periods of time. In addition, the beads are inert and stable at a wide range of temperatures, and do not contain any antibodies, biologics, ligands, or drugs. Because of this, the beads have a very long shelf life that is consistent with blood storage bag manufacturing standards. No special equipment or handling is required, making it well-suited for mainstream and military applications, as well as for use in less developed countries that are not well-equipped to test and process blood products.

 

ContrastSorb is a development-stage blood purification technology that is being optimized for the removal of IV contrast from blood in order to prevent contrast-induced nephropathy, CIN. Contrast-induced nephropathy is the acute loss of renal function within the first 48 hours following IV contrast administration. An estimated 65 million CT scans are performed worldwide with IV contrast each year to enhance the images and make it easier to identify anatomic structures. IV contrast is also administered during vascular interventional radiology procedures and angiography of blood vessels in the brain, heart, limbs, and other parts of the body to diagnose and treat atherosclerosis (narrowing of blood vessels due to cholesterol deposits), vascular injury, aneurysms, etc. For example, an estimated 10 million coronary angiograms are performed worldwide each year to diagnose and treat coronary artery disease by placing coronary stents, performing balloon angioplasty, or atherectomy (removal of plaque in arteries). The reported risk of CIN in patients undergoing contrast enhanced CT scans has been reported to be 2-13%. For coronary intervention, the risk has been estimated to be as high as 20-30% in high risk patients with pre-existing renal insufficiency, long-term diabetes, hypertension, congestive heart failure, and older age. The use of low osmolar IV contrast, hydration of patients pre-procedure, orally administration of N-acetylcysteine, and other agents to prevent CIN have demonstrated modest benefit in some clinical studies, but in many cases, the results across studies have been equivocal and inconsistent. In high risk patients, the direct removal of IV contrast from the blood with ContrastSorb to prevent CIN represents a potentially more effective alternative.

 

9
 

 

DrugSorb is a development-stage blood purification technology that is capable of removing a wide variety of drugs and chemicals from blood, as a potential treatment for drug overdose, drug toxicity, toxic chemical exposure, use in high-dose regional chemotherapy, and other applications. It has demonstrated extremely high single pass removal efficiency of a number of different drugs that exceeds the extraction capability of hemodialysis or other filtration technologies. It is similar in action to activated charcoal hemoperfusion cartridges that have been available for many years, but has the advantage of having inherent biocompatibility and hemocompatibility without coatings, and can be easily customized for specific agents.

 

Our BetaSorb™ device is intended to remove beta 2 -microglobulin and other mid-molecular weight toxins from the blood of patients suffering from chronic kidney failure who rely on long term dialysis therapy to sustain their life. Standard high-flux hemodialysis is very effective in removing small uremic toxins, but much less effective in removing these mid-molecular weight toxins that functional kidneys normally remove. BetaSorb™ utilizes an adsorbent polymer packed into a similarly shaped and constructed cartridge as utilized for our CytoSorb® product, although the polymers used in the two devices are physically different with one optimized for short-term critical care use and the other specifically designed for the needs of long-term chronic usage. The BetaSorb™ device also incorporates industry standard connectors at either end of the device, which connect directly into the extra-corporeal circuit (bloodlines) in series with a dialyzer. To date, we have manufactured the BetaSorb™ device on a limited basis for testing purposes, including for use in clinical studies.

 

We had initially identified end stage renal disease, or ESRD, as the target market for our polymer-based adsorbent technology. However, during the development of BetaSorb™, we identified several applications for our adsorbent technology in the treatment of critical care patients. As a result, we shifted our priorities to pursue critical care applications (such as for the treatment of sepsis) for our technology given that BetaSorb™’s potential for usage in chronic conditions such as end stage renal disease is anticipated to have a longer and more complex regulatory pathway. We may pursue our BetaSorb™ product in the future after the commercialization of the CytoSorb® device. At such time as we determine to proceed with our proposed BetaSorb™ product, if ever, we will need to conduct additional clinical studies using the BetaSorb™ device and obtain separate regulatory approval in Europe and/or the United States.

 

We have conducted clinical studies using our BetaSorb™ device in patients with chronic kidney failure, which have provided valuable data that underpin the development of the critical care applications for our technology. The BetaSorb™ device has been used in a total of four human pilot studies, involving 20 patients, in the U.S. and Europe. The studies included approximately 345 treatments, with some patients using the device for up to 24 weeks (in multiple treatment sessions lasting up to four hours, three times per week) in connection with the application of our products to patients suffering from chronic kidney failure.

 

Corporate History

 

CytoSorbents Corporation was incorporated in Nevada on April 25, 2002 as Gilder Enterprises, Inc. and was originally engaged in the business of installing and operating computer networks that provided high-speed access to the Internet. On June 30, 2006, we disposed of our original business, and pursuant to an Agreement and Plan of Merger, acquired all of the stock of MedaSorb Technologies, Inc., a Delaware corporation, in a merger, and its business became our business. Following the merger, in July 2006 we changed our name to MedaSorb Technologies Corporation. In November 2008, we changed the name of our operating subsidiary from MedaSorb Technologies, Inc. to CytoSorbents, Inc. In May 2010, we finalized the name change of MedaSorb Technologies Corporation to CytoSorbents Corporation. On October 28, 2014, we changed the name of our operating subsidiary from CytoSorbents, Inc. to CytoSorbents Medical, Inc. Unless otherwise indicated, all references in this Annual Report to “MedaSorb”, “CytoSorbents”, “us” or “we” with respect to events prior to June 30, 2006 are references to CytoSorbents Medical, Inc. and its predecessors.

 

10
 

 

On December 3, 2014 we effected a twenty-five-for-one (25:1) reverse split of our common stock. As a result of the twenty-five-to-one (25:1) reverse stock split, shares of our common stock outstanding were reduced by approximately 96%. Based on the 582,097,092 shares of common stock outstanding as of December 3, 2014, the total number of shares of common stock outstanding after the reverse stock split, including accounting for fractional shares which were rounded up to the next whole number, were 23,284,040 shares. Accordingly, all share, option and warrant information included in this Annual Report has been retroactively adjusted to reflect the reduced number of shares resulting from this action. Immediately after the reverse stock split, on December 3, 2014 we changed our state of incorporation from the State of Nevada to the State of Delaware pursuant to an Agreement and Plan of Merger, dated December 3, 2014, whereby we merged with and into our recently formed, wholly-owned Delaware subsidiary. Pursuant to the Agreement and Plan of Merger, we adopted the certificate of incorporation, as amended and restated, and bylaws of our Delaware subsidiary as our certificate of incorporation and bylaws at effective time of the merger. At the effective time of our merger, (i) we merged with and into our Delaware subsidiary, (ii) our separate corporate existence in Nevada ceased to exist, (iii) our Delaware subsidiary became the surviving corporation, and (iv) each share of our common stock, $0.001 par value per share outstanding immediately prior to the effective time was converted into one fully-paid and non-assessable share of common stock of CytoSorbents Corporation, a Delaware corporation, $0.001 par value per share. The reverse stock split, the merger and the Agreement and Plan of Merger were approved by our Board of Directors and stockholders representing a majority of our outstanding common stock. All references to “us”, “we”, or the Company, on or after December 3, 2014, refer to CytoSorbents Corporation, a Delaware corporation.

 

Our executive offices are located at 7 Deer Park Drive, Suite K, Monmouth Junction, New Jersey 08852. Our telephone number is (732) 329-8885.

 

CytoSorbents was originally organized as a Delaware limited liability company in August 1997 as Advanced Renal Technologies, LLC. The Company changed its name to RenalTech International, LLC in November 1998, and to MedaSorb Technologies, LLC in October 2003. In December 2005, MedaSorb converted from a limited liability company to a corporation.

 

CytoSorbents has been engaged in research and development since its inception through December 31, 2014 and has raised approximately $87 million from investors. These proceeds have been used to fund the development of multiple product applications and to conduct clinical studies. These funds have also been used to establish in-house manufacturing capacity to meet clinical testing needs, expand our intellectual property through additional patents and to develop extensive proprietary know-how with regard to our products. For the years ended December 31, 2014 and 2013, the Company’s research and development expenses amounted to approximately $2,432,000 and $1,739,000, respectively.

 

The Company has raised funds through various means including convertible note offerings and equity transactions. Our four most significant financing transactions are discussed below.

 

Principal Terms of the January 2015 $10,312,500 Equity Offering

 

On January 14, 2015, the Company closed on an underwritten public offering, or the Offering, consisting of 1,250,000 shares of common stock at a price of $8.25 per share for an aggregate price of $10,312,500.

 

The Company received net proceeds from the Offering of approximately $9,409,000. The net proceeds received by the Company from the Offering will be used to fund clinical studies, expansion of production capacity, support various sales and marketing efforts, product development and general working capital purposes.

 

The Company conducted the Offering pursuant to a registration statement on Form S-1 (File No. 333-199762) which was declared effective by the Securities and Exchange Commission on January 8, 2015. The Company filed a final prospectus on January 9, 2015, disclosing the final terms of the Offering.

 

In connection with the Offering, on January 8, 2015, the Company entered into underwriting agreements with Brean Capital, LLC and H.C. Wainwright & Co., LLC, or the Representatives, who are acting as book-running managers and as representatives of the underwriters in the Offering.

 

11
 

 

In connection with the successful completion of the Offering, the underwriters received aggregate discounts and commissions of 6% of the gross proceeds of the sale of the shares in the Offering. In addition, the Company agreed to issue warrants to the Representatives, or the Representatives’ warrants, that allow for the purchase of shares of the Company’s common stock equal to 3% of the aggregate number of shares sold in the Offering. The Representatives’ warrants are exercisable at any time for a period of five years, commencing on the date of the effectiveness of the registration statement, at a price per share equal to 120% of the public offering price per share of the common stock in the Offering. The Company also agreed to reimburse the underwriters for actual out-of-pocket expenses related to the offering. These out-of-pocket expenses amounted to approximately $85,000. The Company also granted the Representatives a right of first refusal to participate in any subsequent offering or placement of our securities that takes place within nine months following the effective date of the registration statement.

 

Principal Terms of the March 2014 $10,200,000 Equity Offering

 

On March 7, 2014, the Company entered into subscription agreements with certain investors providing for the issuance and sale by the Company, or the March 2014 Offering, of 1,632,000 units, or the Units, for an aggregate purchase price of $10,200,000.  Each Unit is comprised of one share of the Company’s common stock, priced at $6.25 per share, par value $0.001 per share and a warrant to purchase 0.50 shares of common stock at an exercise price of $7.8125 per share. The warrants are convertible into a total of 816,000 shares of common stock. Each warrant is exercisable for a period of five (5) years beginning on March 11, 2014, the date of the closing of the sale of these securities, and is only exercisable for cash if at the time of exercise there is an effective registration statement registering the warrants and shares underlying the warrants.

 

The Company received net proceeds from the March 2014 Offering of approximately $9,451,000. The net proceeds received by the Company from the March 2014 Offering will be used for building additional sales and marketing infrastructure, clinical studies, working capital and general corporate purposes.

 

The Company conducted the March 2014 Offering pursuant to a registration statement on Form S-1 (File No. 333-193053) which was declared effective by the Securities and Exchange Commission on February 14, 2014 and an additional registration statement on Form S-1 (File No. 333-194394) to register an additional amount of securities having a proposed maximum aggregate offering price of $2,762,500, which increased the total registered amount to $16,575,000 assuming the full cash exercise of the warrants for cash. The Company filed a final prospectus on March 7, 2014, disclosing the final terms of the March 2014 Offering.

 

In connection with the March 2014 Offering, on March 7, 2014, the Company entered into a placement agency agreement with Brean Capital, LLC pursuant to which the placement agent agreed to act as the Company’s exclusive placement agent for the March 2014 Offering and sale of the Units.

 

In connection with the successful completion of the March 2014 Offering, the placement agent received an aggregate cash placement agent fee equal to 6% of the gross proceeds of the sale of the Units in the Offering and a warrant to purchase 48,960 shares of Common Stock at an exercise price of $7.50 per share exercisable for five years from the effective date of the placement agency agreement. The placement agent warrant contains piggy-back registration rights which expire on the fifth anniversary of the effective date of the registration statement. We have also agreed to reimburse the placement agent for actual out-of-pocket expenses up to a maximum of 2% of gross proceeds from the transaction. We also granted the placement agent a right of first refusal to participate in any subsequent offering or placement of our securities that takes place within twelve months following the effective date of the registration statement.

 

On October 9, 2014, the Company filed with the Nevada Secretary of State an Amendment, or the Series A Amendment, to the Certificate of Designation, as amended, or the Series A Certificate of Designation, of the Series A Preferred Stock. The Series A Amendment, which became effective on October 9, 2014, (i) amended the Series A Certificate of Designation to allow the stockholders representing eighty percent (80%) of the issued and outstanding shares of Series A Preferred Stock to elect to convert all issued and outstanding shares of Series A Preferred Stock into Common Stock of the Company, $0.001 par value per share, or the Common Stock, at the then-effective "Conversion Price," as defined in the Series A Certificate of Designation, and (ii) as consideration for approving such amendment, amended the Conversion Price from $31.25 per share to $19.25 per share, except with respect to the shares of Series A Preferred Stock covered by that certain Agreement and Consent dated as of June 25, 2008 by and among the Company and certain holders of Series A Preferred Stock. The fair value of the reduction in the conversion price was determined based on the five day volume weighted average price of the Company’s common stock at the date of the conversion. Immediately following effectiveness of the Series A Amendment, the stockholders representing over 88 percent (88%) of the then-issued and outstanding Series A Preferred Stock elected to convert all issued and outstanding Series A Preferred Stock into Common Stock at the Conversion Price, as amended. As a result of this election by the holders of Series A Preferred Stock, 1,894,969 shares of Series A Preferred Stock were converted into 4,133 shares of Common Stock.

 

12
 

 

After giving effect to the conversion of the Series A Preferred Stock described above, there are no shares of Series A Preferred Stock of the Company issued and outstanding as of December 31, 2014.

 

In addition, on October 9, 2014, the Company also filed with the Nevada Secretary of State an Amendment (the "Series B Amendment") to the Certificate of Designation (the "Series B Certificate of Designation") of the Series B Preferred Stock. The Series B Amendment, which became effective on October 9, 2014, amended the Series B Certificate of Designation to allow the holders of a majority of the Series B Preferred Stock, including NJTC Investment Fund, LP, to elect to convert all issued and outstanding shares of Series B Preferred Stock into Common Stock. Immediately following effectiveness of the Series B Amendment, the stockholders representing over 93 percent (93%) of the then-issued and outstanding Series B Preferred Stock elected to convert all issued and outstanding Series B Preferred Stock into Common Stock. Each share of Series B Preferred Stock had a stated value of $100.00 (the "Series B Stated Value"), and was convertible into that number of shares of Common Stock equal to the Series B Stated Value at a conversion price of $0.90. As consideration for approving the Series B Amendment, the holders of Series B Preferred Stock received a one-time dividend equal to ten percent (10%) of the shares of Series B Preferred Stock then held. As a result of this election by the holders of Series B Preferred Stock, 84,283.99 shares of Series B Preferred Stock were issued a dividend of 10% and then the 92,712.27 shares were converted into 409,778 shares of Common Stock. As a result of the conversion, the carrying value of the Series B stock was reclassified to permanent equity.

 

After giving effect to the conversion of the Series B Preferred Stock described above, there are no shares of Series B Preferred Stock of the Company issued and outstanding as of December 31, 2014.

 

Research and Development

 

We have been engaged in research and development since inception. Our research and development costs were approximately $2,432,000 and $1,739,000 for the years ended December 31, 2014 and 2013, respectively. We have recently been awarded more than $5 million in contracts from DARPA ($3.8M over 5 years), the U.S. Army ($100,000 Phase I SBIR; $50,000 Phase I extension, $1 million Phase II SBIR), and a $203,000 Phase I SBIR contract from the National Heart, Lung and Blood Institute to further develop our technologies for sepsis, trauma and burn injury, and blood transfusions, respectively. Payments are based on achieving certain technology milestones. In addition, the U.S. Air Force is funding a 30-patient, randomized controlled human pilot study evaluating CytoSorb® in patients with severe trauma and rhabdomyolysis. The FDA approved the trial under an IDE application in 2013. In response to slower than expected enrollment, a protocol amendment was submitted to the FDA to increase the number of trial sites to three and to modify the study’s inclusion criteria.

 

Technology, Products and Applications

 

For approximately the past half-century, the field of blood purification has been focused on hemodialysis, a mature, well accepted medical technique primarily used to sustain the lives of patients with permanent or temporary loss of kidney function. It is widely understood by the medical community that dialysis has inherent limitations in that its ability to remove toxic substances from blood drops precipitously as the size of toxins increases. Our hemocompatible adsorbent technology is expected to address this shortcoming by removing toxins and toxic compounds largely untouched by dialysis technology.

 

Our polymer adsorbent technology can remove drugs, bioactive lipids, inflammatory mediators such as cytokines, free hemoglobin, toxins, and immunoglobulin from blood and physiologic fluids depending on the polymer construct. We believe that our technology may have many applications in the treatment of common, chronic and acute healthcare conditions including, but not limited to, the adjunctive treatment and/or prevention of sepsis; the treatment of other critical care illnesses such as severe burn injury, trauma, acute respiratory distress syndrome and pancreatitis; the prevention of post-operative complications of cardiopulmonary bypass surgery; the treatment of cancer cachexia; the prevention of damage to organs donated by brain-dead donors prior to organ harvest; the prevention of transfusion reactions caused by contaminants in transfused blood products; the prevention of contrast induced nephropathy, the treatment of drug overdose, and the treatment of chronic kidney failure. These applications vary by cause and complexity as well as by severity but share a common characteristic i.e. high concentrations of inflammatory mediators and toxins in the circulating blood.

 

13
 

 

CytoSorbents’ flagship product, CytoSorb® and other products under development, including BetaSorb™, ContrastSorb, and DrugSorb consist of a cartridge containing adsorbent, porous polymer beads, although the polymers used in these devices are physically different. The cartridges incorporate industry standard connectors at either end of the device, which connect directly to the extracorporeal circuit (bloodlines) in series with a dialyzer as a standalone device. The extra-corporeal circuit consists of plastic blood tubing, our blood filtration cartridges containing adsorbent polymer beads, pressure monitoring gauges, and a blood pump to maintain blood flow. The patient’s blood is accessed through a catheter inserted into his or her veins. The catheter is connected to the extra-corporeal circuit and the blood pump draws blood from the patient, pumps it through the cartridge and returns it back to the patient in a closed loop system. All of these devices are expected to be compatible with standard blood pumps or hemodialysis machines used commonly in hospitals and will therefore not require hospitals to purchase additional expensive equipment, and will require minimal training.

 

The polymer beads designed for the HemoDefend™ platform are intended to be used in multiple configurations, including the common in-line filter between the blood bag and the patient, as well as a patent-pending “Beads in a Bag” configuration, where the beads are placed directly into a blood storage bag.

 

Markets

 

CytoSorbents is a critical care focused immunotherapy company. Immunotherapy is the ability to control the immune response to fight disease. Critical care medicine includes the treatment of patients with serious or life-threatening conditions who require comprehensive care in the intensive care unit (ICU), with highly-skilled physicians and nurses and advanced technologies to support critical organ function to keep patients alive. Examples of such conditions include severe sepsis and septic shock, severe burn injury, trauma, acute respiratory distress syndrome and severe acute pancreatitis. In the U.S., an estimated $82 billion or 0.7% of the U.S. gross domestic product (GDP) is spent annually on critical care medicine. In most larger hospitals, critical care treatment accounts for up to 20% of a hospital’s overall budget and often results in financial losses for the hospital.

 

In many critical care illnesses, the mortality is often higher than 30%. A major cause of death is multiple organ failure, where vital organs such as the lungs, kidneys, heart and liver are damaged and no longer function properly. Such patients are kept alive with supportive care therapy, or “life support”, such as mechanical ventilation, dialysis and vasopressor treatment, that is designed to keep the patient from dying while using careful patient management to tip the balance towards gradual recovery over time. Unfortunately, most supportive care therapies only help to keep patients alive by supporting organ function but do not help reverse the underlying causes of organ failure and do not help patients recover more quickly. Because of this, the treatment course is often poorly defined and highly variable, leading to lengthy ICU stays, a higher risk of adverse outcomes from hospital acquired infections, medical errors, and other factors, as well as exorbitant costs. There is an urgent need for more effective “active” therapies that can help to reverse or prevent organ failure. CytoSorbents’ main product, CytoSorb® is a unique cytokine filter designed to try to address this void, by reducing “cytokine storm” and working to reduce the subsequent deadly inflammation that can lead to organ failure and death. Together the total addressable market to address these numerous critical care applications in the U.S. and E.U. with CytoSorb® is estimated at $10-15 billion.

 

Sepsis

 

Sepsis is characterized by a systemic inflammatory response triggered by a severe infection. It is commonly seen in the intensive care unit, accounting for approximately 10-20% of all ICU admissions. However, there are currently no approved products that are available to treat sepsis in the U.S. or E.U. Each year, there are more than one million and 1.5 million new cases of severe sepsis or septic shock in the United States and Europe, respectively. Based on the reported incidence of sepsis in a number of developed countries, the worldwide incidence is estimated to be 18 million cases per year. According to the U.S. Centers of Disease Control and Prevention (CDC), the incidence of serious infection and sepsis has doubled in the U.S. in the past 10 years. The main driver of sepsis incidence is the aging demographic, specifically patients who are older than age 65 who are more prone to infection and now account for two-thirds of patients hospitalized for sepsis and the majority of sepsis deaths. Other factors contributing to the increase in sepsis incidence include the spread of antibiotic resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA), an increase in co-morbid conditions like HIV, cancer and diabetes that increases the risk of infection, an increasing use of implantable devices like artificial hips and knees that are prone to colonization by bacteria, and the appearance of new highly virulent or contagious strains of common pathogens such as H1N1 influenza.

 

14
 

 

There are generally three categories of sepsis, including mild to moderate sepsis, severe sepsis and septic shock. Mild to moderate sepsis typically occurs with an infection that is responsive to antibiotics or antiviral medication. An example is a patient with self-limiting influenza or a treatable community acquired pneumonia. Mortality is generally very low. Severe sepsis is sepsis with evidence of organ dysfunction. An example is a patient who develops respiratory failure due to a severe pneumonia and requires mechanical ventilation in the intensive care unit. Severe sepsis has a mortality rate of approximately 25-35%. Septic shock, or severe sepsis with low blood pressure that is not responsive to fluid resuscitation, is the most serious form of sepsis with an expected mortality in excess of 40-50%.

 

In sepsis, there are two major problems: the infection and the body’s immune response to the infection. Antibiotics are main therapy used to treat the triggering infection, and although antibiotic resistance is growing, the infection is often eventually controlled. However, it is the body’s immune response to this infection that frequently leads to the most devastating damage. The body’s immune system normally produces large amounts of inflammatory mediators called cytokines to help stimulate and regulate the immune response during an infection. In severe infection, however, many people suffer from a massive, unregulated overproduction of cytokines, often termed “cytokine storm” that can kill cells and damage organs, leading to multiple organ dysfunction syndrome (MODS) and multiple organ failure (MOF), and in many cases death. Until recently, there have been no available therapies in the U.S. or E.U. that can control the aberrant immune response and cytokine storm. Our CytoSorb® device is a first-in-class, clinically-proven broad-spectrum extracorporeal cytokine filter currently approved for sale in the E.U. The goal of CytoSorb® is to prevent or treat organ failure by reducing cytokine storm and controlling a “run-away” immune response, while antibiotics work to control the actual infection. CytoSorb® has been evaluated in the randomized, controlled European Sepsis Trial in 43 patients in Germany with predominantly septic shock and acute respiratory distress syndrome or acute lung injury. The therapy was safe in more than 300 human treatments and generally well tolerated. CytoSorb® demonstrated the ability to reduce a broad range of cytokines from the blood of critically ill patients. In a post-hoc analysis, this was associated with improvements in clinical outcome in two high-risk patient populations – those with very high cytokine levels and patients 65 years of age and older. CytoSorbents is currently conducting a Dosing study at 8 clinical trial sites in Germany, and has demonstrated the safety of continuous treatment over 7 days.

 

The Company estimates that the market potential in Europe for its products is larger than that in the U.S. For example, in the U.S. and Europe, there are an estimated one million and 1.5 million new cases, respectively, of severe sepsis and septic shock annually. In Germany alone, according to the German Sepsis Society (GSS), there are approximately 154,000 cases of severe sepsis each year. Patients are treated in the intensive care unit for 12-18 days on average and for a total of 20-25 days in the hospital. Germany is the largest medical device market in Europe and the third largest in the world.

 

The only treatment that had been approved to treat sepsis in the U.S. or E.U. was Xigris (Eli Lilly). Because of concerns of cost, limited efficacy, and potentially dangerous side effects including the increased risk of fatal bleeding events such as intracranial bleeding for those at risk, and also because of problems with reimbursement, worldwide sales of Xigris decreased from $160M in 2009 to $104M in 2010. In October 2011, following its PROWESS SHOCK trial that demonstrated no benefit in mortality in septic shock patients, Lilly voluntarily withdrew Xigris from all markets worldwide, and is no longer available as a treatment.

 

Development of most other experimental therapies has been discontinued, including Eritoran from Eisai, CytoFab from BTG/Astra Zeneca, Talactoferrin from Agennix, and others. Currently, there are two late stage trials ongoing. In November 2012, an 800 patient Phase III randomized controlled study began for Recomodulin (ART 123, Artisan/Asahi Kasei), a recombinant human thrombomodulin, for the treatment of septic patients with coagulopathy. In mid-2013, following an interim analysis of safety data, the Data Safety Monitoring Board (DSMB) recommended that the trial continue. The primary completion date of the trial is expected to be March 2015. Recomodulin has been approved in Japan since 2009 for the treatment of disseminated intravascular coagulation (DIC), a late complication of sepsis, at a cost of $5,800 per treatment. Although it has other activity, it works primarily by a similar anticoagulant mechanism to Xigris. Because of this, it has only demonstrated a limited mortality benefit (~9%: 34.6% control vs 26% treatment), similar to that seen in Xigris’ initial PROWESS Trial (~6%: 31% control vs 25% treatment) and is unlikely to have greater benefit in larger scale studies.

 

15
 

 

Spectral Medical, Inc. is collaborating with Toray on the EUPHRATES trial, combining an endotoxin assay with extracorporeal endotoxin removal by Toraymyxin, a polymyxin-B immobilized polystyrene fiber cartridge. The study began in June 2010 and is still enrolling patients. Endotoxemia is a result of Gram negative sepsis, which only accounts for 45% of cases of sepsis. It is a potent stimulator of cytokine storm. However, all anti-endotoxin strategies have failed pivotal studies to date, believed to be the result of intervening too late in the sepsis cascade. The original trial was designed as a randomized control trial in 360 patients with septic shock and high endotoxin levels (≥ 0.60 EAA units) as confirmed by Spectral’s Endotoxin Activity Assay (EAA). In a second interim analysis finalized in April 2014, following the enrollment of 184 patients with 28-day follow-up, the DSMB recommended that the trial continue. However, the expected trial size was increased to 650 patients and the exclusion criteria was modified to only accept sicker patients with a MODS (multiple organ dysfunction syndrome) score greater than 9. As of January 31, 2015, the trial has randomized 325 patients. An interim analysis is expected in Q4 2015. Because of the lack of available therapies, there remains a significant medical need for improved treatments for sepsis.

 

Severe sepsis and septic shock patients are amongst the most expensive patients to treat in a hospital. Because of this, we believe that cost savings to hospitals and/or clinical efficacy, rather than the cost of treatment itself, will be the determining factor in the adoption of CytoSorb® in the treatment of sepsis. CytoSorb ® is approved in the E.U. and is being sold directly in Germany, Austria, and Switzerland. CytoSorbents has ongoing discussions with potential corporate partners and independent distributors to market CytoSorb in other select E.U. countries and in other countries outside the E.U. that accept CE Mark approval. CytoSorb ® is currently reimbursed in Germany and Austria at more than $500 per unit. A seven day treatment costs ~$3,500, approximately the cost of 1-2 days in the ICU. The cost of therapy represents a fraction of what is currently spent on the treatment of patients with sepsis. For example, a typical severe sepsis or septic shock patient in the U.S. costs approximately $45,000-60,000 to treat. Based upon this price point, the total addressable market for CytoSorb® for the treatment of sepsis in the U.S. and E.U. is approximately $6-8 billion.

 

Cardiac Surgery

 

There are approximately 500,000 cardiopulmonary bypass (CPB) and cardiac surgery procedures performed annually in the U.S., 500,000 in the E.U., and approximately 1.5 million procedures worldwide. These include relatively common procedures including coronary artery bypass graft surgery, valve replacement surgery, heart and lung transplant, congenital heart defect repair, and left ventricular assist device implantation for the treatment of heart failure. Cardiac surgery can result in inflammation and the production of high levels of inflammatory cytokines, as well as hemolysis, causing the release of free hemoglobin. These can lead to post-operative complications including infection, pulmonary, renal, and neurological dysfunction. Complications lead to longer ICU recovery times and hospital stays, increased morbidity and mortality, and higher costs. An average coronary artery bypass graft procedure already costs approximately $36,000 in the U.S. without complications. The use of CytoSorb® to reduce cytokines and other inflammatory mediators during and after the surgical procedure may prevent or mitigate these post-operative complications. During the procedure, the CytoSorb® filter can be incorporated in a bypass circuit in the heart-lung machine without the need for a separate pump, a unique competitive advantage over other technologies. After the surgery, CytoSorb® can be used similarly to dialysis on patients that develop a severe post-operative inflammatory response. Direct cytokine and hemoglobin removal with CytoSorb® enables it to replace the existing market for leukoreduction filters in cardiac surgery that attempt to indirectly reduce cytokines by capturing cytokine-producing leukocytes – an inefficient and suboptimal approach. Modified ultrafiltration is sometimes used after termination of cardiopulmonary bypass in cardiac surgery to remove excess fluid and inflammatory substances, but has had mixed benefit. The peri-procedural total addressable market for CytoSorb® in the U.S. and E.U in cardiothoracic surgery procedures is estimated to be $500 million to $1 billion.

 

16
 

 

Acute Respiratory Distress Syndrome

 

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are two of the most serious conditions on the continuum of respiratory failure when both lungs are compromised by inflammation and fluid infiltration, severely compromising the lung’s ability to both oxygenate the blood and rid the blood of carbon dioxide produced by the body. There are an estimated 165,000 cases of acute respiratory distress syndrome in the U.S. each year, with more cases in the E.U. Patients with ALI and ARDS typically require mechanical ventilation, and sometimes extracorporeal membrane oxygenation therapy, to help achieve adequate oxygenation of the blood. Patients on mechanical ventilation are at high risk of ongoing ventilator-induced lung injury, oxygen toxicity, ventilator-acquired pneumonias, and other hospital acquired infections, and outcome is significantly dependent on the presence of other organ dysfunction as well as co-morbid conditions such as pre-existing lung disease (e.g. emphysema or chronic obstructive pulmonary disease) and age. Because of this, mortality is typically greater than 30%, even with modern medicine and ventilation techniques. ALI and ARDS can be precipitated by a number of conditions including pneumonia and other infections, burn and smoke inhalation injury, aspiration, reperfusion injury and shock. Cytokine injury plays a major role in the vascular compromise and cell-mediated damage to the lung. Reduction of cytokine levels may either prevent or mitigate lung injury, enabling patients to wean from mechanical ventilation faster, potentially reducing numerous sequelae such as infection, pneumothoraces, and respiratory muscle deconditioning, and allow faster intensive care unit discharge, thereby potentially saving costs. CytoSorb® treatment of patients with either ALI or ARDS in the setting of sepsis was the subject of our European Sepsis Trial where in a post-hoc analysis in patients with very high cytokine levels, we observed faster ventilator weaning in CytoSorb® treated patients that showed a statistical trend to benefit. Future, prospectively defined, larger studies are required to confirm these findings. Although a number of therapies have been tried such as corticosteroids, nitric oxide, surfactant therapy, and others, there are currently no approved treatments for ARDS. Only low tidal volume ventilation has been demonstrated to improve mortality (31.0 vs 39.8% control) in this patient population. However, even with this intervention, mortality is still unacceptably high. The total addressable market for CytoSorb® to treat ARDS/ALI in the E.U. is estimated to be between $500 million to $1.25 billion, and $1-2 billion in the U.S. and E.U.

 

Severe Burn Injury

 

In the U.S., there are approximately 2.4 million burn injuries per year, with 650,000 treated by medical professionals and approximately 75,000 requiring hospitalization. Aggressive modern management of burn injury, including debridement, skin grafts, anti-microbial dressings and mechanical ventilation for smoke and chemical inhalation injury has led to significant improvements in survival of burn injury to approximately 95% on average in leading burns centers. However, there remains a need for better therapies to reduce the mortality in those patients with large burns and inhalation injury as well as to reduce complications of burn injury and hospital length of stay for all patients. According to National Burn Repository Data, the average hospital stay for burn patients is directly correlated with the percent total body surface area (TBSA) burned. Every 1% increase of TBSA burned equates to approximately 1 additional day in the hospital. A single patient with more than 30% TBSA burned who survives, is hospitalized for an average of 30 days and costs approximately $200,000 to treat. Major causes of death following severe burn and smoke inhalation injury are multi-organ failure (hemodynamic shock, respiratory failure, acute renal failure) and sepsis, particularly in patients with greater than 30% TBSA burns. Specifically, burns and inhalation injury lead to severe systemic and localized lung inflammation, loss of fluid, and cytokine overproduction. This “cytokine storm” causes numerous problems, including: hypovolemic shock and inadequate oxygen and blood flow to critical organs, acute respiratory distress syndrome preventing adequate oxygenation of blood, capillary leakage resulting in tissue edema and intravascular depletion, hypermetabolism leading to massive protein degradation and catabolism and yielding increased risk of infection, impaired healing, severe weakness and delayed recovery, immune dysfunction causing a higher risk of secondary infections (wound infections, pneumonia) and sepsis, and direct apoptosis and cell-mediated killing of cells, leading to organ damage. Up to a third of severe hospitalized burn patients develop multi-organ failure and sepsis that can often lead to complicated, extended hospital courses, or death. Broad reduction of cytokine storm has not been previously feasible and represents a novel approach to limiting or reversing organ failure, potentially enabling more rapid mechanical ventilation weaning, prevention of shock, reversal of the hypermetabolic state encouraging faster healing and patient recovery, reducing hospital costs, and potentially improving survival. The total addressable market in the E.U. for CytoSorb to address burn and smoke inhalation injury is estimated at $150-350 million and $300-600 million in the U.S and E.U.

 

17
 

 

Trauma

 

According to the National Center for Health Statistics, in the U.S., there are more than 31 million visits to hospital emergency rooms, with 1.9 million hospitalizations, and 167,000 deaths every year due to injury. The leading causes of injury are trauma from motor vehicle accidents, being struck by an object or other person, and falls. Trauma is a well-known trigger of the immune response and a surge of cytokine production or cytokine storm. In trauma, cytokine storm contributes to a systemic inflammatory response syndrome (SIRS) and a cascade of events that cause cell death, organ damage, organ failure and often death. Cytokine storm exacerbates physical trauma in many ways. For instance, trauma can cause hypovolemic shock due to blood loss, while cytokine storm causes capillary leak and intravascular volume loss, and triggers nitric oxide production that causes cardiac depression and peripheral dilation. Shock can lead to a lack of oxygenated blood flow to vital organs, causing organ injury. Severe systemic inflammation and cytokine storm can lead to acute lung injury and acute respiratory distress syndrome as is often seen in ischemia and reperfusion injury following severe bleeding injuries. Penetrating wound injury from bullets, shrapnel and knives, can lead to infection and sepsis, another significant cause of organ failure in trauma. Complicating matters is the breakdown of damaged skeletal muscle, or rhabdomyolysis, from blunt trauma that can lead to a massive release of myoglobin into the blood that can crystallize in the kidneys, leading to acute kidney injury and renal failure. Renal failure in trauma is associated with a significant increase in expected mortality. Cytokine and myoglobin reduction by CytoSorb® and related technologies may have benefit in trauma, potentially improving clinical outcome. In December 2011 and September 2012, CytoSorbents was awarded a Phase I and a Phase II SBIR award, respectively, from the U.S. Army Medical Research and Materiel Command to develop its technology for the treatment of trauma and burn injury. The total addressable market for CytoSorb® for the treatment of trauma is estimated to be $1.5-2.0 billion in the U.S. and E.U.

 

Severe Acute Pancreatitis

 

Acute pancreatitis is the inflammation of the pancreas that results in the local release of digestive enzymes and chemicals that cause severe inflammation, necrosis and hemorrhage of the pancreas and local tissues. Approximately 210,000 people in the U.S. are hospitalized each year with acute pancreatitis with roughly 20% requiring ICU care. It is caused most frequently by a blockage of the pancreatic duct or biliary duct with gallstones, cancer, or from excessive alcohol use. Severe acute pancreatitis is characterized by severe pain, inflammation, and edema in the abdominal cavity, as well as progressive systemic inflammation, generalized edema, and multiple organ failure that is correlated with high levels of cytokines and digestive enzymes in the blood. Little can be done to treat severe acute pancreatitis today, except for pancreatic duct decompression with endoscopic techniques, supportive care therapy, pain control, enternal tube feeding, and fluid support. ICU stay is frequently measured in weeks and although overall ICU mortality is approximately 10%, patients with multiple organ failure have a much higher risk of death. CytoSorb® may potentially benefit overall outcomes in episodes of acute pancreatitis by removing a diverse set of toxins from blood. The total addressable market for CytoSorb® for the treatment of severe acute pancreatitis in the U.S. and E.U. is estimated to be between $400-600 million.

 

Cancer Cachexia and Cancer Immunotherapy

 

Cancer cachexia is a progressive wasting syndrome characterized by rapid weight loss, anorexia, and physical debilitation that significantly contributes to death in the majority of cancer patients. Cancer cachexia is a systemic inflammatory condition, driven by excessive pro-inflammatory cytokines and other factors, that cripples the patient’s physical and immunologic reserve to fight cancer. Despite afflicting millions of patients worldwide each year, there are no effective approved treatments for cancer cachexia, with only symptomatic treatments available. CytoSorb® blood purification may stop or reverse cancer cachexia through broad reduction of cytokines and other inflammatory mediators. For example, CytoSorb® efficiently removes TNF-alpha (originally called “cachectin” or “cachexin” when first isolated in cancer cachexia patients) and other major pro-inflammatory cytokines including IL-1, IL-6, and gamma interferon that can cause cachexia. This broad immunotherapy approach may lead to improved clinical outcomes while reducing patient suffering.

 

In February 2014, CytoSorbents announced a research collaboration with researchers at the University of Pennsylvania School of Veterinary Medicine to evaluate the use of CytoSorb® as a treatment for cancer cachexia in animals. Demonstrating the potential benefit of CytoSorb® therapy in animals may provide the data to begin evaluating the therapy in human cancer patients in the U.S. and Europe. CytoSorb® is approved in the European Union with a broad indication for use, allowing it to be used in any clinical situation where cytokines are elevated, including the potential treatment today of cancer related issues such as cancer cachexia. Because of this, any positive data from this collaboration could potentially be translated to human studies relatively quickly.

 

18
 

 

The collaboration will also explore the use of CytoSorb® as a primary immunotherapy to treat cancer, or in synergy with more traditional chemotherapy or immunotherapy agents. Cancer cells have evolved ways to proliferate while confusing and evading the immune response. Many of these mechanisms rely on immunologic messages relayed by cytokines and other soluble factors that CytoSorb® has the potential to remove. In doing so, CytoSorb® may help to restore the ability of the immune system to attack cancer cells

 

CytoSorb® may also represent a rescue or salvage therapy in activated T-cell cancer immunotherapy, where cytokine release syndrome (i.e. cytokine storm) is common, and can lead to organ failure and death in certain patients. .

 

The total addressable market for CytoSorb for the treatment of cancer cachexia and cancer in the U.S. and E.U. is estimated to be in excess of $4 billion.

 

Brain-Dead Organ Donors

 

There are in excess of 6,000 brain dead organ donors each year in the United States; worldwide, the number of these organ donors is estimated to be at least double the U.S. brain dead organ donor population. There is a severe shortage of donor organs. Currently, there are more than 100,000 individuals on transplant waiting lists in the United States. Cytokine storm is common in these organ donors, resulting in reduced viability of potential donor organs. The potential use of CytoSorb® hemoperfusion to control cytokine storm in brain dead organ donors could increase the number of viable organs harvested from the donor pool and improve the survival of transplanted organs. A proof-of-concept pilot study using the Company’s technology in human brain dead donors has been published. In addition, CytoSorb® treatment in a porcine animal model of brain death demonstrated a reduction in cytokines as well as a preservation of cardiac function compared to untreated controls.

 

Blood Transfusions

 

The HemoDefend™ platform is designed to be a practical, low cost, and effective way to safeguard the quality and safety of the blood supply. In the United States alone, 15 million packed red blood cell (pRBC) transfusions and another 15 million transfusions of other blood products (e.g. platelet, plasma, and cryoprecipitate) are administered each year with an average of 10% of all US hospital admissions requiring a blood transfusion. The sheer volume of transfusions, not just in the US, but worldwide, complicates an already difficult task of maintaining a safe and reliable blood supply. Trauma, invasive operative procedures, critical care illnesses, supportive care in cancer, military usage, and inherited blood disorders are just some of the drivers of the use of transfused blood. In war, hemorrhage from trauma is a leading cause of preventable death, accounting for an estimated 30-40% of all fatalities. For example, in Operation Iraqi Freedom, due to a high rate of penetrating wound injuries, up to 8% of admissions required massive transfusions, defined as 10 units of blood or more in the first 24 hours. There is a clear need for a stable and safe source of blood products. However, blood shortages are common and exacerbated by the finite lifespan of blood. According to the Red Cross, packed red blood cell (pRBC) units have a refrigerated life span of 42 days. However, many medical experts believe there is an increased risk of infection and transfusion reactions once stored blood ages beyond two weeks. Transfusion-related acute lung injury (TRALI) is the leading cause of non-hemolytic transfusion-related morbidity and mortality, with an incidence of 1 in 2,000-5,000 transfusions and a mortality rate of up to 10%. Fatal cases of TRALI have been most closely related to anti-HLA or anti-granulocyte antibodies found in a donor’s transfused blood. Other early transfusion reactions such as transfusion-associated dyspnea, fever and allergic reactions occur in 3-5% of all transfusions and can vary in severity depending on the patient’s condition. These are caused by cytokines, bioactive lipids, free hemoglobin, toxins, foreign antigens, certain drugs, and a number of other inflammatory mediators that accumulate in transfused blood products during storage. Leukoreduction can remove the majority of white cells that can produce new cytokines but cannot eliminate those cytokines already in blood, and cannot otherwise remove other causative agents such as free hemoglobin and antibodies. Automated washing of pRBC is effective but is impractical due to the time, cost, and logistics of washing each unit of blood. The HemoDefend™ platform is a potentially superior alternative to purify blood transfusion products to these methods. The total addressable market for HemoDefend™ is more than $500 million for pRBCs alone.

 

19
 

 

Radiocontrast Removal

 

ContrastSorb is a development-stage blood purification technology that is being optimized for the removal of IV contrast from blood in order to prevent contrast-induced nephropathy (CIN). Contrast-induced nephropathy is the acute loss of renal function within the first 48 hours following IV contrast administration. IV contrast is widely administered to patients undergoing CT scans, to enhance the images and make it easier to identify anatomic structures. IV contrast is also administered during vascular interventional radiology procedures and angiography of blood vessels in the brain, heart, limbs, and other parts of the body to diagnose and treat atherosclerosis (narrowing of blood vessels due to cholesterol deposits), vascular injury, aneurysms, etc. For example, an estimated 10 million coronary angiograms are performed worldwide each year to diagnose and treat coronary artery disease by placing coronary stents, performing balloon angioplasty, or atherectomy (removal of plaque in arteries). Overall, there are an estimated 80 million doses of IV contrast administered worldwide each year, split between approximately 65 million contrast-enhanced CT scans, 10 million coronary angiograms, and 5 million conventional angiograms. There are an estimated 30 million doses administered each year in the U.S. alone. The reported risk of CIN in patients undergoing contrast enhanced CT scans has been reported to be 2-13%. For coronary intervention, the risk has been estimated to be as high as 20-30% in high risk patients with pre-existing renal insufficiency, long-term diabetes, hypertension, congestive heart failure, and older age. The use of low osmolar IV contrast, hydration of patients pre-procedure, orally administration of N-acetylcysteine, and other agents to prevent CIN have demonstrated modest benefit in some clinical studies, but in many cases, the results across studies have been equivocal and inconsistent. In high risk patients, the direct removal of IV contrast from the blood with ContrastSorb to prevent CIN represents a potentially more effective alternative. The worldwide market opportunity for ContrastSorb in this high risk group is approximately $1-2 billion.

 

Drug Removal

 

DrugSorb is a development-stage blood purification technology that is capable of removing a wide variety of drugs and chemicals from blood, as a potential treatment for drug overdose, drug toxicity, toxic chemical exposure, use in high-dose regional chemotherapy, and other applications. It has demonstrated extremely high single pass removal efficiency of a number of different drugs that exceeds the extraction capability of hemodialysis or other filtration technologies. It is similar in action to activated charcoal hemoperfusion cartridges that have been available for many years, but has the advantage of having inherent biocompatibility and hemocompatibility without coatings, and can be easily customized for specific agents.

 

Chronic Kidney Failure

 

The National Kidney Foundation estimates that more than 20 million Americans have chronic kidney disease. Left untreated, chronic kidney disease can ultimately lead to chronic kidney failure, which requires a kidney transplant or chronic dialysis (generally three times per week) to sustain life. There are more than 340,000 patients in the United States currently receiving chronic dialysis and more than 1.5 million worldwide. Approximately 66% of patients with chronic kidney disease are treated with hemodialysis. One of the problems with standard high-flux dialysis is the limited ability to remove certain mid-molecular weight toxins such as b 2 -microglobulin. Over time, b 2 -microglobulin can accumulate and cause amyloidosis in joints and elsewhere in the musculoskeletal system, leading to pain and disability. Our BetaSorb™ device has been designed to remove these mid-molecular weight toxins when used in conjunction with standard dialysis. Standard dialysis care typically involves three sessions per week, averaging approximately 150 sessions per year.

 

20
 

 

Products

 

The polymer adsorbent technology used in our products can remove middle molecular weight toxins, such as cytokines, from blood and physiologic fluids. All of the potential applications described below ( i.e. , the adjunctive treatment and/or prevention of sepsis; the adjunctive treatment and/or prevention of other critical care conditions such as acute respiratory distress syndrome, burn injury, trauma and pancreatitis; the prevention of damage to organs donated by brain-dead donors prior to organ harvest; the prevention of post-operative complications of cardiopulmonary bypass surgery; the prevention of kidney injury from IV contrast; and the treatment of chronic kidney failure) share in common high concentrations of toxins in the circulating blood. However, because of the limited studies we have conducted to date, we are subject to substantial risk that our technology will have little or no effect on the treatment of any of these indications. In 2011 we completed our European Sepsis Trial of our CytoSorb® device. The study was a randomized, open label, controlled clinical study in fourteen (14) sites in Germany of one hundred (100) critically ill patients with predominantly septic shock and respiratory failure. The trial successfully demonstrated CytoSorb®’s ability to reduce circulating levels of key cytokines from whole blood by in treated patients, and that treatment was safe in these critically-ill patients with multiple organ failure. The Company completed the CytoSorb® technical file review with our Notified Body and CytoSorb® subsequently received European Union regulatory approval under the CE Mark as an extracorporeal cytokine filter indicated for use in any clinical situation where cytokines are elevated. Given sufficient and timely financial resources, we intend to continue to commercialize in Europe and conduct additional clinical studies of our products. However, there can be no assurance that we will ever obtain regulatory approval for any other device, or that the CytoSorb® device will be able to generate significant sales.

 

The CytoSorb® Device (Critical Care)

 

APPLICATION: Adjunctive Therapy in the Treatment of Sepsis

 

Sepsis is a potentially life threatening disease defined as a systemic inflammatory response in the presence of a known or suspected infection. Sepsis is mediated by high levels of toxic compounds “cytokines”, which are released into the blood stream as part of the body’s immune response to severe infection or injury. These toxins cause severe inflammation and damage healthy tissues, which can lead to organ dysfunction and failure. Organ failure is the leading cause of death in the ICU. Sepsis is very expensive to treat and has a high mortality rate.

 

Potential Benefits: To the extent our adsorbent blood purification technology is able to prevent or reduce the accumulation of cytokines in the circulating blood, we believe our products may be able to prevent or mitigate severe inflammation, organ dysfunction and failure in sepsis patients. Therapeutic goals as an adjunctive therapy include improved clinical outcome, reduced ICU and total hospitalization time, and reduced hospital costs.

 

Background and Rationale: We believe that the effective treatment of sepsis is the most valuable potential application for our technology. Severe sepsis (sepsis with organ dysfunction) and septic shock (severe sepsis with persistent hypotension despite fluid resuscitation) carries mortality rates of between 28% and 80%. Death can occur within hours or days, depending on many variables, including cause, severity, patient age and co-morbidities. Researchers estimate that there are approximately one million new cases of sepsis in the U.S. each year; and based on estimates by the Sepsis Alliance, the worldwide incidence is estimated to be 27 million cases annually. The incidence of sepsis is also rising due to:

 

1) An aging population;
2) Increased incidence of antibiotic resistance;
3) Increase in co-morbid conditions like cancer and diabetes; and
4) Increased use of indwelling medical devices that are susceptible to infection.

 

In the U.S. alone, treatment of sepsis costs nearly $18 billion annually. According to the Centers for Disease Control, sepsis is a top ten cause of death in the U.S. The incidence of sepsis is believed to be under-reported as the primary infection (i.e., pneumonia, pyelonephritis, etc.) is often cited as the cause of death.

 

An effective treatment for sepsis has been elusive. Pharmaceutical companies have been trying to develop drug therapies to treat the condition. With the exception of Xigris® from Eli Lilly, no other products have been approved in either the U.S. or Europe for the treatment of sepsis. In 2011 after completing a follow up study required by the FDA, it was subsequently determined that Xigris® does not have a statistically significant mortality benefit, and Eli Lilly has withdrawn Xigris® from all markets worldwide.

 

Many medical professionals believe that blood purification for the treatment of sepsis holds tremendous promise. Studies using dialysis and hemofiltration technology have been encouraging, but have only had limited benefit to sepsis patients. The reason for this appears to be rooted in a primary limitation of dialysis technology itself: the inability of standard dialysis to effectively and efficiently remove significant quantities of larger toxins such as cytokines from circulating blood. CytoSorb® has demonstrated the ability to safely reduce key cytokines by in the blood of septic patients with multiple-organ failure in our European Sepsis Trial.

 

21
 

 

CytoSorb®’s ability to interact safely with blood (hemocompatibility) has been demonstrated through ISO 10993 testing, which includes testing for hemocompatibility, biocompatibility, cytotoxicity, genotoxicity, acute sensitivity and complement activation.. CytoSorb use has been considered safe and well-tolerated in approximately 5,500 human treatments to date.

 

CytoSorb® has been designed to achieve broad-spectrum removal of both pro- and anti-inflammatory cytokines, preventing or reducing the accumulation of high concentrations in the bloodstream. This approach is intended to modulate the immune response without causing damage to the immune system. For this reason, researchers have referred to the approach reflected in our technology as ‘immunomodulatory’ therapy.

 

Projected Timeline: In 2011, the CytoSorb® filter received European Union regulatory approval under the CE Mark as an extracorporeal cytokine filter to be used in clinical situations where cytokines are elevated. CytoSorbents’ manufacturing facility has also achieved ISO 13485:2003 Full Quality Systems certification, an internationally recognized quality standard designed to ensure that medical device manufacturers have the necessary comprehensive management systems in place to safely design, develop, manufacture and distribute medical devices in the European Union. The Company is currently manufacturing its CytoSorb® device for commercial sale in the European Union. CytoSorbents is currently selling CytoSorb® in Germany, Austria, and Switzerland with a direct sales force. Based on its CE Mark approval, CytoSorb® can also be sold throughout all 28 countries of the European Union and countries outside the E.U. that will accept European regulatory approval with registration. Overall, CytoSorbents has established either direct sales (as above) or distribution (via distributors or strategic partners) of CytoSorb in 29 countries worldwide. Registration of CytoSorb is typically required in each of these countries prior to active commercialization. With CE Mark approval, this can be typically achieved within several months in E.U. countries. Outside of the E.U., the process is more variable and can take months to more than a year due to different requirements for documentation and clinical data. Variability in the timing of registration affects the initiation of active commercialization in these countries, which affects the timing of expected CytoSorb sales. We actively support all of our distributors and strategic partners in the product registration process. Outside of the E.U., CytoSorb is actively being commercialized in Turkey and India. CytoSorb is registered in Saudi Arabia, but is currently awaiting Saudi FDA approval, a proxy for the rest of the Gulf Cooperation Council (GCC) countries. CytoSorb and its distribution partner in Russia have submitted all requested documentation for registration, and await a response from the Russian authorities. We cannot generally predict the timing of these registrations, and there can be no guarantee that we will ultimately achieve registration in countries where we have established distribution. We also cannot guarantee that we will generate meaningful sales in the countries where we have established registration, due to other factors such as market adoption and reimbursement. The Company is currently actively evaluating other potential distributor and strategic partner networks in other major countries that accept CE Mark approval. With sufficient resources and continued positive clinical data, assuming availability of adequate and timely funding, and continued positive results from our clinical studies, the Company intends to continue its commercialization plans of its product worldwide as well as pursue U.S. clinical trials to seek FDA regulatory approval for CytoSorb® in the United States.

 

APPLICATION: Adjunctive Therapy in Other Critical Care Applications

 

Potential Benefits: Cytokine-mediated organ damage and immune suppression can increase the risk of death and infection in patients with commonly seen critical care illnesses such as acute respiratory distress syndrome, severe burn injury, trauma and pancreatitis. By reducing both pro- and anti-inflammatory cytokines, CytoSorb® has the potential to reduce the systemic inflammatory response and:

 

· prevent or mitigate MODS and/or MOF;
· prevent or reduce secondary infections;
· reduce the need for expensive life-sparing supportive care therapies such as mechanical Ventilation; and
· reduce the need for ICU care, freeing expensive critical care resources, and reducing hospital costs and costs to the healthcare system.

 

22
 

 

Background and Rationale: A shared feature of many life-threatening conditions seen in the ICU is severe inflammation (either sepsis or systemic inflammatory response syndrome) due to an over-reactive immune system and high levels of cytokines that can cause or contribute to organ dysfunction, organ failure and patient death. Examples of such conditions include severe burn injury, trauma, acute respiratory distress syndrome and severe acute pancreatitis. MODS and MOF are common causes of death in these illnesses and mortality is directly correlated with the number of organs involved. There are currently few active therapies to prevent or treat MODS or MOF. If CytoSorb® can reduce direct or indirect cytokine injury of organs, it may mitigate MODS or MOF, improve overall patient outcome and reduce costs of treatment. In addition, secondary infection, such as ventilator-acquired pneumonia, urinary tract infections, or catheter-related line infections, are another major cause of morbidity and mortality in all patients treated in the ICU that increase with longer ICU stay. Prolonged illness, malnutrition, age, multiple interventional procedures, and exposure to antibiotic resistant pathogens are just some of the many risk factors for functional immune suppression and infection. In sepsis and SIRS, the overexpression of pro-inflammatory cytokines can also cause a depletion of immune effector cells through apoptosis and other means, and anti-inflammatory cytokines can cause profound immune suppression, both major risk factors for infection.

 

Projected Timeline: CytoSorb’s E.U. CE Mark approval as an extracorporeal cytokine filter and its broad approved indication to be used in any clinical situation where cytokines are elevated, allows it to be used “on label” in critical care applications such as acute respiratory distress syndrome, severe burn injury, trauma, liver failure, and pancreatitis, and in other conditions where cytokine storm, sepsis and/or SIRS plays a prominent role in disease pathology. Our goal is to stimulate investigator-initiated clinical studies with our device for these applications. Currently, we have more than 40 investigator initiated or company sponsored studies being planned in Germany, Austria, the United Kingdom, India and the U.S. with approximately twelve of which are currently enrolling patients. We have been moving forward in parallel with a program to further understand the potential benefit of CytoSorb® hemoperfusion in these conditions through additional investigational animal studies and potential human pilot studies in the U.S. funded either directly by the company, through grants, or through third-parties. Commencement of these and other formal studies is contingent upon adequate funding and, in the case of U.S. human studies, FDA IDE approval of the respective human trial protocols.

 

APPLICATION: Prevention and treatment of post-operative complications of cardiopulmonary bypass surgery

 

Potential Benefits: If CytoSorb® is able to prevent or reduce high-levels of cytokines, free hemoglobins, and other inflammatory mediators from accumulating in the blood system during and following cardiac surgery, we anticipate that post-operative complications of cardiopulmonary bypass surgery may be able to be prevented or mitigated. The primary goals for this application are to:

 

· reduce ventilator and oxygen therapy requirements;
· reduce post-operative complications such as ARDS, acute kidney injury, post-perfusion syndrome, and the SIRS;
· reduce length of stay in hospital intensive care units; and
· reduce the total cost of patient care.

 

Background and Rationale: Due to the highly invasive nature of cardiopulmonary bypass surgery, high levels of cytokines are produced by the body, triggering severe inflammation. In addition, hemolysis of red blood cells frequently occurs, resulting in the release of free hemoglobin into the bloodstream. These inflammatory mediators can lead to post-operative complications. CytoSorb® is the only cytokine reduction technology approved in the E.U. that can be used intraoperatively in a bypass circuit in a heart-lung machine during cardiopulmonary bypass without the need for another machine. If our products are able to prevent or reduce the accumulation of cytokines or free hemoglobin in a patient’s blood stream, we may be able to prevent or mitigate post-operative complications caused by an excessive or protracted inflammatory response to the surgery. Intra-operative use of CytoSorb® on high risk cardiac surgery patients, where the risk of post-operative complications is the highest, is expected to be the main initial target market. The use of CytoSorb® in the post-operative period to treat post-operative SIRS is another application of the technology.

 

23
 

 

Projected Timeline: We commissioned the University of Pittsburgh to conduct a study to characterize the production of cytokines as a function of the surgical timeline for cardiopulmonary bypass surgery. An observational study of 32 patients was completed, and information was obtained with respect to the onset and duration of cytokine release. Cardiac surgeons and cardiac perfusionists in Germany and Austria have now used CytoSorb® successfully intra-operatively and post-operatively on cardiac surgery patients. This application is also the subject of many planned and enrolling investigator-initiated studies in Germany and Austria.

 

In February 2015, the FDA approved our IDE application to commence a planned U.S. cardiac surgery feasibility study.  This single-arm study in 20 patients and three U.S. clinical sites represents the first part of a larger clinical trial strategy intended to support the U.S. approval of CytoSorb® for intra-operative use during cardiac surgery.

 

The study is designed to evaluate the safety of CytoSorb® when used intra-operatively in a heart-lung machine to reduce plasma free hemoglobin and cytokines in patients undergoing complex cardiac surgery.  The length, complexity and invasiveness of these procedures cause hemolysis and inflammation, leading to high levels of plasma free hemoglobin, cytokines, activated complement, and other substances.  These inflammatory mediators directly correlate with the incidence of serious post-operative complications such as kidney injury and failure.  The goal of CytoSorb® is to actively remove these inflammatory and toxic substances as they are being generated during the surgery and reduce complications.

 

Concurrently, the Company is funding a non-interventional study amongst a broader array of U.S. cardiac surgery centers that will assess adverse event rates (e.g. incidence of acute kidney injury and respiratory failure) and levels of free hemoglobin and other inflammatory mediators in patients undergoing complex cardiac surgery.  These patients will be selected using similar inclusion and exclusion criteria to the feasibility study.  The data from these two studies will help to rapidly validate assumptions in this surgical patient population and help to appropriately power a U.S. pivotal cardiac surgery trial.

 

APPLICATION : Prevention and treatment of organ dysfunction in brain-dead organ donors to increase the number and quality of viable organs harvested from donors

 

Potential Benefits: If CytoSorb® is able to prevent or reduce high-levels of cytokines from accumulating in the bloodstream of brain-dead organ donors, we believe CytoSorb® may be able to mitigate organ dysfunction and failure, which results from severe inflammation following brain-death. The primary goals for this application are:

 

· improving the viability of organs which can be harvested from brain-dead organ donors, and
· increasing the likelihood of organ survival following transplant.

 

Background and Rationale: When brain death occurs, the body responds by generating large quantities of inflammatory cytokines. This process is similar to the systemic inflammatory response syndrome and sepsis. A high percentage of donated organs are never transplanted due to this response, which damages healthy organs and prevents transplant. In addition, inflammation in the donor may damage organs that are harvested and reduce the probability of graft survival following transplant. CytoSorb® treatment in a porcine animal model of brain death demonstrated a reduction in cytokines as well as a preservation of cardiac function compared to untreated controls.

 

There is a shortage of donated organs worldwide, with approximately 100,000 people currently on the waiting list for organ transplants in the United States alone. Because there are an insufficient number of organs donated to satisfy demand, it is vital to maximize the number of viable organs donated, and optimize the probability of organ survival following transplant.

 

Projected Timeline: Studies have been conducted under a $1 million grant from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services. Researchers at the University of Pittsburgh Medical Center and the University of Texas, Houston Medical Center have completed the observational and dosing phases of the project. The results were published in Critical Care Medicine, January 2008. The next phase of this study, the treatment phase, would involve viable donors treated with the CytoSorb® device. In this phase of the project, viable donors will be treated and the survival and function of organs in transplant recipients will be tracked and measured. The treatment phase would be contingent upon further discussion with the FDA and HRSA regarding study design, as well as obtaining additional funding.

 

24
 

 

The HemoDefend™ Blood Purification Technology Platform (Acute and Critical Care)

 

APPLICATION: Reduction of contaminants in the blood supply that can cause transfusion reactions or disease when administering blood and blood products to patients.

 

Potential Benefits: The HemoDefend™ blood purification technology platform is designed to reduce contaminants in the blood supply that can cause transfusion reactions or disease. It is a development stage technology that is not yet approved in any markets, but is comprised of CytoSorbents’ highly advanced, biocompatible, polymer bead technology. If this technology is successfully developed and then incorporated into a regulatory approved product, it could have a number of important benefits, including:

 

· reduce the risk of transfusion reactions and improve patient outcome;
· improve the quality, or extend the shelf life of stored blood products;
· improve the availability of blood and reduce blood shortages by reducing the limitations of donors to donate blood; and
· allow easier processing of blood.

 

Background and Rationale: The HemoDefend™ technology platform was built upon our successes in designing and manufacturing porous polymer beads that can remove cytokines. We have expanded the technology to be able to remove substances as small as drugs and bioactive lipids, to proteins as large as antibodies from blood that can cause transfusion reactions and disease. Although the frequency of these reactions are relatively low (~3-5%), the sheer number of blood transfusions is so large, that the number of transfusion reactions, ranging from mild to life-threatening, is substantial, ranging from several hundreds of thousands to millions of reactions each year. In critically-ill patients, the risk of transfusion reactions is significantly higher than in the general population and can increase the risk of death because their underlying illnesses have depleted protective mechanisms and have primed their bodies to respond more vigorously to transfusion-associated insults.

 

A number of retrospective studies have also suggested that administration of older blood leads to increased adverse events and even increased mortality, compared with blood recently harvested. Biological studies have demonstrated the accumulation of erythrocyte storage lesions that compromise the function and structural integrity of packed red blood cells and have also demonstrated the accumulation of substances during blood storage that can lead to transfusion reactions. There are currently three adult, prospective, randomized, controlled studies, RECESS (completed with top-line data reported), ABLE (completed but no data available), and TRANSFUSE (ongoing) examining the morbidity and mortality in cardiovascular surgery patients, critically ill patients, and critically ill patients, respectively, treated with either “new or fresh” or “older” blood. Top line data from the RECESS Trial was presented at the American Association of Blood Banking conference in October 2014. The RECESS Trial was a randomized, controlled trial in a total of 1,098 evaluable patients undergoing complex cardiac surgery given fresh blood (≤10 days old) vs older blood (≥21 days old). The overall conclusion was that the age of blood had no statistically significant impact on the progression to organ dysfunction (as measured by the multiple organ dysfunction score – MODS) or death. The serious adverse event rate in both new and old blood groups was approximately 50%, which is considered high for this group of patients. There are many details and subgroup analyses that were not discussed, particularly an analysis of those patients receiving more units of blood than average, as the risk of adverse events is cumulative. The outcome of this study and those of ABLE and TRANSFUSE would not alter the current pressing need for better solutions to reduce transfusion-related adverse events and to improve clinical outcome. However, should ABLE OR TRANSFUSE demonstrate that older blood has increased risk, it could result in an increased need for new technologies such as the HemoDefend™ platform.

 

Projected Timeline: The HemoDefend™ platform is a development stage product based on our advanced polymer technology. The base polymer is ISO 10993 biocompatible, meeting standards for biocompatibility, hemocompatibility, cytotoxicity, genotoxicity, acute sensitivity and complement activation. HemoDefend™ has demonstrated the in vitro removal of many different substances from blood such as antibodies, free hemoglobin, cytokines and bioactive lipids. We have also prototyped a number of different implementations of the HemoDefend™ technology, including the “Beads in a Bag” blood treatment blood storage bag, and standard in-line blood filters. The technology has been supported by the National Heart, Lung and Blood Institute, or NHLBI, under a Phase I SBIR contract. We have recently submitted a Phase II SBIR application at the invitation of NHLBI. The Company seeks to out-license this technology to a strategic partner in the transfusion medicine space, but may elect to continue its development in parallel with out-licensing efforts.

 

25
 

 

ContrastSorb (Radiology and Interventional Radiology)

 

APPLICATION: Removal of IV contrast in blood administered during CT imaging, an angiogram, or during a vascular interventional radiology procedure, in order to reduce the risk of contrast-induced nephropathy.

 

Potential Benefits: IV contrast can lead to contrast-induced nephropathy, or CIN, in susceptible patients. Risk factors include chronic kidney disease and renal insufficiency caused by age, diabetes, congestive heart failure, long-standing hypertension, and others co-morbid illnesses. CIN can lead to increased risk of patient morbidity and mortality. Removal of IV contrast by ContrastSorb may

 

· reduce the risk of acute kidney injury
· improve the safety of these procedures and reduce the risk of morbidity and mortality

 

Background and Rationale: Contrast-induced nephropathy is the acute loss of renal function within the first 48 hours following IV contrast administration. IV contrast is widely administered to patients undergoing CT scans, to enhance the images and make it easier to identify anatomic structures. IV contrast is also administered during vascular interventional radiology procedures and angiography of blood vessels in the brain, heart, limbs, and other parts of the body to diagnose and treat atherosclerosis (narrowing of blood vessels due to cholesterol deposits), vascular injury, aneurysms, etc. The reported risk of CIN undergoing contrast enhanced CT scans has been reported to be 2-13%. For coronary intervention, the risk has been estimated to be as high as 20-30% in high risk patients with pre-existing renal insufficiency, and other risk factors. The use of low osmolar IV contrast, hydration of patients pre-procedure, orally administration of N-acetylcysteine, and other agents to prevent CIN have demonstrated modest benefit in some clinical studies, but in many cases, the results across studies have been equivocal and inconsistent. In high risk patients, the direct removal of IV contrast from the blood with ContrastSorb to prevent CIN represents a potentially more effective alternative.

 

Projected Timeline: ContrastSorb has demonstrated the high efficiency single pass removal of IV contrast and is in the process of optimization. The underlying polymer is made of the same ISO 10993 biocompatible polymer as CytoSorb®, but with different structural characteristics. The ContrastSorb device is a hemoperfusion device similar in construction to CytoSorb® and BetaSorb™. Assuming successful optimization of the ContrastSorb polymer, safety and efficacy of IV contrast removal will need to be established in human clinical studies. The Company seeks to out-license this technology to a potential strategic partner.

 

The BetaSorb™ Device (Chronic Care)

 

APPLICATION: Prevention and treatment of health complications caused by the accumulation of metabolic toxins in patients with chronic renal failure

 

Potential Benefits: If BetaSorb™ is able to prevent or reduce high levels of metabolic waste products from accumulating in the blood and tissues of long-term dialysis patients, we anticipate that certain health complications characteristic to these patients can be prevented or mitigated. The primary goals for this application are to

 

· improve and maintain the general health of dialysis patients;
· reduce disability and improve the quality of life of these patients
· reduce the total cost of patient care; and
· increase life expectancy.

 

Background and Rationale: Our BetaSorb™ device is intended for use on patients suffering from chronic kidney failure who rely on long-term dialysis therapy to sustain life. Due to the widely recognized inability of dialysis to remove larger proteins from blood, metabolic waste products, such as beta 2 microglobulin, accumulate to toxic levels and are deposited in the joints and tissues of patients. Specific toxins known to accumulate in these patients have been linked to their severe health complications, increased healthcare costs, and reduced quality of life.

 

26
 

 

Researchers also believe that the accumulation of toxins may play an important role in the significantly reduced life expectancy experienced by dialysis patients. In the U.S., the average life expectancy of a dialysis patient is five years. Industry research has identified links between many of these toxins and poor patient outcomes. If our BetaSorb™ device is able to routinely remove these toxins during dialysis and prevent or reduce their accumulation, we expect our BetaSorb™ device to maintain or improve patient health in the long-term. We believe that by reducing the incidence of health complications, the annual cost of patient care will be reduced and life expectancy increased.

 

The poor health experienced by chronic dialysis patients is illustrated by the fact that in the U.S. alone, more than $20 billion is spent annually caring for this patient population. While the cost of providing dialysis therapy alone is approximately $23,000 per patient per year, the total cost of caring for a patient ranges from $60,000 to more than $120,000 annually due to various health complications associated with dialysis.

 

Projected Timeline: We have collected a significant amount of empirical data for the development of this application. As the developer of this technology, we had to undertake extensive research, as no comparable technology was available for reference purposes. We have completed four human pilot studies, including a clinical pilot of six patients in California for up to 24 weeks in which our BetaSorb™ device removed the targeted toxin, beta 2 -microglobulin, as expected. In total, we have sponsored clinical studies utilizing our BetaSorb™ device on 20 patients involving approximately 345 total treatments. Each study was conducted by a clinic or hospital personnel with CytoSorbents providing technical assistance as requested.

 

As discussed above, due to practical and economic considerations, we are focusing our efforts and resources on commercializing our CytoSorb® device for critical care and cardiac surgery applications. Following commercial introduction of the CytoSorb® device, and with sufficient additional resources, we may continue development of the BetaSorb™ resin and may conduct additional clinical studies using the BetaSorb™ device in the treatment of end stage renal disease patients.

 

Commercial and Research Partners

 

Biocon LTD

 

In September 2013, we entered into a strategic partnership with Biocon Ltd., Asia’s largest biotech company, or Biocon, with an initial Distribution Agreement, or the Distribution Agreement, for India and select emerging markets, under which Biocon has the exclusive commercialization rights for CytoSorb® initially focused on sepsis. Pursuant to the Distribution Agreement, Biocon shall purchase CytoSorb® from us at negotiated prices.  The term of the Distribution Agreement is 36 months from the date that Biocon obtains the first regulatory approval to promote and sell CytoSorb® in the Territory (as defined in the Distribution Agreement).  Either party may terminate the Distribution Agreement upon the occurrence of a material breach or default as to any obligation thereunder by the other party and the failure of the breaching party to (within thirty (30) days after receiving written notice from the non-breaching party) cure such material breach or default, such termination being immediately effective upon the delivery of such notice of termination. After the first twelve months of the Distribution Agreement, either party may terminate such agreement for convenience upon sixty (60) days’ written notice.  The Agreement contains standard representations and warranties of the parties. 

 

On October 30, 2014, the parties entered into the First Amendment to the Distribution Agreement, which, among other things, provided for the extension of the term of the original agreement to September 20, 2017.  Pursuant to the First Amendment, the Biocon partnership was expanded to include all critical care applications and cardiac surgery. In addition, Biocon committed to higher annual minimum purchases of CytoSorb® to maintain distribution exclusivity and committed to conduct and publish results from multiple investigator initiated studies and patient case studies.  Otherwise, the original terms of the Distribution Agreement remain in full force and effect. 

 

Fresenius Medical Care AG

 

In February 2015, the Company entered into a multi-country strategic partnership with Fresenius Medical Care AG & Co KGaA, (or “Fresenius”), to commercialize the CytoSorb® therapy. Under the terms of this agreement, Fresenius has exclusive rights to distribute CytoSorb® for critical care applications in France, Poland, Sweden, Denmark, Norway, and Finland. The partnership will allow Fresenius to offer an innovative and easy way to use blood purification therapy for removing cytokines in patients that are treated in the intensive care unit. To promote the success of CytoSorb®, Fresenius will also engage in the ongoing clinical development of the product. This includes the support and publication of a number of small case series and patient case reports as well as the potential for future larger, clinical collaborations.

 

Fresenius Medical Care is the one of the world's largest, integrated provider of products and services for individuals with chronic kidney failure. Through its network of more than 2,100 dialysis clinics in North America, Europe, Latin America, Asia-Pacific, and Africa, Fresenius Medical Care provides dialysis treatment to hundreds of thousands of patients around the globe. Fresenius Medical Care is also the world's largest provider of dialysis products, such as hemodialysis machines, dialyzers and related disposable products.

 

27
 

 

Separately, in 1999, we entered into an exclusive, long-term agreement with Fresenius Medical Care for the global marketing and distribution of our BetaSorb™ device for the treatment of renal disease. We may or may not pursue our BetaSorb™ product after the commercialization of the CytoSorb® product. At such time as we determine to proceed with our proposed BetaSorb™ product, if ever, we will need to conduct additional clinical studies using the BetaSorb™ device to obtain European or FDA approval.

 

Cardiac Surgery Company

 

In addition, in November 2014, the Company entered into an initial partnership agreement with a leading global medical device company in cardiac surgery and other cardiovascular diseases, to use CytoSorb® intra-operatively during cardiac surgery in France. Under the terms of the agreement, the partnership will commence with an initial six-month market evaluation period to determine various market parameters, to obtain clinical data, and to build key opinion leader support in France. Following a successful evaluation, the parties plan to jointly determine how to expand upon both the size and geographic footprint of its partnership.

 

University of Pittsburgh Medical Center

 

Two government research grants by the National Institutes of Health, or NIH, and Health and Human Services, or HHS, have been awarded to investigators at the University of Pittsburgh to explore the use of adsorbent polymers in the treatment of sepsis and organ transplant preservation. Under “Sub Award Agreements” with the University of Pittsburgh, we have been developing polymers for use in these studies.

 

A grant of $1 million was awarded to the University of Pittsburgh Medical Center in 2003. The project seeks to improve the quantity and viability of organs donated for transplant by using CytoSorb® to detoxify the donor’s blood. The observational and dosing phases of the study, involving 30 viable donors and eight non-viable donors, respectively, have been completed. The next phase of this study, the treatment phase, will involve viable donors. We are not currently focusing our efforts on the commercialization of CytoSorb® for application in organ donors. The treatment phase would be contingent upon further discussion with the FDA and HRSA regarding study design, as well as obtaining additional funding.

 

In addition, in September 2005, the University of Pittsburgh Medical Center was awarded a grant of approximately $7 million from NIH entitled “Systems Engineering of a Pheresis Intervention for Sepsis (SEPsIS)” to study the use of adsorbent polymer technology in the treatment of severe sepsis. The study, which lasted for a total of five years, commenced in September 2005. Under a SubAward Agreement, we worked with researchers at the University of Pittsburgh - Critical Care Medicine Department. We believe that the only polymers used in this study were polymers we have developed specifically for use in the study, which are similar to the polymers used in our devices. Under the SubAward Agreement, for our efforts in support of the grant during 2006 through 2010, we received approximately $402,000.

 

These grants represent a substantial research cost savings to us and demonstrate the strong interest of the medical and scientific communities in our technology.

 

Researchers at UPMC have participated in nearly every major clinical study of potential sepsis intervention during the past twenty years. Drs. Derek Angus and John Kellum were investigators for Eli Lilly’s sepsis drug, Xigris®. Dr. Kellum, a member of the UPMC faculty since 1994, is the Chairman of our Severe Sepsis and Inflammatory Disease Advisory Board. Dr. Kellum’s research interests span various aspects of Critical Care Medicine, but center on critical care nephrology (including acid-base, and renal replacement therapy), sepsis and multi-organ failure, and clinical epidemiology. He is Chairman of the Fellow Research Committee at the University of Pittsburgh Medical Center , has authored more than 300 publications and has received numerous research grants from foundations and industry.

 

28
 

 

DARPA

 

In August 2012, the Company was awarded a $3.8 million, five-year contract by the Defense Advanced Research Projects Agency, or DARPA, for its “Dialysis-Like Therapeutics” program to treat sepsis. DARPA has been instrumental in funding many of the major technological and medical advances since its inception in 1958, including development of the Internet, the global positioning system, or GPS, and robotic surgery. The DLT program in sepsis seeks to develop a therapeutic blood purification device that is capable of identifying the cause of sepsis (e.g. cytokines, toxins, pathogens, activated cells) and remove these substances in an intelligent, automated, and efficient manner. CytoSorbents’ contract is for advanced technology development of its hemocompatible porous polymer technologies to remove cytokines and a number of pathogen and biowarfare toxins from blood. CytoSorbents is in Year 3 of the program and is currently working with the systems integrator, Battelle Laboratories, and its subcontractor NxStage Medical, who are responsible for integrating the technology developed by CytoSorbents and others into a final medical device design prototype, and evaluating this device in septic animals and eventually in human clinical trials in sepsis. CytoSorbents’ work is supported by DARPA and SSC Pacific under Contract No. N66001-12-C-4199. As of December 31, 2014, we have received approximately $2,818,000 to date and have approximately $1,007,000 not yet billed under this contract.

 

United States Army

 

In September 2012 CytoSorbents was awarded a Phase II SBIR (Small Business Innovation Research) contract by the US Army Medical Research and Materiel Command to evaluate our technology for the treatment of trauma and burn injury in large animal models. In 2013, we finalized the Phase II SBIR contract whjch provided for a maximum funding of approximately $753,000 with the granting agency. This work is supported by the U.S. Army Medical Research and Material Command under an amendment to Contract W81XWH-12-C-0038. As of December 31, 2014, the Company received approximately $649,000 in funding under this contract and no further amounts are expected under this contract.

 

National Heart, Lung, and Blood Institute

 

In September 2013, the National Heart, Lung, and Blood Institute, or NHLBI, a division of the National Institutes of Health (“NIH”), awarded the Company a Phase I SBIR (Small Business Innovation Research) contract valued at $203,351 to further advance its HemoDefend™ blood purification technology for packed red blood cell, or pRBC, transfusions. The University of Dartmouth collaborated with us as a subcontractor on the project, entitled “Elimination of blood contaminants from pRBCs using HemoDefend™ hemocompatible porous polymer beads. The overall goal of this program is to reduce the risk of potential side effects of blood transfusions, and help to extend the useful life of pRBCs. As of December 31, 2014, we completed the Phase I program and have been invited to apply for the Phase II SBIR, which has now been submitted.

 

Advisory Boards

 

From time to time our management meets with scientific advisors who sit on our Scientific Advisory Board, our Medical Advisory Board – Critical Care Medicine, our Medical Advisory Board – Chronic Kidney Failure / Dialysis and our Scientific Advisory Board – Cardiac Surgery.

 

Our Scientific Advisory Board consists of three scientists with expertise in the fields of fundamental chemical research, and polymer research and development.

 

Our Sepsis Advisory Board consists of four medical doctors, one of whom is affiliated with UPMC, with expertise in critical care medicine, sepsis, multi-organ failure and related clinical study design.

 

Our Trauma Advisory Board consists of four medical doctors with expertise in trauma, burn injury and critical care medicine.

 

Our Cardiac Surgery Advisory Board consists of seven medical doctors with experience in cardiac surgery and complications caused by inflammation generated by the surgery.

 

29
 

 

We compensate members of our Advisory Boards at the rate of $2,000 for each full-day meeting they attend in person; $1,200 if attendance is by telephone. When we consult with members of our Advisory Board (whether in person or by telephone) for a period of less than one day, we compensate them at the rate of $200 per hour. We also reimburse members of our Advisory Boards for their travel expenses for attending our meetings.

 

Royalty Agreements

 

With Principal Stockholder

 

In August 2003, in order to induce Guillermina Vega Montiel, a principal stockholder of ours at the time, to make a $4 million investment in the Company, we granted Ms. Montiel a perpetual royalty equal to three percent of all gross revenues received by us from sales of CytoSorb® in the applications of sepsis, cardiopulmonary bypass surgery, organ donor, chemotherapy and inflammation control. In addition, for her investment, Ms. Montiel received 1,230,770 membership units of the Company, which at the time was a limited liability company. Those membership units ultimately became 7,420 shares of our Common Stock following our June 30, 2006 merger. For the year ended December 31, 2014 the Company has recorded royalty costs of approximately $93,000.

 

With Purolite

 

In 2003, Purolite filed a lawsuit against us asserting, among other things, co-ownership and co-inventorship of certain of our patents. On September 1, 2006, the United States District Court for the Eastern District of Pennsylvania approved a Stipulated Order and Settlement Agreement under which we and Purolite agreed to the settlement of the action. The Settlement Agreement provides us with the exclusive right to use our patented technology and proprietary know how relating to adsorbent polymers for a period of 18 years. In particular, the Settlement Agreement relates to several of our issued patents and several of our pending patent applications covering our biocompatible polymeric resins, our methods of producing these polymers, and the methods of using the polymers to remove impurities from physiological fluids, such as blood.

 

Under the terms of the Settlement Agreement, we have agreed to pay Purolite royalties of 2.5% to 5% on the sale of those of our products, if and when those products are sold commercially, that are used in direct contact with blood. However, if the first product we offer for commercial sale is a biocompatible polymer to be used in direct contact with a physiological fluid other than blood, royalties will be payable with respect to that product as well. The royalty payments provided for under the Settlement Agreement would apply to our currently envisioned CytoSorb® and BetaSorb™ products. For the year ended December 31, 2014 per the terms of the license agreement the Company has recorded royalty costs of approximately $77,000.

 

Following the expiration of the eighteen year term of the Settlement Agreement, the patents and patent applications that are the subject of the Settlement Agreement should have expired under current patent laws, and the technology claimed in them will be available to the public. However, following such time, we would continue to exclusively own any confidential and proprietary know how.

 

Product Payment & Reimbursement

 

CytoSorb®

 

Europe

 

Payment for our CytoSorb® device for the removal of cytokines in patients with life-threatening illnesses is country dependent in Europe. We are initially marketing the device in Germany where a path for separate CytoSorb® reimbursement has been established. Reimbursement can also be covered by the standard “diagnosis related group” (DRG) acute care reimbursement. Under this system, hospitals would purchase CytoSorb® and subtract the cost from a pre-determined lump-sum payment made by the payor to the hospital based on the patient’s diagnosis. If we continue to gain traction of the CytoSorb® device into the German market we intend to apply for reimbursement in France, England, Italy and Spain representing the other four economic leaders in Europe and introduce our products in those countries accordingly. Reimbursement is specific to each country. There can be no assurances that reimbursement will be granted or that additional clinical data may not be required to establish reimbursement.

 

30
 

 

United States

 

We have not yet sought reimbursement for the CytoSorb® device in the United States, but expect to in the future. As in Germany, payment for our CytoSorb® device in the US for the treatment and prevention of sepsis and other related acute care applications is initially anticipated to fall under the DRG in-patient reimbursement system, which is currently the predominant basis of hospital medical billing in the United States. Under this system, predetermined payment amounts are assigned to categories of medical patients with respect to their treatments at medical facilities based on the DRG that they fall within (which is a function of such characteristics as medical condition, age, sex, etc.) and the length of time spent by the patient at the facility. Reimbursement is not determined by the actual procedures used in the treatment of these patients, and a separate reimbursement decision would not be required to be made by Medicare, the HMO or other provider of medical benefits in connection with the actual method used to treat the patient.

 

Critical care applications such as those targeted by our CytoSorb® device involve a high mortality rate and extended hospitalization, coupled with extremely expensive ICU time. In view of these high costs and high mortality rates, we believe acceptance of our proprietary technology by critical care practitioners and hospital administrators will primarily depend on safety and efficacy factors rather than solely based on cost.

 

Competition

 

General

 

We believe that our products represent a unique approach to disease states and health complications associated with the presence of larger toxins (often referred to as middle molecular weight toxins) in the bloodstream, including sepsis, acute respiratory distress syndrome, trauma, severe burn injury, pancreatitis, post-operative complications of cardiac surgery, damage to organs donated for transplant prior to organ harvest, and renal disease. Researchers have explored the potential of using existing membrane-based dialysis technology to treat patients suffering from sepsis. These techniques are unable to effectively remove the middle molecular weight toxins. We have demonstrated the statistically significant reduction of a number of key cytokines by CytoSorb® on the order of 30-50% in human patients with predominantly septic shock and acute respiratory distress syndrome. In a post-hoc subgroup analysis of our European Sepsis Trial, we have also demonstrated statistically significant improvements in mortality in patients at high risk of death, including patients with either very high cytokine levels or patients older than age 65, both of which have a high predicted mortality.

 

The CytoSorb®, DrugSorb, ContrastSorb, and BetaSorb™ devices consist of a cartridge containing adsorbent polymer beads. The cartridge incorporates industry standard connectors at either end of the device which connect directly to an extra-corporeal circuit (bloodlines) on a standalone basis. The extra-corporeal circuit consists of plastic tubing through which the blood flows, our cartridge containing our adsorbent polymer beads, pressure monitoring gauges, and a blood pump to maintain blood flow. The patient’s blood is accessed through a catheter inserted into his or her veins. The catheter is connected to the extra-corporeal circuit and the blood pump draws blood from the patient, pumps it through the cartridge and returns it back to the patient in a closed loop system. As blood passes over the polymer beads in the cartridge, toxins are adsorbed from the blood, without removing any fluids from the blood or the need for replacement fluid or dialysate.

 

There are three common forms of blood purification, including hemodialysis, hemofiltration, and hemoperfusion. All modes are generally supported by standard hemodialysis machines. All take blood out of the body to remove toxins and unwanted substances from blood, and utilize extracorporeal circuits and blood pumps. Dialysis and hemofiltration remove substances from blood by diffusion and ultrafiltration, respectively, through a semi-permeable membrane, allowing the passage of certain sized molecules across the membrane, but preventing the passage of other, larger molecules. Hemoperfusion utilizes solid or porous sorbents to remove things based on pore capture and surface adsorption, not filtration.

 

31
 

 

CytoSorb® is a hemoperfusion cartridge, using an adsorbent of specified pore size, which controls the size of the molecules which can pass into the adsorbent and vastly increases the area available for surface adsorption. As blood flows over our polymer adsorbent, middle molecules such as cytokines flow into the polymer adsorbent and are adsorbed. Our devices do not use semipermeable membranes or dialysate. In addition, our devices do not remove fluids from the blood like hemodialysis or hemofiltration. Accordingly, we believe that our technology has significant advantages as compared to traditional dialysis techniques, including ease of use.

 

CytoSorbents’ HemoDefend™ platform is a development-stage technology utilizing a mixture of proprietary porous polymer beads that target the removal of contaminants that can cause transfusion reactions or cause disease in patients receiving transfused blood products. The HemoDefend™ beads can be used in multiple configurations, including the common in-line filter between the blood bag and the patient as well as a unique, patent-pending “Beads in a Bag” treatment configuration, where the beads are placed directly into a blood storage bag.

 

Sepsis

 

Researchers have explored the potential of using existing membrane-based dialysis technologies to treat patients suffering from sepsis. These techniques are unable to effectively remove middle molecular weight toxins, which leading researchers have shown to cause and complicate sepsis. The same experts believe that a blood purification technique that efficiently removes, or significantly reduces, the circulating concentrations of such toxins might represent a successful therapeutic option. CytoSorb® has demonstrated the ability to remove middle molecular weight toxins, such as cytokines, from circulating blood in a statistically significant manner.

 

Medical research during the past two decades has focused on drug interventions aimed at chemically blocking or suppressing the function of one or two inflammatory agents. In hindsight, some researchers now believe this approach has little chance of significantly improving patient outcomes because of the complex pathways and multiple chemical factors at play. Clinical studies of these drug therapies have been largely unsuccessful. An Eli Lilly drug, Xigris®, cleared by the FDA in November 2001, is the first and only drug to be approved for the treatment of severe sepsis. Clinical studies demonstrated that use of Xigris® resulted in an average absolute 6% reduction in 28-day mortality, and an absolute 13% reduction in 28-day mortality in the most severe sepsis patients. The drug remains controversial and is considered expensive when compared to the percentage of patients who benefit. In 2011 after completing a follow up study required by the FDA, it was subsequently determined that Xigris® does not have a statistically significant mortality benefit, and in October 2011, Eli Lilly withdrew Xigris® from all markets worldwide.

 

Development of most other experimental therapies has been discontinued, including Eritoran from Eisai, CytoFab from BTG/Astra Zeneca, Talactoferrin from Agennix, and others. Currently, there are two late stage trials ongoing. In November 2012, an 800 patient Phase III randomized controlled study began for Recomodulin (ART 123, Artisan/Asahi Kasei), a recombinant human thrombomodulin, for the treatment of septic patients with coagulopathy. In mid-2013, following an interim analysis of safety data, the Data Safety Monitoring Board (DSMB) recommended that the trial continue. The primary completion date of the trial is expected to be March 2015. Recomodulin has been approved in Japan since 2009 for the treatment of disseminated intravascular coagulation (DIC), a late complication of sepsis, at a cost of $5,800 per treatment. Although it has other activity, it works primarily by a similar anticoagulant mechanism to Xigris. Because of this, it has only demonstrated a limited mortality benefit (~9%: 34.6% control vs 26% treatment), similar to that seen in Xigris’ initial PROWESS Trial (~6%: 31% control vs 25% treatment) and is unlikely to have greater benefit in larger scale studies.

 

Using a medical device to treat sepsis remains a relatively novel treatment approach. Toray Industries currently markets an endotoxin removal cartridge called Toraymyxin™ for the treatment of sepsis in Europe, Japan, and 16 other countries, but is not yet approved in the United States. To date, it has been used in more than 100,000 treatments since 1994. Toraymyxin does not directly reduce cytokines. Spectral Medical Inc has obtained exclusive development and commercial rights in the U.S. for Toraymyxin, with plans to combine the use of its endotoxin activity assay to create a theranostic product. Spectral is collaborating with Toray on the EUPHRATES trial, combining an endotoxin assay with extracorporeal endotoxin removal by Toraymyxin, a polymyxin-B immobilized polystyrene fiber cartridge. The study began in June 2010 and is still enrolling patients. Endotoxemia is a result of Gram negative sepsis, which only accounts for 45% of cases of sepsis. It is a potent stimulator of cytokine storm. However, all anti-endotoxin strategies have failed pivotal studies to date, believed to be the result of intervening too late in the sepsis cascade. The original trial was designed as a randomized control trial in 360 patients with septic shock and high endotoxin levels (≥ 0.60 EAA units) as confirmed by Spectral’s Endotoxin Activity Assay (EAA). In a second interim analysis finalized in April 2014, following the enrollment of 184 patients with 28-day follow-up, the DSMB recommended that the trial continue. However, the expected trial size was increased to 650 patients and the exclusion criteria was modified to only accept sicker patients with a MODS (multiple organ dysfunction syndrome) score greater than 9. As of January 31, 2015, the trial has randomized 325 patients. An interim analysis is expected in Q4 2015. Because of the lack of available therapies, there remains a significant medical need for improved treatments for sepsis.

 

32
 

 

Toray also markets its Hemofeel CH1.0 polymethylmethacrylate membrane (PMMA) in Japan and it has been used in several non-controlled, or historically controlled, clinical or case studies treating patients with sepsis, acute respiratory distress syndrome and pancreatitis. We are not aware of any prospective, randomized controlled studies using this PMMA hemofilter in patients with sepsis. Without such studies, it is difficult to assess the true impact of this technology in these conditions. Gambro AB launched its Prismaflex eXeed system in August 2009 and introduced the SepteX high molecular weight cutoff hemodialyzer in Europe, intended to treat patients with acute renal failure and the removal of inflammatory mediators from blood. It is not specifically approved for the treatment of sepsis. In September 2013, Baxter International, Inc acquired Gambro AB. Fresenius has launched a similar high molecular weight cut off filter called the Ultraflux EMiC2. To our knowledge, there has been a lack of published data on the treatment of sepsis with these devices. Bellco S.R.L. also sells the CPFA (coupled plasma filtration and adsorption) system in Europe. This uses a sorbent cartridge to remove cytokines from plasma. However, because the sorbent cannot treat blood directly, it requires the cost and complexity of an additional plasma separator to treat blood. This system is similar to the I.M.P.A.C.T. System being currently commercialized outside of the US by Hemolife Medical Inc., that requires a 3 cartridge system and a proprietary blood pump. According to Hemolife, the product is in product registration in 32 countries with initial shipments to the EU and Asia Pacific in process. We believe that CytoSorb®, which can treat whole blood directly, and which works with standard hemodialysis pumps already found in hospitals worldwide, has significant competitive advantages compared to these multi-cartridge sorbent systems.

 

Kaneka Corporation currently markets Lixelle™, a modified porous cellulosic bead, for the removal of beta 2 –microglobulin during hemodialysis in Japan. Lixelle has been used in several small human pilot studies including a 5 patient pilot study in 2002 and a 4 patient pilot study in 2009. Though these studies correlate Lixelle use with cytokine reduction, they are not randomized, controlled studies and so do not control for natural cytokine clearance. To our knowledge, no large, randomized, controlled trials have been conducted with Lixelle as a treatment for sepsis. Kaneka has since developed a modified cellulosic resin called CTR that can also remove cytokines from experimental pre-clinical systems. In 2009, CTR was used in an 18-patient randomized, controlled trial in patients with septic shock with undisclosed improvements in APACHE II scores and IL-6 and IL-8. To our knowledge, Kaneka has not conducted or published any other study using CTR to treat human sepsis patients since then. Ube Industries, LTD is currently developing an adsorbent resin called CF-X for the removal of cytokines. To our knowledge, Ube has not published any study using CF-X to treat human sepsis patients. CytoPherx Inc., has developed an extracorporeal system based on selective cytapheresis, or the inactivation or removal of activated leukocytes. It was enrolling a 344 patient pivotal trial that began in August 2011 and was expected to be completed by December 2014 in patients with acute kidney injury with or without severe sepsis, on continuous renal replacement therapy with the goal of reducing mortality. This system does not remove cytokines directly, but attempts to reduce the numbers of activated white blood cells that can produce cytokines or cause cell-mediated injury. The status of the trial and the company is unknown. ExThera Medical Corporation is a privately held company that has developed its Seraph™ (Selective Removal by Apheresis) platform that consists of heparin coated, solid polyethylene beads. Heparin has the ability to bind some, but not all viruses, bacteria, toxins and cytokines. In in vitro studies using 1 mL of human septic blood, there was no statistically different change in IL-6 or Interferon-gamma compared to control, but effected a ~50% reduction in TNF-alpha. This inability to remove a broad range of cytokines will likely limit its efficacy as a treatment in sepsis. It has repositioned Seraph™ as a pathogen removal technology, and plans to conduct a human trial in Germany in the future. In addition, it has partnered with BioBridge Global to apply its technology to pathogen reduction in transfused blood products. Other potential competitors include the now defunct Arbios Systems, Inc. and Hemocleanse Technologies, LLC. We believe our CytoSorb® cartridge has significant competitive, technological, and economic advantages over systems by these other companies.

 

33
 

 

Acute Respiratory Distress Syndrome (ARDS)

 

Treatment of ARDS is predominantly supportive care using supplemental oxygen, careful fluid management and multiple modes of ventilation incorporating the concepts of low tidal volume, high frequency oscillation, and prone ventilation. Corticosteroids, nitric oxide, statins, non-steroidal anti-inflammatory drugs, and surfactant therapy have been tried, but are not indicated for the treatment of ARDS. We are not aware of any specific products approved to treat ARDS.

 

Severe Burn Injury

 

Modern management of severe burn injury patients involves a combination of therapies. From a burn standpoint, patients undergo active escharotomy and debridement of burns, the use of skin grafts and substitutes, anti-microbial dressings and negative pressure dressings. Tight fluid control, nutrition, prevention of hypothermia and infection are also priorities. Smoke and chemical inhalation injury in burn victims is also common and increasing as a cause of death in severe burn injury. Carbon monoxide and cyanide poisoning is also an issue. Supplemental oxygen and mechanical ventilation are often required and are the mainstay of supportive care treatment. Recently continuous renal replacement therapy has been used to treat patients with acute kidney injury with an improvement in survival compared to a historical control cohort. We believe CytoSorb® therapy may yield improved results. We are not aware of any specific products approved to directly address inhalational lung injury or multiple organ failure in severe burn injury.

 

Trauma

 

Trauma management initially involves respiratory, hemodynamic and physical stabilization of the patient. However, in the days to weeks that ensue, the focus shifts to preventing or treating organ failure and preventing or treating infection. We are not aware of any specific therapies to prevent or treat multiple organ dysfunction or multiple organ failure in trauma. Rhabdomyolysis, or the breakdown of muscle fibers due to crush injury or other means, occurs in trauma and can lead to acute kidney injury or renal failure. Aggressive hydration, urine alkalinization, and forced diuresis are the main therapies to prevent renal injury. Continuous hemodiafiltration with super-high-flux membranes has demonstrated modest myoglobin clearance but was associated with albumin loss. In general, however, most extracorporeal therapies are not well-suited to remove myoglobin. We have developed a polymer resin that removes myoglobin efficiently without major losses of albumin. The US Army Medical Research and Materiel Command has funded the development of our polymer resins to treat trauma and rhabdomyolysis under a Phase I and Phase II SBIR grant awarded to CytoSorbents in December 2011 and September 2012, respectively. The US Air Force is also currently funding a 30 patient human pilot study to treat trauma and rhabdomyolysis patients with CytoSorb.

 

Severe Acute Pancreatitis

 

Treatment of severe acute pancreatitis is predominantly supportive care focused on aggressive hydration, enteral nutrition and pain control. Mechanical ventilation, hemodialysis and vasopressor use is common in cases of multiple organ failure. In cases where cholelithiasis or other obstruction is the underlying cause of the pancreatitis, endoscopic retrograde cholangiopancreatography and/or stent placement can be used to relieve the obstruction. Antibiotics are often instituted to prevent or treat infection. Surgery is sometimes indicated to remove or drain necrotic or infected portions of the pancreas. To our knowledge, there are no other specific treatments approved to treat severe acute pancreatitis or multiple organ failure that is caused by systemic inflammation in this disease.

 

Cardiopulmonary Bypass Surgery

 

There is currently a pre-existing market for the use of leukocyte reduction filters sold by Pall Corporation, Terumo Medical Corporation and others in the cardiopulmonary bypass circuit. The purpose of these devices is to reduce cytokine-producing white blood cells from blood. They do not remove cytokines directly and are not considered by many to be an effective solution for cytokine reduction. We are not aware of any practical competitive approaches for removing cytokines in CPB patients. To our knowledge, CytoSorb® is the only cytokine reduction therapy capable of being placed directly into a bypass circuit in the heart-lung machine and used during cardiopulmonary bypass without the need for another pump. Modified ultrafiltration is sometimes used after termination of cardiopulmonary bypass in cardiac surgery to remove excess fluid and inflammatory substances, but has had mixed benefit. Alternative therapies such as “off-pump” surgeries are available but “post-bypass” syndrome and cytokine production still remain a problem in this less invasive, but more technically challenging procedure. If successful, CytoSorb® is expected to be useful in both on-pump and off-pump procedures.

 

34
 

 

Radiocontrast Removal

 

ContrastSorb has demonstrated the rapid, high efficiency single pass removal of IV contrast. The use of low osmolar IV contrast, oral administration of N-acetylcysteine, and other agents to prevent CIN have demonstrated modest benefit in some clinical studies, but in many cases, the results across studies have been equivocal and inconsistent. Hydration of high risk patients pre-procedure is standard of care but has limited efficacy. PLC Medical Systems, Inc, received CE Mark approval for its RenalGuard system in 2007. RenalGuard encourages excretion of IV contrast and a reduction of CIN, by administering IV hydration that matches urine output in patients receiving a loop diuretic. Hemodialysis can remove IV contrast, but is relatively slow (46% at 1 hour, 65% at 2 hours, 75 % at 3 hours) in chronic renal failure patients who lack normal renal clearance. In high risk patients, the rapid and direct removal of IV contrast from the blood with ContrastSorb to prevent CIN represents a potentially more effective alternative.

 

Chronic Dialysis

 

Although standard dialysis treatment effectively removes urea and creatinine from the blood stream (which are normally filtered by functioning kidneys), standard dialysis has not been effective in removing beta 2 -microglobulin toxins from the blood of patients suffering from chronic kidney failure. High flux dialyzers by Gambro, Fresenius, Nephros and others are capable of removing some beta 2 -microglobulin. However, we believe our technology would significantly improve clearance of this and other toxins. Kaneka markets Lixelle™, a cellulosic resin, outside the US to remove beta 2 -microglobulin in dialysis patients. In March 2015, Lixelle received Humanitarian Device Exemption (HDE) approval in the U.S. for the treatment of beta-amyloidosis and removal of beta 2 -microglobulin, a complication of chronic dialysis. HDE approval applies to the treatment of diseases with an incidence of less than 4,000 cases a year in the U.S. annually. We know of no other device, medication or therapy considered directly competitive with our technology.

 

Treatment of Organ Dysfunction in Brain-Dead Organ Donors

 

We are not aware of any directly competitive products to address the application of our technology for the mitigation of organ dysfunction and failure resulting from severe inflammation following brain-death.

 

HemoDefend™ Purification Technology Platform for Transfused Blood Products

 

There are only a few directly competitive approved products to address the removal of substances from blood and blood products that can cause transfusion reactions. Leukoreduction (Pall Corporation, Terumo-BCT, Hemerus Corporation, others) is widely used in transfusion medicine and can remove the majority of white cells that can produce new cytokines but cannot eliminate those cytokines already in blood, and cannot otherwise remove other causative agents. Automated washing of pRBC is very effective at cleansing contaminants from blood, but is impractical due to the time, cost, materials, and logistics of washing each unit of blood and is not widely used. Blood filters that utilize affinity technologies are in development to remove certain substances such as antibodies from blood, but have other issues, such as cost and concern about the stability or leachability of the affinity technology. The HemoDefend™ platform represents a potentially superior alternative to these methods, as it can provide comprehensive removal of a wide variety of contaminants that can trigger transfusion reactions without washing blood, requires no additional equipment, energy source, or manipulation, and can be incorporated directly into the blood storage bag or used as an in-line blood filter.

 

35
 

 

Clinical Studies

 

Our first clinical studies were conducted in patients with chronic renal failure. The health of these patients is challenged by high levels of toxins circulating in their blood but, unlike sepsis patients, they are not at imminent risk of death. The toxins involved in chronic renal failure are generally different from those involved in sepsis, eroding health gradually over time. The treatment of patients with chronic renal failure is a significant target market for us, although not the current focus of our efforts and resources. Our clinical studies and product development work in this application functioned as a low risk method of evaluating the safety of the technology in a clinical setting, with direct benefit to the development of the critical care applications on which we are now focusing our efforts.

 

The Company is focusing its research efforts on critical care and cardiac surgery applications of its technology.

 

Sepsis

 

In 2011, the CytoSorb® filter received European Union regulatory approval under the CE Mark as an extracorporeal cytokine filter to be used in clinical situations where cytokines are elevated. As part of the CE Mark approval process, we completed our randomized, controlled, European Sepsis Trial amongst fourteen trial sites in Germany, with enrollment of one hundred (100) patients with sepsis and respiratory failure. The purpose of the trial was to demonstrate safety and the broad reduction of key cytokines such as IL-6 in critically-ill patients. Taking into account all 100 patients, the treatment was well-tolerated and considered safe in more than 300 human treatments in the trial. Although the trial was not powered to demonstrate significant reduction in other clinical endpoints such as mortality, these were also included as secondary and exploratory endpoints in the trial.

 

The first 22 patients in the study represented a sepsis pilot study. In the next 31 patients, a compromise of the manual randomization schedule at two trial sites led to an imbalance in the severity of illness between the control and treatment patient groups of the study. After a thorough review, the Scientific Advisory Board (SAB) and the independent Data Safety Monitoring Board (DSMB) both recommended that due to this enrollment bias, these 31 patients should only be used for safety evaluation purposes and that new patients should be enrolled into the trial using electronic web-based randomization to randomly assign patients into either the control or treatment arms.

 

Excluding four patients that withdrew, the remaining forty three (43) patients enrolled under electronic randomization were relatively balanced in terms of the severity of illness in treatment and control patients, confirming the findings of the SAB and DSMB. An independent CRO, RCRI, Inc., analyzed these forty three (43) patients the European Sepsis Trial and showed on a statistically significant basis (p<0.05), CytoSorb®’s ability to reduce circulating levels of key cytokines from whole blood in treated patients on the average of 30-50% over the 7 day treatment period. Additionally, post-hoc subgroup analyses of the clinical outcome data from patients enrolled under electronic randomization demonstrated statistically significant reduction in mortality in patients at high risk of death in sepsis, specifically in patients with:

 

· Very high cytokine levels (IL-6 ≥ 1,000 pg/mL and/or IL-1ra ≥ 16,000 pg/mL) where 28-day mortality was 0% treated vs 63% control, p=0.03, n=14, and
· Age ≥ 65 (14-day mortality: 0% treated vs 36% control, p=0.04, n=21).

 

In patients aged ≥ 65 years old, however, seven days of treatment with CytoSorb® was not adequate to extend the observed 14-day mortality benefit out to 28-days (40% vs 45% control, p=0.6, n=21). These critically ill patients carried two major mortality risk factors: multiple organ failure and age ≥ 65 years old, which itself confers a 2.3-fold relative risk of death. Treatment of life-threatening infections with antibiotics often requires 7-14 days of treatment. We hypothesize that treatment of the “run-away” immune response should mirror treatment with antibiotics. We are currently conducting a dose ranging study (“Dosing Study”) in Germany amongst eight clinical trial sites to evaluate the safety and efficacy of CytoSorb® when used continuously for 7 days. Patients are being stratified for age, cytokine levels, and co-morbid illnesses in this matched pairs analysis. Data from this Dosing study are intended to help clinicians with additional treatment options for CytoSorb®, help support the positive clinical data from the Company’s first European Sepsis Trial, and help shape the trial protocol for a U.S. based pivotal study. The Dosing study is not powered to look at effects on mortality. We are also considering an extension to this study where treatment is performed for 6 hours per day for more than 7 days.

 

36
 

 

At the end of 2013, we reported a clinical update on the first 28 treated patients that were enrolled in the first arm of the Dosing study (24 hours of treatment for 7 days, each day with a new device). Treatment was safe and well-tolerated at flow rates up to 300 mL/min, with no serious device related adverse events. 24-hour treatment increased platelet reduction compared to 6-hour treatment in the EST, but with no reported complications. Broad spectrum antibiotics, such as the carbapenem class, were compatible with CytoSorb®, requiring only modest dose adjustments. IL-6 reduction continued throughout the entire 24-hour period, higher at the beginning of treatment when IL-6 levels are highest, and with an overall average instantaneous IL-6 reduction of 8% per pass. In this preliminary analysis, the overall 28-day all-cause mortality and 28-day all-cause mortality in patients 65 years and older was not statistically different from the treatment data reported in the EST (electronic randomized cohort). Severity of illness in the overall treatment groups were comparably high, with 50% or more of the treated patients (dosing > EST) having an APACHE II severity of illness score > 25 at the time of enrollment, predicting very high mortality of 55% or more. In comparison, the overall control patients reported in the EST (electronic randomization cohort) had a lower severity of illness with only 20% having an APACHE 2 score > 25. The Company expects to complete this study and conduct statistical analyses based on the matched pairs design in 2015.

 

In 2007, CytoSorbents received FDA approval of its investigational device exemption (IDE) application to run a single center sepsis study in the United States. The Company has since generated safety data in approximately 500 human treatments in patients with septic shock and multiple organ failure in its European Sepsis Trial and Dosing study. Assuming availability of adequate and timely funding, and continued positive results from our clinical studies, the Company intends to continue commercializing its product in Europe while pursuing pivotal sepsis studies in the E.U.

 

Cardiac Surgery

 

 In February 2015, the FDA approved the Company’s Investigational Device Exemption (IDE) application to commence a planned U.S. cardiac surgery feasibility study.  This single-arm study in 20 patients and three U.S. clinical sites represents the first part of a larger clinical trial strategy intended to support the U.S. approval of CytoSorb® for intra-operative use during cardiac surgery.

 

The study is designed to evaluate the safety of CytoSorb® when used intra-operatively in a heart-lung machine to reduce plasma free hemoglobin and cytokines in patients undergoing complex cardiac surgery.  The length, complexity and invasiveness of these procedures cause hemolysis and inflammation, leading to high levels of plasma free hemoglobin, cytokines, activated complement, and other substances.  These inflammatory mediators directly correlate with the incidence of serious post-operative complications such as kidney injury and failure.  The goal of CytoSorb® is to actively remove these inflammatory and toxic substances as they are being generated during the surgery and reduce complications.

 

Concurrently, the Company is funding a non-interventional study amongst a broader array of U.S. cardiac surgery centers that will assess adverse event rates (e.g. incidence of acute kidney injury and respiratory failure) and levels of free hemoglobin and other inflammatory mediators in patients undergoing complex cardiac surgery.  These patients will be selected using similar inclusion and exclusion criteria to the feasibility study.  The data from these two studies will help to rapidly validate assumptions in this surgical patient population and help to appropriately power a U.S. pivotal cardiac surgery trial.

 

Trauma

 

In June 2013, we announced that the U.S. Air Force will fund a 30 patient, single site, randomized controlled human pilot study in the United States amongst trauma patients with rhabdomyolysis most commonly associated with trauma. The primary endpoint is myoglobin removal. The FDA approved our Investigational Device Exemption (IDE) application for this study and we also received ethics committee approval, allowing the study to commence. However, because of the stringency of our inclusion criteria, and because of the patient mix seen at our single center, we have experienced difficulty in enrolling patients. We have subsequently modified one of the key inclusion criteria and have expanded the number of clinical trial sites to three in a revised protocol which has been submitted to the FDA.

 

37
 

 

Other Critical Care Applications

 

There are currently more than 40 ongoing investigator initiated studies being planned or enrolling in Germany, Austria and the United Kingdom. These trials, which are funded and supported by renowned university hospitals and key opinion leaders, will provide invaluable information regarding the success of the device in the treatment of sepsis, cardiac surgery, trauma, burn injury, pancreatitis, liver failure, acute kidney injury, acute respiratory distress syndrome, and many other indications, and will be integral to helping the Company determine the ultimate course of its U.S. clinical trial pathway.

 

Even though we have obtained CE Mark approval, no assurance can be given that our CytoSorb® product will work as intended in these studies or that we will be able to obtain FDA approval to sell CytoSorb® in the U.S. Even though we have obtained CE Mark approval, there is no guarantee or assurance that we will be successful in obtaining FDA approval in the United States or approval in any other country or jurisdiction. Because of the limited studies we have conducted, we are subject to substantial risk that our technology will have little or no effect on the treatment of any indications that we have targeted.

 

Government Research Grants

 

Two government research grants by the National Institutes of Health (NIH) and Health and Human Services (HHS) have been awarded to investigators at the University of Pittsburgh to explore the use of adsorbent polymers in the treatment of sepsis and organ transplant preservation. Under “SubAward Agreements” with the University of Pittsburgh, we have been developing polymers for use in these studies.

 

A grant of $1 million was awarded to the University of Pittsburgh Medical Center in 2003. The project seeks to improve the quantity and viability of organs donated for transplant by using CytoSorb™ to detoxify the donor’s blood. The observational and dosing phases of the study, involving 30 viable donors and eight non-viable donors, respectively, have been completed. The next phase of this study, the treatment phase, will involve viable donors. We are not currently focusing our efforts on the commercialization of CytoSorb™ for application in organ donors. The treatment phase would be contingent upon further discussion with the FDA and HRSA regarding study design, as well as obtaining additional funding.

 

In addition, in September 2005, the University of Pittsburgh Medical Center was awarded a grant of approximately $7 million from NIH entitled “Systems Engineering of a Pheresis Intervention for Sepsis (SEPsIS)” to study the use of adsorbent polymer technology in the treatment of severe sepsis. The study, which lasted for a total of five years, commenced in September 2005. Under a SubAward Agreement, we worked with researchers at the University of Pittsburgh - Critical Care Medicine Department. We believe that the only polymers used in this study were polymers we have developed specifically for use in the study, which are similar to the polymers used in our devices. Under the SubAward Agreement, for our efforts in support of the grant during 2006 through 2010, we received approximately $402,000.

 

In October 2010 CytoSorbents was awarded a grant of approximately $489,000 from the federal Qualifying Therapeutic Discovery Project (QTDP) program for two products in its pipeline including the development of CytoSorb® for the treatment of sepsis and other critical care illnesses. The Company received half of the grant in November 2010 and the second half in February 2011.

 

In December 2011 CytoSorbents was awarded a $100,000 Phase I SBIR (Small Business Innovation Research) contract, and subsequently a $50,000 Phase I extension, by the US Army Medical Research and Materiel Command to evaluate our technology for cytokine and myoglobin removal in the treatment of burn injury and trauma. This work is supported by the U.S. Army Medical Research and Material Command under an amendment to Contract W81XWH-12-C-0038.

 

38
 

 

In August 2012, the Company was awarded a $3.8 million, five-year contract by the Defense Advanced Research Projects Agency, or DARPA, for its “Dialysis-Like Therapeutics” program to treat sepsis. DARPA has been instrumental in funding many of the major technological and medical advances since its inception in 1958, including development of the Internet, the global positioning system, or GPS, and robotic surgery. The DLT program in sepsis seeks to develop a therapeutic blood purification device that is capable of identifying the cause of sepsis (e.g. cytokines, toxins, pathogens, activated cells) and remove these substances in an intelligent, automated, and efficient manner. CytoSorbents’ contract is for advanced technology development of its hemocompatible porous polymer technologies to remove cytokines and a number of pathogen and biowarfare toxins from blood. CytoSorbents is in Year 3 of the program and is currently working with the systems integrator, Battelle Laboratories, and its subcontractor NxStage Medical, who are responsible for integrating the technology developed by CytoSorbents and others into a final medical device design prototype, and evaluating this device in septic animals and eventually in human clinical trials in sepsis. CytoSorbents’ work is supported by DARPA and SSC Pacific under Contract No. N66001-12-C-4199. As of December 31, 2014, we have received approximately $2,818,000 to date and have approximately $1,007,000 not yet billed under this contract.

 

In September 2012 CytoSorbents was awarded a Phase II SBIR (Small Business Innovation Research) contract by the US Army Medical Research and Materiel Command to evaluate our technology for the treatment of trauma and burn injury in large animal models. In 2013, we finalized the Phase II SBIR contract whjch provided for a maximum funding of approximately $753,000 with the granting agency. This work is supported by the U.S. Army Medical Research and Material Command under an amendment to Contract W81XWH-12-C-0038. As of December 31, 2014, the Company received approximately $649,000 in funding under this contract and no further amounts are expected from this contract.

 

In June 2013, we announced that the U.S. Air Force will fund a 30 patient, single site, randomized controlled human pilot study in the United States amongst trauma patients with rhabdomyolysis. The primary endpoint is myoglobin removal. The FDA approved our Investigational Device Exemption (IDE) application for this study and we also received ethics committee approval, allowing the study to commence. However, because of the stringency of our inclusion criteria, and because of the patient mix seen at our single center, we have experienced difficulty in enrolling patients. We have subsequently modified one of the key inclusion criteria and have expanded the number of clinical trial sites to three in a revised protocol which has been submitted to the FDA. Though CytoSorbents does not expect to receive material direct funding from this $3 million budgeted program, the study may generate valuable data that can be used commercially or in future trauma studies.

 

In September 2013, the National Heart, Lung, and Blood Institute (“NHLBI”), a division of the National Institutes of Health (“NIH”), awarded the Company a Phase I SBIR (Small Business Innovation Research) contract to further advance its HemoDefend™ blood purification technology for packed red blood cell (“pRBC”) transfusions. The project, entitled “Elimination of blood contaminants from pRBCs using HemoDefend™ hemocompatible porous polymer beads,” is valued at $203,351 over six months. The overall goal of this new program is to reduce the risk of potential side effects of blood transfusions, and help to extend the useful life of pRBCs. As of December 31, 2014, we completed the Phase I program and have been invited to apply for the Phase II SBIR, which has now been submitted.

 

The Company’s business could be adversely impacted by automatic cuts in Federal spending.  The American Taxpayer Relief Act (ATRA) of 2012, referred to generally as the fiscal cliff deal, that went into effect on March 1, 2013, enacted automatic spending cuts of nearly $1 trillion over the next 10 years (commonly known as “sequestration”) that were included under the Budget Control Act of 2011.  Sequestration may delay payments under the DARPA and SBIR grant agreements, although no material delays have occurred to date. The short term and long term economic impact of the sequestration will not be known until the actual spending cuts are implemented and the economic impact of the changes in the budget and taxes are known. It will take an extended number of years to understand the impact of any changes brought about from the sequester.

 

These grants represent a substantial research cost savings to us and we believe demonstrate the strong interest of the medical and scientific communities in our technology.

 

Regulation

 

The medical devices that we manufacture are subject to regulation by numerous regulatory bodies, including the FDA and comparable international regulatory agencies. These agencies require manufacturers of medical devices to comply with applicable laws and regulations governing the development, testing, manufacturing, labeling, marketing and distribution of medical devices. Devices are generally subject to varying levels of regulatory control, the most comprehensive of which requires that a clinical evaluation program be conducted before a device receives approval for commercial distribution.

 

39
 

 

In the European Union, medical devices are required to comply with the Medical Devices Directive and obtain CE Mark certification in order to market medical devices. The CE Mark certification, granted following approval from an independent Notified Body, is an international symbol of adherence to quality assurance standards and compliance with applicable European Medical Devices Directives. Distributors of medical devices may also be required to comply with other foreign regulations such as Ministry of Health Labor and Welfare approval in Japan. The time required to obtain these foreign approvals to market our products may be longer or shorter than that required in the U.S., and requirements for those approvals may differ from those required by the FDA.

 

In March 2011 the Company successfully completed its technical file review with its Notified Body, and received approval to apply the CE Mark to the CytoSorb® device as an extracorporeal cytokine filter. CytoSorbents also achieved ISO 13485:2003 Full Quality Systems certification, an internationally recognized quality standard designed to ensure that medical device manufacturers have the necessary comprehensive management systems in place to safely design, develop, manufacture and distribute medical devices in the E.U. In February 2015, CytoSorbents extended the coverage of its ISO 13485 Certificate with the inclusion of Canadian Quality Systems requirements. This additional level of certification will allow CytoSorbents to apply for product approvals in Canada in the future.

 

In the U.S., permission to distribute a new device generally can be met in one of two ways. The first process requires that a pre-market notification (510(k) Submission) be made to the FDA to demonstrate that the device is as safe and effective as, or substantially equivalent to, a legally marketed device that is not subject to pre-market approval (PMA). A legally marketed device is a device that (i) was legally marketed prior to May 28, 1976, (ii) has been reclassified from Class III to Class II or I, or (iii) has been found to be substantially equivalent to another legally marketed device following a 510(k) Submission. The legally marketed device to which equivalence is drawn is known as the “predicate” device. Applicants must submit descriptive data and, when necessary, performance data to establish that the device is substantially equivalent to a predicate device. In some instances, data from human clinical studies must also be submitted in support of a 510(k) Submission. If so, these data must be collected in a manner that conforms with specific requirements in accordance with federal regulations. The FDA must issue an order finding substantial equivalence before commercial distribution can occur. Changes to existing devices covered by a 510(k) Submission which do not significantly affect safety or effectiveness can generally be made by us without additional 510(k) Submissions.

 

The second process requires that an application for premarket approval (PMA) be made to the FDA to demonstrate that the device is safe and effective for its intended use as manufactured. This approval process applies to most Class III devices. In this case, two steps of FDA approval are generally required before marketing in the U.S. can begin. First, investigational device exemption (IDE) regulations must be complied with in connection with any human clinical investigation of the device in the U.S. Second, the FDA must review the PMA application that contains, among other things, clinical information acquired under the IDE. The FDA will approve the PMA application if it finds that there is a reasonable assurance that the device is safe and effective for its intended purpose.

 

In the United States, our CytoSorb® and BetaSorb™ devices are classified as Class III (CFR 876.5870—Sorbent Hemoperfusion System) 510(k) devices, but may require pre-market approval (PMA) by the FDA. In Europe, our devices are classified as Class IIb, and will need to conform to the Medical Devices Directive.

 

The process of obtaining clearance to market products is costly and time-consuming in virtually all of the major markets in which we expect to sell products and may delay the marketing and sale of our products. Countries around the world have recently adopted more stringent regulatory requirements, which are expected to add to the delays and uncertainties associated with new product releases, as well as the clinical and regulatory costs of supporting those releases. No assurance can be given that any of our other medical devices will be approved on a timely basis, if at all, or that our CytoSorb® device will be approved for CE Mark labeling in other potential medical applications or that it will be approved for cytokine filtration in markets not covered by the CE Mark on a timely basis, or at all. In addition, regulations regarding the development, manufacture and sale of medical devices are subject to future change. We cannot predict what impact, if any, those changes might have on our business. Failure to comply with regulatory requirements could have a material adverse effect on our business, financial condition and results of operations.

 

40
 

 

Exported devices are subject to the regulatory requirements of each country to which the device is exported. Some countries do not have medical device regulations, but in most foreign countries medical devices are regulated. Frequently, regulatory approval may first be obtained in a foreign country prior to application in the U.S. to take advantage of differing regulatory requirements.

 

Sales and Marketing

 

In 2012, we established our European subsidiary, CytoSorbents Europe GmbH, a wholly-owned subsidiary of CytoSorbents Corporation. Located in Berlin, Germany, it serves as the center of our sales activities in Europe. Following the completion of a controlled market release in late June 2012, CytoSorb® was formally launched in Germany with reimbursement established at more than $500 per cartridge. We recruited Dr. Christian Steiner, MD as our Vice President of Sales and Marketing and hired three additional sales representatives who completed training in Q3 2012. Q4 2012 was the first full quarter of direct CytoSorb® sales with our sales force in place. We began expansion into Austria, where reimbursement for CytoSorb® is now available, and Switzerland. From the beginning of the controlled market release in Q4 2011 through the end of December 31, 2014, we achieved cumulative sales of approximately $4,145,000 in sales of CytoSorb®. At the end of 2014, we had more than 150 key opinion leaders (KOL) in our direct sales territories who were either using CytoSorb® or interested in using it in clinical practice and/or in clinical studies. These KOL relationships were an essential step in our initial goal of driving usage, adoption and reorders of CytoSorb® as they facilitate ordering and reimbursement within the hospital, have a strong influential role within their department and amongst their peers and colleagues outside the hospital, and have the ability to conduct studies and generate data, papers and conference presentations that could drive awareness and demand.

 

We are approved to sell CytoSorb® in all 28 countries in the European Union, including Germany, United Kingdom, Italy, France and Spain, and currently have either direct sales or distributor or strategic partnership in 29 countries worldwide. We plan to expand to other countries in the E.U., and with registration, other countries outside the E.U. that will accept CE Mark approval with a mixed direct and independent distributor strategy, that can be augmented through strategic partnerships.

 

In 2013, we reached agreements with distributors in the United Kingdom, Ireland, Turkey, Russia, and the Netherlands. In April 2014, the Company announced distribution of CytoSorb® in the Middle East, including Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman (the Gulf Cooperative Council or GCC) and Yemen, Iraq, and Jordan through an exclusive agreement with Techno Orbits. In August 2014, the Company announced exclusive distribution of CytoSorb® in Taiwan with Hemoscien Corporation, which was subsequently terminated by us in March 2015 due to the complexity of Taiwanese FDA product registration. In December 2014, the Company entered into an exclusive agreement with Smart Medical Solutions S.R.L., to distribute CytoSorb® for critical care applications in Romania and the neighboring Republic of Moldova.  In January 2015, the Company announced its exclusive distribution agreement with Aferetica SRL to distribute CytoSorb® in Italy for critical care applications.

 

The Company has been expanding the number and scope of its strategic partnerships. In September 2013, we entered into a strategic partnership with Biocon, Ltd., Asia’s largest biotech company with an initial distribution agreement for India and select emerging markets, under which Biocon will have the exclusive commercialization rights for CytoSorb® initially focused on sepsis. In September 2014, the Biocon partnership was expanded to include all critical care applications and cardiac surgery. In addition, Biocon committed to to higher annual minimum purchases of CytoSorb® to maintain distribution exclusivity and conduct and publish results from multiple Investigator Initiated studies and patient case studies.

 

In addition, in November 2014, the Company entered into an initial partnership agreement with a leading global medical device company in cardiac surgery and other cardiovascular diseases, to use CytoSorb® intra-operatively during cardiac surgery in France. Under the terms of the agreement, the partnership will commence with an initial six-month market evaluation period to determine various market parameters, to obtain clinical data, and to build key opinion leader support in France. Following a successful evaluation, the parties plan to jointly determine how to expand upon both the size and geographic footprint of its partnership.

 

41
 

 

In February 2015, the Company entered into a multi-country strategic partnership with Fresenius Medical Care AG & CO KGaA to commercialize the CytoSorb® therapy. Under the terms of the agreement, Fresenius Medical Care has exclusive rights to distribute CytoSorb® for critical care applications in France, Poland, Sweden, Denmark, Norway, and Finland. The partnership will allow Fresenius Medical Care to offer an innovative and easy to use blood purification therapy for removing cytokines in patients that are treated in the intensive care unit.  To promote the success of CytoSorb®, Fresenius will also engage in the ongoing clinical development of the product. This includes the support and publication of a number of small case series and patient case reports as well as the potential for future larger, clinical collaborations.

 

Intellectual Property and Patent Litigation

 

The medical device market in which we primarily participate is in large part technology driven. As a result, intellectual property rights, particularly patents and trade secrets, play a significant role in product development and differentiation. However, intellectual property litigation to defend or create market advantage is inherently complex, unpredictable and is expensive to pursue. Litigation often is not ultimately resolved until an appeal process is completed and appellate courts frequently overturn lower court patent decisions.

 

Moreover, competing parties frequently file multiple suits to leverage patent portfolios across product lines, technologies and geographies and to balance risk and exposure between the parties. In some cases, several competitors are parties in the same proceeding, or in a series of related proceedings, or litigate multiple features of a single class of devices. These forces frequently drive settlement not only of individual cases, but also of a series of pending and potentially related and unrelated cases. In addition, although monetary and injunctive relief is typically sought, remedies are generally not determined until the conclusion of the proceedings, and are frequently modified on appeal. Accordingly, the outcomes of individual cases are difficult to time, predict or quantify and are often dependent upon the outcomes of other cases in other forums, both domestic and international.

 

We rely on a combination of patents, trademarks, trade secrets and non-disclosure agreements to protect our intellectual property. We hold 32 issued U.S. patents, some of which have foreign counterparts, and additional patent applications pending worldwide that cover various aspects of our technology. The issued patents expire at various dates ranging from two to twelve years. The following table provides a brief description of our patents that have been issued in the United States:

 

42
 

 

Product
Group
  Description./Indications   Patent
Term
  Patent
Expiration
  Patent
Type
                 
CytoSorb   Material and Method of Producing: Hypercrosslinked Polystyrene Resins with Various Surface Modifications   20 Years   11/25/2016   Standard
                 
CytoSorb   Method of Removing Beta-2 Microglobulin Using Hypercrosslinked Polystyrene-Type Resins   20 Years   7/30/2017   Standard
                 
CytoSorb   Method of Removing Beta-2 Microglobulin Using Polymers with Surface-Exposed Vinyl Groups Modified for Biocompatibility   20 Years   7/30/2017   Standard
                 
CytoSorb   Devices, Systems & Methods for Reducing Cytokines, Etc in Plasma and Other Separated Blood Components   20 Years   7/30/2017   Standard
                 
CytoSorb   Biocompatible Devices, Systems & Methods for Reducing levels of Pro-Inflammatory and Anti-Inflammatory Stimulators or mediators in Blood   20 Years   7/30/2017   Standard
                 
CytoSorb   Methods for reducing levels of pro-inflammatory or anti-inflammatory stimulators or mediators in the blood   20 Years   7/30/2017   Standard
                 
CytoSorb   Biocompatible Devices, Systems & Methods for Reducing levels of Pro-Inflammatory and Anti-Inflammatory Stimulators or mediators in Blood   20 Years   7/30/2017   Standard
                 
CytoSorb   Biocompatible Devices, Systems, and Methods for Reducing Levels of Pro-Inflammatory or Anti-Inflammatory Stimulators or Mediators in the Blood   20 Years   7/30/2017   Standard
                 
CytoSorb   Devices, Systems, and Methods for Reducing Levels of Pro-Inflammatory or Anti-Inflammatory Stimulators or Mediators in Blood Products   20 Years   7/30/2017   Standard
                 
CytoSorb   Material for Purification: DVB Copolymer with Surface Vinyl Groups Modified to One of Four Functional Groups   20 Years   2/6/2018   Standard
                 
CytoSorb   Method of Producing Material: Chloromethylated Styrene or DVB Polymers with Chlorine Replaced for Improved Biocompatibility   20 Years   2/6/2018   Standard
                 
CytoSorb   Method of Purification Using DVB Copolymer with Surface-Exposed Vinyl Groups Modified for Biocompatibility   20 Years   2/6/2018   Standard
                 
CytoSorb   Material and Method of Producing: Chloromethylated Styrene or DVB Polymers with Chlorine Replaced for Improved Biocompatibility   20 Years   2/6/2018   Standard
                 
CytoSorb   Method of Producing Material: DVB Copolymer with No Endotoxin Contamination   20 Years   2/6/2018   Standard
                 
CytoSorb   Material for Purification: DVB Copolymer with Surface Vinyl Groups Modified in Three Ways for Biocompatibility   20 Years  

2/6/2018

 

  Standard
                 
CytoSorb   Method of Purification Using Chloromethylated Styrene or DVB Polymers with Chlorine Replaced for Improved Biocompatibility   20 Years   2/6/2018   Standard
                 
CytoSorb   Method of Producing Material: Polymer with Modification of Surface-Exposed Vinyl Groups   20 Years   2/6/2018   Standard
                 
CytoSorb   Material and Method of Producing: Chloromethylated Polymers with Chlorine Replaced for Improved Biocompatibility   20 Years   2/6/2018   Standard
                 
CytoSorb   Method of Producing Material: Polymer with Modification of Surface-Exposed Vinyl Groups   20 Years   12/14/2018   Standard
                 
CytoSorb   Method of and Device for Introducing Fluids into a Patient’s Body   20 Years   2/14/2020   Standard
                 
CytoSorb   Perfusion Device Combining Adsorbing Material and Hollow Fibers to Filter and Recombine Plasma   20 Years   4/17/2020   Standard
                 
CytoSorb   Method of Peritoneal Dialysis   20 Years   4/27/2020   Standard
                 
CytoSorb   Material and Method of Producing: Biocompatible Polymeric Adsorbents Using a One-Pot Process   20 Years   10/10/2020   Standard
                 
CytoSorb   Protective clothing   20 Years   2/14/2021   Standard
                 
CytoSorb   Devices, systems, and methods for reducing levels of pro-inflammatory or anti-inflammatory stimulators or mediators in the blood   20 Years   4/10/2021   Standard
                 
CytoSorb   Method of Producing Devices   20 Years   4/25/2021   Standard
                 
CytoSorb   Hemocompatible Coated Polymer and Related One-Step Methods   20 Years   10/18/2022   Standard
                 
CytoSorb   Hemocompatible Coated Polymer and Related Methods   20 Years   10/18/2022   Standard
                 
CytoSorb   Hemocompatible Coated Polymer and Related One-Step Methods   20 Years   10/18/2022   Standard
                 
CytoSorb   Hemocompatible Polymer Systems And Related Devices   20 Years   10/18/2022   Standard
                 
CytoSorb   Size-Selective Hemoperfusion Polymeric Adsorbents   20 Years   11/20/2026   Standard
                 
CytoSorb   Size-Selective Hemoperfusion Polymeric Adsorbents   20 Years   11/20/2026   Standard

 

43
 

 

Certain of these patents also have foreign counterparts.

 

There can be no assurance that pending patent applications will result in issued patents, that patents issued to us will not be challenged or circumvented by competitors, or that such patents will be found to be valid or sufficiently broad to protect our technology or to provide us with a competitive advantage.

 

We also rely on non-disclosure and non-competition agreements with employees, consultants and other parties to protect, in part, trade secrets and other proprietary technology. There can be no assurance that these agreements will not be breached, that we will have adequate remedies for any breach, that others will not independently develop equivalent proprietary information or that third parties will not otherwise gain access to our trade secrets and proprietary knowledge.

 

Several years ago we engaged in discussions with the Dow Chemical Company, which had indicated a strong interest in being our polymer manufacturer. After a Dow representative on our Advisory Board resigned, Dow filed and received five patents naming our former Advisory Board member as an inventor. These patents, two of which subsequently lapsed for failure to pay maintenance fees, concern the area of coating high divinylbenzene-content polymers to render them hemocompatible, and using such coated polymers to treat blood or plasma. In management’s view the Dow patents improperly incorporate our technology, are based on our proprietary technology, and should not have been granted to Dow. While we believe that our own patents would prevent Dow from producing our products as they are currently envisioned, Dow could attempt to assert its patents against us. To date, to our knowledge, Dow has not utilized their patents for the commercial manufacture of products that would be competitive with us, and we currently have no plans to challenge Dow’s patents. However, the existence of these Dow patents could result in a potential dispute with Dow in the future and additional expenses for us.

 

We may find it necessary to initiate litigation to enforce our patent rights, to protect our trade secrets or know-how and to determine the scope and validity of the proprietary rights of others. Patent litigation can be costly and time-consuming, and there can be no assurance that our litigation expenses will not be significant in the future or that the outcome of litigation will be favorable to us. Accordingly, we may seek to settle some or all of our pending litigation described below. Settlement may include cross-licensing of the patents which are the subject of the litigation as well as our other intellectual property and may involve monetary payments to or from third parties.

 

Environmental Matters

 

The Company believes that there are no compliance issues associated with applicable environmental laws and regulations that would have a material adverse effect on the Company. The Company incurs waste removal costs in connection with both its solid and liquid wastes which are byproducts of our manufacturing process. The Company utilizes the services of various qualified contractors to dispose of these waste products. These waste removal costs amounted to approximately $81,000 for the year ended December 31, 2014.

 

Employees

 

As of February 28, 2015 we had forty-five full-time employees. We also utilize consultants and temporary service providers who are not employees of the Company, as necessary. None of our employees are represented by a labor union or are subject to collective-bargaining agreements.

 

44
 

 

Item 1A. Risk Factors

 

Risks Related to our Industry and our Business

 

We may require additional capital in the future to fund our operations

 

As of December 31, 2014 we had current assets of approximately $7,607,000 including cash on hand of approximately $3,605,000 and short-term investments of approximately $1,945,000 and current liabilities of approximately $4,505,000. On January 14, 2015, we received approximately $9,409,000 in net proceeds in connection with a registered offering of our common stock. Through December 31, 2014, our cash burn was approximately $6,400,000 for fiscal year 2014. Our current and historical cash burn is not necessarily indicative of our future use of cash and cash equivalents.

 

We may require additional financing in the future in order to complete additional clinical studies and to support the commercialization of our proposed products. There can be no assurance that we will be successful in our capital raising efforts. Our long-term capital requirements are expected to depend on many factors, including:

 

continued progress and cost of our research and development programs;
progress with pre-clinical studies and clinical studies;
the time and costs involved in obtaining regulatory clearance in other countries and/or for other indications;
costs involved in preparing, filing, prosecuting, maintaining, defending and enforcing patent claims;
costs of developing sales, marketing and distribution channels;
market acceptance and reimbursement of our products; and
cost for training physicians and other health care personnel.

 

Should the financing we require to sustain our working capital needs be unavailable or prohibitively expensive when we require it, the consequences could be a material adverse effect on our business, operating results, financial condition and prospects.

 

In addition, in the event that additional funds are obtained through arrangements with collaborative partners or other sources, we may have to relinquish economic and/or proprietary rights to some of our technologies or products under development that we would otherwise seek to develop or commercialize by ourselves.

 

We currently are in the process of commercializing our products, but there can be no assurance that we will be successful in developing commercial operations .

 

We have been engaged primarily in research and development activities and have generated limited revenues to date. There can be no assurance that we will be able to successfully manage the transition to a commercial enterprise. Potential investors should be aware of the problems, delays, expenses and difficulties frequently encountered by an enterprise in the early stage of development, which include unanticipated problems relating to development of proposed products, testing, regulatory compliance, manufacturing, competition, market adoption, product registration, reimbursement, marketing problems and additional costs and expenses that may exceed current estimates. Our proposed products will require significant additional research and testing, and we will need to overcome significant regulatory burdens prior to commercialization in other countries, such as the U.S., and for ongoing compliance for our CE Mark. We will also need to raise significant additional funds to complete additional clinical studies and obtain regulatory approvals in other countries before we can begin selling our products in markets not covered by the CE Mark. There can be no assurance that after the expenditure of substantial funds and efforts, we will successfully develop and commercialize any products, generate any significant revenues or ever achieve and maintain a substantial level of sales of our products.

 

We have a history of losses and expect to incur substantial future losses, and the report of our auditor on our consolidated financial statements expresses substantial doubt about our ability to continue as a going concern .

 

We have experienced substantial operating losses since inception. As of December 31, 2014, we had an accumulated deficit of $124,394,120, which included net losses of $9,321,672 for the year ended December 31, 2014 and $4,677,795 for the year ended December 31, 2013. In part due to these losses, our audited consolidated financial statements have been prepared assuming we will continue as a going concern, and the auditors’ report on those financial statements express substantial doubt about our ability to continue as a going concern. Our losses have resulted principally from costs incurred in the research and development of our polymer technology and general and administrative expenses. We intend to conduct significant additional research, development, and clinical study activities which, together with expenses incurred for the establishment of manufacturing arrangements and a marketing and distribution presence and other general and administrative expenses, are expected to result in continuing operating losses for the foreseeable future. The amount of future losses and when, if ever, we will achieve profitability are uncertain. Our ability to achieve profitability will depend, among other things, on successfully completing the development of our technology and commercial products, obtaining additional requisite regulatory approvals in markets not covered by the CE Mark and for potential label extensions of our current CE Mark, establishing manufacturing and sales and marketing arrangements with third parties, and raising sufficient funds to finance our activities. No assurance can be given that our product development efforts will be successful, that our current CE Mark will enable us to achieve profitability, that additional regulatory approvals in other countries will be obtained, that any of our products will be manufactured at a competitive cost and will be of acceptable quality, or that the we will be able to achieve profitability or that profitability, if achieved, can be sustained.

 

45
 

 

We depend upon key personnel who may terminate their employment with us at any time.

 

As of February 28, 2015 we currently have forty- five full-time employees and several full-time temporary employees. Our success will depend to a significant degree upon the continued services of our key management and advisors, including, Dr. Phillip Chan, our Chief Executive Officer; Kathleen P. Bloch, our Chief Financial Officer; Vincent Capponi, our Chief Operating Officer and Dr. Robert Bartlett our Chief Medical Officer, who works with us on a consulting basis. These individuals do not have long-term employment agreements, and in some cases, including with respect to Dr. Chan and Mr. Capponi, do not have current and effective employment agreements in place. Although we are discussing formalizing our employment and consulting arrangements, as applicable, with Dr. Chan, Mr. Capponi and Dr. Bartlett , there can be no assurance that Dr. Chan, Mr. Capponi, Dr. Bartlett or other members of our management team and advisors will continue to provide services to us. In addition, our success will depend on our ability to attract and retain other highly skilled personnel. We may be unable to recruit such personnel on a timely basis, if at all. Management and other employees may voluntarily terminate their employment with us at any time. The loss of services of key personnel, or the inability to attract and retain additional qualified personnel, could result in delays in development or approval of our products, loss of sales and diversion of management resources.

 

Our Chief Medical Officer works with us on a consulting basis.

 

Our Chief Medical Officer, Dr. Robert Bartlett, works with us on a consulting basis. Because of the part time nature of his consulting agreement, Dr. Bartlett may not always be available to provide us with his services when needed by us in a timely manner.

 

Acceptance of our medical devices in the marketplace is uncertain, and failure to achieve market acceptance will prevent or delay our ability to generate revenues.

 

Our future financial performance will depend, at least in part, upon the introduction and customer acceptance of our polymer products. Even with our approval to apply the CE Mark to our CytoSorb® device as a cytokine filter, our products may not achieve market acceptance in the European countries that recognize and accept the CE Mark. Additional approvals from other regulatory authorities (such as the U.S. Food and Drug Administration, or FDA) will be required before we can market our device in countries not covered by the CE Mark. There is no guarantee that the Company will be able to achieve additional regulatory approvals, and even if we do, our products may not achieve market acceptance in the countries covered by such approvals. The degree of market acceptance will depend upon a number of factors, including:

 

the receipt of regulatory clearance of marketing claims for the uses that we are developing;
the establishment and demonstration of the advantages, safety and efficacy of the our polymer technology;
pricing and reimbursement policies of government and third-party payers such as insurance companies, health maintenance organizations and other health plan administrators;
our ability to attract corporate partners, including medical device companies, to assist in commercializing our products; and
our ability to market our products.

 

46
 

 

Physicians, patients, payers or the medical community in general may be unwilling to accept, utilize or recommend any of our products. Approval of our CytoSorb® device as a cytokine filter as well as the data we have gathered in our clinical studies to support device usage in this indication may not be sufficient for market acceptance in the medical community. We may also need to conduct additional clinical studies to gather additional data for marketing purposes. If we are unable to obtain regulatory approval or commercialize and market our products when planned, we may not achieve any market acceptance or generate revenue.

 

Even with our approval to apply the CE Mark to our CytoSorb® device as a cytokine filter, there can be no assurance that the data from our limited clinical studies will be viewed as sufficient by the medical community to support the purchase of our products in substantial quantities or at all.

 

CytoSorb® is currently reimbursable in Germany and Austria. We plan to seek reimbursement for our product in other E.U. and non-E.U. countries to help further adoption. There can be no assurance when, or if, this additional reimbursement might be approved.

 

We may face litigation from third parties claiming that our products infringe on their intellectual property rights, or seek to challenge the validity of our patents.

 

Our future success is also dependent on the strength of our intellectual property, trade secrets and know-how, which have been developed from years of research and development. In addition to the “Purolite” litigation discussed below, we may be exposed to additional future litigation by third parties seeking to challenge the validity of our rights based on claims that our technologies, products or activities infringe the intellectual property rights of others or are invalid, or that we have misappropriated the trade secrets of others.

 

Since our inception, we have sought to contract with large, established manufacturers to supply commercial quantities of our adsorbent polymers. As a result, we have disclosed, under confidentiality agreements, various aspects of our technology with potential manufacturers. We believe that these disclosures, while necessary for our business, have resulted in the attempt by potential suppliers to improperly assert ownership claims to our technology in an attempt to gain an advantage in negotiating manufacturing rights.

 

We have previously engaged in discussions with the Brotech Corporation and its affiliate, Purolite International, Inc. (collectively “Purolite”), which had demonstrated a strong interest in being our polymer manufacturer. For a period of time beginning in December 1998, Purolite engaged in efforts to develop and optimize the manufacturing process needed to produce our polymer products on a commercial scale. However, the parties eventually decided not to proceed. In 2003, Purolite filed a lawsuit against us asserting, among other things, co-ownership and co-inventorship of certain of our patents. On September 1, 2006, the United States District Court for the Eastern District of Pennsylvania approved a Stipulated Order and Settlement Agreement under which we and Purolite agreed to the settlement of the action. The Settlement Agreement provides us with the exclusive right to use our patented technology and proprietary know how relating to adsorbent polymers for a period of 18 years. Under the terms of the Settlement Agreement, we have agreed to pay Purolite royalties of 2.5% to 5% on the sale of certain of our products if and when those products are sold commercially.

 

Several years ago we engaged in discussions with the Dow Chemical Company, which had indicated a strong interest in being our polymer manufacturer. After a Dow representative on our Advisory Board resigned, Dow filed and received several patents naming our former Advisory Board member as an inventor. In management’s view the Dow patents improperly incorporate our technology and should not have been granted to Dow. The existence of these Dow patents could result in a potential dispute with Dow in the future and additional expenses for us.

 

47
 

 

We have commenced the process of seeking regulatory approvals of our products, but the approval process involves lengthy and costly clinical studies and is, in large part, not in the control of the Company. The failure to obtain government approvals, internationally or domestically, for our polymer products, or to comply with ongoing governmental regulations could prevent, delay or limit introduction or sale of our products and result in the failure to achieve revenues or maintain our operations.

 

CytoSorb® has already achieved European Union regulatory approval under the CE Mark and the Medical Devices Directive. It is manufactured at our manufacturing facility in New Jersey under ISO 13485 Full Quality Systems certification. The manufacturing and marketing of our products will be subject to extensive and rigorous government regulation in the European market, the United States, in various states and in other foreign countries. In the United States and other countries, the process of obtaining and maintaining required regulatory approvals is lengthy, expensive, and uncertain. There can be no assurance that we will ever obtain the necessary additional approvals to sell our products in the United States or other non E.U. countries. Even if we do ultimately receive FDA approval for any of our products, we will be subject to extensive ongoing regulation. While the Company has received approval from its Notified Body to apply the CE Mark to our CytoSorb® device, we will be subject to extensive ongoing regulation and auditing requirements to maintain the CE Mark.

 

Our products will be subject to international regulation as medical devices under the Medical Devices Directive. In Europe, which we expect to provide the initial market for our products, the Notified Body and Competent Authority govern, where applicable, development, clinical studies, labeling, manufacturing, registration, notification, clearance or approval, marketing, distribution, record keeping, and reporting requirements for medical devices. Different regulatory requirements may apply to our products depending on how they are categorized by the Notified Body under these laws. Current international regulations classify our CytoSorb® device as a Class IIb device. Even though we have received CE Mark certification of the CytoSorb® device, there can be no assurance that we will be able to continue to comply with the required annual auditing requirements or other international regulatory requirements that may be applicable. In addition, there can be no assurance that government regulations applicable to our products or the interpretation of those regulations will not change. The extent of potentially adverse government regulation that might arise from future legislation or administrative action cannot be predicted. There can be no assurances that reimbursement will be granted or that additional clinical data may be required to establish reimbursement.

 

We have conducted limited clinical studies of our CytoSorb® device. Clinical and pre-clinical data is susceptible to varying interpretations, which could delay, limit or prevent additional regulatory clearances.

 

To date, we have conducted limited clinical studies on our CytoSorb® product. There can be no assurance that we will successfully complete additional clinical studies necessary to receive additional regulatory approvals in markets not covered by the CE Mark. While studies conducted by us and others have produced results we believe to be encouraging and indicative of the potential efficacy of our products and technology, data already obtained, or in the future obtained, from pre-clinical studies and clinical studies do not necessarily predict the results that will be obtained from later pre-clinical studies and clinical studies. Moreover, pre-clinical and clinical data are susceptible to varying interpretations, which could delay, limit or prevent additional regulatory approvals. A number of companies in the medical device and pharmaceutical industries have suffered significant setbacks in advanced clinical studies, even after promising results in earlier studies. The failure to adequately demonstrate the safety and effectiveness of an intended product under development could delay or prevent regulatory clearance of the device, resulting in delays to commercialization, and could materially harm our business. Even though we have received approval to apply the CE Mark to our CytoSorb® device as a cytokine filter, there can be no assurance that we will be able to receive approval for other potential applications of CytoSorb®, or that we will receive regulatory clearance from other targeted regions or countries.

 

We rely extensively on research and testing facilities at various universities and institutions, which could adversely affect us should we lose access to those facilities.

 

Although we have our own research laboratories and clinical facilities, we collaborate with numerous institutions, universities and commercial entities to conduct research and studies of our products. We currently maintain a good working relationship with these parties. However, should the situation change, the cost and time to establish or locate alternative research and development could be substantial and delay gaining CE Mark for other potential applications or technologies, and/or FDA approval and commercializing our products.

 

48
 

 

We are and will be exposed to product liability risks, and clinical and preclinical liability risks, which could place a substantial financial burden upon us should we be sued.

 

Our business exposes us to potential product liability and other liability risks that are inherent in the testing, manufacturing and marketing of medical devices. We cannot be sure that claims will not be asserted against us. A successful liability claim or series of claims brought against us could have a material adverse effect on our business, financial condition and results of operations.

 

We cannot give assurances that we will be able to continue to obtain or maintain adequate product liability insurance on acceptable terms, if at all, or that such insurance will provide adequate coverage against potential liabilities. Claims or losses in excess of any product liability insurance coverage that we may obtain could have a material adverse effect on our business, financial condition and results of operations.

 

Certain university and other relationships are important to our business and may potentially result in conflicts of interests.

 

Dr. John Kellum and others, are critical care advisors and consultants of ours and are associated with institutions such as the University of Pittsburgh Medical Center. Their association with these institutions may currently or in the future involve conflicting interests in the event they or these institutions enter into consulting or other arrangements with competitors of ours.

 

We have limited manufacturing experience, and once our products are approved, we may not be able to manufacture sufficient quantities at an acceptable cost, or without shut-downs or delays.

 

In March, 2011 we received approval from our Notified Body to apply the CE Mark to our CytoSorb® device for commercial sale as a cytokine filter. CytoSorbents also achieved ISO 13485:2003 Full Quality Systems certification, an internationally recognized quality standard designed to ensure that medical device manufacturers have the necessary comprehensive management systems in place to safely design, develop, manufacture and distribute medical devices in the European Union. CytoSorbents manufactures CytoSorb® at its manufacturing facilities in New Jersey for sale in the E.U. and for additional clinical studies. We will need to maintain compliance on an ongoing basis. We have limited experience in establishing, supervising and conducting commercial manufacturing. If we or the third-party manufacturers of our products fail to adequately establish, supervise and conduct all aspects of the manufacturing processes, we may not be able to commercialize our products.

 

While we currently believe we have established sufficient production capacity to supply potential near term demand for the CytoSorb® device, we will need to scale up and increase our manufacturing capabilities in the future. No assurance can be given that we will be able to successfully scale up our manufacturing capabilities or that we will have sufficient financial or technical resources to do so on a timely basis or at all.

 

Due to our limited marketing, sales and distribution experience, we may be unsuccessful in our efforts to sell our products.

 

We expect to enter into agreements with third parties for the commercial marketing, and distribution of our products. There can be no assurance that parties we may engage to market and distribute our products will:

 

satisfy their financial or contractual obligations to us;
adequately market our products; or
not offer, design, manufacture or promote competing products.

 

If for any reason any party we engage is unable or chooses not to perform its obligations under our marketing and distribution agreement, we would experience delays in product sales and incur increased costs, which would harm our business and financial results.

 

Our results of operations can be significantly affected by foreign currency fluctuations and regulations.

 

A significant portion of our revenues is currently derived in the local currencies of the foreign jurisdictions in which our products are sold. Accordingly, we are subject to risks relating to fluctuations in currency exchange rates. In the future, and especially as we further expand our sales efforts in international markets, our customers will increasingly make payments in non-U.S. currencies. Fluctuations in foreign currency exchange rates could affect our revenues, operating costs and operating margins. In addition, currency devaluation can result in a loss to us if we hold deposits of that currency. We cannot predict the effect of future exchange rate fluctuations on our operating results.

 

If we are unable to convince physicians and other health care providers as to the benefits of our products, we may incur delays or additional expense in our attempt to establish market acceptance.

 

Broad use of our products may require physicians and other health care providers to be informed about our products and their intended benefits. The time and cost of such an educational process may be substantial. Inability to successfully carry out this education process may adversely affect market acceptance of our products. We may be unable to educate physicians regarding our products in sufficient numbers or in a timely manner to achieve our marketing plans or to achieve product acceptance. Any delay in physician education may materially delay or reduce demand for our products. In addition, we may expend significant funds towards physician education before any acceptance or demand for our products is created, if at all.

 

49
 

 

The market for our products is rapidly changing and competitive, and new devices and drugs, which may be developed by others, could impair our ability to maintain and grow our business and remain competitive.

 

The medical device and pharmaceutical industries are subject to rapid and substantial technological change. Developments by others may render our technologies and products noncompetitive or obsolete. We also may be unable to keep pace with technological developments and other market factors. Technological competition from medical device, pharmaceutical and biotechnology companies, universities, governmental entities and others diversifying into the field is intense and is expected to increase. Many of these entities have significantly greater research and development capabilities and budgets than we do, as well as substantially more marketing, manufacturing, financial and managerial resources. These entities represent significant competition for us.

 

If users of our products are unable to obtain adequate reimbursement from third-party payers, or if new restrictive legislation is adopted, market acceptance of our products may be limited and we may not achieve anticipated revenues.

 

The continuing efforts of government and insurance companies, health maintenance organizations and other payers of healthcare costs to contain or reduce costs of health care may affect our future revenues and profitability, and the future revenues and profitability of our potential customers, suppliers and collaborative partners and the availability of capital. For example, in certain foreign markets, pricing or profitability of medical devices is subject to government control. In the United States, given recent federal and state government initiatives directed at lowering the total cost of health care, the U.S. Congress and state legislatures will likely continue to focus on health care reform, the cost of medical devices and on the reform of the Medicare and Medicaid systems. While we cannot predict whether any such legislative or regulatory proposals will be adopted, the announcement or adoption of these proposals could materially harm our business, financial condition and results of operations.

 

Our ability to commercialize our products will depend in part on the extent to which appropriate reimbursement levels for the cost of our products and related treatment are obtained by governmental authorities, private health insurers and other organizations, such as health maintenance organizations (“HMOs”). Third-party payers are increasingly challenging the prices charged for medical care. Also, the trend toward managed health care in the United States and the concurrent growth of organizations such as HMOs, which could control or significantly influence the purchase of health care services and medical devices, as well as legislative proposals to reform health care or reduce government insurance programs, may all result in lower prices for our products. The cost containment measures that health care payers and providers are instituting and the effect of any health care reform could materially harm our ability to operate profitably.

 

CytoSorb® is currently reimbursable in Germany and Austria. We plan to seek reimbursement for our product in other E.U. and non-E.U. countries to help further adoption. There can be no assurance when, or if, this additional reimbursement might be approved.

 

Risks Connected to our Securities

 

The price of our Common Stock has been highly volatile due to factors that will continue to affect the price of our stock.

 

Our Common Stock closed as high as $8.75 and as low as $3.00 per share between January 1, 2014 and December 2, 2014 on the OTCQB. On December 3, 2014, we effected a twenty-five-for-one (25:1) reverse split of our common stock. Immediately after the reverse stock split, on December 3, 2014 we changed our state of incorporation from the State of Nevada to the State of Delaware pursuant to an Agreement and Plan of Merger, dated December 3, 2014, whereby we merged with and into our recently formed, wholly-owned Delaware subsidiary. On December 17, 2014, CytoSorbents received approval for up-listing to The NASDAQ Capital Market and its common stock began trading on the NASDAQ Capital Market on December 23, 2014. On March 9, 2015 the closing price of our common stock, as reported on the NASDAQ Capital Market was $11.68. Historically, the over-the-counter markets for securities such as our Common Stock have experienced extreme price fluctuations. Some of the factors leading to this volatility include, but are not limited to:

 

50
 

 

fluctuations in our operating results;

 

announcements of product releases by us or our competitors;

 

announcements of acquisitions and/or partnerships by us or our competitors; and

 

general market conditions.

 

Although share of our common stock currently trade on the NASDAQ Capital Market under the symbol “CTSO”, there is no assurance that our stock will not continue to be volatile while listed on NASDAQ in the future.

 

Directors, executive officers and principal stockholders own a significant percentage of the shares of Common Stock, which will limit your ability to influence corporate matters.

 

Our directors, executive officers and principal stockholders together beneficially own a significant percentage of the voting control of the Common Stock on a fully diluted basis. Accordingly, these stockholders could have a significant influence over the outcome of any corporate transaction or other matter submitted to stockholders for approval, including mergers, consolidations and the sale of all or substantially all of our assets and also could prevent or cause a change in control. The interests of these stockholders may differ from the interests of our other stockholders. Third parties may be discouraged from making a tender offer or bid to acquire us because of this concentration of ownership.

 

Our Board of Directors may, without stockholder approval, issue and fix the terms of shares of preferred stock and issue additional shares of common stock adversely affecting the rights of holders of our common stock.

 

On December 3, 2014, we effected a twenty-five-for-one (25:1) reverse split of our common stock. Immediately after the reverse stock split, on December 3, 2014 we changed our state of incorporation from the State of Nevada to the State of Delaware pursuant to an Agreement and Plan of Merger, dated December 3, 2014, whereby we merged with and into our recently formed, wholly-owned Delaware subsidiary. Pursuant to the Agreement and Plan of Merger effecting the merger, we adopted the certificate of incorporation, as amended and restated, and bylaws of our Delaware subsidiary as our certificate of incorporation and bylaws at effective time of the merger. As a result, our certificate of incorporation, as amended and restated, authorizes the issuance of up to 5,000,000 shares of “blank check” preferred stock, with such designation rights and preferences as may be determined from time to time by the Board of Directors. Currently, our certificate of incorporation, as amended and restated, which was effective December 3, 2014, authorizes the issuance of up to 50,000,000 shares of common stock, of which approximately 26,715,960 shares remain available for issuance and may be issued by us without stockholder approval.

 

Anti-takeover provisions in our charter documents and under Delaware law could prevent or delay transactions that our stockholders may favor and may prevent stockholders from changing the direction of our business or our management.

After giving effect to our merger into our wholly-owned Delaware subsidiary, provisions of our certificate of incorporation, as amended and restated, and bylaws may discourage, delay or prevent a merger or acquisition that our stockholders may consider favorable, including transactions in which you might otherwise receive a premium for your shares, and may also frustrate or prevent any attempt by stockholders to change the direction or management of us. For example, these provisions:

 

authorize the issuance of “blank check” preferred stock without any need for action by stockholders;

 

eliminate the ability of stockholders to call special meetings of stockholders;

 

prohibit stockholder action by written consent; and

 

establish advance notice requirements for nominations for election to the board of directors or for proposing matters that can be acted on by stockholders at stockholder meetings.

 

51
 

 

Compliance with changing corporate governance and public disclosure regulations may result in additional expense.

 

Keeping abreast of, and in compliance with, changing laws, regulations and standards relating to corporate governance and public disclosure, including the Sarbanes-Oxley Act of 2002, new SEC regulations will require an increased amount of management attention and external resources. In addition, prior to the merger, our current management team was not subject to these laws and regulations, as the Company was a private corporation. We intend to continue to invest all reasonably necessary resources to comply with evolving standards, which may result in increased general and administrative expense and a diversion of management time and attention from revenue-generating activities to compliance activities.

 

Our Common Stock is thinly traded on the NASDAQ Capital Market exchange and no assurances can be made about stock performance, liquidity, or maintenance of our NASDAQ listing.

 

Historically, our common stock was quoted on the OTCQB, which provided significantly less liquidity than a securities exchange (such as the New York Stock Exchange or the Nasdaq Stock Market). On December 17, 2014, our common stock was approved for trading on the NASDAQ Capital Market, or NASDAQ. Beginning on December 23, 2014, our common stock began trading on NASDAQ under the symbol “CTSO.” Although currently listed on NASDAQ, there can be no assurance that we will continue to meet NASDAQ’s minimum listing requirements or that of any other national exchange. In addition, there can be no assurances that a liquid market will be created for our common stock. If we are unable to maintain listing on the NASDAQ or if a liquid market for our common stock does not develop, our common stock may remain thinly traded.

 

Item 1B.     Unresolved Staff Comments.

 

This information is not required for smaller reporting companies.

 

Item 2.        Properties.

 

We currently operate a facility near Princeton, New Jersey with approximately 12,400 sq. ft., housing research laboratories, clinical manufacturing operations and administrative offices, under a lease agreement, which expires in May 2016. We expect to renew this lease upon expiration. In the opinion of management, the leased properties are adequately insured, are in good condition and suitable for the conduct of our business. We also collaborate with numerous institutions, universities and commercial entities who conduct research and testing of our products at their facilities. Our monthly base rent as of March 2015 is approximately $16,449 and additionally we reimburse the landlord for monthly operating expenses of approximately $14,100.

 

We also operate a small office facility in Berlin, Germany housing sales and administrative offices. We entered into a lease for this office on March 1, 2012. The lease expires on December 31, 2016. We rent this space for €1,200 per month or US $1,459 per month.

 

Item 3.          Legal Proceedings.

 

We are from time to time subject to claims and litigation arising in the ordinary course of business. We intend to defend vigorously against any future claims and litigation.  We are not currently a party to any legal proceedings.

  

Item 4.          Mine Safety Disclosures

 

Not applicable

 

52
 

 

PART II

 

Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities.

 

Market Information

 

Beginning on December 23, 2014, our Common Stock began trading on NASDAQ. Prior to December 23, 2014, our Common Stock traded on the OTC Bulletin Board (“OTCBB”) and OTCQB under the symbol “CTSO.” The OTCBB is a quotation service that displays real-time quotes, last-sale prices, and volume information in the OTC equity securities. An OTCBB equity security generally is any equity security that is not listed or traded on a national securities exchange. Prior to May 2010, our Common Stock traded on the OTCBB under the symbol “MSBT”, but was changed to “CTSO” as part of our name change to CytoSorbents Corporation. Our Common Stock began trading on such market on August 9, 2006.

 

Price Range of Common Stock

 

The following table shows, for the periods indicated, the high and low bid prices per share of our common stock as reported by NASDAQ and the OTCBB quotation service. These bid prices represent prices quoted by broker-dealers on the OTCBB quotation service and the NASDAQ Capial Market. The quotations reflect inter-dealer prices, without retail mark-up, mark-down or commissions, and may not represent actual transactions.

 

    High     Low  
             
2013                
First quarter   $ 3.75     $ 2.25  
Second quarter   $ 3.75     $ 2.75  
Third quarter   $ 3.25     $ 2.00  
Fourth quarter   $ 3.50     $ 2.25  
                 
2014                
First quarter   $ 8.75     $ 3.00  
Second quarter   $ 6.47     $ 5.02  
Third quarter   $ 7.75     $ 5.05  
Fourth quarter   $ 12.87     $ 4.40  

 

Approximate Number of Equity Security Holders

 

As of February 28, 2015, there were approximately 5,200 stockholders. Because shares of our Common Stock are held by depositaries, brokers and other nominees, the number of beneficial holders of our shares is larger than the number of stockholders.

 

Dividends

 

We have not declared or paid any cash dividends on our common stock, and we do not anticipate declaring or paying cash dividends for the foreseeable future. We are not subject to any legal restrictions respecting the payment of dividends, except that we may not pay dividends if the payment would render us insolvent. Any future determination as to the payment of cash dividends on our common stock will be at our board of directors’ discretion and will depend on our financial condition, operating results, capital requirements and other factors that our board of directors considers to be relevant.

 

53
 

  

EQUITY COMPENSATION PLAN INFORMATION

 

The following table summarizes outstanding options as of December 31, 2014:  

 

    Number of securities to
be
issued upon exercise of
outstanding options
    Weighted-average
exercise price of
outstanding options
    Number of securities
remaining
available for future
issuance under
equity compensation
plans
(excluding securities
reflected in
first column)
 
Equity compensation plans approved      by stockholders     926,900               2,173,100 (1)
Equity compensation plans not approved by stockholders     1,375,287     $       67,195 (2)
Total     2,302,187 (3)   $ 5.37 (3)     2,240,295  

 

  (1) Represents the number of options that may be issued under our 2014 Long-term Incentive Plan.
  (2) Represents the number of options that may be issued under our 2006 Long-Term Incentive Plan, after giving effect to options cancelled. The options available under the pool may be increased to maintain 15% of the fully diluted share count as needed.
  (3) Represents options to purchase (i) 16,558 shares of Common Stock at a price of $166.00 per share, (ii) 6,800 shares of Common Stock at a price of $47.50 per share, (iii) 12,240 shares of Common Stock at a price of $41.25 per share, (iv) 16,000 shares of Common Stock at a price of $31.50 per share, (v) 6,673 shares of Common Stock at a price of $31.25 per share, (vi) 8,000 shares of Common Stock at a price of $8.05 per share, (vii) 8,000 shares of Common Stock at a price of $6.850 per share, (viii) 8,000 shares of Common Stock at a price of $6.625, (ix) 1,000 shares of Common Stock at a price of $6.45 per share, (x) 132,200 shares of Common Stock at a price of $6.25, (xi) 3,000 shares of Common Stock at a price of $6.20, (xii) 1,000 shares of Common Stock at a price of $6.10, (xiii) 2,000 shares of Common Stock at a price of $6.075, (xiv) 3,000 shares of Common Stock at a price of $6.00, (xv) 8,000 shares of Common Stock at a price of $5.925, (xvi) 8,000 shares of Common Stock at a price of $5.875, (xvii) 2,000 shares of Common Stock at a price of $5.825, (xviii) 7,000 shares of Common Stock at a price of $5.75, (xix) 14,000 shares of Common Stock at a price of $5.55, (xx) 30,505 shares of Common Stock at a price of $5.50, (xxi) 8,000 shares of Common Stock at a price of $5.475, (xxii) 1,400 shares of Common Stock at a price of $5.45, (xxiii) 400 shares of Common Stock at a price of $5.25 per share, (xxiv) 582,000 shares of Common Stock at a price of $4.875 per share, (xxv) 76,440 shares of Common Stock at a price of $4.325 per share, (xxvi) 72,400 shares of Common Stock at a price of $4.20 per share, (xxvii) 1,000 shares of Common Stock at a price of $4.173 per share,  (xxviii) 16,320 shares of Common Stock at a price of $4.15 per share, (xxix) 16,320 shares of Common Stock at a price of $4.125 per share, (xxx) 1,000 shares of Common Stock at a price of $3.91 per share, (xxxi) 80 shares of Common Stock at a price of $3.85 per share, (xxxii) 2,000 shares of Common Stock at a price of $3.845 per share, (xxxiii) 12,000 shares of Common Stock at a price of $3.705 per share, (xxxiv) 1,400 shares of Common Stock at a price of $3.575 per share, (xxxv) 4,000 shares of Common Stock at a price of $3.50 per share, (xxxvi) 324,800 shares of Common Stock at a price of $3.45 per share, (xxxvii) 3,600 shares at a price of $3.40 per share, (xxxviii) 12,080 shares of Common Stock at a price of $3.35 per share, (xxxix) 1,000 shares of Common Stock at a price of $3.325 per share, (xl) 2,000 shares of Common Stock at a price of $3.323 per share, (xli) 21,000 shares of Common Stock at a price of $3.25 per share, (xlii) 30,000 shares of Common Stock at a price of $3.225 per share, (xliii) 8,000 shares of Common Stock at a price of $3.215 per share, (xliv) 3,240 shares of Common Stock at a price of $3.075 per share, (xlv) 40,000 shares of Common Stock at a price of $2.90 per share, (xlvi) 240,100 shares of Common Stock at a price of $2.875 per share, (xlvii) 29,850 shares of Common Stock at a price of $2.65 per share, (xlviii) 12,000 shares of Common Stock at a price of $2.60 per share, (xlix) 2,000 shares of Common Stock at a price of $2.50 per share, (l) 4,000 shares of Common Stock at a price of $2.45 per share, (li) 80 shares of Common Stock at a price of $2.25 per share, (lii) 80 shares of Common Stock at a price of $2.225 per share, (liii) 108,155 shares of Common Stock at a price of $2.10 per share, (liv) 4,000 shares of Common Stock at a price of $2.00 per share, and (lv) 367,466 shares of Common Stock at a price of $0.875 per share.

 

54
 

  

Item 6. Selected Financial Data.

 

We are not required to provide the information required by this Item because we are a smaller reporting company.

 

Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations.

 

The following discussion and analysis of the results of operations and financial condition for the fiscal years ended December 31, 2014 and 2013 should be read in conjunction with our financial statements, and the notes to those financial statements that are included elsewhere in this Report.  

 

Overview

 

We are a critical care focused immunotherapy company that uses blood purification to modulate inflammation with the goal of preventing or treating multiple organ failure in life-threatening illnesses. The technology is based upon biocompatible, highly porous polymer sorbent beads that are capable of extracting unwanted substances from blood and other bodily fluids. The technology is protected by 32 issued U.S. patents with multiple applications pending both in the U.S. and internationally. The Company’s intellectual property consist of composition of matter, materials, methods of production, systems incorporating the technology and multiple medical uses with expiration dates ranging from 3 to 12 years.

 

In March 2011, the Company received E.U. regulatory approval under the CE Mark and Medical Devices Directive for the Company’s flagship product, CytoSorb ® , as an extracorporeal cytokine filter indicated for use in clinical situations where cytokines are elevated. The goal of CytoSorb® is to prevent or treat organ failure by reducing cytokine storm and the potentially deadly systemic inflammatory response syndrome in diseases such as sepsis, trauma, burn injury, acute respiratory distress syndrome, pancreatitis, liver failure, and many others. Organ failure is the leading cause of death in the intensive care unit, and remains a major unmet medical need, with little more than supportive care therapy (e.g. mechanical ventilation, dialysis, vasopressors, fluid support, etc.) as treatment options. By potentially preventing or treating organ failure, CytoSorb® may improve clinical outcome, including survival, while reducing the need for costly intensive care unit treatment, thereby potentially saving significant healthcare costs.

 

Our CE Mark enables CytoSorb ® to be sold throughout all 28 countries of the European Union. In addition, many countries outside the E.U. accept CE Mark approval for medical devices, but may also require registration with or without additional clinical studies. The broad approved indication enables CytoSorb® to be used “on-label” in diseases where cytokines are elevated including, but not limited to, critical illnesses such as those mentioned above, autoimmune disease flares, cancer cachexia, and many other conditions where cytokine-induced inflammation plays a detrimental role.

 

As part of the CE Mark approval process, we completed our randomized, controlled, European Sepsis Trial amongst fourteen trial sites in Germany in 2011, with enrollment of 100 patients with sepsis and respiratory failure. The trial established that CytoSorb® was safe in this critically-ill population, and that it was able to broadly reduce key cytokines. The Company plans to conduct larger, prospective studies in septic patients in the future to confirm the European Sepsis Trial findings.

 

In addition to CE Mark approval, CytoSorbents also achieved ISO 13485:2003 Full Quality Systems certification, an internationally recognized quality standard designed to ensure that medical device manufacturers have the necessary comprehensive management systems in place to safely design, develop, manufacture and distribute medical devices in the E.U. CytoSorbents manufactures CytoSorb® at its manufacturing facilities in New Jersey for sale in the E.U. and for additional clinical studies. The Company also established a reimbursement path for CytoSorb® in Germany and Austria.

 

From September 2011 through June 2012, the Company began a controlled market release of CytoSorb® in select geographic territories in Germany with the primary goal of preparing for commercialization of CytoSorb® in Germany in terms of manufacturing, reimbursement, logistics, infrastructure, marketing, contacts, and other key issues. 

 

55
 

 

In late June 2012, following the establishment of our European subsidiary, CytoSorbents Europe GmbH, CytoSorbents began the commercial launch of CytoSorb® in Germany with the hiring of Dr. Christian Steiner as Vice President of Sales and Marketing and three additional sales representatives who joined the Company and completed their sales training in Q3 2012. The fourth quarter of 2012 represented the first full quarter of direct sales with the full sales team in place. During this period, we expanded our direct sales efforts to include both Austria and Switzerland. At the end of 2014, we had more than 150 key opinion leaders (KOLs) in our direct sales territories and the U.K. in critical care, cardiac surgery, and blood purification who were either using CytoSorb® or committed to using CytoSorb® in the near future.

 

As of March 1, 2015, our sales force includes seven direct sales people, two contract sales people and seven sales support staff.

 

The Company has complemented its direct sales efforts with sales to distributors and/or corporate partners. In 2013, we reached agreements with distributors in the United Kingdom, Ireland, Turkey, Russia, and the Netherlands. In April 2014, the Company announced distribution of CytoSorb® in the Middle East, including Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman (the Gulf Cooperative Council or GCC) and Yemen, Iraq, and Jordan through an exclusive agreement with Techno Orbits. In August 2014, the Company announced exclusive distribution of CytoSorb® in Taiwan with Hemoscien Corporation, which was subsequently terminated by us in March 2015 due to the complexity of Taiwanese FDA product registration.. In December 2014, the Company entered into an exclusive agreement with Smart Medical Solutions S.R.L., to distribute CytoSorb® for critical care applications in Romania and the neighboring Republic of Moldova.  In January 2015, the Company announced its exclusive distribution agreement with Aferetica SRL to distribute CytoSorb® in Italy for critical care applications.

 

The Company has been expanding the number and scope of its strategic partnerships. In September 2013, we entered into a strategic partnership with Biocon, Ltd., Asia’s largest biotech company with an initial distribution agreement for India and select emerging markets, under which Biocon will have the exclusive commercialization rights for CytoSorb® initially focused on sepsis. In September 2014, the Biocon partnership was expanded to include all critical care applications and cardiac surgery. In addition, Biocon committed to higher minimum purchases of CytoSorb® to maintain distribution exclusivity and to conduct and publish results from multiple Investigator-Initiated studies and patient case studies.

 

In addition, in November 2014, the Company entered into an initial partnership agreement with a leading global medical device company in cardiac surgery and other cardiovascular diseases, to use CytoSorb® intra-operatively during cardiac surgery in France. Under the terms of the agreement, the partnership will commence with an initial six-month market evaluation period to determine various market parameters, to obtain clinical data, and to build key opinion leader support in France. Following a successful evaluation, the parties plan to jointly determine how to expand upon both the size and geographic footprint of its partnership.

 

In February 2015, the Company entered into a multi-country strategic partnership with Fresenius Medical Care AG & CO KGaA to commercialize the CytoSorb® therapy. Under the terms of the agreement, Fresenius Medical Care has exclusive rights to distribute CytoSorb® for critical care applications in France, Poland, Sweden, Denmark, Norway, and Finland. The partnership will allow Fresenius Medical Care to offer an innovative and easy to use blood purification therapy for removing cytokines in patients that are treated in the intensive care unit.  To promote the success of CytoSorb®, Fresenius will also engage in the ongoing clinical development of the product. This includes the support and publication of a number of small case series and patient case reports as well as the potential for future larger, clinical collaborations.

 

The Company is currently evaluating other potential distributor and strategic partner networks in other major countries where we are approved to market the device.

 

Concurrent with our commercialization plans, the Company intends to conduct or support additional clinical studies in sepsis, cardiac surgery, and other critical care diseases to generate additional clinical data to expend the scope of clinical experience for marketing purposes, to increase the number of treated patients, and to support potential future publications. We are currently conducting a matched pairs analysis, dose ranging trial in Germany amongst eight clinical trial sites to evaluate the safety and efficacy of CytoSorb® when used continuously for 7 days. Data from this dosing study are intended to help clinicians with additional treatment options for CytoSorb®, help support the positive clinical data from the Company’s first European Sepsis Trial, and help shape the trial protocol for a pivotal sepsis study.

 

56
 

 

In addition, we now have more than 40 investigator-initiated studies being planned in Germany, Austria, and the United Kingdom in multiple applications including sepsis, cardiac surgery, lung injury, trauma, pancreatitis, liver failure, kidney failure, and others, with many already enrolling patients, which will provide additional clinical data.

 

In February 2015, the U.S. Food and Drug Administration, or FDA, approved the Company’s Investigational Device Exemption, or IDE, application to commence a planned U.S. cardiac surgery feasibility study.  This single-arm study in 20 patients and three U.S. clinical sites represents the first part of a larger clinical trial strategy intended to support the U.S. approval of CytoSorb® for intra-operative use during cardiac surgery. 

 

The study is designed to evaluate the safety of CytoSorb® when used intra-operatively in a heart-lung machine to reduce plasma free hemoglobin and cytokines in patients undergoing complex cardiac surgery.  The length, complexity and invasiveness of these procedures cause hemolysis and inflammation, leading to high levels of plasma free hemoglobin, cytokines, activated complement, and other substances.  These inflammatory mediators directly correlate with the incidence of serious post-operative complications such as kidney injury and failure.  The goal of CytoSorb® is to actively remove these inflammatory and toxic substances as they are being generated during the surgery and reduce complications.

 

Concurrently, the Company is funding a non-interventional study amongst a broader array of U.S. cardiac surgery centers that will assess adverse event rates (e.g. incidence of acute kidney injury and respiratory failure) and levels of free hemoglobin and other inflammatory mediators in patients undergoing complex cardiac surgery.  These patients will be selected using similar inclusion and exclusion criteria to the feasibility study.  The data from these two studies will help to rapidly validate assumptions in this surgical patient population and help to appropriately power a U.S. pivotal cardiac surgery trial.  

 

The market focus for CytoSorb ® is the prevention or treatment of organ failure in life-threatening conditions, including commonly seen illnesses in the intensive care unit such as infection and sepsis, trauma, burn injury, acute respiratory distress syndrome, or ARDS, and others. Sepsis is a major unmet medical need with no approved products in the U.S. or Europe to treat it. As with other critical care illnesses, multiple organ failure is the primary cause of death in sepsis. When used with standard of care therapy, that includes antibiotics, the goal of CytoSorb ® in sepsis is to reduce excessive levels of cytokines and other inflammatory toxins, to help reduce the SIRS response and either prevent or treat organ failure.

 

In addition to the sepsis indication, we intend to continue to foster research in other critical care illnesses where CytoSorb ® could be used, such as ARDS, trauma, severe burn injury and acute pancreatitis, or in other acute conditions that may benefit by the reduction of cytokines in the bloodstream. Some examples include the prevention of post-operative complications of cardiac surgery (cardiopulmonary bypass surgery) and damage to organs donated for transplant prior to organ harvest.

 

The Company’s proprietary hemocompatible porous polymer bead technology forms the basis of a broad technology portfolio. Some of our products include:

 

  · CytoSorb® - an extracorporeal hemoperfusion cartridge approved in the E.U. for cytokine removal, with the goal of reducing SIRS and preventing or treating organ failure

 

  · HemoDefend™ – a development-stage blood purification technology designed to remove contaminants in blood transfusion products. Goal is to reduce transfusion reactions and improve the safety of older blood

 

  · ContrastSorb – a development-stage extracorporeal hemoperfusion cartridge designed to remove IV contrast from the blood of high risk patients undergoing CT imaging with contrast, or interventional radiology procedures such as cardiac catheterization. The goal is to prevent contrast-induced nephropathy

 

57
 

 

  · DrugSorb – a development-stage extracorporeal hemoperfusion cartridge designed to remove toxic chemicals from the blood (e.g. drug overdose, high dose regional chemotherapy, etc)

 

  · BetaSorb™ – a development-stage extracorporeal hemoperfusion cartridge designed to remove mid-molecular weight toxins, such as b 2-microglobulin, that standard high-flux dialysis cannot remove effectively. The goal is to improve the efficacy of dialysis or hemofiltration

 

The Company has been successful in obtaining technology development contracts from agencies in the U.S. Department of Defense, including DARPA, the U.S. Army, and the U.S. Air Force.

 

In September 2013, the National Heart, Lung, and Blood Institute, or NHLBI, a division of the National Institutes of Health, or NIH, awarded the Company a Phase I SBIR (Small Business Innovation Research) contract valued at $231,351 to further advance its HemoDefend™ blood purification technology for packed red blood cell (“pRBC”) transfusions. The University of Dartmouth collaborated with us as a subcontractor on the project, entitled “Elimination of blood contaminants from pRBCs using HemoDefend™ hemocompatible porous polymer beads.” The overall goal of this program is to reduce the risk of potential side effects of blood transfusions, and help to extend the useful life of pRBCs. We completed the Phase I program and have been invited to apply for the Phase II SBIR, which has now been submitted.

 

In June 2013, we announced that the U.S. Air Force will fund a 30 patient, single site, randomized controlled human pilot study in the United States amongst trauma patients with rhabdomyolysis. The primary endpoint is myoglobin removal. The FDA approved our Investigational Device Exemption, or IDE, application for this study and we also received ethics committee approval, allowing the study to commence. However, because of the stringency of our inclusion criteria, and because of the patient mix seen at our single center, we have experienced difficulty in enrolling patients. We have subsequently modified one of the key inclusion criteria and have expanded the number of clinical trial sites to three in a revised protocol which has been submitted to the FDA.

 

In June 2013, the Company began work on its previously announced $1 million Phase II SBIR U.S. Army contract to further develop its technology for the treatment of burn injury and trauma in animal models. This work is supported by the U.S. Army Medical Research and Material Command under an amendment to Contract W81XWH-12-C-0038 and has now received committed funding of $1.15 million to date.

 

In August 2012, the Company was awarded a $3.8 million, five-year contract by the Defense Advanced Research Projects Agency (“DARPA”) for its “Dialysis-Like Therapeutics” program to treat sepsis. DARPA has been instrumental in funding many of the major technological and medical advances since its inception in 1958, including development of the Internet, the global positioning system, or GPS, and robotic surgery. The DLT program in sepsis seeks to develop a therapeutic blood purification device that is capable of identifying the cause of sepsis (e.g., cytokines, toxins, pathogens, activated cells) and remove these substances in an intelligent, automated, and efficient manner. CytoSorbents’ contract is for advanced technology development of its hemocompatible porous polymer technologies to remove cytokines and a number of pathogen and biowarfare toxins from blood. CytoSorbents is in Year 3 of the program and is currently working with the recently announced systems integrator, Battelle Laboratories, and its subcontractor NxStage Medical, who are responsible for integrating the technology developed by CytoSorbents and others into a final medical device design prototype, and evaluating this device in septic animals and eventually in human clinical trials in sepsis. CytoSorbents’ work is supported by DARPA and SSC Pacific under Contract No. N66001-12-C-4199. 

 

Results of Operations

 

Our financial statements have been presented on the basis that it is a going concern, which contemplates the realization of revenues from our subscriber base and the satisfaction of liabilities in the normal course of business. We have incurred losses from inception. These factors raise substantial doubt about our ability to continue as a going concern.

 

58
 

  

Comparison of the year ended December 31, 2014 and 2013

 

Revenues:

 

For the year ended December 31, 2014, the Company generated total revenue, that includes product revenue and grant income, of approximately $4,123,000 as compared to revenues of approximately $2,423,000 for the year ended December 31, 2013, an increase of 70%. Revenue from product sales was approximately $3,135,000 for the year ended December 31, 2014, as compared to approximately $822,000 in the year ended December 31, 2013, an increase of 281%. This increase was largely driven by efforts of our direct sales force and the continued expansion of our distributor network. Product gross margins were approximately 63% for the year ended December 31, 2014, as compared to approximately 61% for the year ended December 31, 2013.

 

Grant income decreased from approximately $1,601,000 in 2013 to approximately $978,000 in 2014 as a result of the conclusion of several significant grants.

 

Cost of Revenue:

 

For the year ended December 31, 2014 and 2013 cost of revenue was approximately $2,134,000 and $1,912,000, respectively. The increase is due to increased sales and expenditures related to progress on grant objectives.

 

Research and Development Expenses:

 

Our research and development costs were, approximately $2,432,000 and $1,739,000, for the years ended December 31, 2014 and 2013, respectively. The increase of approximately $693,000 in research and development expenditures is directly related to a decrease of approximately $507,000 of direct labor and other costs being deployed toward grant-funded activities, which has the effect of increasing the amount of the Company’s non-reimbursable research and development costs. Also, stock-based compensation expense increased approximately $31,000 due to certain milestone options earned and awarded by the Board of Directors. In addition in 2014, the Company commenced various clinical studies and trials in Germany and which resulted in costs of approximately $205,000.

 

Legal, Financial and Other Consulting Expenses:

 

Our legal, financial and other consulting costs were approximately $1,285,000 and $909,000, for the years ended December 31, 2014 and 2013 respectively, an increase of approximately $376,000 or 41%. This increase is due to an increase in legal and consulting fees, investor relations costs and other costs relating to our preparation for the NASDAQ up-listing incurred in 2014 of approximately $385,000 and an increase in employment related fees of approximately $75,000 incurred in 2014 to secure specialized executive talent. These increases were offset by decreases in accounting consulting fees and temporary employment services of approximately $65,000.

 

Selling, General and Administrative Expense:

 

Our selling, general and administrative expenses were approximately $5,551,000 and $2,577,000 for the years ended December 31, 2014 and 2013, respectively, an increase of approximately $2,974,000. This increase is attributable to increased investor relations expenses of approximately $160,000 due to filings and associated fees incurred related to listing the Company’s common stock on the NASDAQ Capital Market, the reverse stock split and the conversion of the Company’s preferred stock, additional salaries and related costs of approximately $706,000 due to headcount additions during 2014, the full year impact of the headcount additions made during the year ended December 31, 2013 and bonuses accrued for the year ended December 31, 2014, royalties increased approximately $127, 000 in 2014 due solely to the increase in sales, losses on foreign currency exchange increased approximately $367,000 in 2014 due to a large decrease in the exchange rate of the Euro during 2014 and stock-based compensation expense increased approximately $208,000 during 2014 due to certain milestone options earned and awarded by the Board of Directors. In addition, as a result of the continuing ramp up of the business in Europe, selling, general and administrative expenses at our European subsidiary increased approximately $1,338,000. The main drivers of this increase were an increase in personnel and related expenses of approximately $748,000 related to headcount additions during 2014 and the full year impact of headcount additions made during 2013 related to building our direct sales team, an increase in advertising and marketing related expenses of approximately $158,000 due primarily to an increase in the number of conferences and meetings attended during 2014 and an increase in travel and entertainment expenses of approximately $136,000 related to the significant increase in international travel and sales calls made to customers during 2014.

 

59
 

  

Interest Expense:

 

For the year ended December 31, 2014, our net interest expense was approximately $310,000, as compared to interest expenses of approximately $423,000 for the year ended December 31, 2013. This decrease was principally due to interest expense related to our convertible debt.

 

Change in Warrant Liability:

 

The Company recognizes warrants as liabilities at their fair value on the date of the grant because of price adjustment provisions in the warrants, then measures the fair value of the warrants on each reporting date and records a change to the warrant liability as appropriate. The change in the warrant liability was approximately $2,118,000 and -0- for the year ended December 31, 2014 and 2013, respectively. The change in the warrant liability was primarily due to the increased stock price from the date of issuance through December 31, 2014. There was no warrant liability in 2013, and therefore there was no change in warrant expense in 2013.

 

Benefit from Income Taxes:

 

Our benefit from income taxes was approximately $386,000 and $458,000 for the years ended December 31, 2014 and 2013, respectively. These benefits were realized by utilizing the New Jersey Technology Business Tax Certificate Transfer Program whereby we sold our net operating losses to the State of New Jersey.

  

History of Operating Losses:

 

The Company has experienced substantial operating losses since inception. As of December 31, 2014, we had an accumulated deficit of approximately $124,394,120, which included losses of approximately $9,322,000 and $4,678,000 for years ended December 31, 2014 and 2013 respectively. Historically, our losses have resulted principally from costs incurred in the research and development of our polymer technology, and selling, general and administrative expenses, which together were $7,983,000 and $4,316,000 for the years ended December 31, 2014 and 2013 respectively.  

 

Liquidity and Capital Resources

 

Since inception, our operations have been primarily financed through the private and public placement of our debt and equity securities. At December 31, 2014, we had current assets of approximately $7,607,000 including cash on hand of $3,605,000 and short-term investments of approximately $1,945,000 and current liabilities of $4,505,000. In January of 2015, we filed a Form S-1 which became effective on January 8, 2015. On January 14, 2015, we received approximately $9,609,000 in net proceeds in connection with this registered offering of our common stock. In addition, in January 2015, we received approximately $386,000 in cash from the sale of our net operating losses to the State of New Jersey. 

 

We believe that we have sufficient cash to fund our operations into 2016; however, we may need to raise additional capital to fully fund Pivotal trials in the United States and/or Germany. We will be better able to assess this need once the specific protocols are finalized.

 

Contractual Obligations

 

The following table summarizes our obligations with regard to our leases and long-term debt at December 31, 2014:

 

    1 Year     1-3 Years     3-5 Years     Over 5 Years  
Leases related to premises   $ 211,240       98,445              

 

60
 

 

This Annual Report has been prepared assuming we will continue as a going concern, and the auditors’ report on the financial statements expresses substantial doubt about our ability to continue as a going concern.

 

Effects of Recent Accounting Pronouncements

 

    Accounting Standards Update (“ASU”) 2014-10, which for public business entities will be effective for annual reporting periods beginning after December 15, 2014 and interim periods therein (early adoption permitted), removes the definition of a development stage entity from the Accounting Standards Codification, thereby eliminating the financial reporting distinction between development stage entities from U.S. GAAP. Specifically eliminated are the requirements to (1) present inception-to-date information in the statements of income, cash flows, and shareholder equity, (2) label the financial statements as those of a development stage entity, (3) disclose a description of the development stage activities in which the entity is engaged, and (4) disclose in the first year in which the entity is no longer a development state entity that in prior years it had been in the development stage. The Company has early adopted ASU 2014-10 within its September 30, 2014 financial statements.

  

In May 2014, the Financial Account Standards Board (“FASB”) issued ASU 2014-09, “Revenue with Contracts from Customers.” ASU 2014-09 supercedes the current revenue recognition guidance, including industry-specific guidance. The ASU introduces a five-step model to achieve its core principal of the entity recognizing revenue to depict the transfer of goods or services to customers at an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods and services. The updated guidance is effective for public entities for interim and annual periods beginning after December 15, 2016 and early adoption is not permitted. The Company is currently evaluating the impact of the updated guidance, but the Company does not believe that the adoption of ASU 2014-09 will have a significant impact on its consolidated financial statements.

 

In August 2014, the FASB issued ASU No. 2014-15, Presentation of Financial Statements—Going Concern (Subtopic 205-40). The ASU requires all entities to evaluate for the existence of conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the issuance date of the financial statements.  The amendments in this Update are effective for the annual period ending after December 15, 2016, and for annual periods and interim periods thereafter. Early application is permitted.  The Company is currently evaluating the impact of the updated guidance, but the Company does not believe that the adoption of ASU 2014-15 will have a significant impact on its consolidated financial statements but may impact the Company’s footnote disclosures.

 

Critical Accounting Policies

 

The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. We believe the following critical accounting policies have significant effect in the preparation of our consolidated financial statements.

 

Patents

 

Legal costs incurred to establish patents are capitalized. When patents are issued, capitalized costs are amortized on the straight-line method over the related patent term. In the event a patent is abandoned, the net book value of the patent is written off.

 

Revenue Recognition

 

Product Sales : Revenues from sales of products are recognized at the time when title and risk of loss passes to the customer. Recognition of revenue also requires reasonable assurance of collection of sales proceeds and completion of all performance obligations.

 

61
 

  

Grant Revenue : Revenue from grant income is based on contractual agreements. Certain agreements provide for reimbursement of costs, while other agreements provide for reimbursement of costs and an overhead margin. Revenues are recognized when milestones have been achieved and revenues have been earned. Costs are recorded as incurred. Costs subject to reimbursement by these grants have been reflected as costs of revenue.

 

Deferred Revenue : The Company defers revenue that has been received but not yet earned on government contracts. This revenue will be recognized as income in the period in which the revenue is earned. All deferred revenue is expected to be earned within a one year of the balance sheet date.

 

Research and Development

 

All research and development costs, payments to laboratories and research consultants are expensed when incurred.

 

Stock Based-Compensation

 

The Company accounts for its stock-based compensation under the recognition requirements of accounting standards for accounting for stock-based compensation, for employees and directors whereby each option granted is valued at fair market value on the date of grant. Under these accounting standards, the fair value of each option is estimated on the date of grant using the Black-Scholes option pricing model.

 

The Company also follows the guidance of accounting standards for accounting for equity instruments that are issued to other than employees for acquiring, or in conjunction with selling, goods or services for equity instruments issued to consultants.

 

Determination of Fair Value for Stock Dividend and Stock Based Compensation 

 

The Company estimates the fair value of the preferred stock dividends using a five day volume weighted average price of actual closing market prices for the Company’s common stock. The Company believes that this market based methodology provides for a fair valuation of its preferred stock dividends.

   

Warrant Liability

 

The Company recognizes the fair value of the warrants as of the date of the warrant grant using the binomial lattice valuation model. At each subsequent reporting date, the Company again measures the fair value of the warrants, and records a change to the warrant liability as appropriate, and the change is reported in the statement of operations. 

 

Off-Balance Sheet Arrangements  

 

We currently operate a facility near Princeton, New Jersey with approximately 12,400 sq. ft., housing research laboratories, clinical manufacturing operations and administrative offices, under a lease agreement, which expires in May 2016. We expect to renew this lease upon expiration. We also operate a small office facility in Berlin, Germany housing sales and administrative offices. We entered into a lease for this office on March 1, 2012. The lease expires on December 31, 2016. We rent this space for €1,200 per month or US $1,459 per month. 

 

Item 7A. Quantitative and Qualitative Disclosures About Market Risk.  

 

Smaller reporting companies are not required to provide the information required by this item.

 

Item 8. Financial Statements and Supplementary Data.

 

 The Financial Statements and Notes thereto can be found beginning on page F-1, "Index to Financial Statements," at the end of this Form 10-K.  

 

62
 

 

Item 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure.

 

None.

 

Item 9A. Controls and Procedures.

 

Evaluation of Disclosure Controls and Procedures  

 

Management of the Company, with the participation of the Company’s Chief Executive Officer and Chief Financial Officer evaluated the effectiveness of the Company’s disclosure controls and procedures (as such term is defined in Rules 13a-15(e) and 15d-15(e)) under the Securities Exchange Act of 1934, as amended, or the Exchange Act, as of the end of the period covered by this report.. Based upon their evaluation, as of the end of the period covered by this Form 10-K, the Company’s Chief Executive Officer and Chief Financial Officer have concluded that the Company’s disclosure controls and procedures were effective.  

 

The management of the Company is responsible for establishing and maintaining adequate internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) for the Company. Management conducted an evaluation of the effectiveness of internal control over financial reporting based on the framework in Internal Control – Integrated Framework issued in 2013 by the Committee of Sponsoring Organizations of the Treadway Commission. Based upon this evaluation, management concluded that internal control over financial reporting was effective as of December 31, 2014.

 

Management's Responsibility for Financial Statements

 

Responsibility for the integrity and objectivity of the Company’s financial statements rests with management. The financial statements report on management’s stewardship of Company assets. These statements were prepared in conformity with generally accepted accounting principles and, accordingly, include amounts that are based upon management’s best estimates and judgments. Nonfinancial information included in the Annual Report on Form 10-K has also been prepared by management and is consistent with the financial statements.

 

To assure that financial information is reliable and assets are safeguarded, management maintains an effective system of internal controls and procedures, important elements of which include: careful selection, training and development of operating and financial managers; an organization that provides appropriate division of responsibility; and communications aimed at assuring that Company policies and procedures are understood throughout the organization. Management, working with an external consultant, evaluated and tested its internal controls on a worldwide basis.

 

To ensure that personnel continue to understand the system of internal controls and procedures, and policies concerning good and prudent business practices, annually all employees of the Company are required to complete Code of Conduct training, which includes financial stewardship. This training reinforces the importance and understanding of internal controls by reviewing key corporate policies, procedures, and systems. In addition, the Company has compliance programs, including an ethical business practices program to reinforce the Company’s commitment to high ethical standards in the conduct of its business. 

 

The financial statements and other financial information included in this Annual Report on Form 10-K fairly present, in all material respects, our financial condition, results of operations and cash flows. Our formal certification to the Securities and Exchange Commission is included in this Form 10-K filing.

 

This annual report does not include an attestation report of the Company’s registered public accounting firm regarding internal control over financial reporting. As a smaller reporting company, management's report is not subject to attestation by the Company's registered public accounting firm pursuant to the rules of the Securities and Exchange Commission that permit the Company to provide only management's report in this annual report.  

 

63
 

 

Management’s Report on Internal Control over Financial Reporting

 

Management is responsible for establishing and maintaining adequate internal control over financial reporting, as such term is defined in Rule 13a-15(f) and 15d-15(f) under the Exchange Act. The Company’s internal control over financial reporting is designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles in the United States of America. Management, working with an external consultant, conducted an evaluation of the effectiveness of internal control over financial reporting based on the framework in Internal-Control –Integrated Framework issued in 2013 by the Committee of Sponsoring Organizations of the Treadway Commission. Based on this evaluation, management concluded that internal control over financial reporting was effective as of December 31, 2014.

   

Changes in Internal Control over Financial Reporting

 

On November 11, 2014, the Board of Directors, or the Board, of the Company, unanimously appointed Alan D. Sobel to serve as a member of the Board effective November 13, 2014. The Board also appointed Mr. Sobel to serve as Chairperson of the Nominating and Corporate Governance Committee of the Board and to serve as Chairperson of the Audit Committee of the Board. The Board also determined that Mr. Sobel qualifies as an “audit committee financial expert,” as such term is defined by Item 407(d)(5) of Regulation S-K as promulgated by the Securities and Exchange Commission. The Board has adopted a Charter of Audit Committee which outlines the Audit Committee’s authority and responsibility. The Audit Committee will begin meeting in the first quarter of 2015.

 

Except for the appointment of Alan D. Sobel to serve as a member of the Board as fully described above, no change in our internal control over financial reporting occurred during the fiscal quarter ended December 31, 2014 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting. 

 

Item 9B. Other Information.

 

None.

 

PART III

 

Item 10. Directors, Executive Officers and Control Persons; Compliance with Section 16(a) of the Exchange Act.

 

Information required to be disclosed by this Item with respect to our executive officers is incorporated in this Annual Report on Form 10-K by reference from the section entitled “Officers and Key Employees” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

Information required to be disclosed by this Item about our board of directors is incorporated in this Annual Report on Form 10-K by reference from the section entitled “Nomination and Election of Directors” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

Information required to be disclosed by this Item about the Section 16(a) compliance of our directors and executive officers is incorporated in this Annual Report on Form 10-K by reference from the section entitled “Section 16(a) Beneficial Ownership Reporting Compliance” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

Information required to be disclosed by this Item about our board of directors, the audit committee of our board of directors, our audit committee financial expert, our Code of Business Conduct and Ethics, and other corporate governance matters is incorporated in this Annual Report on Form 10-K by reference from the section entitled “Board of Directors and Corporate Governance Matters” contained in our definitive proxy statement related to our 2015 annual meeting of stockholders scheduled to be held on June 10, 2014, which we intend to file within 120 days of the end of our fiscal year.

 

64
 

 

The text of our Code of Business Conduct and Ethics, which applies to our directors and employees (including our principal executive officer, principal financial officer, and principal accounting officer or controller, or persons performing similar functions), is posted in the “Corporate Governance” section of our website, www.cytosorbents.com. A copy of the Code of Business Conduct and Ethics can be obtained free of charge on our website. We intend to disclose on our website any amendments to, or waivers from, our Code of Business Conduct and Ethics that are required to be disclosed pursuant to the rules of the Securities and Exchange Commission and The NASDAQ Stock Market.

 

Item 11. Executive Compensation

 

Information required to be disclosed by this Item is incorporated in this Annual Report on Form 10-K by reference from the sections entitled “Compensation for Executive Officers and Directors” and “Board of Directors and Corporate Governance Matters” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

 

Information required to be disclosed by this Item is incorporated in this Annual Report on Form 10-K by reference from the sections entitled “Principal Stockholders,” “Stock Ownership of Directors, Nominees for Director, and Executive Officers” and “Compensation for Executive Officers and Directors” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

Item 13. Certain Relationships and Related Transactions and Director Independence

 

The information required to be disclosed by this Item is incorporated in this Annual Report on Form 10-K by reference from the section(s) entitled “Certain Relationships and Related Party Transactions” and “Board of Directors and Corporate Governance Matters,” “Compensation for Executive Officers and Directors, “Compensation Committee Interlocks and Insider Participation” and “Compensation Committee Report” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

Item 14. Principal Accounting Fees and Services

 

This information required to be disclosed by this Item is incorporated in this Annual Report on Form 10-K by reference from the section entitled “Audit and Other Fees” contained in our definitive proxy statement for our 2015 annual meeting of stockholders scheduled to be held on June 10, 2015, which we intend to file within 120 days of the end of our fiscal year.

 

65
 

 

PART IV

 

Item 15. Exhibits, Financial Statement Schedules.

 

(a) The following documents are filed as part of this report:

 

Exhibit    
No.   Description
     
3.1   Articles of Incorporation, dated April 25, 2002 (filed as Exhibit 3.1 to the Registrant’s Registration Statement on Form SB-2 (Commission File Number 333-114002) filed on March 29, 2004).
     
3.2   Certificate of Designation of Series A 10% Cumulative Convertible Preferred Stock, $.001 Par Value Per Share (filed as Exhibit 4.1 to the Registrant’s Current Report on Form 8-K filed on July 6, 2006).
     
3.3   Amendment to Articles of Incorporation dated August 1, 2006 (filed as Exhibit 3.1 to the Registrant’s Current Report on Form 8-K filed on August 7, 2006).
     
3.4   Certificate of Designation of Series B 10% Cumulative Convertible Preferred Stock, $0.001 Par Value Per Share (filed as Exhibit 4.2 to the Registrant’s Current Report on Form 8-K filed on July 1, 2008).
     
3.5   Certificate of Amendment to Certificate of Designation of Series A 10% Cumulative Convertible Preferred Stock, $0.001 Par Value Per Share (filed as Exhibit 4.3 to the Registrant’s Current Report on Form 8-K filed on July 1, 2008).
     
3.6   Amendment to Articles of Incorporation, dated December 15, 2008 (filed as Exhibit 3(i).3to the Registrant’s Registration Statement on Form S-1/A (Commission File Number 333-193053) filed on February 14, 2014).
     
3.7   Amendment to Articles of Incorporation, dated April 16, 2013 (filed as Exhibit 3(i).5to the Registrant’s Registration Statement on Form S-1/A (Commission File Number 333-193053) filed on February 14, 2014).
     
3.8   Certificate of Amendment to Articles of Incorporation, dated February 17, 2010 (filed as Exhibit 3.1 to the Registrant’s Current Report on Form 8-K filed on May 7, 2010).
     
3.9   Certificate of Amendment to the Certificate of Designation of Series A 10% Cumulative Convertible Preferred Stock, $0.001 par value per share of CytoSorbents Corporation (filed as Exhibit 3.1 to the Registrant’s Current Report on Form 8-K filed on October 14, 2014).
     
3.10   Certificate of Amendment to the Certificate of Designation of Series B 10% Cumulative Convertible Preferred Stock, $0.001 par value per share of CytoSorbents Corporation (filed as Exhibit 3.2 to the Registrant’s Current Report on Form 8-K filed on October 14, 2014).
     
3.11   First Amended and Restated Certificate of Incorporation, dated December 3, 2014 (filed as Exhibit 3(i).4 to the Registrant’s Current Report on Form 8-K filed on December 4, 2014).
     
3.12   Bylaws of the Company (filed as Exhibit 3(ii).1 to the Registrant’s Current Report on Form 8-K filed on December 4, 2014).
     
4.1   Form of Convertible Note for sale of stock that occurred June 21, 2013 (filed as Exhibit 4.1 to the Registrant’s Current Report on Form 8-K filed on June 27, 2013).
     
4.2   Form of Warrant for sale of stock that occurred June 21, 2013 (filed as Exhibit 4.2 to the Registrant’s Current Report on Form 8-K filed on June 27, 2013).
     
4.3   Form of Convertible Note for sale of stock that occurred September 30, 2013 (filed as Exhibit 4.1 to the Registrant’s Current Report on Form 8-K filed on October 10, 2013).

 

66
 

  

4.4   Form of Warrant for sale of stock that occurred September 30, 2013 (filed as Exhibit 4.2 to the Registrant’s Current Report on Form 8-K filed on October 10, 2013).
     
4.5   Form of Underwriter Warrant  (filed as Exhibit 4.5 to the Registrant’s Registration Statement on Form S-1/A (Commission File Number 333-199762) filed on December 30, 2014).
     
10.1   Employment Agreement with Dr. Phillip P. Chan Effective December 3, 2013 (filed as Exhibit 10.1 to the Registrant’s Current Report on Form 8-K filed on January 7, 2014).
     
10.2   Employment Agreement with Vincent Capponi Effective December 3, 2013 (filed as Exhibit 10.2 to the Registrant’s Current Report on Form 8-K filed on January 7, 2014).
     
10.3   Employment Agreement with Kathleen Bloch Effective May 7, 2013 (filed as Exhibit 10.1 to the Registrant’s Current Report on Form 8-K filed on May 14, 2013).
     
10.4   Lease Agreement between Princeton Corporate Plaza LLC and the Registrant dated as of March 9, 2000.*
     
10.5   Third Amendment to Lease Agreement between Princeton Corporate Plaza LLC and the Registrant dated as of December 12, 2014.*
     
10.6   Royalty Agreement between Guillermina Vega Montiel and the Registrant dated as of August 11, 2003.*
     
10.7   Stipulated Order and Settlement Agreement between Bro-Tech Corporation, Purolite International Ltd. And the Registrant, dated August 7, 2006 (filed as Exhibit 10.1 to the Registrant’s Current Report on Form 8-K filed on September 8, 2006).
     
10.8   Distribution Agreement between Biocon Limited and the Registrant dated as of September 20, 2013. †*
     
10.9   First Amendment to the Distribution Agreement between Biocon Limited and the Registrant dated as of October 30, 2014. †*
     
21.1   List of Subsidiaries*
     
23.1   Consent of WithumSmith + Brown, PC*
     
31.1   Certification of the Chief Executive Officer pursuant to Rules 13a-14(a) and 15d-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.*
     
31.2   Certification of the Chief Financial Officer pursuant to Rules 13a-14(a) and 15d-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. *
     
32.1   Certification of the Chief Executive Officer pursuant to 18 U.S.C Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. *
     
32.2   Certification of the Chief Financial Officer pursuant to 18 U.S.C Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
     
101   The following materials from CytoSorbents Form 10-K for the fiscal year ended December 31, 2014, formatted in Extensible Business Reporting Language (XBRL): (1) Consolidated Balance Sheets at December 31, 2014 and December 31, 2013, (iii) Consolidated Statements of Operations and Comprehensive Loss for the years ended December 31, 2014 and December 31, 2013, (iii) Consolidated Statements of Changes in Redeemable Convertible Preferred Stock and Stockholders’ Equity (Deficiency), (iv) Consolidated Statements of Cash Flows for the years ended December 31, 2014 and December 31, 2013, and (v) Notes to the Consolidated Financial Statements.

 

67
 

 

* Filed or furnished herewith.

 

† Confidential treatment requested. Confidential materials omitted and filed separately with Securities and Exchange Commission.

 

In accordance with SEC Release 33-8238, Exhibit 32.1 and 32.2 are being furnished and not filed. 

 

68
 

   

SIGNATURES

 

In accordance with Section 13 or 15(d) of the Exchange Act, CytoSorbents Corporation has caused this report to be signed on its behalf by the undersigned, thereunto duly authorized, on this 31 th day of March, 2015.

 

  CYTOSORBENTS CORPORATION
       
    By: /s/ Phillip Chan
      Phillip Chan
      Chief Executive Officer

 

Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the registrant and in the capacities and on the dates indicated.

 

Signature   Title   Date
         
/s/ Phillip Chan   Chief Executive Officer (Principal   March 31, 2015
Phillip Chan   Executive Officer) and Director    
         
/s/ Kathleen P. Bloch   Chief Financial Officer   March 31, 2015
Kathleen P. Bloch   (Principal Financial and Accounting Officer)    
         
/s/ Al Kraus   Chairman of the Board   March 31, 2015
Al Kraus        
         
/s/ Alan D. Sobel   Director   March 31, 2015
Alan D. Sobel        
         
/s/ Edward R. Jones   Director   March 31, 2015
Edward R. Jones        
         
/s/ James Gunton   Director   March 31, 2015
James Gunton        

 

69
 

  

FINANCIAL STATEMENTS

 

  Page
   
Report of Independent Registered Public Accounting Firm 71
   
Consolidated Balance Sheets at December 31, 2014 and December 31, 2013 72
   
Consolidated Statements of Operations and Comprehensive Loss for the years ended December 31, 2014 and 2013 73
   
Consolidated Statements Of Changes in Redeemable Convertible Preferred Stock and Stockholders' Equity (Deficiency) 74
   
Consolidated Statements of Cash Flows for the for the years ended December 31, 2014 and 2013 75
   
Notes to Consolidated Financial Statements 77

 

70
 

 

Report of Independent Registered Public Accounting Firm

 

To the Board of Directors and Stockholders,

 

CytoSorbents Corporation:

 

We have audited the accompanying consolidated balance sheets of CytoSorbents Corporation as of December 31, 2014 and 2013, and the related consolidated statements of operations and comprehensive loss, changes in redeemable convertible preferred stock and stockholders’ equity (deficiency) and cash flows for the years then ended. These consolidated financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on these consolidated financial statements based on our audits.

 

We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement. The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. Our audits included consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Company’s internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion.

 

In our opinion, based on our audits, the consolidated financial statements referred to above present fairly, in all material respects, the consolidated financial position of CytoSorbents Corporation as of December 31, 2014 and 2013 and the consolidated results of their operations and their cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America.

 

The accompanying financial statements have been prepared assuming that the Company will continue as a going concern. As discussed in Note 1 to the consolidated financial statements, although management has indicated that the Company currently has adequate funding for more than the next twelve months of operations, the Company has experienced recurring net losses and negative cash flows from operations. As a result, the Company may have to raise additional capital to continue to operate and these matters raise substantial doubt about its ability to continue as a going concern. Management’s plans in regard to these matters are also described in Note 1. The consolidated financial statements do not include any adjustments that might result from the outcome of this uncertainty.

 

/s/ WithumSmith+Brown, PC

New Brunswick, New Jersey 

March 31, 2015

 

71
 

  

CYTOSORBENTS CORPORATION

CONSOLIDATED BALANCE SHEETS

 

December 31,   2014     2013  
             
ASSETS                
Current Assets:                
Cash and cash equivalents   $ 3,605,280     $ 2,183,030  
Short-term investments     1,944,547        
Grants and accounts receivable, net of allowance for doubtful accounts of $3,756 and -0- at December 31, 2014 and 2013, respectively     819,151       453,017  
Inventories     537,566       245,608  
Prepaid expenses and other current assets     700,462       605,312  
                 
Total current assets     7,607,006       3,486,967  
                 
Property and equipment – net     245,821       144,393  
Other assets     615,798       414,375  
                 
Total long-term assets     861,619       558,768  
                 
Total Assets   $ 8,468,625     $ 4,045,735  
                 
LIABILITIES AND STOCKHOLDERS' EQUITY (DEFICIENCY)                
                 
Current Liabilities:                
Accounts payable   $ 698,307     $ 786,517  
Accrued expenses and other current liabilities     824,884       361,700  
Deferred revenue     833       272,359  
Warrant liability     2,981,418        
Current portion of convertible notes payable, net of debt discount in the amount of $198,644 at December 31, 2013           1,644,356  
                 
Total current liabilities     4,505,442       3,064,932  
                 
Redeemable Series B Convertible Preferred Stock, -0- and 200,000 shares authorized;  -0- and 79,336.54 issued and outstanding at December 31, 2014 and 2013, respectively           15,246,350  
                 
Stockholders’ Equity/(Deficiency):                
Preferred Stock, 5,000,000 shares authorized; -0- shares issued and outstanding at December 31, 2014 and 2013, respectively            
10% Series A Convertible Preferred Stock, -0- and 12,000,000 shares authorized; -0- and 1,759,666 shares issued and outstanding at December 31, 2014 and 2013, respectively           1,760  
Common Stock, Par Value $0.001, 50,000,000 shares authorized; 23,304,640 and 10,052,782 shares issued and outstanding at December 31, 2014 and 2013, respectively     23,305       10,053  
Additional paid-in capital     128,106,297       91,584,402  
Accumulated other comprehensive income (loss)     227,701       (55,987 )
Accumulated deficit     (124,394,120 )     (105,805,775 )
Total stockholders’ equity/(deficiency)     3,963,183       (14,265,547 )
Total Liabilities and Stockholders' Equity/(Deficiency)   $ 8,468,625     $ 4,045,735  

 

The Notes to Consolidated Financial Statements are an integral part of these statements 

 

72
 

 

CYTOSORBENTS CORPORATION

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS

 

    Year ended     Year ended  
    December 31,     December 31,  
    2014     2013  
             
Revenue:                
Sales   $ 3,135,387     $ 821,787  
Grant income     978,271       1,600,880  
Other revenue     9,167        
Total revenue     4,122,825       2,422,667  
                 
Cost of revenue     2,133,888       1,911,565  
                 
Gross profit     1,988,937       511,102  
                 
Operating expenses:                
Research and development     2,431,759       1,738,938  
Legal, financial and other consulting     1,284,947       908,644  
Selling, general and administrative     5,551,023       2,576,751  
                 
Total operating expenses     9,267,729       5,224,333  
                 
Loss from operations     (7,278,792 )     (4,713,231 )
                 
Other (income) expense:                
Interest (income) expense, net     310,024       422,843  
Change in warrant liability     2,118,498        
                 
Total other (income) expense, net     2,428,522       422,843  
                 
Loss before benefit from income taxes     (9,707,314 )     (5,136,074 )
Benefit from income taxes     385,642       458,279  
                 
Net loss     (9,321,672 )     (4,677,795 )
                 
Preferred stock dividends     9,266,673       2,395,520  
                 
Net loss available to common shareholders   $ (18,588,345 )   $ (7,073,315 )
                 
Basic and diluted net loss per common share   $ (1.29 )   $ (0.75 )
                 
Weighted average number of shares of common stock outstanding     14,382,813       9,440,763  
                 
Net loss   $ (9,321,672 )   $ (4,677,795 )
                 
Other comprehensive income (loss):                
Currency translation adjustment     283,688       (43,325 )
                 
Comprehensive loss   $ (9,037,984 )   $ (4,721,120 )

 

The Notes to Consolidated Financial Statements are an integral part of these statements.

 

73
 

  

CYTOSORBENTS CORPORATION

CONSOLIDATED STATEMENTS OF CHANGES REDEEMABLE CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS' EQUITY (DEFICIENCY)

FOR THE YEARS ENDED DECEMBER 31, 2014 and 2013

  

    Series B Redeemable Convertible                       Accumulated     Deficit        
    Preferred Stock     Common Stock     Preferred Stock A           Other     Accumulated     Stockholders'  
    Shares     Amount     Shares     Par 
value
    Shares     Par 
Value
    Paid-In
Capital
    Comprehensive
Income
    Development
Stage
    Equity 
(Deficit)
 
                                                             
Balance at December 31, 2012     72,073.26     $ 12,887,817       8,598,698     $ 8,599       1,594,164     $ 1,594     $ 87,109,784     $ (12,662 )   $ (98,732,460 )   $ (11,625,145 )
                                                                                 
Stock based compensation - employees, consultants and directors                                                     456,937                       456,937  
                                                                                 
Issuance of Series A Preferred Stock as dividends                                     165,502       166       16,435               (16,601 )      
                                                                                 
Issuance of Series B Preferred Stock as dividends     7,461.55       2,378,919                                                       (2,378,919 )     (2,378,919 )
                                                                                 
                                                                                 
Issuance of common stock for services rendered                     20,000       20                       65,448                       65,468  
                                                                                 
Conversion of Series A and Series B Preferred into Common     (198.27 )     (20,386 )     21,909       22                       20,364                       20,386  
                                                                                 
Issuance of common stock for cash                     840,851       841                       2,299,126                       2,299,967  
                                                                                 
Cost of raising capital                                                     (100,000 )                     (100,000 )
                                                                                 
Conversion of convertible notes to common                     389,597       390                       1,225,652                       1,226,042  
                                                                                 
Relative fair value of warrants and beneficial conversion feature in connection with issuance of convertible notes                                                     331,117                       331,117  
                                                                                 
Proceeds from exercise of warrants                     159,458       159                       139,367                       139,526  
                                                                                 
Exercise of stock options                     22,269       22                       20,172                       20,194  
                                                                                 
Other comprehensive income/(loss) foreign translation adjustment                                                             (43,325 )             (43,325 )
                                                                                 
Net loss                                                                     (4,677,795 )     (4,677,795 )
                                                                                 
Balance at December 31, 2013     79,336.54     $ 15,246,350       10,052,782     $ 10,053       1,759,666     $ 1,760     $ 91,584,402     $ (55,987 )   $ (105,805,775 )   $ (14,265,547 )
                                                                                 
Stock based compensation - employees, consultants and directors                                                     695,841                       695,841  
                                                                                 
Issuance of Series A Preferred Stock as dividends                                     135,303       135       238,178               (238,313 )      
                                                                                 
Issuance of Series B Preferred Stock as dividends     14,499.96       9,028,360                                                     (9,028,360 )     (9,028,360 )
                                                                                 
Issuance of common stock for services rendered                     44,922       45                       180,055                       180,100  
                                                                                 
Conversion of Series A and Series B Preferred into Common     (93,836.50 )     (24,274,710 )     10,472,062       10,472       (1,894,969 )     (1,895 )     24,266,131                       24,274,708  
                                                                                 
Issuance of common stock for cash                     99,336       99                       299,901                       300,000  
                                                                                 
Issuance of common stock for cash - offering                     1,632,000       1,632                       10,198,368                       10,200,000  
                                                                                 
Cost of raising capital                                                     (748,545 )                     (748,545 )
                                                                                 
Conversion of convertible notes to common                     701,309       702                       1,989,738                       1,990,440  
                                                                                 
                                                                                 
Proceeds from exercise of warrants                     20,000       20                       156,230                       156,250  
                                                                                 
Cashless exercise of warrants                     165,435       165                       (165 )                      
                                                                                 
Additional shares issued related to the round-up of fractional shares  as a result of stock split                     151                                                          
                                                                                 
Exercise of stock options                     116,643       117                       109,083                       109,200  
                                                                                 
Other comprehensive income foreign translation adjustment                                                             283,688               283,688  
                                                                                 
Warrant Liability                                                     (862,920 )                     (862,920 )
                                                                                 
Net loss                                                                     (9,321,672 )     (9,321,672 )
                                                                                 
Balance at December 31, 2014         $       23,304,640     $ 23,305           $     $ 128,106,297     $ 227,701     $ (124,394,120 )   $ 3,963,183  

  

The Notes to Consolidated Financial Statements are an integral part of these statements.

 

74
 

 

CYTOSORBENTS CORPORATION

CONSOLIDATED STATEMENTS OF CASH FLOWS

 

    Year ended     Year ended  
    December 31,     December 31,  
    2014     2013  
             
Cash flows from operating activities:                
Net loss   $ (9,321,672 )   $ (4,677,795 )
Adjustments to reconcile net loss to net cash used in operating activities:                
Issuance of common stock to consultants for services     180,100       65,468  
Depreciation and amortization     65,547       64,350  
Amortization of debt discount     198,644       311,248  
Bad debt expense     4,106        
Change in warrant liability     2,118,498        
Stock-based compensation     695,841       456,937  
Changes in operating assets and liabilities:                
Grants and accounts receivable     (412,118 )     (401,238 )
Inventories     (303,129 )     436,764  
Prepaid expenses and other current assets     (108,153 )     (129,219 )
Other assets     (4,784 )     (6,942 )
Accounts payable and accrued expenses     497,453       118,748  
Deferred revenue     (271,526 )     272,359  
Net cash used by operating activities     (6,661,193 )     (3,489,320 )
                 
Cash flows from investing activities:                
Purchases of property and equipment     (153,157 )     (38,684 )
Patent costs     (214,165 )     (177,672 )
Proceeds from sale of short-term investments     4,745,000        
Purchases of short-term investments     (6,689,547 )      
Net cash used by investing activities     (2,311,869 )     (216,356 )
                 
Cash flows from financing activities:                
Equity contributions - net of fees incurred     9,751,455       2,199,967  
Proceeds from borrowing           1,843,000  
Proceeds from exercise of stock options     109,201       20,194  
Proceeds from exercise of warrants     156,250       139,526  
Net cash provided by financing activities     10,016,906       4,202,687  
Effect of exchange rates on cash     378,406       (43,325 )

 

The Notes to Consolidated Financial Statements are an integral part of these statements.

 

75
 

  

CYTOSORBENTS CORPORATION

CONSOLIDATED STATEMENTS OF CASH FLOWS

 

    Year ended     Year ended  
    December 31,     December 31,  
    2014     2013  
             
Net change in cash and cash equivalents     1,422,250       453,686  
                 
Cash and cash equivalents at beginning of period     2,183,030       1,729,344  
Cash and cash equivalents at end of period   $ 3,605,280     $ 2,183,030  
                 
Supplemental disclosure of cash flow information:                
Cash paid during the period for interest   $     $  
                 
Supplemental schedule of noncash financing activities:                
Fair value of warrant liability upon issuance   $ 862,920     $  
Debt discount in connection with issuance of convertible debt   $       331,117  
Fair value of shares issued as costs of raising capital   $ 7,137       49,647  
Note payable principal and interest conversion to equity   $ 1,990,440     $ 1,226,042  
Costs paid from proceeds in conjunction with issuance of common stock   $ 748,545     $  
Preferred stock dividends   $ 9,266,673     $ 2,395,520  

 

During the years ended December 31, 2014 and 2013, 93,836.50 and 198.27 Series B Preferred Shares were converted into 10,368,730 and 21,908 Common Shares, respectively. During the years ended December 31, 2014 and 2013, 1,894,969 and -0- Series A Preferred Shares were converted into 103,332 and -0- Common Shares, respectively.

 

The Notes to Consolidated Financial Statements are an integral part of these statements.

 

76
 

 

CYTOSORBENTS CORPORATION

Notes to Consolidated Financial Statements

 

1. BASIS OF PRESENTATION

 

The accompanying consolidated financial statements include the results of CytoSorbents Corporation (the “Parent”), CytoSorbents Medical Inc., its wholly-owned operating subsidiary (the “Subsidiary”), and CytoSorbents Europe GmbH, its wholly-owned European subsidiary (the “European Subsidiary”), collectively referred to as “the Company.”

 

The accompanying consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. The Company believes that it has adequate funding for more than the next twelve months of operations, however, it may have to raise additional capital to fund its future operations.

 

As of December 31, 2014, the Company had an accumulated deficit of $124,394,120, which included net losses of $9,321,672 for the year ended December 31, 2014 and $4,677,795 for the year ended December 31, 2013. Our losses have resulted principally from costs incurred in the research and development of our polymer technology and selling, general and administrative expenses. We intend to continue to conduct significant additional research, development, and clinical study activities which, together with expenses incurred for the establishment of manufacturing arrangements and a marketing and distribution presence and other selling, general and administrative expenses, are expected to result in continuing operating losses for the foreseeable future. The amount of future losses and when, if ever, we will achieve profitability are uncertain. Our ability to achieve profitability will depend, among other things, on successfully completing the development of our technology and commercial products, obtaining additional requisite regulatory approvals in markets not covered by the CE Mark and for potential label extensions of our current CE Mark, establishing manufacturing and sales and marketing arrangements with third parties, and raising sufficient funds to finance our activities. No assurance can be given that our product development efforts will be successful, that our current CE Mark will enable us to achieve profitability, that additional regulatory approvals in other countries will be obtained, that any of our products will be manufactured at a competitive cost and will be of acceptable quality, or that the we will be able to achieve profitability or that profitability, if achieved, can be sustained. These matters raise substantial doubt about the Company’s ability to continue as a going concern. These consolidated financial statements do not include any adjustments related to the outcome of this uncertainty.

 

2. PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES:

 

Nature of Business

 

CytoSorbents Corporation is a critical care focused immunotherapy company using blood purification to control severe inflammation –with the goal of preventing or treating multiple organ failure in life-threatening illnesses. The Company, through its subsidiary CytoSorbents Medical Inc.(formally known as CytoSorbents, Inc.), is engaged in the research, development and commercialization of medical devices with its platform blood purification technology incorporating a proprietary adsorbent polymer technology. The Company, through its European Subsidiary, has commenced initial sales and marketing related operations for the CytoSorb ® device in the European Union. CytoSorb ®, t he Company’s flagship product, is approved in the European Union and marketed in twenty-nine countries around the world, as a safe and effective extracorporeal cytokine absorber, designed to reduce the “cytokine storm” that could otherwise cause massive inflammation, organ failure and death in common critical illnesses such as sepsis, burn injury, trauma, lung injury, and pancreatitis. CytoSorb ® is also being used during and after cardiac surgery to remove inflammatory mediators, such as cytokines and free hemoglobin, which can lead to post-operative complications, including multiple organ failure. In March 2011, the Company received CE Mark approval for its CytoSorb ® device.

 

77
 

 

The technology is based upon biocompatible, highly porous polymer sorbent beads that can actively remove toxic substances from blood and other bodily fluids by pore capture and surface absorption. CytoSorbents has numerous products under development based upon this unique blood purification technology, which is protected by 32 issued U.S. patents and multiple applications pending, including HemoDefend™, ContrastSorb, DrugSorb, and others, with multiple patent applications pending both in the U.S. and internationally. Our intellectual property consists of composition of matter, materials, method of production systems incorporating the technology, and multiple medical uses with expiration dates ranging from 3 to 12 years.

 

Recent Corporate Actions

 

On December 1, 2014, the Company received stockholder approval authorizing our Board of Directors to (i) amend our Articles of Incorporation, as amended, to effect a reverse split of our Common Stock, with a reverse split ratio of twenty-five-to-one (25:1); (ii) amend our Articles of Incorporation, as amended, to reduce the total number of authorized shares of Common Stock from 800,000,000 to 50,000,000, after giving effect to the reverse stock split; (iii) amend our Articles of Incorporation, as amended, to reduce the total number of authorized shares of undesignated preferred stock from 100,000,000 to 5,000,000, after giving effect to the reverse stock split; (iv) implement the form, terms and provisions of the CytoSorbents Corporation 2014 Long-Term Incentive Plan; and (v) change our domicile from the State of Nevada to the State of Delaware through our merger with and into a newly-organized subsidiary organized under the laws of the State of Delaware.

 

On December 3, 2014, the Company effected a twenty-five-for-one (25:1) reverse split of our common stock. As a result of the twenty-five-for-one (25:1) reverse stock split, shares of its common stock outstanding were reduced by approximately 96%. Immediately after the reverse split, on December 3, 2014 the Company changed its state of incorporation from the State of Nevada to the State of Delaware pursuant to an Agreement and Plan of Merger, dated December 3, 2014, whereby the Company merged with and into the recently formed, wholly-owned Delaware subsidiary. Pursuant to the Agreement and Plan of Merger, the Company adopted the certificate of incorporation, as amended and restated, and bylaws of its Delaware subsidiary as its certificate of incorporation and bylaws at effective time of the merger. At the effective time of our merger, (i) the Company merged with and into its Delaware subsidiary, (ii) separate corporate existence in Nevada ceased to exist, (iii) the Delaware subsidiary became the surviving corporation, and (iv) each share of common stock, $0.001 par value per share outstanding immediately prior to the effective time was converted into one fully-paid and non-assessable share of common stock of CytoSorbents Corporation, a Delaware corporation, $0.001 par value per share. The reverse stock split, the merger and the Agreement and Plan of Merger were approved by our Board of Directors and stockholders representing a majority of our outstanding common stock.

 

Reverse Stock Split

 

As discussed above, the Company’s twenty-five-for-one reverse stock split became effective on December 3, 2014. As a result of this action, funds were shifted from the common stock account to the additional paid in capital account to reflect the par value of the reduced number of shares. All share, option and warrant information presented in these financial statements and accompanying footnotes has been retroactively adjusted to reflect the reduced number of shares resulting from this action.

 

Stock Market Listing

 

On December 17, 2014 the Company’s common stock was approved for listing on the NASDAQ Capital Market (“NASDAQ”), and it began trading on NASDAQ on December 23, 2014 under the symbol “CTSO”. Previously, the Company’s common stock traded in the over-the-counter-market on the OTC Bulletin Board.

 

Basis of Consolidation and Foreign Currency Translation

 

The consolidated financial statements include the accounts of the Parent, CytoSorbents Corporation, and its wholly-owned subsidiaries, CytoSorbents Medical, Inc. and CytoSorbents Europe GmbH. All significant intercompany transactions and balances have been eliminated in consolidation.

 

78
 

 

Translation gains and losses resulting from the process of remeasuring into the United States of America dollar, the foreign currency financial statements of the European subsidiary, for which the United States of America dollar is the functional currency, are included in operations. Foreign currency translation losses included in net loss amounted to approximately $386,000 and $14,000 for the years ended December 31, 2014 and 2013, respectively. We translate assets and liabilities of the European subsidiary, whose functional currency is their local currency, at the exchange rate in effect at the balance sheet date. We translate revenue and expenses at the monthly average exchange rates. We include accumulated net translation adjustments in stockholders’ equity as a component of accumulated other comprehensive income.

 

Cash and Cash Equivalents

 

The Company considers all highly liquid instruments purchased with an original maturity of three months or less to be cash equivalents.

 

Short-Term Investments

 

Short-term investments include certificates of deposit with original maturities of greater than three months. The cost of the certificates of deposit approximates fair value. The Company classifies these investments as held-to-maturity securities in accordance with the provisions of ASC-320-10.

 

Grants and Accounts Receivable

 

Grants receivable represent amounts due from U.S. government agencies.

 

Accounts receivable are unsecured, non-interest bearing customer obligations due under normal trade terms. The Company sells its devices to various hospitals and distributors. The Company performs ongoing credit evaluations of customers’ financial condition. Management reviews accounts receivable periodically to determine collectability. Balances that are determined to be uncollectible are written off to the allowance for doubtful accounts. The allowance for doubtful accounts contains a general accrual for estimated bad debts and amounted to $3,756 and -0- at December 31, 2014 and December 31, 2013, respectively.

 

Inventories

 

Inventories are valued at the lower of cost or market. Cost is determined using a first-in first-out (“FIFO”) basis. At December 31, 2014 and December 31, 2013 the Company’s inventory was comprised of finished goods, which amounted to $142,693 and $107,098, respectively, work in process which amounted to $326,047 and $100,528, respectively and raw materials which amounted to $68,826 and $37,982, respectively. Devices used in clinical trials or for research and development purposes are removed from inventory and charged to research and development expenses at the time of their use.

 

Property and Equipment

 

Property and equipment are recorded at cost less accumulated depreciation. Depreciation of property and equipment is provided for by the straight-line method over the estimated useful lives of the related assets. Leasehold improvements are amortized over the lesser of their economic useful lives or the term of the related leases. Gains and losses on depreciable assets retired or sold are recognized in the statements of operations in the year of disposal. Repairs and maintenance expenditures are expensed as incurred.

 

Patents

 

Legal costs incurred to establish and successfully defend patents are capitalized. When patents are issued, capitalized costs are amortized on the straight-line method over the related patent term. In the event a patent is abandoned, the net book value of the patent is written off.

 

Impairment or Disposal of Long-Lived Assets

 

The Company assesses the impairment of patents and other long-lived assets under accounting standards for the impairment or disposal of long-lived assets whenever events or changes in circumstances indicate that the carrying value may not be recoverable. For long-lived assets to be held and used, the Company recognizes an impairment loss only if its carrying amount is not recoverable through its undiscounted cash flows and measures the impairment loss based on the difference between the carrying amount and fair value.

 

79
 

 

Warrant Liability

 

The Company recognizes the fair value of the warrants as of the date of the warrant grant using the binomial lattice valuation model. At each subsequent reporting date, the Company again measures the fair value of the warrants, and records a change to the warrant liability as appropriate, and the change is reported in the statement of operations.

 

Revenue Recognition

 

Product Sales : Revenues from sales of products are recognized when title and risk of loss passes to the customer. Recognition of revenue also requires reasonable assurance of collection of sales proceeds and completion of all performance obligations.

 

Grant Revenue : Revenue from grant income is based on contractual agreements. Certain agreements provide for reimbursement of costs, while other agreements provide for reimbursement of costs and an overhead margin. Revenues are recognized when milestones have been achieved and revenues have been earned. Costs are recorded as incurred. Costs subject to reimbursement by these grants have been reflected as costs of revenue.

 

Deferred Revenue : The Company defers revenue that has been received but not yet earned on government contracts and product sales. This revenue will be recognized as income in the period in which the revenue is earned. All deferred revenue is expected to be earned within a one year of the balance sheet date.

 

Research and Development

 

All research and development costs, payments to laboratories and research consultants are expensed when incurred.

 

Advertising Expenses

 

Advertising costs are charged to activities when incurred. Advertising expense amounted to approximately $142,000 and $269,000 in 2014 and 2013, respectively, and is included in selling, general, and administrative expenses on the consolidated statement of operations.

 

Income Taxes

 

Income taxes are accounted for under the asset and liability method prescribed by accounting standards for accounting for income taxes. Deferred income taxes are recorded for temporary differences between financial statement carrying amounts and the tax basis of assets and liabilities. Deferred tax assets and liabilities reflect the tax rates expected to be in effect for the years in which the differences are expected to reverse. A valuation allowance is provided if it is more likely than not that some or all of the deferred tax asset will not be realized. Under Section 382 of the Internal Revenue Code the net operating losses generated prior to the previously completed reverse merger may be limited due to the change in ownership. Additionally, net operating losses generated subsequent to the reverse merger may be limited in the event of changes in ownership.

 

The Company follows the accounting standards associated with uncertain tax provisions. The Company had no unrecognized tax benefits at December 31, 2014 or 2013. The Company files tax returns in the U.S. federal and state jurisdictions. The Company currently has no open years prior to December 31, 2011 and has no income tax related penalties or interest for the periods presented in these financial statements.

 

Our European subsidiary, CytoSorbents Europe GmbH annually files a corporate tax return, VAT return, and a trade tax return in Germany.

 

80
 

 

Use of Estimates

 

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities. Actual results could differ from these estimates. Significant estimates in these financials are the valuation of options granted, the valuation of preferred shares issued as stock dividends, valuation methods used to determine the fair value of the warrant liability and valuation methods used in determining any debt discount associated with the convertible securities.

 

Concentration of Credit Risk

 

The Company maintains cash balances, at times, with financial institutions in excess of amounts insured by the Federal Deposit Insurance Corporation. Management monitors the soundness of these institutions in an effort to minimize its collection risk of these balances.

 

As of December 31, 2014, three distributors accounted for approximately 53 percent of outstanding grant and accounts receivable. As of December 31, 2013, a U.S. Government agency accounted for approximately 66 percent of outstanding accounts receivable. For the year ended December 31, 2014, approximately 24 percent of revenue was from two U.S. government grant agencies and approximately 12 percent of revenues was from one distributor. For the year ended December 31, 2013, approximately 62 percent of revenues were from two U.S. government agencies. For the year ended December 31, 2013, no other agency, distributor, or direct customer represented more than 10% of the Company’s revenue.

 

Financial Instruments

 

The carrying values of cash and cash equivalents, accounts receivable, accounts payable and other debt obligations approximate their fair values due to their short-term nature.

 

Net Loss per Common Share

 

Basic EPS is computed by dividing income (loss) available to common stockholders by the weighted average number of common shares outstanding during the period. Diluted EPS gives effect to all dilutive potential common shares outstanding during the period. The computation of diluted EPS does not assume conversion, exercise or contingent exercise of securities that would have an anti-dilutive effect on earnings. (See Note 11).

 

Stock-Based Compensation

 

The Company accounts for its stock-based compensation under the recognition requirements of accounting standards for accounting for stock-based compensation for employees and directors whereby each option granted is valued at fair market value on the date of grant. Under these accounting standards, the fair value of each option is estimated on the date of grant using the Black-Scholes option pricing model.

 

The Company also follows the guidance of accounting standards for accounting for equity instruments that are issued to other than employees for acquiring, or in conjunction with selling, goods or services for equity instruments issued to consultants.

 

Effects of Recent Accounting Pronouncements

 

Accounting Standards Update (“ASU”) 2014-10, which for public business entities will be effective for annual reporting periods beginning after December 15, 2014 and interim periods therein (early adoption permitted), removes the definition of a development stage entity from the Accounting Standards Codification, thereby eliminating the financial reporting distinction between development stage entities from U.S. GAAP. Specifically eliminated are the requirements to (1) present inception-to-date information in the statements of income, cash flows, and shareholder equity, (2) label the financial statements as those of a development stage entity, (3) disclose a description of the development stage activities in which the entity is engaged, and (4) disclose in the first year in which the entity is no longer a development state entity that in prior years it had been in the development stage. The Company has early adopted ASU 2014-10 within these financial statements.

 

81
 

  

In May 2014, the Financial Account Standards Board (“FASB”) issued ASU 2014-09, “Revenue with Contracts from Customers.” ASU 2014-09 supersedes the current revenue recognition guidance, including industry-specific guidance. The ASU introduces a five-step model to achieve its core principal of the entity recognizing revenue to depict the transfer of goods or services to customers at an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods and services. The updated guidance is effective for public entities for interim and annual periods beginning after December 15, 2016 and early adoption is not permitted. The Company is currently evaluating the impact of the updated guidance, but the Company does not believe that the adoption of ASU 2014-09 will have a significant impact on its consolidated financial statements.

 

In August 2014, the FASB issued ASU No. 2014-15, Presentation of Financial Statements—Going Concern (Subtopic 205-40). The ASU requires all entities to evaluate for the existence of conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the issuance date of the financial statements.  The amendments in this Update are effective for the annual period ending after December 15, 2016, and for annual periods and interim periods thereafter. Early application is permitted.  The Company is currently evaluating the impact of the updated guidance, but the Company does not believe that the adoption of ASU 2014-15 will have a significant impact on its consolidated financial statements but may impact the Company’s footnote disclosures.

 

Shipping and Handling Costs

 

The cost of shipping product to customers and distributors is typically borne by the customer or distributor. The Company records shipping and handling costs in Research and Development. Total freight costs amounted to approximately $103,000 and $33,000 for the years ended December 31, 2014 and 2013 respectively.

 

Reclassifications

 

Certain reclassifications have been made to the December 31, 2013 financial statements in order to conform to the 2014 financial statement presentation. There was no change in the reported amount of the accumulated deficit as a result of these reclassifications.

 

3. PROPERTY AND EQUIPMENT, NET:

 

Property and equipment - net, consists of the following:

 

                Depreciation/
                Amortization
December 31,   2014     2013     Period
                 
Furniture and fixtures   $ 186,121     $ 130,716     7 years
Equipment and computers     2,000,821       1,952,051     3 to 7 years
Leasehold improvements     515,515       462,980     Term of lease
      2,702,457       2,545,747      
Less accumulated depreciation and amortization     2,456,636       2,401,354      
Property and Equipment, Net   $ 245,821     $ 144,393      

 

Depreciation expense for the years ended December 31, 2014 and 2013 amounted to $48,429 and $39,891 respectively.

 

82
 

 

4. OTHER ASSETS:

 

Other assets consist of the following: 

 

December 31,   2014     2013  
             
Intangible assets, net   $ 557,528     $ 360,481  
Security deposits     58,270       53,894  
Total   $ 615,798     $ 414,375  

 

Intangible assets consist of the following:

 

December 31,   2014     2013  
    Gross     Accumulated     Gross     Accumulated  
    Amount     Amortization     Amount     Amortization  
                                 
Patents   $ 706,796     $ 149,268     $ 492,631     $ 132,150  

 

Amortization expense amounted to $17,118 and $24,459 for the years ended December 31, 2014 and 2013, respectively.

 

Amortization expense for the next five years will be approximately $26,500 for the year ended December 31, 2015; approximately $26,500 for the year ended December 31, 2016; approximately $21,000 for the year ended December 31, 2017; approximately $14,100 for the year ended December 31, 2018 and approximately $14,000 for the year ended December 31, 2019.

 

5. ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES:

 

Accrued expenses and other current liabilities consist of the following:

 

    2014     2013  
             
Professional fees   $ 293,758     $ 80,880  
Travel and entertainment     107,542       -  
Clinical study costs     36,465       15,016  
Sales, payroll and income taxes payable     64,745       179,970  
Accrued salaries and commissions     204,515       -  
Accrued royalties     45,200       15,000  
Customer deposits     30,000       -  
Board of Director fees     11,250       -  
Accrued interest     -       25,326  
Accrued financing costs     -       36,371  
Other     31,409       9,137  
    $ 824,884     $ 361,700  

 

6. CONVERTIBLE NOTES:

 

On June 21, 2013 (the “June Closing Date”), the Company issued convertible notes to certain accredited investors (the “June Purchasers”), whereby the Company agreed to sell and the June Purchasers agreed to purchase the convertible notes in the aggregate principal amount of $1,098,000 (the “June Notes”). The June Notes were to mature one (1) year from the June Closing Date (the “June Maturity Date”), bear interest at an annual rate of 8%, and automatically convert into shares of the Company’s Common Stock at a conversion price of $3.125 at maturity or earlier at the option of the June Purchaser. In connection with the issuance of the June Notes, the Company issued warrants to purchase shares of Common Stock, providing 50% coverage, exercisable at $3.75 per share (the “June Warrants”). On June 21, 2014, all outstanding June Notes were converted into 379,469 shares of Common Stock, consisting of 351,360 shares related to the principal value of the June Notes and 28,109 shares of Common Stock for payment of interest earned on the June Notes.

 

83
 

 

On September 30, 2013 (the “September Closing Date”), the Company issued convertible notes to certain accredited investors (the “September Purchasers”), whereby the Company agreed to sell and the September Purchasers agreed to purchase the convertible notes in the aggregate principal amount of $745,000 (the “September Notes”). The September Notes were to mature one (1) year from the September Closing Date (the “September Maturity Date”), bear interest at an annual rate of 8%, and automatically convert into shares of Common Stock at a conversion price of $2.50 at maturity, or earlier at the option of the September Purchaser. In connection with the issuance of the September Notes, the Company issued warrants to purchase shares of Common Stock, providing 50% coverage, exercisable at $3.125 per share (the “September Warrants”). On September 30, 2014, all outstanding September Notes were converted into 298,000 shares of Common Stock related to the principal value of the September Notes and 23,840 shares of Common Stock for payment of interest earned on the September Notes.

 

The Company allocates the proceeds associated with the issuance of convertible notes based on the relative fair value of the convertible notes and warrants. Additionally, the Company evaluates if the embedded conversion option results in a beneficial conversion feature by comparing the relative fair value allocated to the convertible notes to the market value of the underlying Common Stock subject to conversion. In connection with the convertible note issuances during the years ended December 31, 2013, the Company received proceeds of $1,843,000. The Company allocated the proceeds in accordance with FASB Codification Topic 470 based on the related fair value as follows: $1,511,883 was allocated to the convertible notes and $171,012 to the warrants. Additionally, the embedded conversion feature resulted in a beneficial conversion feature in the amount of $160,105. The value assigned to the warrants resulting from the relative fair value calculation as well as the value of the beneficial conversion feature is recorded as a debt discount and is presented in the consolidated balance sheets. The debt discount has been amortized to interest expense over the term of the convertible notes. During the years ended December 31, 2014 and 2013, debt discount of approximately $199,000 and $311,000, respectively, was charged to interest expense.

 

7. INCOME TAXES:

 

Tax losses amounted to approximately $7,700,000 and $3,300,000 for the years ended December 31, 2014 and December 31, 2013, respectively. The Company’s Federal net operating loss carry forward amounts to approximately $31,663,000 and expires through 2034. The Company’s remaining New Jersey net operating loss carry forward amounts to approximately $7,700,000 and expires in 2034. These loss carry forwards are subject to limitation in future years should certain ownership changes occur. A full valuation allowance equal to the deferred tax asset has been recorded due to the uncertainty that the Company will have the ability to utilize such asset.

 

During the years ended December 31, 2014 and 2013 the Company utilized the Technology Business Tax Certificate Transfer Program to sell a portion of its New Jersey Net Operating Loss tax carryforwards to an industrial company, receiving proceeds of approximately $386,000 and $458,000, respectively. There can be no assurance that the Company will again be eligible in the future to participate or be successful in future sales of its New Jersey Net Operating Loss tax carryforwards.

 

For the years ended December 31, 2014 and December 31, 2013, respectively, the Company’s effective tax rate differs from the federal statutory rate principally due to net operating losses offset by certain non-deductible expenses for which no benefit has been recorded.

 

A reconciliation of the Federal statutory rate to the Company’s effective tax rate for the years ended December 31, 2014 and December 31, 2013 is as follows:

 

    2014     2013  
Federal statutory rate     (34.0 )%     (34.0 )%
Decrease resulting from:                
Non-deductible expenses     1.0       2.9  
Timing differences     (1.0 )     0.9  
Change in valuation allowance     34.0       29.8  
Net operating losses           0.4  
Effective tax rate     %     %

 

84
 

 

8. WARRANT LIABILITY:

 

In connection with its March 11, 2014 offering, the Company issued warrants to purchase 816,000 shares of Common Stock. The Company recognizes these warrants as liabilities at their fair value on the date of grant, then measures the fair value of the warrants on each reporting date, and records a change to the warrant liability as appropriate. The warrants have certain pricing provisions which apply if the Company sells or issues Common Stock or Common Stock equivalents at a price that is less than the exercise price of the warrants, over the life of the warrants, excluding certain exempt issuances.

 

The Company recognized an initial warrant liability for the warrants issued in connection with the Offering completed in March 2014. The initial warrant liability recognized on the related warrants totaled $862,920, which was based on the March 11, 2014 five-day weighted average closing price per share of the Company’s Common Stock of $6.00. On December 31, 2014, the five day weighted average closing price per share of Common Stock was $10.22. Due to the fluctuations in the market value of the Company’s Common Stock from March 11, 2014 through December 31, 2014, the Company recorded a change in the fair value of the warrant liability of $2,118,498 during the year ended December 31, 2014.

 

The assumptions used in connection with the valuation of warrants issued utilizing the binomial lattice valuation model were as follows:

 

          Initial  
    December 31,     Measurement  
    2014     March 11, 2014  
Number of shares underlying the warrants     816,000       816,000  
Exercise price   $ 7.8125     $ 7.8125  
Volatility     28.3 %     28.3 %
Risk-free interest rate     1.43 %     1.62 %
Expected dividend yield     0       0  
Expected warrant life (years)     4.19       5  
Stock price   $ 10.22     $ 6.00  

 

9. COMMITMENTS AND CONTINGENCIES:

 

The Company is obligated under non-cancelable operating leases for office space expiring at various dates through December 2016. The aggregate minimum future payments under these leases are approximately as follows:

 

Year ending December 31,        
         
2015    $ 211,240  
2016     98,445  
Total   $ 309,685  

 

The preceding data reflects existing leases through the date of this report and does not include replacements upon their expiration. In the normal course of business, operating leases are normally renewed or replaced by other leases.

 

Rent expense for the years ended December 31, 2014 and 2013 amounted to approximately $328,000 and $315,000, respectively.

 

85
 

 

Employment Agreements

 

The Company has employment agreements with its Chief Executive Officer and Chief Operating Officer through December 2013, and expects to renew similar agreements for 2015. The agreements provide for annual base salaries of specified amounts.

 

On May 7, 2013, the Company entered into an employment agreement with Kathleen P. Bloch to become the Company’s Chief Financial Officer. Ms. Bloch’s employment agreement states that she will perform the services and duties that are normally and customarily associated with this position as well as other associated duties as our Board reasonably determines. The agreement commences on May 29, 2013 and expires on May 31, 2015 and calls for an initial base salary of $200,000 payable in equal semi-monthly installments in accordance with the Company’s usual practice. As a signing bonus, Ms. Bloch was also given a ten-year option to purchase 40,000 shares of the Company’s common stock at an exercise price of $2.90 per share. This option vests in equal installments over the next two years: 20,000 options at the 12 month anniversary, and 20,000 options at 24 month anniversary of the signing of the employment agreement, provided that Ms. Bloch remains a full-time employee of the Company.

 

Litigation

 

The Company is, from time to time, subject to claims and litigation arising in the ordinary course of business. The Company intends to defend vigorously against any future claims and litigation. The Company is not currently a party to any legal proceedings. 

 

Royalty Agreements

 

Pursuant to an agreement dated August 11, 2003, an existing investor agreed to make a $4 million equity investment in the Company. These amounts were received by the Company in 2003. In connection with this agreement the Company granted the investor a future royalty of 3% on all gross revenues received by the Company from the sale of its CytoSorb® device. For the years ended December 31, 2014 and 2013 the Company recorded royalty expenses of approximately $93,000 and $26,000 respectively.

 

License Agreements

 

In an agreement dated September 1, 2006, the Company entered into a license agreement which provides the Company the exclusive right to use its patented technology and proprietary know how relating to adsorbent polymers for a period of 18 years. Under the terms of the agreement, the Company has agreed to pay royalties of 2.5% to 5% on the sale of certain of its products if and when those products are sold commercially for a term not greater than 18 years commencing with the first sale of such product. For the years ended December 31, 2014 and 2013 per the terms of the license agreement the Company recorded royalty expenses of approximately $77,000 and $21,000 respectively.

 

10. STOCKHOLDERS' EQUITY

 

Preferred Stock

 

In December 2014, the Company amended its articles of incorporation to reduce the total number of authorized shares of preferred stock after giving effect to the reverse stock split (see Note 2). The amended articles of incorporation authorize the issuance of up to 5,000,000 shares of “blank check” preferred stock, with such designation rights and preferences as may be determined from time to time by the Board of Directors.  

 

86
 

 

Conversion of Series A and Series B Preferred Stock into Common Stock.

 

On October 9, 2014, the Company filed with the Nevada Secretary of State an Amendment (the "Series A Amendment") to the Certificate of Designation, as amended (the "Series A Certificate of Designation") of the Series A Preferred Stock. The Series A Amendment, which became effective on October 9, 2014, (i) amended the Series A Certificate of Designation to allow the stockholders representing eighty percent (80%) of the issued and outstanding shares of Series A Preferred Stock to elect to convert all issued and outstanding shares of Series A Preferred Stock into Common Stock of the Company, $0.001 par value per share (the "Common Stock"), at the then-effective "Conversion Price," as defined in the Series A Certificate of Designation, and (ii) as consideration for approving such amendment, amended the Conversion Price from $31.25 per share to $19.25 per share, except with respect to the shares of Series A Preferred Stock covered by that certain Agreement and Consent dated as of June 25, 2008 by and among the Company and certain holders of Series A Preferred Stock. The fair value of the reduction in the conversion price was determined based on the five day volume weighted average price of the Series A common stock equivalent immediately before and immediately after the reduction in conversion price . Immediately following effectiveness of the Series A Amendment, the stockholders representing over 88 percent (88%) of the then-issued and outstanding Series A Preferred Stock elected to convert all issued and outstanding Series A Preferred Stock into Common Stock at the Conversion Price, as amended. As a result of this election by the holders of Series A Preferred Stock, 1,894,969 shares of Series A Preferred Stock were converted into 4,133 shares of Common Stock.

 

In addition, on October 9, 2014, the Company also filed with the Nevada Secretary of State an Amendment (the "Series B Amendment") to the Certificate of Designation (the "Series B Certificate of Designation") of the Series B Preferred Stock. The Series B Amendment, which became effective on October 9, 2014, amended the Series B Certificate of Designation to allow the holders of a majority of the Series B Preferred Stock, including NJTC Investment Fund, LP, to elect to convert all issued and outstanding shares of Series B Preferred Stock into Common Stock. Immediately following effectiveness of the Series B Amendment, the stockholders representing over 93 percent (93%) of the then-issued and outstanding Series B Preferred Stock elected to convert all issued and outstanding Series B Preferred Stock into Common Stock. Each share of Series B Preferred Stock had a stated value of $100.00 (the "Series B Stated Value"), and was convertible into that number of shares of Common Stock equal to the Series B Stated Value at a conversion price of $0.90. As consideration for approving the Series B Amendment, the holders of Series B Preferred Stock received a one-time dividend equal to ten percent (10%) of the shares of Series B Preferred Stock then held. As a result of this election by the holders of Series B Preferred Stock, 84,283.99 shares of Series B Preferred Stock were issued a dividend of 10% and then the 92,712.27 shares were converted into 409,778 shares of Common Stock. As a result of the conversion, the carrying value of the Series B stock was reclassified to permanent equity.

 

After giving effect to the conversions of the Series A Preferred Stock and Series B Preferred Stock described above, there are no shares of Preferred Stock of the Company issued and outstanding as of December 31, 2014.

 

During the years ended December 31, 2014 and 2013, the Company issued 135,303 and 165,502 shares of Series A Preferred Stock respectively as payment of stock dividends at the stated value of $1.00 per share. The fair value of the non-cash stock dividends, including the value of the conversion price reduction, amounted to $238,313 and $16,601, respectively, for the years ended December 31, 2014 and 2013.

 

During the years ended December 31, 2014 and 2013, the Company issued 14,499.96 and 7,461.55 shares of Series B Preferred Stock respectively as payment of stock dividends at the stated value of $100.00 per share. The fair value of the non-cash stock dividends, which includes the one-time dividend disclosed above, amounted to $9,028,360 and $2,378,919, respectively, for the years ended December 31, 2014 and 2013.

 

Determination of Stock Dividend Fair Value

 

The Company utilizes a five day volume weighted average price of actual closing market prices for the Company’s Common Stock as its basis for estimating the fair value of the preferred stock dividends.

 

Common Stock

 

On March 7, 2014, the Company entered into subscription agreements with certain investors providing for the issuance and sale by the Company, or the March 2014 Offering, of 1,632,000 units, or the Units, for an aggregate purchase price of $10,200,000.  Each Unit is comprised of one share of the Company’s common stock, priced at $6.25 per share, par value $0.001 per share and a warrant to purchase 0.50 shares of common stock at an exercise price of $7.8125 per share. The warrants are convertible into a total of 816,000 shares of common stock. Each warrant is exercisable for a period of five (5) years beginning on March 11, 2014, the date of the closing of the sale of these securities, and are only exercisable for cash if at the time of exercise there is an effective registration statement registering the warrants and shares underlying the warrants.

 

87
 

 

The Company received net proceeds from the March 2014 Offering of approximately $9,451,000 million. The net proceeds received by the Company from the March 2014 Offering will be used for building additional sales and marketing infrastructure, clinical studies, working capital and general corporate purposes. 

 

The Company conducted the March 2014 Offering pursuant to a registration statement on Form S-1 (File No. 333-193053) which was declared effective by the Securities and Exchange Commission on February 14, 2014 and an additional registration statement on Form S-1 (File No. 333-194394) to register an additional amount of securities having a proposed maximum aggregate offering price of $2,762,500, which increased the total registered amount to $16,575,000 assuming the full cash exercise of the warrants for cash. The Company filed a final prospectus on March 7, 2014, disclosing the final terms of the March 2014 Offering.

 

In connection with the March 2014 Offering, on March 7, 2014, the Company entered into a placement agency agreement with Brean Capital, LLC pursuant to which the placement agent agreed to act as the Company’s exclusive placement agent for the March 2014 Offering and sale of the Units.

 

In connection with the successful completion of the March 2014 Offering, the placement agent received an aggregate cash placement agent fee equal to 6% of the gross proceeds of the sale of the Units in the Offering and a warrant to purchase 48,960 shares of Common Stock at an exercise price of $7.50 per share exercisable for five years from the effective date of the placement agency agreement. The placement agent warrant contains piggy-back registration rights which expire on the fifth anniversary of the effective date of the registration statement. We have also agreed to reimburse the placement agent for actual out-of-pocket expenses up to a maximum of 2% of gross proceeds from the transaction. We also granted the placement agent a right of first refusal to participate in any subsequent offering or placement of our securities that takes place within twelve months following the effective date of the registration statement.

 

In December 2014, the Company amended its articles of incorporation to reduce the total number of authorized shares of common stock after giving effect to the reverse stock split (see Note 2). The amended articles of incorporation authorize the issuance of up to 50,000,000 shares with a par value of $0.001 per share.

 

In May 2010, the Company executed a purchase agreement, or the Purchase Agreement, and a registration rights agreement, or the Registration Rights Agreement, with Lincoln Park Capital Fund, LLC (“LPC”). Under the Purchase Agreement, LPC is obligated, under certain conditions, to purchase from the Company up to $6 million of our Common Stock, from time to time over a 750 day (twenty-five (25) monthly) period.

 

The Company had the right, but not the obligation, to direct LPC to purchase up to $6,000,000 of its Common Stock in amounts up to $50,000 as often as every two business days under certain conditions. The Company could also accelerate the amount of its common stock to be purchased under certain circumstances. No sales of shares could occur at a purchase price below $2.50 per share or without a registration statement having been declared effective. The purchase price of the shares will be based on the market prices of our shares at the time of sale as computed under the Purchase Agreement without any fixed discount. The Company may at any time at its sole discretion terminate the Purchase Agreement without fee, penalty or cost upon one business days’ notice.

 

The Company issued 46,154 shares of our Common Stock to LPC as a commitment fee for entering into the agreement, and was obligated to issue up to an additional 46,154 shares pro rata as LPC purchases up to $6,000,000 of its Common Stock as directed by the Company. LPC may not assign any of its rights or obligations under the Purchase Agreement. During the years ended December 31, 2014 and 2013 the Company issued a total of 99,336 and 840,851 shares of Common Stock, which includes the commitment shares per the terms of the Purchase Agreement with LPC at an average price of approximately $3.09 and $2.80 per share of Common respectively. The fair value of the Commitment shares has been recorded as a cost of raising capital.

 

In December 2011, the Company terminated the Purchase Agreement and executed a new purchase agreement, or the New Purchase Agreement, and a registration rights agreement, or the New Registration Rights Agreement, with Lincoln Park Capital Fund, LLC (“LPC”). Under the New Purchase Agreement, LPC is obligated, under certain conditions, to purchase from the Company up to $8.5 million of our Common Stock, from time to time over a thirty-two (32) month) period.

 

88
 

  

The Company had the right, but not the obligation, to direct LPC to purchase up to $8,500,000 of its Common Stock in amounts up to $50,000 as often as every two business days under certain conditions. The Company could also accelerate the amount of its common stock to be purchased under certain circumstances. No sales of shares could occur at a purchase price below $2.50 per share or without a registration statement having been declared effective. The purchase price of the shares was based on the market prices of our shares at the time of sale as computed under the Purchase Agreement without any fixed discount. The Company could at any time at its sole discretion terminate the Purchase Agreement without fee, penalty or cost upon one business days’ notice.

 

There was no up-front commitment fee paid to LPC for entering into the new agreement, however the Company is obligated to issue up to an additional 65,385 shares pro rata as LPC purchases up to $8,500,000 of its Common Stock as directed by the Company. LPC could not assign any of its rights or obligations under the Purchase Agreement.

 

The Company has not sold any shares of its Common Stock under the New Purchase Agreement since January 17, 2014. The New Purchase Agreement expired pursuant to its terms in August 2014. At the time of expiration, $2,400,000 remained unused under the New Purchase Agreement with LPC.

  

Stock Option Plans

 

As of December 31, 2014, the Company had two Long Term Incentive Plans (the “2014 Plan” and the “2006 Plan”) to attract, retain, and provide incentives to employees, officers, directors, and consultants. The Plans generally provide for the granting of stock, stock options, stock appreciation rights, restricted shares, or any combination of the foregoing to eligible participants.

 

A total of 3,100,000 and 1,600,000 shares of common stock are reserved for issuance under the 2014 Plan and the 2006 Plan, respectively. As of December 31, 2014 there were outstanding options to purchase approximately 927,000 and 1,375,000 shares of common stock reserved under the 2014 Plan and the 2006 Plan, respectively.

 

The 2014 and 2006 Plans as well as grants issued outside of the Plan are administered by the Board of Directors. The Board is authorized to select from among eligible employees, directors, advisors and consultants those individuals to whom incentives are to be granted and to determine the number of shares to be subject to, and the terms and conditions of the options. The Board is also authorized to prescribe, amend and rescind terms relating to options granted under the Plans. Generally, the interpretation and construction of any provision of the Plans or any options granted hereunder is within the discretion of the Board.

 

The Plan provides that options may or may not be Incentive Stock Options (ISOs) within the meaning of Section 422 of the Internal Revenue Code. Only employees of the Company are eligible to receive ISOs, while employees and non-employee directors, advisors and consultants are eligible to receive options, which are not ISOs, i.e. “Non-Qualified Options.” Because the Company has not yet obtained shareholder approval of the 2006 Plan, all options granted thereunder to date are “Non-Qualified Options” and until such shareholder approval is obtained, all future options issued under the 2006 Plan will also be “Non-Qualified Options.”

 

In December 2014, the Company’s received shareholder approval authorizing the Board of Directors to implement the form, terms and provisions of the 2014 Plan. Accordingly, any options issued to employees under the 2014 Plan will be ISOs within the meaning of Section 422 of the Internal Revenue Code.

 

Stock-based Compensation

 

Total share-based employee, director, and consultant compensation for the years ended December 31, 2014 and 2013 amounted to approximately $695,800 and $456,900, respectively. These amounts are included in the statement of operations under the captions research and development ($143,700 and $112,500) and general and administrative ($552,100 and $344,400), respectively.

 

89
 

  

The summary of the stock option activity for the years ended December 31, 2014 and 2013 is as follows:

 

                Weighted  
          Weighted     Average  
          Average     Remaining  
          Exercise     Contractual  
    Shares     per Share     Life (Years)  
Outstanding January 1, 2013     1,466,709     $ 5.75       6.1  
Granted      563,040     $ 2.75       5.5  
Cancelled     (89,400 )   $ 3.00        
Expired     (1,129 )   $ 192.75        
Exercised     (22,269 )   $ 1.00        
Outstanding, December 31, 2013     1,916,951     $ 5.00       5.1  
Granted     732,800     $ 5.02       8.7  
Cancelled     (227,810 )   $ 3.26        
Expired     (2,502 )   $ 45.80        
Exercised     (117,252 )   $ 0.97        
Outstanding, December 31, 2014     2,302,187     $ 5.37       6.1  

 

The fair value of each stock option was estimated using the Black Scholes pricing model which takes into account as of the grant date the exercise price (ranging from $2.88 to $8.05 per share) and expected life of the stock option (ranging from 5 to 10 years), the current price of the underlying stock and its expected volatility (approximately 28 percent), expected dividends (-0- percent) on the stock and the risk free interest rate (.93 to 2.06 percent) for the term of the stock option.

 

The weighted-average grant date fair value for options granted during the years ended December 31, 2014 and 2013 amounted to approximately $1.48 and $0.75 per share, respectively. As of December 31, 2014 the Company’s outstanding options had exercise prices ranging from $0.88 to $539.25 per share of Common Stock.

 

At December 31, 2014, the aggregate intrinsic value of options outstanding and options currently exercisable amounted to approximately $10,001,000. As of December 31, 2014, the Company had options currently exercisable into an aggregate total of 1,427,657 shares of common stock which have a weighted average exercise price of $5.80 per share.

 

The summary of the status of the Company’s non-vested options for the year ended December 31, 2014 is as follows: 

 

          Weighted  
          Average  
          Grant
Date
 
    Shares     Fair
Value
 
Non-vested, December 31, 2012     536,720     $ 0.85  
Granted     732,800       1.47  
Cancelled     (194,450 )     0.83  
Vested     (200,540 )     1.91  
Non-vested, December 31, 2013     874,530     $ 1.37  

 

As of December 31, 2014, there was approximately $389,000 of total unrecognized compensation cost related to stock options. In 2014, the Board of Directors has set aside a pool of 548,000 options to be awarded to the Company’s employees if the Company achieves certain specific, predetermined milestones. In January of 2015, the Board of Directors determined that the Company had achieved certain specific 2014 milestones and awarded 441,380 of these options. The total expense associated with these options was approximately $637,000 of which approximately $486,000 has been included in the 2014 financial statements.

 

90
 

 

The Company has reserved a separate pool of 624,000 shares of restricted stock that may be issued to employees and directors as part of a long term incentive plan tied to corporate objectives.

 

As of December 31, 2014, the Company has the following warrants to purchase common stock outstanding:

 

Number of Shares     Warrant Exercise     Warrant
To be Purchased     Price per Share     Expiration Date
  70,000     $ 2.500     August 16, 2015
  64,000     $ 3.125     August 16, 2015
  53,335     $ 3.750     August 16, 2015
  19,600     $ 2.500     October 22, 2015
  7,840     $ 3.125     October 22, 2015
  6,535     $ 3.750     October 22, 2015
  20,000     $ 2.500     November 19, 2015
  8,000     $ 3.125     November 19, 2015
  6,667     $ 3.750     November 19, 2015
  28,000     $ 2.500     February 15, 2016
  61,600     $ 3.125     February 15, 2016
  56,670     $ 3.750     February 15, 2016
  9,605     $ 31.250     October 24, 2016
  46,668     $ 4.375     February 15, 2017
  175,680     $ 3.750     June 21, 2018
  134,000     $ 3.150     September 30, 2018
  48,960     $ 7.500     March 11, 2019
  796,000     $ 7.8125     March 11, 2019
  1,613,160              

 

11. NET LOSS PER SHARE

 

Basic earnings per share and diluted earnings per share for the years ended December 31, 2014 and 2013 have been computed by dividing the net loss for each respective period by the weighted average number of shares outstanding during that period. All outstanding warrants and options representing approximately 3,915,000 and 2,974,000 incremental shares at December 31, 2014 and 2013, respectively, as well as shares issuable upon conversion of the conversion of Series A & B Convertible Preferred Stock representing -0- and 8,827,720 incremental shares at December 31, 2014 and 2013, respectively, as well as potential shares issuable upon Promissory Note conversion into Common Stock of approximately -0- and 649,360 shares at December 31, 2014 and 2013, respectively, have been excluded from the computation of diluted loss per share as they are anti-dilutive.

 

12. RETIREMENT PLAN

 

In June 2014, the Company formed the CytoSorbents 401(k) Plan. The plan is a defined contribution plan as described in section 401(k) of the Internal Revenue Code (“IRC”) covering substantially all full time employees. Employees are eligible to participate in the plan on the first day of the calendar quarter following three full months of employment. Participants may defer up to 100% of their eligible compensation subject to certain IRC limitations. In addition, the Company provides for a matching contribution of twenty percent of the participants contribution on a maximum of a five percent compensation contribution. Matching contributions amounted to approximately $10,500 for the year ended December 31, 2014.

 

13. SUBSEQUENT EVENTS

 

The Company has evaluated subsequent events occurring after the balance sheet date which include the following:

  

On January 14, 2015, the Company closed on an underwritten public offering (the “Offering”) consisting of 1,250,000 shares of common stock at a price of $8.25 per share for an aggregate price of $10,312,500.

 

91
 

 

The Company received net proceeds from the Offering of approximately $9,409,000 million. The net proceeds received by the Company from the Offering will be used to fund clinical studies, expansion of production capacity, support various sales and marketing efforts, product development and general working capital purposes. 

 

The Company conducted the Offering pursuant to a registration statement on Form S-1 (File No. 333-199762) which was declared effective by the Securities and Exchange Commission on January 8, 2015. The Company filed a final prospectus on January 9, 2015, disclosing the final terms of the Offering.

 

In connection with the Offering, on January 8, 2015, the Company entered into underwriting agreements with Brean Capital, LLC and H.C. Wainwright & Co., LLC (the “Representatives”), who are acting as book-running managers and as representatives of the underwriters in the Offering.

 

In connection with the successful completion of the Offering, the underwriters received aggregate discounts and commissions of 6% of the gross proceeds of the sale of the shares in the Offering. In addition, the Company agreed to issue warrants to the Representatives (the “Representatives’ warrants”) that allow for the purchase of shares of the Company’s common stock equal to 3% of the aggregate number of shares sold in the Offering. The Representatives’ warrants are exercisable at any time for a period of five years, commencing on the date of the effectiveness of the registration statement, at a price per share equal to 120% of the public offering price per share of the common stock in the Offering. The Company also agreed to reimburse the underwriters for actual out-of-pocket expenses related to the offering. These out-of-pocket expenses amounted to approximately $85,000. The Company also granted the Representatives a right of first refusal to participate in any subsequent offering or placement of our securities that takes place within nine months following the effective date of the registration statement.

 

As an approved participant of the Technology Business Tax Certificate Transfer Program sponsored by the New Jersey Economic Development Authority in January 2015 the Company received $385,642 from the sale of our prior unused net operating loss carryovers.

 

92

 

 

Exhibit 10.4

 

COMMENCEMENT DATE MEMORANDUM

 

THIS COMMENCEMENT DATE MEMORANDUM, made as of the 12th day of May, 2000, by and between Princeton Corporate Plaza, LLC (“Landlord”) and RenalTech International, LLC (“Tenant”).

 

WITNESSETH:

 

WHEREAS, Landlord and Tenant entered into a lease dated March 9, 2000 (the “Lease”) setting forth the terms of occupancy by Tenant of a portion of the the building known as 7 Deer Park Drive, Suite K Monmouth Junction, New Jersey (the “Demised Premises”); and

 

WHEREAS, the Lease provides the actual Commencement Date shall be May 1 2000 or the date upon which landlord’s work is substantially completed; and

 

WHEREAS, the parties desire to acknowledge delivery by Landlord and receipt by Tenant of the Demised Premises in accordance with the terms of the Lease and to set forth the Commencement Date and Expiration Date as defined in the Lease.

 

NOW, THEREFORE, it is agreed that the Commencement Date and Expiration Date are as follows:

 

COMMENCEMENT DATE: May 12, 2000
   
TERMINATION DATE: April 30, 2002

 

Tenant acknowledges and agrees that it has unconditionally accepted possession and occupancy of the Demised Premises, except for the storage space as set forth in paragraph 12.3 of the Lease.

 

IN WITNESS WHEREOF, Landlord and Tenant have executed this Commencement Date Memorandum as of the date first above written.

 

WITNESS: LANDLORD
  Princeton Corporate Plaza, L.L.C.
  By:

Princeton Corporate Management Corp.,

Managing Member

 

    By: /s/ Teresa Ryan Kent
  Name: Teresa Ryan Kent
6/22/00   Title: Treasurer
Date    

 

WITNESS: TENANT
  RenalTech International, LLC

 

    By: /s/ Frank Clark
    Name: Frank Clark
6/22/00   Title: Vice President
Date    

 

 
 

 

THIS LEASE AGREEMENT , made this 9 th day of March 2000,

 

Between             Princeton Corporate Plaza, LLC

a New Jersey limited liability company, located at 7 Deer Park Drive, Suite M-1 in the Township of South Brunswick in the County of Middlesex and State of New Jersey (“ Landlord ”), having a postal address at Monmouth Junction, NJ 08852

 

And                     RenalTech International, LLC

a Delaware limited liability company, located at 320 East 65 th Street, Suite 116 in the City of New York in the County of New York and State of New York 10021 (“ Tenant ”);

 

Witnesseth that Landlord does hereby lease to Tenant and Tenant does hereby rent from Landlord, the following described premises: approximately 3,600 square feet of space in Landlord’s building at 7 Deer Park Drive, Suite K (the “ Demised Premises ”) in the Township of South Brunswick in the County of Middlesex and State of New Jersey being known as Block 97 Lot 13.05 on the tax map of the Township of South Brunswick (the “ Property ”) and being further described as the cross-hatched area on the Floor Plan marked Exhibit A attached hereto and made a part hereof, for a Term of two(2) years, commencing on May 1, 2000 (the “ Commencement Date ”) and ending on April 30, 2002 (the “ Expiration Date ”) to be used and occupied only and for no other purpose than offices and laboratories (the “ Use ”)

 

Upon the following Conditions and Covenants:

 

1st. Payment of Rent . Commencing on the Commencement Date, Tenant covenants and agrees to pay to Landlord, as Base Rent for and during the Term hereof without defense, demand or offset, the sum of Two Hundred Forty-Four Thousand Eight Hundred Dollars ($244,800) payable on the first day of each month during the Term in the following manner:

 

    Annual     Monthly  
5/1/00 - 4/30/01   $ 122,400.00     $ 10,200.00  
5/1/01 - 4/30/02   $ 122,400.00     $ 10,200.00  

 

together with such Additional Rent as may hereinafter be provided (collectively, the “ Rent ”).

 

2nd. Advance Rental. Upon the execution hereof, Tenant shall pay to Landlord, 1) advance rental (applied to the first month’s Rent and Additional Rent) in the amount of $8,815.00 and 2) the security required hereunder in the amount of $22,100.00, for a total of $30,915.00.

 

3rd. Not Used .

 

4th. Security . Tenant has this day deposited with Landlord the sum of $22,100.00, as security for the payment of the Rent hereunder and the full and faithful performance by Tenant of the covenants and conditions on the part of Tenant to be performed. Said sum shall be returned to Tenant, without interest, after the expiration of the Term hereof provided that Tenant has fully and faithfully performed all such covenants and conditions on the part of Tenant to be performed. During the Term hereof, Landlord may, if Landlord so elects, have recourse to such security, to make good any default by Tenant in which event Tenant, shall, on demand, promptly restore said security to its original amount. Liability to repay said security to Tenant shall run with the reversion and title to the Demised Premises, whether any change in ownership thereof be by voluntary alienation or as the result of judicial sale, foreclosure or other proceedings, or the exercise of a right of taking or entry by any mortgagee. Landlord shall have the right to assign or transfer said security for the benefit of Tenant, to any subsequent owner or holder of the reversion or title to the Demised Premises, in which case the assignee shall become liable for the repayment thereof as herein provided, and the assignor shall be deemed to be released by Tenant from all liability to return such security. This provision shall be applicable to every alienation or change in title and shall in no way be deemed to permit Landlord to retain the security after termination of Landlord’s ownership of the reversion or title. Tenant shall not mortgage, encumber or assign said security without the prior written consent of Landlord.

 

5th. Net Lease . It is the purpose and intent of Landlord and Tenant that the Base Rent shall be net to Landlord, so that this Lease shall yield, net to Landlord, the Base Rent specified in Paragraph 1 hereof in each year during the Term of this Lease. All costs, expenses, taxes, damages and charges of every kind and nature relating to the Demised Premises (except any payment on account of interest and principal under any mortgages or deeds of trust) which may arise or become due during the Term of this Lease shall be paid by Tenant.

 

6th. Proportionate Share .
1) The approximate area of the Demised Premises leased to Tenant is approximately 3,600 square feet. The total area of the building of which the demised premises are a part is approximately 55,000 square feet. Tenant’s share of costs and charges, if applicable, as set forth in this Lease shall be determined by dividing the square footage of the Demised Premises by the total square footage of the building of which the Demised Premises is a part (“ Tenant’s Proportionate Share ”). As of the Commencement Date it is, therefore, established that Tenant’s Proportionate Share is Four and Seventy-three one-hundredths percent (6.54%).

 

1
 

2) Tenants Proportionate Share shall be adjusted from time to time as appropriate based upon adjustments to the total square footage of the building and/or the square footage rented by Tenant.

 

7th Operating Expenses .
1) It is understood and agreed that in addition to the Base Rent to be paid by Tenant during the Term of this Lease add any renewals thereof, Tenant shall pay to Landlord Tenant’s Proportionate Share of all taxes, assessments against the Demised Premises, water rents, rates and charges, sewer rents and other governmental impositions. Tenant shall also pay Tenant’s Proportionate Share of Landlord’s cost of the operation of common area appurtenances, the maintenance, repairs and replacements of and for the building of which the Demised Premises are a part, the maintenance, repair and replacement of the parking lot, sidewalks, curbs and landscaped areas, which shall include but not necessarily be limited to the following: cleaning, sweeping, snow removal, striping; landscaping, insurance, lighting, trash removal, and policing if necessary, plus an administrative charge of fifteen percent (15%) of said costs (“ Operating Expenses ”).

 

2) Nothing herein contained shall require or be construed to require Tenant to pay any inheritance, estate, successions, transfer, gift franchise, corporation, income or profit tax, or capital levy that is or may be imposed upon or that is or may be payable by Landlord, its successors or assigns.

 

3) Commencing on the Commencement Date, Tenant shall pay monthly Tenant’s Proportionate Share of Operating Expenses based upon Landlord’s reasonable estimate of the current year expenses due from Tenant. Thereafter, Landlord shall provide an actual statement of expenses to Tenant on a calendar year basis and Tenant shall pay or receive a credit for the difference between the actual amount and the estimate. Tenant’s subsequent monthly estimated payments shall be adjusted accordingly. Upon Tenant’s request, Landlord shall provide to Tenant copies of invoices substantiating the statement of actual expenses. To the extent that Landlord incurs expenses that are disproportionately allocable to Tenant as a result of Tenant’s occupancy as determined by Landlord, Tenant’s Proportionate Share shall not apply to said disproportionate expense items and Tenant shall pay the amount that is actually incurred by Landlord as a result of its tenancy.

 

4) Should Tenant’s maintenance or service requirements exceed the standard supplied to the other tenants of the Property, Tenant shall pay the additional costs attributable to such extra requirements.

 

5) All taxes, charges, costs and expenses which Tenant assumes or agrees to pay under any provisions of this Lease together with all interest and penalties that may accrue thereon in the event of Tenant’s failure to pay the same as herein provided shall be deemed to be Additional Rent and, in the event of non-payment, Landlord shall have all the rights and remedies herein provided in the case of non-payment of Rent.

 

8th. Taxes, Licenses and Fees . Tenant shall make timely payment of all ad valorem or other taxes and assessments levied upon Tenant’s stock of merchandise, fixtures, furnishings, furniture, equipment, supplies and other property located on or used in connection with the Demised Premises and of all privilege and business licenses, fees, taxes and similar charges.

 

9th. Tenant’s Electric Responsibility .
1) All electrical current utilized by Tenant within the Demised Premises, including, without limitation, HVAC shall be at Tenant’s sole cost and expense, unless otherwise directed by Landlord in writing. Landlord shall not be liable for any inconvenience or harm caused by any stoppage or reduction of any utilities and services, and in no event shall the stoppage of any utilities and services excuse Tenant from the timely payment of Rent.

 

2) Landlord may install a separate meter to measure Tenant’s use of electricity and, in such event, Tenant shall, at Tenant’s sole cost and expense, arrange and pay for all utilities and services required for the Demised Premises, including payment of any deposit which may be required by the utility company.

 

3) In the event a separate meter is not provided, then bills shall be rendered to Tenant based upon an estimated amount of $900.00 per month. The estimated amount may be adjusted from time to time based upon changes in utility company rates or if, in the judgment of Landlord, Tenant’s demand and consumption varies from this estimate. The amount thereof shall be deemed to be Additional Rent and shall be due and payable at the same time as the monthly installments of Rent shall be due from Tenant.

 

10th. Tenant’s Gas Usage Responsibility .
1) Landlord shall provide Tenant heat at Tenant’s sole cost and expense. All gas usage utilized by Tenant within the Demised Premises shall be strictly at Tenant’s sole cost and expense. Landlord shall not be liable for any inconvenience or harm caused by any stoppage or reduction of any utilities and services, and in no event shall the stoppage of any utilities and services excuse Tenant from the timely payment of Rent.

 

2) Landlord may install a separate meter to measure Tenant’s gas usage and, in such event, Tenant shall, at Tenant’s sole cost and expense, arrange and pay for all utilities and services required for the Demised Premises, including payment of any deposit which may be required by the utility company.

 

3) In the event a separate meter is not provided, then bills shall be rendered to Tenant based upon an estimated amount of $315.00 per month. The estimated amount may be adjusted from time to time based upon changes in utility company rates or if, in the judgment of Landlord, Tenant’s demand and consumptibn varies from this estimate. The amount thereof shall be deemed to be Additional Rent and shall be due and payable at the same time as the monthly installments of Rent shall be due from Tenant

 

2
 

11th. Acceptance and Workletter .
1) Landlord shall complete at its own expense and in a good and workmanlike manner all of the alterations set forth on Exhibit B (“Landlord’s Work”) attached hereto and made a part hereof. Tenant acknowledges that it has inspected and examined the Demised Premises and, except as set forth in Exhibit B , has entered into this Lease without any representations on the part of Landlord, its agents or representatives as to the condtion thereof, and, except as set forth in Exhibit B , is leasing and accepting the Demised Premises “as- is” and “where-is”. No representations or promises, except as specified herein, have been made by or on behalf of Landlord, its agents, employees or representatives, or by any real estate broker, prior to or at the execution of this Lease, and Landlord is not bound by, and Tenant will make no claim on account of, any representation, promise or assurance, expressed or implied, with respect to conditions, repairs, ’ improvements, services, accomodations, concessions or any other matter, other than as contained herein.

 

2) Landlord shall be complete at Tenant’s sole cost and expense in a good and workmanlike manner all of the alterations set forth on Exhibit B-l (“Tenant’s Work”) attached hereto and made a part hereof. Prior to the commencement of the work, Tenant shall pay $16,500.00 to Landlord’s contractor, which shall represent payment in full for item A listed in Exhibit B-l . Tenant shall pay for the item B work listed in Exhibit B-l by monthly payment to Landlord of $1,500.00 per month, which amount shall be deemed to be Additional Rent and shall be due and payable on the first day of each month beginning May 1, 2000 and ending April 30, 2002.

 

12th. Commencement .
1) Notwithstanding anything to the contrary contained herein, the Lease will not commence until the work listed in Exhibit B , to be performed by Landlord, is substantially completed, unless Tenant chooses to occupy the Demised Premises, or any part thereof, prior to substantial completion, in which case Rent shall commence upon said occupancy by Tenant.

 

2) Landlord shall not be liable for failure to give possession of the Demised Premises, or any part thereof, upon the Commencement Date by reason of the fact that Demised Premises, or any part thereof, are not ready for occupancy, or due to a prior tenant holding over in the Demised Premises or due to any other person being in possession of the Demised Premises or for any other reason.

 

3) Tenant and Landlord agree that the space marked “Storage”on Exhibit A will not be released to Tenant until July 1, 2000 and that Tenant shall receive a credit against Rent and Additional Rent until such time as Landlord releases said space to Tenant. The credit shall be $2,073.00 per month, broken down as follows: Rent - $1,700.00; Estimated Operating Expense - $170.00; Electric - $150.00; Gas - $53.00.

 

13th. Repairs and Care . Tenant has examined the Demised Premises and has entered into this Lease without any representation on the part of Landlord as to the condition thereof. Tenant shall take good care of the Demised Premises and shall at Tenant’s sole cost and expense, make all repairs, including painting and decorating, and shall maintain the Demised Premises in good condition and state of repair. Tenant shall neither encumber nor obstruct the sidewalks, driveways, yards, entrances, hallways and stairs in and about the Property, but shall keep and maintain the same in a neat and clean condition as to its own activities, free from debris, trash and refuse.

 

14th. Glass, Damage and Repairs . In case of the destruction of or any damage to the glass in the Demised Premises, or the destruction of or damage of any kind whatsoever to the Property, which is caused by the carelessness, negligence or improper conduct on the part of Tenant or Tenant’s agents, employees, guests licensees, invitees, subtenants, assignees or successors, Tenant shall promptly repair at its sole cost and expense said damage or riplace or restore said damage to the Property at Tenant’s sole cost and expense.

 

15th. Utilities . Tenant; shall be responsible for the cost of the prompt repair of any utility, ventilating, heating, air conditioning, electrical, gas and other utility lines within the Demised Premises, except if damage outside the Demised Premises is caused by the acts or omissions of Tenant, its agents, servants or employees, in which event Tenant shall likewise be responsible for the cost of repair of such damage outside the Demised Premises. Landlord will guarantee the HVAC and electrical systems for the period of one (1) year except in the case where damage is due to the acts or omissions of Tenant. Landlord shall not be liable for any inconvenience or harm caused by any stoppage or reduction of any utilities and services, and in no event shall the stoppage or reduction of any utilities and services excuse Tenant from the timely payment of Rent.

 

16th. Alterations and Improvements .
1) No alterations, additions or improvements shall be made, and no climate regulating, air conditioning, cooling, heating or sprinkler systems, television or radio antennas, heavy equipment, apparatus or fixtures, shall be installed in or attached to the Demised Premises, without the prior written consent of Landlord, which shall not be unreasonably withheld, and the issuance of all required permits from all government agencies having jurisdiction. Unless otherwise provided herein, all such alterations, additions or improvements installed in or attached to the Demised Premises shall belong to and become the property of Landlord and be surrendered with the Demised Premises and as a part thereof upon the expiration or sooner termination of this Lease, without hindrance, molestation or injury.

 

3
 

2) Notwithstanding anything to the contrary contained in this Lease, provided that Tenant is not in default of any of the terms of this Lease, Tenant shall have the right to remove any trade fixtures which were installed at Tenant’s sole cost and expense; provided, however, that Tenant shall restore the Demised Premises to the condition existing prior to the installation of said improvements, reasonable wear and tear excepted.

 

17th. Construction Lien . If any mechanics’ or other liens shall be created or filed against the Demised Premises by reason of labor performed or materials furnished for Tenant in the creation, construction, completion, alteration, repair or addition to any building or improvement, Tenant shall, at Tenant’s sole cost and expense within ten (10) days of filing, cause such lien or liens to be satisfied and discharged of record together with any construction liens that may have been filed. Failure so to do shall entitle Landlord to resort to such remedies as are provided herein in the case of any default of this Lease, in addition to any remedies permitted by law.

 

18th. Tenant Loans and Landlord Waiver . Should Tenant desire to use its property located within the Demised Premises as collateral on any loan, Landlord shall not be required to execute any documents evidencing its consent and subordination to any such loan unless and until Landlord has been provided with true copies of all of the loan documents, including, but not limited to, the note, the security agreement and a complete description of the proposed collateral. All such consent and subordination documents shall be in a form and under terms that are acceptable to Landlord.

 

19th. Signs . Tenant shall not place any signs of any kind whatsoever upon, in or about the Property or any part thereof, except of a design and structure and in or at such places as may be indicated and consented to by Landlord in writing. In case Landlord or Landlord’s agents, employees or representatives shall deem it necessary to remove any such signs in order to paint or make any repairs, alterations or improvements in or upon the Property or any part thereof, they may be so removed, but shall be replaced at Landlord’s expense when the said repairs, alterations or improvements shall have been completed. Any signs permitted by Landlord shall at all times conform with all municipal ordinances or other laws and regulations applicable thereto. Landlord’s consent shall not be required for signs placed within the Demised Premises which are not visible from outside the Demised Premises.

 

20th. End of Term . Upon the Expiration Date or sooner termination of this Lease, Tenant shall: (a) leave the Demised Premises in a “broom clean” condition; (b) remove all of Tenant’s property; (c) remove all signs in and about the Demised Premises and restore that portion of the Demised Premises on which they were placed; (d) repair all damage caused by moving; and (e) return the Demised Premises to Landlord in the same condition as it was at the beginning of the Term, except for normal wear and tear.

 

21st. Removal of Tenant’s Property . Any-equipment, fixtures, goods or other property of Tenant not removed by Tenant upon the expiration or sooner termination of this Lease or upon any quitting, vacating or abandonment of the Demised Premises by Tenant, or upon Tenant’s eviction, shall be considered as abandoned and Landlord shall have the right, without any notice to Tenant, to sell or otherwise dispose of the same, at the sole cost and expense of Tenant, and shall not be accountable to Tenant for any part of the proceeds of such sale, if any.

 

22nd. Compliance with Laws, Etc . Tenant shall promptly comply with (i) all laws, ordinances, rules, regulations, requirements and directives of the Federal, State and Municipal governments or public authorities and of all of their departments, bureaus and subdivisions, applicable to and affecting the Demised Premises, their use and occupancy, for the correction, prevention and abatement of nuisances, violations or other grievances in, upon or connected with the Demised Premises, during the Term; and (ii) all orders, regulations, requirements and directives of the Board of Fire Underwriters or similar authority; and (iii)of any insurance companies which have issued or are about to issue policies of insurance covering the Property and/or its contents, for the prevention of fire or other casualty, damage or injury, at Tenant’s sole cost and expense.

 

23rd. Environmental Matters .
1) Tenant warrants and represents that, with respect to maintenance and operations thereon of the Demised Premises and any other premises that it occupies anywhere in the United States, it is in compliance with all laws, ordinances, rules, regulations and policies of any government authority having jurisdiction regarding the environment, human health or safety (collectively, “ Environmental Laws ”), including, but not limited to, its storage and use of chemicals, its generation and disposal of hazardous wastes and the training, education and safety of its employees.

 

2) Tenant shall remain in compliance with the above representations during its entire occupancy of the Property or any part thereof.

 

3) Landlord and Landlord’s agents, employees or other representatives shall have the right to demand documentation supporting these representations. The failure of Tenant to supply any documentation so demanded within thirty days (30) of written notice of such demand (or immediately in the case of an emergency or suspected violation) shall entitle Landlord to the option of cancelling this Lease, and the Term hereof is hereby expressly limited accordingly.

 

4) Tenant shall comply with all of terms of Exhibit C which is attached hereto and made a part hereof.

 

24th. Restriction of Use . Tenant shall not occupy or use the Demised Premises or any part thereof, nor permit or suffer the same to be occupied or used for any purposes other than for the Use, nor for any purpose deemed unlawful, disreputable, or extra hazardous on account of fire or other casualty, nor in a manner which interferes with other tenants in the beneficial use of their premises. Tenant covenants and agrees not to suffer, allow or permit any offensive or obnoxious vibration, noise, odor or other undesirable effect to emanate from the Demised Premises or from any machine, equipment or other installation therein, or otherwise suffer, allow or permit the same to constitute a nuisance or otherwise interfere with the safety, comfort or convenience of Landlord or any of the other tenants or occupants of the building or their customers, clients, patron, guests, agents or invitees, or any others lawfully in or upon the Property.

 

4
 

  

25th. Assignment and Sublet .
1) Tenant shall not, without the prior written consent of Landlord, assign, mortgage or hypothecate this Lease, nor sublet or sublease the Demised Premises or any part thereof or permit any other person or business to use the Demised Premises except as permitted in the following sentence. If Tenant shall be a corporation, limited liability company or partnership, a transfer of a majority interest of the Tenant shall be deemed an assignment of this Lease and subject to the provisions of this Paragraph, except where such transfer is in conjunction with an equity financing of Tenant or the transfer of Tenant’s publicly traded equity securities on a nationally recognized exchange. The provisions of this Paragraph shall be binding upon the legal representatives of Tenant and every person to whom Tenant’s interest under this Lease passes by operation of law or otherwise, except that it shall not apply to an assignment or subletting to an affiliate, a subsidiary or related entity of Tenant, nor to the sale of Tenant’s business or in connection with a merger or consolidation (collectively, a “Permitted Transfer”), provided that Tenant has notified Landlord of the Permitted Transfer and supplied Landlord with any reasonable information and documentation it may request.

 

2) Provided Tenant is not in default under any of the terms or conditions of this Lease, Landlord will not unreasonably withhold consent to a partial sublet of the Demised Premises, provided that Tenant remains in occupancy of the Demised Premises and that the subtenant does not violate any of the terms of this Lease.

 

3) Notwithstanding any assignment or sublet, Tenant shall not be released from any obligation under this Lease without the express written consent of Landlord, which may be withheld in Landlord’s sole discretion.

 

26th. Access to Demised Premises . Tenant agrees that Landlord and Landlord’s agents, employees or other representatives, shall have the right to enter into and upon the Demised Premises or any part thereof, at all reasonable hours and with reasonable notice, for the purpose of examining the same or making such repairs or alterations therein as may be necessary for the safety and preservation thereof as determined in Landlord’s sole and absolute discretion. This clause shall not be deemed to be a covenant by Landlord nor be construed to create an obligation on the part of Landlord to make such inspection or repairs. Landlord shall have the right to enter the Demised Premises at any time without notice to Tenant in case of emergency. Landlord shall take reasonable steps to insure that any entry hereunder does not interfere with Tenant’s lawful use and occupancy of the Demised Premises.

 

27th. Reimbursement of Landlord . If Tenant shall fail or refuse to comply with or perform any conditions and covenants of this Lease, Landlord may, if Landlord so elects; carry out and perform such conditions and covenants, at the cost and expense of Tenant, and the said cost and expense shall be payable on demand, or at the option of Landlord shall be added to the installment of Rent due immediately thereafter but in no case later than one (1) month after such demand, whichever occurs sooner, and shall be due and payable as such. This remedy shall be in addition to such other remedies as Landlord may have hereunder by reason of the breach by Tenant of any of the covenants and conditions contained in this Lease.

 

28th Late Charges, Returned Check Charges, Etc.. Tenant hereby acknowledges that late payment by Tenant to Landlord of Rent or other sums due hereunder will cause Landlord to incur costs not contemplated by this Lease, the exact amount of which will be extremely difficult to ascertain. Accordingly:

 

1) If any installment of Rent or any sum due from Tenant shall not be received by Landlord or Landlord’s designee within seven (7) days after the due date then Tenant shall pay to Landlord a late charge equal to ten percent (10%) of such overdue amount.

 

2) If any Tenant check deposited by Landlord is returned unpaid, Tenant shall pay to Landlord a returned check charge equal to two (2) times the amount charged to Landlord by Landlord’s Bank.

 

3) If two (2) or more Tenant checks are returned to Landlord in any twelve (12) month period, Landlord shall have the right to require all charges due from Tenant for the balance of the Term to be paid by certified check, bank check or money order.

 

4) It and when any installment of Rent or any sum due from Tenant has not been paid within ninety (90) days after the due date, then Landlord shall have the right from the ninety-first (91 st ) day forward to charge interest on Tenant’s entire unpaid balance at the rate of eight percent (8%) per annum until all Rent due from Tenant has been received by Landlord.

 

5) Any such late charge, returned check charge and/or interest charge, if not previously paid, shall, at the option of the Landlord, be added to and shall become part of the succeeding rental payment to be made hereunder and shall be deemed to constitute Additional Rent.

 

5
 

  

6) Late charges, returned check charges and interest charges shall be in addition to and not in lieu of any other remedy Landlord may have and is in addition to any reasonable fees and charges of any agents or attorneys Landlord may employ as a result of any default under this Lease.

 

29th. Remedies upon Tenant’s Default . If there should occur any default on the part of Tenant in the performance of any conditions and covenants herein contained including, without limitation, the payment of Rent when due, or if during the Term hereof the Demised Premises or any part thereof shall be or become abandoned or deserted, vacated or vacant, or should Tenant be evicted by summary proceedings or otherwise, Landlord, in addition to any other remedies herein contained or as may be permitted by law, may either by force or otherwise, without being liable for prosecution therefor or for damages, re-enter the Demised Premises and have and again possess and enjoy the same; and as agent for Tenant or otherwise, re-let the Demised Premises and receive the rents therefor and apply the same, first to the payment of such expenses, reasonable attorney fees and costs, as Landlord may have incurred in the re-entering and repossessing of the same and in making such repairs and alterations as may be necessary; and second to the payment of the Rent due hereunder. Tenant shall remain liable for such Rent as may be in arrears and also the Rent as may accrue subsequent to the re-entry by Landlord, to the extent of the difference between the Rent reserved hereunder and the Rent, if any, received by Landlord during the remainder of the unexpired term hereof, after deducting the aforementioned expenses, fees and costs; the same to be paid as such deficiencies arise and are ascertained each month. Landlord shall have the right to elect to terminate the Term by giving notice of such election, and the effective date thereof, to Tenant and to receive Termination Damages , defined as the amount which, at the time of actual payment thereof to Landlord, is the sum of:

 

1) all accrued but unpaid Rent;

 

2) the present value (calculated using the most recently available (at the time of calculation) published weekly average yield on United States Treasury securities having maturities comparable to the balance of the then remaining Term) of the sum of all payments of Rent remaining due (at the time of calculation) until the date the Term would have expired (had there been no election to terminate it earlier) less the present value (similarly calculated) of all payments of Rent to be received through the end of the Term (had there been no election to terminate it earlier) from a lessee, if any, of the Demised Premises under commercially reasonably terms existing at the time of calculation (and it shall be assumed for purposes of such calculations that (i) the amount of future Additional Rent due per year under this Agreement will be equal to the average Additional Rent per month due during the twelve (12) calendar months immediately preceding the date of any such calculation, increasing annually at a rate of eight percent (8%) compounded; and (ii) if any calculation is made before the end of the first full calendar year of occupancy under this Lease, operating expenses may be extrapolated based on the year-to-date experience of Landlord);

 

3) Landlord’s cost of demolishing any leasehold improvements to the Demised Premises; and

 

4) that amount, which as of the occurrence of the default on the part of Tenant, bears the same ratio to the costs, if any, incurred by Landlord (and not paid by Tenant) in building out the Leased Premises in accordance with this Lease as the number of months remaining in the Term (immediately before the occurrence of the said default) bears to the number of months in the entire Term (immediately before the occurrence of the said default).

 

30th. Termination on Default . Upon the occurrence of any of the contingencies set forth in Paragraph 29 th , or should Tenant be adjudicated a bankrupt, insolvent or placed in receivership, or should proceedings be instituted by or against Tenant for bankruptcy, insolvency, receivership, agreement of composition or assignment for the benefit of creditors, or if this Lease or the estate of Tenant hereunder shall pass to another by virtue of any court proceedings, writ of execution, levy, sale or by operation of law, Landlord may, if Landlord so elects, at any time thereafter, terminate this Lease and the Term hereof, upon giving to Tenant or to any trustee, receiver, assignee or other person in charge of or acting as custodian of the assets or property of Tenant, five (5) days notice. Upon the giving of such notice, this Lease and the Term hereof shall end on the date fixed in such notice as if the said date was the date originally fixed in this Lease for the expiration hereof; and Landlord shall have the right to remove all persons, goods, fixtures and chattels therefrom, by force or otherwise, without liability for damages.

 

31st. Tenant’s Right to Cure . Anything in this Lease to the contrary notwithstanding, in the event of a default under the terms, covenants, provisions and conditions of this Lease other than the vacating by Tenant of the Demised Premises, Tenant shall have the right to cure and correct the same but only within the following specified periods next following receipt of notice from Landlord specifying said event of default:

 

1) five (5) days with respect to defaults in the payment of Rent and

 

2) sixty (60) with respect to an adjudication of bankruptcy of Tenant or any assignment by Tenant for the benefit of its creditors and

 

3) ten (10) days with respect to all other acts of default; and if the correction of the said event of default requires the performance by Tenant of any work, the said period shall be extended until said work is completed provided that Tenant commences the performance of said work and thereafter promptly and diligently pursues said work to completion. In any such event, Tenant shall furnish Landlord with written evidence of its acts and efforts in the performance and completion of any said work and Tenant shall indemnify and hold harmless the Landlord and each mortgagee of the property from and against any and all liabilities, damages, claims, losses, judgments, causes of action, costs and expenses (including the reasonable fees and expenses of counsel) which may be incurred by the Landlord or any such mortgagee relating to or arising out of the Tenant’s failure to complete the work within the time required hereunder.

 

6
 

  

32nd. Non-Waiver by Landlord . The various rights, remedies, options and elections of Landlord expressed herein are cumulative, and the failure of Landlord to enforce strict performance by Tenant of the conditions and covenants of this Lease or to exercise any remedy herein conferred or the acceptance by Landlord of any installment of Rent after any breach by Tenant, in one or more instances, shall not be construed or deemed to be a waiver or a relinquishment for the future by Landlord of any such conditions and covenants, options, elections or remedies, but the same shall continue in full force and effect.

 

33rd. Waiver of Redemption . Upon the expiration or sooner termination of this Lease or in the event of entry of judgment for the recovery of possession of the Demised Premises in any action or proceeding, or if Landlord shall enter the Demised Premises by process of law or otherwise, Tenant, for itself and all persons claiming through or under Tenant, including, but not limited to, its creditors, hereby waives and surrenders any right or privileges of redemption provided or permitted by any statute, law or decision now or hereafter in force, to the extent legally authorized, and does hereby waive and surrender all rights or privileges which it may or might have under and by reason of any present or future law or decision, to redeem the Demised Premises or for a continuation of this Lease after having been dispossessed or ejected therefrom by process of law, or otherwise. Such expiration or termination shall not release or discharge any obligation of Tenant to pay Rent or any other liability incurred by reason of any covenant herein contained on the part of Tenant to be performed.

 

34th. Not Used .

 

35th. Not Used .

 

36th. Not Used .

 

37th. Not Used .

 

38th. Not Used .

 

39th. Right to Exhibit . Tenant agrees from time to time to permit Landlord and Landlord’s agents, employees or other representatives to enter and show the Demised Premises to persons wishing to rent or purchase the same, and Tenant agrees that on and after six (6) months next preceding the expiration of the Term, Landlord or Landlord’s agents, employees or other representatives shall have the right to place notices on the front of the Property or the Demised Premises or any part thereof, offering the same for rent or for sale; and Tenant hereby agrees to permit the same to remain thereon without hindrance or molestation.

 

40th. Mortgage Priority . This Lease shall not be a lien against the Property in respect to any mortgages that may hereafter be placed upon said Property. The recording of such mortgage or mortgages shall have preference and precedence and be superior and prior in lien to this Lease, irrespective of the date of recording.

 

41st. Certification . Tenant, without charge, and at any time during the Term, within ten (10) days after written request from Landlord, agrees to certify by a written instrument duly executed, acknowledged and delivered to Landlord or any other person, firm or corporation specified in such request: (i) whether this Lease has been modified or amended, and if so, the date, substance and manner of such modification or amendment; (ii) as to the validity and force and effect of this Lease; (iii) as to the existence of any default hereunder, and if so, the nature, scope and extent thereof; (iv) as to the existence of any offsets, counterclaims or defenses on the part of Tenant, and if so, the nature, scope and extent thereof; (v) as to the commencement and termination dates of the Term; (vi) as to the dates to which Rent has been paid; (vii) such financial and other credit information as Landlord may reasonably request in connection with any prospective financing or sale of the Demised Premises or the Property; and (viii) as to any other matters as may reasonably be so requested. Any such certificate may be relied upon by Landlord and any other person, firm or corporation to whom the same may be exhibited or delivered, and Tenant shall be bound by the contents of such certificate. A refusal by Tenant to execute and deliver such certificate in accordance with the provisions of this Paragraph shall entitle Landlord to the option of canceling this Lease on five (5) days’ notice.

 

42nd. Attornment . Neither the foreclosure of any mortgage affecting the Demised Premises, nor the institution of any suit, action, summary, or other proceeding by Landlord or any mortgagee, nor the sale, conveyance or transfer of the Demised Premises by Landlord, shall result, by operation of law or otherwise, in the cancellation or termination of this Lease or the obligations of Tenant hereunder, and Tenant covenants and agrees to attorn to Landlord, the holder of any mortgage, or the purchaser, grantee, or transferee of the Demised Premises.

 

43rd. Condemnation and Eminent Domain . If the land and Property of which the Demised Premises are a part, or any portion thereof, shall be taken under eminent domain or condemnation proceedings, or if suit or other action shall be instituted for the taking or condemnation thereof, or in lieu of any formal condemnation proceedings or actions, Landlord shall grant an option to purchase and or shall sell and convey the Property or any portion thereof, to the governmental or other public authority, agency body or public utility seeking to take the Property or any portion thereof, then this Lease, at the option of Landlord, shall terminate, and the Term hereof shall end as of such date as Landlord shall fix by notice in writing as if such date were the date designated as the last day of the Term set forth above; and Tenant shall have no claim or right to claim or be entitled to any portion of any amount which may be awarded as damages or paid as the result of such condemnation proceedings or paid as the purchase price for such option, sale or conveyance in lieu of formal condemnation proceedings; and all rights of Tenant to damages, if any, are hereby assigned to Landlord. Tenant agrees to execute and deliver any instruments promptly upon demand, at the expense of Landlord, as may be deemed necessary or required to expedite any condemnation proceedings or to effectuate a proper transfer of title to such governmental or other public authority, agency, body or public utility seeking to take or acquire the Property or any portion thereof. Tenant covenants and agrees at its sole cost and expense to vacate the Demised Premises, remove all Tenant’s personal property therefrom and deliver up peaceable possession thereof to Landlord or to such other party designated by Landlord in the aforementioned notice. Failure by Tenant to comply with any provisions in this clause shall subject Tenant to such costs, expenses, damages and losses as Landlord may incur by reason of Tenant’s breach hereof including, without limitation, reasonable attorneys’ fees.

 

7
 

  

44th. Fire and other Casualty . In case of fire or other casualty affecting the Demised Premises and/or the Property, Tenant shall give immediate notice to Landlord. If the Demised Premises shall be partially damaged by fire, the elements or other casualty, Landlord shall repair the same as speedily as practicable, but Tenant’s obligation to pay the Rent hereunder shall not cease. If, in the opinion of Landlord, the Demised Premises be so extensively and substantially damaged as to render then untenantable, then the Rent shall cease until such time as the Demised Premises shall be made tenantable by Landlord. However, if, in the opinion of Landlord, the Demised Premises be totally destroyed or so extensively and substantially damaged as to require practically a rebuilding thereof, then the Rent shall be paid up to the time of such destruction and then and from thenceforth this Lease shall automatically and without notice come to an end. In no event however, shall the provisions of this clause become effective or be applicable, if the fire or other casualty and damage shall be the result of the carelessness, negligence or improper conduct of Tenant or Tenant’s agents, employees, guests, licensees, invitees, subtenants, assignees or successors. In such case, Tenant’s liability for the payment of the Rent and the performance of all the covenants, conditions and terms hereof on Tenant’s part to be performed shall continue and Tenant shall be liable to Landlord for the damage and loss suffered by Landlord. If Tenant shall have been insured against any of the risks herein covered, then the proceeds of such insurance shall be paid over to Landlord to the extent of Landlord’s costs and expenses to make the repairs hereunder, and such insurance carriers shall have no recourse against Landlord for reimbursement.

 

45th. Liability Insurance . Tenant, at Tenant’s sole cost and expense, shall obtain or provide and keep in full force and effect for the benefit of Landlord, during the Term, general public liability insurance, insuring Landlord against any and all liability or claims of liability arising out of, occasioned by or resulting from any accident or otherwise in or about the Demised Premises, for injuries to any person or persons, for limits of not less than One Million and 00/100 Dollars ($1,000,000.00) for injuries to one person and Two Million and 00/100 Dollars ($2,000,000.00) for injuries to more than one person, in any one accident or occurrence, for not less than One Millions and 00/100 Dollars ($1,000,000.00) for loss or damage to the property of any person or persons. The policy or policies of insurance shall be of a company or companies authorized to do business in the State in which the Property is located and shall be delivered to Landlord, together with evidence of the payments of the premiums therefor, not less that fifteen (15) days prior to the commencement of the Term hereof or of the date when Tenant shall enter into possession, whichever occurs sooner. At least fifteen (15) days prior to the expiration or termination date of any policy, Tenant shall deliver a renewal or replacement policy with proof of the payment of the premium therefor.

 

46th. Tenant’s Indemnity . Tenant, at its sole cost and expense agrees to and shall indemnify, defend and hold and keep harmless Landlord and its agents, representatives, employees, constituent members, successors and assigns, from and against any and all claims, actions, demands and suits, for, in connection with or resulting from any accident, injury or damage whatsoever (including, without limitation, reasonable attorneys’ fees and actual out-of-pocket costs of enforcement of this provision) caused to any person or property arising, directly or indirectly, in whole or in part, out of the business conducted in or the use of the Demised Premises, or occurring in, on or about the Demised Premises, or arising, directly or indirectly, in whole or in part, from any act or omission of Tenant or any concessionaire or subtenant or their respective licensees, servants, agents, employees or contractors, or arising out of the breach or default by Tenant of any term, provision, covenant or condition contained in the Lease, and from and against any and all losses, costs, expenses, judgments and liabilities incurred in connection with any claim, action, demand, suit or other proceeding brought thereon. This indemnity shall include defending or resisting any proceeding, by attorneys reasonably satisfactory to Landlord. This indemnity shall be insured as a contractual obligation under the policy of liability insurance Tenant is required to carry hereunder.

 

47th. Landlord’s Indemnity . Landlord, at its sole cost and expense agrees to and shall indemnify, defend and hold and keep harmless Tenant and its agents, representatives, employees, constituent members, successors and assigns, from and against any and all claims, actions, demands and suits, for, in connection with or resulting from any accident, injury or damage whatsoever (including, without limitation, reasonable attorneys’ fees and actual out-of-pocket costs of enforcement of this provision) caused to any person or property arising, directly or indirectly, in whole or in part, out of the business conducted in or the use of the Property, or occurring in, on or about the Property, or arising, directly or indirectly, in whole or in part, from any act or omission of Landlord or their respective licensees, servants, agents, employees or contractors, or arising out of the breach or default by Landlord of any term, provision, covenant or condition contained in the Lease, and from and against any and all losses, costs, expenses, judgments and liabilities incurred in connection with any claim, action, demand, suit or other proceeding brought thereon.

 

8
 

  

48th. Tenant’s Contents Insurance . Tenant shall hold Landlord harmless and fully indemnify Landlord against any claims for damages to Tenant’s contents, except in the case of subrogation by an insurance company. In addition to all other insurance required hereunder, Tenant shall fully insure its contents located in, on or about the Demised Premises, at full replacement value. Tenant shall furnish Landlord with a certificate of such insurance from time to time to evidence the continued existence of said policy. Said certificate shall clearly state that such insurance may not be cancelled except upon ten (10) days written notice to Landlord. Should Tenant at any time fail to maintain said contents coverage, said failure shall not be a default hereunder but shall constitute a defacto waiver of all rights of recovery against Landlord for any loss or damage of any nature whatsoever to Tenant’s property regardless of the cause of said damage.

 

49th. Exculpation . Notwithstanding anything to the contrary set forth in this Lease, it is specifically understood and agreed by Tenant that there shall be absolutely no personal liability on the part of Landlord or any individuals associated with Landlord, including, but not limited to, any partners, members or shareholders of Landlord nor joint venturers with Landlord nor any of their successors, assignees, hiers, executors, administrators or personal and legal representatives with respect to any of the terms, covenants and conditions of this Lease, and Tenant shall look solely to the equity, if any, of Landlord in the Property for the satisfaction of each and every remedy (including, without limitation, equitable remedies) of Tenant in the event of any breach by Landlord of any of the terms, covenants and conditions of this Lease to be performed by Landlord; such exculpation of personal liability to be absolute and without any exception whatsoever.

 

50th. Non-Liability of Landlord . Neither Landlord nor any of its agents, co-venturers, representatives, employees, constituent members, successors or assigns shall be liable for any damage or injury which may be sustained by Tenant or by any other person, nor shall Tenant have any right to claim an eviction or constructive eviction as a consequence of: (i) any defect, latent or apparent in the Demised Premises; or (ii) any change of conditions in the Demised Premises; or (iii) the failure, breakage, leakage or obstruction of the street or sub-surface; or (iv) the failure, breakage, leakage or obstruction of the water, plumbing, steam, sewer, waste or soil pipes; or (v) the failure, breakage, leakage or obstruction of the roof, walls, drains, leaders, gutters, valleys, downspouts or the like; or (vi) the failure, breakage, leakage or obstruction of the of the electrical, gas, power, conveyor, refrigeration, sprinkler, air conditioning or heating systems; or (vii) the failure, breakage, leakage or obstruction of elevators or hoisting equipment; or (viii) any structural failure; or (ix) the elements; or (x) any theft or pilferage; or (xi) any fire, explosion or other casualty; or (xii) the carelessness, negligence or improper conduct on the part of any other tenant or of Landlord, or Landlord’s or this or any other tenant’s respective agents, employees, guests, licensees, invitees, subtenants, assignees or successors; or (xiii) any interference with, interruption of or failure, beyond the control of Landlord, of any services to be furnished or supplied by Landlord. All property kept, maintained or stored in, on or at the Demised Premises shall be so kept maintained or stored at the sole risk of Tenant. ’

 

51st. Increase of Insurance Rates . If for any reason it shall be impossible to obtain fire and other hazard insurance on the buildings and improvements on the Property, in an amount and in the form and in insurance companies acceptable to Landlord, Landlord may, if Landlord so elects at any time thereafter, terminate this Lease and the Term hereof, upon giving to Tenant fifteen (15) days’ notice, and upon the giving of such notice, this Lease and the Term thereof shall terminate and end as of the date set forth in said notice as if such date were the date designated as the last day of the Term set forth above. If by reason of the use to which the Demised Premises are put by Tenant or character of or the manner in which Tenant’s business is carried on, the insurance rates for fire and other hazards shall be increased, Tenant shall upon demand, pay to Landlord, as Additional Rent, the amount by which the premiums for such insurance are increased. Such payment shall be paid with the next installment of Rent but in no case later than one (1) month after such demand, whichever occurs sooner.

 

52nd. Waiver of Subrogation Rights . Tenant and Landlord waive all rights of recovery against each other or each other’s agents, employees or other representatives, for any loss, damages or injury of any nature whatsoever to property or persons for which Tenant or Landlord is insured. Tenant shall obtain from Tenant’s insurance carriers, and shall promptly deliver to Landlord, waivers of subrogation rights under its respective policies required hereunder.

 

53rd. No Broker . Tenant and Landlord warrant that they have not dealt with any real estate broker in connection with negotiations for, or execution of, this Lease. In the event of any misrepresentation by either Tenant or Landlord, each party agrees to hold the other harmless from any costs or claims, including, without limitation, reasonable attorneys’ fees.

 

54th. Notices . Any and all notices, requests or other such communications required under the terms of this Lease shall be given either (i) by certified or registered mail, return receipt requested, postage prepaid, or (ii) a national overnight delivery service with receipt provided therefor, prepaid, to the address of the parties as shown at the head of this Lease or to such other address as may be designated in writing, which notice of change of address shall be given in the same manner. Notice shall be deemed effective if by mail, on the third (3) business day after mailing thereof, and if by overnight delivery, on the next business day after deposit or pick-up by such overnight delivery service. In addition, a copy of any notice to Tenant shall also be sent, in the manner provided herein, to Kronish Lieb Weiner & Hellman, LLP, 1114 Avenue of the Americas, New York, NY 10036, Attention:. Alison Newman, Esq.

 

55th. Force Majeure . The period of time during which Landlord or Tenant is prevented or delayed in performing any improvements or repairs or fulfilling any obligation required by Landlord or Tenant under this Lease (except for Tenant s obligation to pay Rent) due to delays caused by reason of fire, catastrophe, strikes or labor trouble, civil commotion, acts of God or the public enemy, governmental prohibitions or regulations, or inability or difficulty in obtaining materials, or other causes beyond Landlord’s or Tenant’s control, as the case may be, shall be added to Landlord or Tenant’s time for performance thereof (except for Tenant’s obligation to pay Rent), and Landlord or Tenant shall have no liability by reason thereof.

 

9
 

 

56th. Rules and Regulations. Rules and regulations regarding use of the Demised Premises and the Property, including the walkways and parking areas, and the use thereof, which may hereafter by promulgated by Landlord from time to time, shall be observed by Tenant and Tenant’s employees, agents and business invitees. Landlord reserves the right to rescind any rules promulgated hereafter, and to make such other and further rules and regulations as, in its reasonable judgment, may from time to time be desirable for the safety and cleanliness of the Demised Premises and the Property and for the preservation of good order therein, which rules, when so made, and notice given to Tenant, shall have the same force and effect as if originally made a part of this Lease.

 

57th. Validity of Leases. The terms, conditions, covenants and provisions of this Lease shall be deemed to be severable. If any clause or provision herein contained shall be adjudged to be invalid or unenforceable by a court of competent jurisdiction or by operation of any applicable law, it shall not affect the validity of any other clause or provision herein, but such other clauses or provisions shall remain in full force and effect.

 

58th. Title and Quiet Enjoyment. Landlord covenants and represents that Landlord is the sole owner of the Property herein leased and has the right and authority to enter into, execute and deliver this Lease; and does further covenant that Tenant on paying the Rent and performing the conditions and covenants herein contained, shall and may peaceably and quietly have, hold and enjoy the Demised Premises for the Term.

 

59th. Entire Lease. This Lease contains the entire contract between the parties hereto. No representative, agent or employee of Landlord has been authorized to make any representations or promises with reference to the within letting or to vary, alter or modify the terms hereof. No additions, changes or modifications, renewals or extensions hereof shall be binding unless made in writing and signed by Landlord and Tenant.

 

60th. Lease Submission. If this Lease is offered to Tenant by an employee or agent of the Landlord, such offer is made subject to Landlord’s acceptance and approval; and Tenant has executed this Lease upon the understanding that this Lease shall not in any way bind Landlord until such time as the same has been approved and executed by Landlord and a counterpart delivered to or received by Tenant.

 

61st. Conformation with Laws and Regulations. Landlord may pursue the relief or remedy sought in any invalid clause in this Lease, by conforming the said clause with the provisions of the statutes or the regulations of any governmental agency in such case made and provided, as if the particular provisions of the applicable statutes or regulations were set forth herein at length.

 

62nd. Recordation. Tenant covenants and agrees not to place this Lease on record without the consent of Landlord, which consent may be withheld for any reason.

 

63rd. Waiver of Trial by Jury. THE PARTIES HEREBY WAIVE TRIAL BY JURY IN ANY ACTION, PROCEEDING OR COUNTERCLAIM BROUGHT BY EITHER OF THE PARTIES HERETO AGAINST THE OTHER ON ANY MATTERS WHATSOEVER ARISING OUT OF OR IN ANY WAY CONNECTED TO THIS LEASE, THE RELATIONSHIP OF LANDLORD AND TENANT, TENANT’S USE OR OCCUPANCY OF THE DEMISED PREMISES, AND/OR CLAIM OF INJURY OR DAMAGE.

 

64th. Jurisdiction. This Lease shall be construed and interpreted in accordance with the substantive and procedural laws of the State of New Jersey.

 

65th. Headings. The descriptive headings of the Paragraphs of this Lease are inserted for convenience only and shall not control or affect the meaning or construction of any of its provisions.

 

66th. Gender, etc. In all references herein to any parties, persons, entities or corporations the use of any particular gender or the plural or singular number is intended to include the appropriate gender or number as the text of the within instrument may require.

 

67th. Succession. All the terms, covenants and conditions herein contained shall be for and shall inure to the benefit of and shall bind the respective parties hereto, and their heirs, executors, administrators, personal or legal representatives, successors and assigns.

 

68th. Consents. With respect to any provision of this Lease which requires that Landlord shall not unreasonably withhold or unreasonably delay any consent or approval, Tenant hereby waives any claim for money damages. Tenant shall not claim any money damages by way of setoff, counterclaim or defense based upon any claim or assertion by Tenant that Landlord has unreasonably withheld or unreasonably delayed any consent or approval. Tenant’s sole and exclusive remedy shall be an action or proceeding for specific performance or injunction.

 

69th. Holding Over. Any holding over or continued occupancy by Tenant after the Expiration Date (other than as may have been provided for in this Lease or in amendments executed in accordance with Paragraph 34 th of this Lease) shall not operate to extend or renew this Lease or to imply or create a new lease. In such event, Landlord shall have the right to immediately terminate Tenant’s occupancy or to treat Tenant’s occupancy as a month-to-month tenancy, in which event Tenant shall continue to perform all Lease obligations, including the payment of Base Rent at a rate equal to two hundred percent (200%) of the Base Rent as shall be in effect immediately prior to the termination of the Term hereof. In no event however, shall Tenant be relieved of any liability to Landlord for damages resulting from such holding over. If the Demised Premises is not surrendered as required Tenant shall indemnify, defend and hold harmless Landlord from and against any and all damages, losses and liabilities resulting therefrom, including, without limitation, any claims made by any succeeding tenant arising out of such delay. Tenant’s obligation under the Paragraph shall survive the expiration or sooner termination of this Lease.

 

10
 

 

70th. Landlord’s Representations. Landlord hereby warrants and represents to Tenant that:

 

1) Landlord has full power and authority to enter into this Lease and the person executing this Lease on behalf of Landlord is authorized to do so.

 

2) Landlord has received no notice of any material violations affecting the Demised Premises or the Property.

 

3) Landlord; has received no notice of any spills, releases, leaks or discharges of Hazardous Substances, as defined in Exhibit C attached hereto and made a part hereof, at or from the Demised Premises.

 

4) The certificate of occupancy issued for the Property permits Tenant to use the Demised Premises for the purposes Permitted under this Lease.

 

5) As of the Commencement Date, the Demised Premises are free from all occupancies or tenancies whatsoever.

 

6) No other tenant or occupant of the Property has been granted a right which would prohibit or limit the Use permitted to Tenant under this Lease.

 

7) All utilities installed in the Demised Premises are in good working order as of the date hereof.

 

IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seals, or caused these presents to be signed by their proper corporate officers or other duly authorized representatives and their proper corporate seal (if applicable) to be hereto affixed, as of the day and year first above written.

 

WITNESS:   LANDLORD
    Princeton Corporate Plaza, L.L.C.
    By: Princeton Corporate Management Corp.,
    Managing Member
       
    By: /s/ Teresa Ryan Kent
    Name: Teresa Ryan Kent
6/22/00   Title: Treasurer
Date        
       
WITNESS:   TENANT
    RenalTech International
       
    By: /s/ Frank Clark
    Name:  Frank Clark
6/22/00   Title:  Vice President
Date:    

 

11
 

 

EXHIBIT A

 

Demised Premises

 

 

12
 

 

EXHIBIT B

 

Description of Landlord’s Work

 

1. FLOORING:  
  Office Area: Existing Carpet
  Laboratory: Epoxy floors by Tenant.
     
2. PARTITIONS:  
  Office Area: Existing.
  Laboratory: Existing.
     
3. ELECTRICAL:  
  Office: Existing plus 10 duplex 110 volt outlets.
  Laboratory: Existing plus 15 duplex 110 volt outlets.
  Special electric by Tenant.
     
4. LIGHTING:  
  Office: Existing.
  Laboratory: Existing.
     
5. CEILINGS:  
  Office Area: Existing.
  Laboratory: Existing, vinyl tile upgrade and sealing by Tenant.
  Storage: Hung ceiling.
     
6. WALL FINISH:  
  Office: Painted, one color.
  Laboratory: Epoxy paint consistent with GMP Standards.
     
7. INTERIOR DOORS:  
  Office & Lab: Per plan.
     
8. PLUMBING: Common Area bathrooms.
    Special plumbing by Tenant.
     
9. HEATING AND AIR CONDITIONING:
  Office & Lab: Cooling 78 degrees at 95 degrees.
    Heating 68 degrees at 0 degrees.
  Storage: Thru-wall air conditioner.
     
10. FIRE EXTINGUISHERS:   As per Township code.
     
11. SPRINKLERS: As per Township code.
     
12. LABORATORY EQUIPMENT & FURNISHINGS;
     
  Supply and install 3 fume hoods, vented, with sinks (4 total) and electric.
  Supply and install 2 sinks.
  Supply and install Base Cabinets per plan.

 

13
 

 

EXHIBIT B-1

 

Description of Tenant’s Work

 

Fit-out costs by Tenant:

 

All special requirements not included in Exhibit B will be at Tenant cost.

 

The following are included in the cost specified in Paragraph 11 th of the Lease

 

A. Hoods, which shall become the property of Tenant:

8’ Walk in Hood

Installation (10 week delivery)

18’ Walk in Hood, Built-in, with mechanicals

 

B. Other:

Additional A.C. 10 Ton with economizer

 

Epoxy Floor & Base, consistent with GMP Standards

 

Existing Ceiling Tiles removed, replaced with vinyl coated tiles and sealed, consistent with GMP Standards

 

Plumbing:

2 additional sewer pumps

2 additional sinks

4 additional water lines

Neutralization tank, if required

 

Gas Piping and connections:

Compressed Air & Nitrogen to all hoods

 

Center Bench & Reagent

 

14
 

 

EXHIBIT C

 

ENVIRONMENTAL MATTERS

 

I. SIC

 

Tenant warrants and represents to the Landlord that the Standard Industrial Classification (“SIC”) major group number, as defined in the most recent issue of the SIC Manual issued by the Federal Office of Management and Budget, for Tenant’s operations at the Demised Premises is 541700 . Prior to any proposed changes of such SIC Number, Tenant will notify Landlord.

 

II. ISRA

 

1. Tenant shall not operate any business at the Demised Premises which shall have an SIC which is subject to the Industrial Site Recovery Act, N.J.S.A. 13:lK-6 et seq. and the regulations promulgated thereunder (hereinafter referred to as “ ISRA ”), nor shall Tenant change its use to any other use subject to ISRA without Landlord’s prior written consent, which may be withheld in Landlord’s sole discrection.

 

2. Notwithstanding any provision of ISRA to the contrary, if Tenant is operating an “ Industrial Establishment ”, as that term is defined in ISRA, Tenant shall, at Tenant’s own expense, comply with ISRA and the regulations promulgated thereunder. In such event Tenant shall, at Tenant’s own expense make all submissions to, provide all information to, and comply with all requirements of the Bureau of Industrial Site Evaluation (hereinafter referred to as the “ Bureau ”) of the State of New Jersey, Department of Environmental Protection and Energy (hereinafter referred to as the “ NJDEPE ”). At no expense to Landlord, Tenant shall promptly provide all documents, studies, surveys, correspondence and other information requested by Landlord relating to or in furtherance of ISRA compliance.

 

3. Tenant’s obligations under this Paragraph shall arise if there is any closing, termination or transferring of operations of an industrial establishment subject to ISRA. At no expense to Landlord, Tenant shall promptly provide all information requested by Landlord for preparation of non-applicability affidavits and shall promptly furnish such affidavits when requested by Landlord.

 

4. Tenant shall indemnify, defend and save harmless Landlord from all fines, fees (including attorney’s fees), suits procedures, claims, and actions of any kind arising out of Tenant’s failure to provide all information, make all submissions, and take all actions required under ISRA or by the NJDEPE.

 

5. Tenant’s obligations and liabilities under this Paragraph shall continue so long as Landlord remains responsible for compliance with ISRA. Tenant’s failure to abide by the terms of this Paragraph shall be restrained by injunction and such other relief as afforded by law.

 

III. HAZARDOUS SUBSTANCES

 

1. As used herein, Hazardous Substances shall be defined as

 

a. any “hazardous chemical”, “hazardous substances”, “hazardous waste”, “toxic substances, pollutants or contaminants” or similar term as defined in the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (“ CERCLA ”), 42 U.S.C.A. 9601 et seq. , ISRA, the New Jersey Spill Compensation and Control Act (the “ Spill Act ”), as amended, N.J.S.A. 58:10-23. lib et seq. (Regulations N.J.A.C. 7:1E-1.1 et seq.), the Solid Waste Management Act, N.J.S.A. 13:IE-1 et seq. (Regulations N.J.A.C. 7:26-1 et seq.), the Resource Conservation and Recovery Act (“ RCRA ”), 42 U.S.C.A. 6901 et seq., any rules or regulations promulgated thereunder or in any other Environmental Law, as defined in this Lease; or

 

b. any substances which are or could be detrimental to the Demised Premises, the Property, the environment, human health or safety; or

 

c. any substance the presence of which could cause liability at common law; or

 

d. any substance that may not be deemed to be a hazardous substance in its virgin state prior to use by the Tenant but may thereafter be deemed to be a hazardous substance.

 

15
 

 

2. As used herein, Release of Hazardous Substances by Tenant shall be defined as the spill, release, discharge or leak of any Hazardous Substances

 

a. onto the Demised Premises from the date Tenant first took possession of the Demised Premises until the date Tenant has completely vacated the Demised Premises; or

 

b. onto the Property at any time resulting from Tenant’s intentional or unintentional act or omission.

 

3. Tenant agrees not to generate, store, manufacture, refine, transport, treat, dispose of or otherwise permit to be present on or about the Demised Premises and/or the Property any Hazardous Substances without the prior express written consent of the Landlord, and the parties acknowledge that no such consent has been given as of the date hereof. In the event that the Landlord gives it consent and to the extent that Tenant may be permitted under applicable law to use the Demised Premises for the generating, manufacturing, refining, transporting, treating, storing, handling, disposing, transferring or processing of Hazardous Substances, Tenant shall insure that said use shall be conducted at all times strictly in accordance with Environmental Laws.

 

4. Tenant will not cause or permit any Release of Hazardous Substances by Tenant. In the event of any Release of Hazardous Substances by Tenant, Tenant shall promptly make the proper notifications and conduct the necessary sampling and cleanup and remediate such release in accordance with Environmental Laws, to the satisfaction of the Landlord.

 

5 Should the Bureau or any division of NJDEPE or any other agency with jurisdiction under any Environmental Laws determine that any investigation or remediation be undertaken because of any Release of Hazardous Substances by Tenant, then Tenant shall, at Tenant’s own expense, conduct the investigation and remediation including, but not limited to, the preparation and submission of any documents and financial assurances that may be required by such agency. Tenant shall not be liable for the cost of that portion of the remediation which is solely related to Hazardous Substances existing on the Demised Premises prior to the date Tenant first took possession of the Demised Premises.

 

6. Tenant’s obligations and liabilities under this Paragraph shall continue so long as Landlord remains responsible for any Release of Hazardous Substances by Tenant at the Demised Premises. Tenant’s failure to abide by the terms of this Paragraph shall be restrained by injunction and such other relief as afforded by law.

 

IV. AIR, WATER AND GROUND POLLUTION

 

1. Tenant shall not install any underground or aboveground storage tanks at or on the Demised Premises or the Property without Landlord’s written consent, which may be withheld in Landlord’s sole discretion.

 

2. Tenant expressly covenants and agrees to indemnify, defend and save the Landlord harmless against any claims, damages, liability, costs, penalties, or fines including, without limitation, attorneys’ fees, which the Landlord may suffer as a result of air, water, ground or toxic waste pollution (hereinafter referred to as “ Pollution ”) caused by the Tenant in its use of the Demised Premises. The Tenant covenants and agrees to notify the Landlord immediately of any claim or notice served upon it with respect to any such claim that the Tenant is causing pollution; and the Tenant, in any event, shall take immediate steps to halt, remedy or cure any pollution caused by the Tenant in its use of the Demised Premises. The foregoing covenant of indemnification shall survive the termination of this Lease in connection with any obligation of the Tenant hereunder.

 

IV. INSPECTION AND DOCUMENTATION

 

1. At any time upon request of Landlord, Tenant must give Landlord and its representatives access to the Demised Premises during normal business hours to permit them to inspect the Demised Premises, inspect any documents pertaining to Tenant’s compliance with Environmental Laws, or perform any work in order to determine that the Demised Premises and its use by Tenant is in compliance with Environmental Laws, all at Tenant’s expense, payable as Additional Rent.

 

16
 

  

2. Tenant shall promptly provide to Landlord a copy of any summons, citation, directive, order, claim, notice of litigation, investigation, proceeding, judgment, letter or other communication, written or oral, actual or threatened, from the NJDEPE, the U.S. Environmental Protection Agency or, other federal, state or local agency or authority or any other entity or any individual, concerning any act or omission by Tenant resulting in or which may result in the releasing of Hazardous Substances into the waters or onto the lands of the State of New Jersey or into waters outside of the jurisdiction of the State of New Jersey or into the “ Environment ” as defined in CERCLA. Written notice to Landlord shall also be made upon the imposition of any liens on any real property, personal property, or revenues of the Tenant, including but not limited to the Tenant’s interest in a premises or any of the Tenant’s property located thereupon, pursuant to the Spill Act or any Environmental Laws, governmental actions, orders or permits or any knowledge after due inquiry or investigation of any facts which could give rise to any of the above.

 

3 . In addition to the above, the Tenant’s notifications to the Landlord shall include but be not limited to all documentation and correspondence provided to the NJDEPE pursuant to the Worker and Community Right-to-Know Act, N.J.S.A. 34:5A-I et seq ., and the regulations promulgated thereunder;

 

4. Tenant shall promptly supply the Landlord with all reports and notices made by Tenant pursuant to the Spill Act, the regulations provided thereunder, and the Hazardous Substances Discharge Reports and Notices Act, N.J.S.A 13:1K-15 et seq., and the regulations promulgated thereunder .

 

5. Tenant shall promptly provide Landlord with a copy of any permit obtained for the Demised Premises pursuant to any Environmental Law.

 

V. CONTINUING OBLIGATIONS AND INDEMNITY

 

1. Notwithstanding the expiration or earlier termination of this Lease, if at any time during Tenant’s occupancy of the Demised Premises, Tenant has operated an Industrial Establishment, as that term is defined in ISRA, then Tenant’s shall have a continuing obligation to pay to Landlord the amount established under this Lease as Rent plus the difference between such Rent and the fair market rental value of the Demised Premises, if greater than the established Rent, for the period after expiration or earlier termination of this Lease until such time as the Tenant obtains and delivers to the Landlord a Negative Declaration or No Further Action Letter as defined in ISRA, or such other proof, reasonably satisfactory to the Landlord, that the Property may be sold without violation of ISRA.

 

2. Notwithstanding the expiration or earlier termination of this Lease, if there exists a violation of Environmental Laws at the Demised Premises which did not exist prior to the date Tenant first took possession of the Demised Premises or if Tenant has failed to fulfill its obligations under this Exhibit C, Tenant shall have a continuing obligation to pay to Landlord the amount established as Rent under this Lease plus the difference between such Rent and the fair market rental value of the Demised Premises, if greater than the established Rent, for the period after expiration or earlier termination of this Lease until the applicable governmental entities confirm, in writing, that the violation of Environmental Laws has been cured and that Tenant has fulfilled its obligation under Environmental Laws and under this Exhibit C.

 

3. If a lien shall be filed against the Demised Premises arising in whole or in part out of (i) any Release of Hazardous Substances by Tenant, or (ii) the violation of Environmental Laws by Tenant, then Tenant shall pay the claim and remove the lien from the Demised Premises within thirty (30) days from the date Tenant is given notice of the lien or within such shorter period of time as may be required if the United States, the State of New Jersey, or any agency or subdivision of either such entity has commenced steps to cause the Demised Premises or the Property to be sold pursuant to the lien. Tenant shall not be responsible for any portion of the lien which is related to a spill, release, leak or discharge of Hazardous Substances which occurred prior to the date Tenant first took possession of the Demised Premises.

 

4. Tenant shall indemnify and hold harmless the Landlord and each mortgagee of the property from and against any and all liabilities, damages, claims, losses, judgments, causes of action, costs and expenses (including the reasonable fees and expenses of counsel) which may be incurred by the Landlord or any such mortgagee relating to or arising out of the Tenant’s generation, storage, manufacturing, refining, transportation, treatment, disposal, or other presence of Hazardous Substances on or about the Demised Premises and/or the Property or any Release of Hazardous Substances by Tenant or the Tenant’s failure to comply with the provisions of this Exhibit C.

 

17
 

 

COMMENCEMENT DATE MEMORANDUM

 

THIS COMMENCEMENT DATE MEMORANDUM, made as of the 12th day of May, 2000, by and between Princeton Corporate Plaza, LLC (“Landlord”) and RenalTech International, LOLC (“Tenant”).

 

WITNESSETH:

 

WHEREAS, Landlord and Tenant entered into a lease dated March 9, 2000 (the “Lease”) setting forth the terms of occupancy by Tenant of a portion of the the building known as 7 Deer Park Drive, Suite K Monmouth Junction, New Jersey (the “Demised Premises”); and

 

WHEREAS, the Lease provides the actual Commencement Date shall be May 1, 2000 or the date upon which landlord’s work is substantially completed; and

 

WHEREAS, the parties desire to acknowledge delivery by Landlord and receipt by Tenant of the Demised Premises in accordance with the terms of the Lease and to set forth the Commencement Date and Expiration Date as defined in the Lease.

 

NOW, THEREFORE, it is agreed that the Commencement Date and Expiration Date are as follows:

 

COMMENCEMENT DATE: May 12, 2000
   
TERMINATION DATE: April 30, 2000

 

Tenant acknowledges and agrees that it has unconditionally accepted possession and occupancy of the Demised Premises, except for the storage space as set forth in paragraph 12.3 of the Lease.

 

IN WITNESS WHEREOF, Landlord and Tenant have executed this Commencement Date Memorandum as of the date first above written.

 

WITNESS:   LANDLORD
    Princeton Corporate Plaza, L.L.C.
    By:  Princeton Corporate Management
Corp.,    
    Managing Member
     
    By:
    Name: Teresa Ryan Kent
    Title: Treasurer
Date    
     
WITNESS:   TENANT
    RenalTech International, LLC
     
    By:
    Name: Frank Clark
    Title: Vice President
Date    

 

 

 

 

Exhibit 10.5

 

THIRD AMENDMENT TO LEASE

 

Amendment made this 22 nd day of April 2002, amending the Lease dated March 9, 2000 and amended on October 26, 2000 and March 12, 2001 (collectively, the “ Lease ”)

 

Between Princeton Corporate Plaza, LLC (“ Landlord ”)
   
And RenalTech International, LLC (“ Tenant ”)

 

Witnesseth:

 

Whereas the Lease terminates on April 30, 2002 and;

 

Whereas Tenant desires Landlord to extend the Term;

 

Now, therefore, in consideration of the mutual understanding between them and intending to be legally bound, Landlord and Tenant hereby agree to amend the Lease as follows:

 

1. Term . The Term of the Lease is hereby extended to April 30, 2003 (the “ Expiration Date ”).

 

2. Payment of Rent . Effective on May 1, 2002, Tenant covenants and agrees to pay to Landlord, as Base Rent for and during the remainder of the Term hereof without defense, demand or offset, the sum of Two Hundred Ninety-Two Thousand Three Hundred Eighty-Three Dollars ($292,383.00) payable on the first day of each month during the Term in the following manner: $24,365.25 per month, together with such Additional Rent as may hereinafter be provided (collectively, the “ Rent ”).

 

3. Payment of Cost of Tenant’s Work.

 

a. Non-Cash Payment. Tenant has this day delivered to Landlord the Units in the Company described in Exhibit D , attached hereto and made a part hereof, which Units represent payment in full of the balance due to Landlord for the Tenant’s Work set forth in paragraph 7 .c. of the Second Amendment to Lease in the amount of $90,000 together with additional work performed by Landlord for Tenant in the amount of $51,635 for a total of $141,635.00.

 

b. Cash Payment. Tenant has this day deposited with Landlord the sum of $26,450.00 in payment of extra work performed by Landlord at Tenant’s request in various laboratories

 

4. Security . Tenant has this day deposited with Landlord the sum of $2,730.00 as additional security thereby increasing Tenant’s total security deposit to $48,730.00.

 

5. Electric and Gas . Effective May 1, 2002, Tenant shall pay as Additional Rent for estimated usage the amounts of $2,389.00 per month for electricity and $785.00 per month for gas.

 

6. Renewal Option . Tenant has the option to renew for one (1) successive one (1) year term(s) upon six (6) months written notice to Landlord prior to the expiration of the term of this Lease or prior to the expiration of a renewal, as the case may be; provided, however, that Tenant is not in default under any of the terms and conditions of this Lease (i) on the date this option is exercised and (ii) on the date the renewal term commences. Base Rent for the renewal term shall be Twenty Five Thousand Five Hundred Seventy-Nine Thousand Two Hundred Dollars ($25,583.50) per month.

 

7. Lease Amendment Submission . Tenant has executed this Amendment upon the understanding that this Lease shall not in any way bind Landlord until such time as the same has been, approved and executed by Landlord and a counterpart delivered to or received by Tenant.

 

8. Entire Lease . This Amendment is made a part of the Lease and where a conflict exists between any provision in the Lease and the provisions of this Amendment, this Amendment shall govern. Except as specifically amended herein, all of the terms and conditions of the Lease shall continue with full force and effect.

 

 
 

 

IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seals, or caused these presents to be signed by their proper corporate officers or other duly authorized representatives and their proper corporate seal (if applicable) to be hereto affixed, as of the day and year first above written.

 

WITNESS:   LANDLORD
    Princeton Corporate Plaza, L.L.C.
    By: Princeton Corporate Management Corp.,
Managing Member
       
  By: /s/  Teresa Ryan Kent
    Name: Teresa Ryan Kent
6/10/2002   Title: Treasurer
Date      
       
WITNESS:   TENANT
    RenalTech International, LLC
       
  By: /s/  Frank Clark
    Name: Frank Clark
5/31/02   Title: Vice President
Date    

 

 

 

Exhibit 10.6

 

RenalTech International, LLC

320 East 65th Street, Suite 116

New York, NY 10021

Telephone:   212-717-8644

Facsimile:    212-717-8643

www.renaltech.com

E-mail: info@renaltech.com

 

Guillermina Vega Montiel August 11, 2003
P.O. Box 894  
Nogales, AZ 85628  

 

Dear Guillermina,

 

This letter shall summarize the points of our discussion from 8/5 regarding the agreed incentive structure for your further investment in RenalTech.:

 

a.  You will purchase $4 million of Membership Units from RenalTech at a price of $3.25 per Unit with a ratchet provision that gives you the lower price if within the next 12 months, after this investment, Membership Units are sold at a lower price.

 

b.  RenalTech will grant you a royalty of 3% on all gross revenues received by RenalTech from the sales of the CytoSorb Device in the areas of sepsis, cardio-pulmonary bypass, organ donation, chemotherapy and inflammation control. The term “revenue” shall include all product sales revenue as well as license fees and proceeds from the sale of RenalTech’s Cytosorb intellectual property.

 

c. You will arrange to (1) immediately wire $1.5mm to RenalTech’s Citibank account #41358084 for purposes of conducting the FDA clinical trials for the BetaSorb ;
   
  (2)   wire an additional $1mm by August 25, to provide working capital;
   
  (3)   wire an additional $1.5 mm by October 15.

 

d. While not contractually committed to do so, you will consider investing an additional $1 million at the same price as stated above provided the Company is, in your opinion, making satisfactory progress. This right to invest the additional $1mm at $3.25+ratchet to lower price shall be exercisable through February 28, 2004.

 

Please sign and return a copy of this letter (by fax) to indicate your agreement.

 

Agreed to:     RenalTech International, LLC
      By:  

 

RenalTech International, LLC Business Confidential

  

 

 

Exhibit 10.8

 

CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT.  EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

 

 

This Distribution Agreement (“ Agreement ”) is entered into on this 20 th day of September 2013, (“ Effective Date ”)

by and between

 

CytoSorbents, Inc ., a corporation having its offices at 7 Deer Park Drive, Suite K, Monmouth Junction, New Jersey 08852, United States, existing under the laws of the United States (hereinafter referred to as " CytoSorbents ")

 

and

 

Biocon Limited , a corporation having its offices at 20th KM, Hosur Road, Electronics City, Bangalore, India - 560 100 existing under the laws of India (hereinafter referred to as " Biocon ")

 


CytoSorbents and Biocon hereinafter collectively referred to as " Parties " and individually as a “ Party ”.

 

 

 

 

 

 

 

(Reminder of the page intentionally left blank)

 

 

 

Page  1  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Preamble 4
1. Appointment, Products, Territory, and Applications 4
2. Order Process, Prices and Payment 6
3. Stock 9
4. Packaging and Labeling 11
5. Product Registration 11
6. Other Obligations of Biocon 13
7. CytoSorbents' Obligations 13
8. Relationship of the Parties 14
9. Best Efforts 15
10. Reporting 16
11. Product Returns 18
12. Field Assistance 19
13. Trademarks, Service Marks and Trade Names; Promotion on Internet 19
14. Covenant Not To Compete 20
15. Representations and Warranties 21
16. Limitations on Liability 26
17. Indemnifications 26
18. Force Majeure 29
19. Confidentiality 30
20. Publicity 32
21. Term and Termination 32
22. Selling Off of Inventory 34
23. Notices 35
24. Modification 36
25. Assignment 36
26. Waiver 37
27. Validity 37
28. Governing Law 37
29. Jurisdiction 38

 

 

Page  2  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

 

30. Entire Agreement 38
31. No Rights by Implication 38
32. Compliance With Laws 39
33. Insurance 39
34. Severability 39
35. Counterparts 38

 

 

 

 

(Reminder of the page intentionally left blank)

 

Page  3  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Preamble

 

WHEREAS, CytoSorbents is a company that develops and sells blood purification products for the treatment of life-threatening diseases;

 

 

WHEREAS, Biocon is in the business of marketing and distribution of pharmaceutical products;

 

WHEREAS, CytoSorbents wishes to have Biocon undertake the distribution of certain such blood purification products for certain applications in the Territory in limited quantities as a pilot transaction for potential future expansion upon the mutual agreement of the Parties in their sole discretion, with such distribution to be on an exclusive basis due to such products being new to the Territory and the fact that competing blood filtration products are available through other distributors.

 

NOW, THEREFORE , In consideration of the mutual covenants and conditions herein contained, and intending to be legally bound hereby, the Parties mutually agree as follows:

 

  

1. Appointment, Products, Territory, and Applications

 

1.1 Subject to the terms and conditions of this Agreement, CytoSorbents hereby appoints Biocon on an exclusive basis as CytoSorbents sole distributor for the sale of the CytoSorbents products listed in Annex 1 (hereinafter referred to as the "Products") solely in the Territory (as defined in Section 1.4) and solely for use in the Applications (defined in Section 1.3) during the Term of this Agreement. During the Term of this Agreement CytoSorbents shall not promote or sell in the Territory, itself or through any third party, the Products or any product competing with the Product. All rights not expressly granted to Biocon under this Agreement, are reserved for CytoSorbents.

 

 

Page  4  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

1.2 Without the prior written consent of CytoSorbents, Biocon shall not sell, market or distribute any version of any Product other than the version CytoSorbents shall designate from time to time as its most current version, with sufficient notice to the Biocon to enable the Biocon to sell its stock of the old version of the Product and ensure a smooth transition. Written consent shall not be unreasonably withheld or delayed.

 

1.3 Biocon shall use all commercially reasonable efforts to promote and sell the Products to the maximum number of buyers ("Purchasers") in the Territory. Biocon shall (a) promote Products only for use in the in the applications identified in Annex 2 as Applications (the "Applications") and not for any other application (including those listed as Applications Not Included in Annex 2 ) and (b) promote Products to customers only for use in the Applications. Biocon shall not promote any Product for application listed among the Applications Not Included (as defined in Annex 2 ).

 

1.4 CytoSorbents is appointing Biocon hereunder with respect to the resale of Products to any Purchasers whose principal place of business is located in the territory and Applications listed in Annex 2 (hereinafter referred to as the “Territory”). Biocon shall not promote, distribute or sell any Product outside the Territory, nor to any Purchaser that Biocon knows will export such Product outside the Territory for any purpose.

 

1.5 Biocon shall not engage in any advertising or promotional activities relating to the Products directed to customers outside the Territory without prior written consent of CytoSorbents. Biocon shall provide to CytoSorbents copies of any written statements related to any therapeutic claims that Biocon wishes to use to market or promote the Products at least thirty (30) days prior to Biocon's planned date of implementation; provided, however, that Biocon shall not make or use any statement related to any therapeutic claim regarding any Product unless CytoSorbents has expressly approved such statement in writing.

 

 

Page  5  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

1.6 Biocon shall not actively solicit orders from any prospective purchaser outside the Territory without prior written consent of CytoSorbents.

 

1.7 If Biocon receives any order from a prospective purchaser outside the Territory, Biocon shall immediately refer that order to CytoSorbents. Biocon shall not accept any such orders without prior written consent of CytoSorbents. Consent shall not be unreasonably withheld for orders received from within India but outside the specific Indian cities that comprise the Territory. Biocon shall not deliver or tender (or cause to be delivered or tendered) any Product outside the Territory.

 

1.8 Biocon shall not establish or maintain any branch, warehouse or distribution facility for the Products outside of the Territory without prior written consent of CytoSorbents.

 

1.9 CytoSorbents reserves the right, in its sole discretion, (i) upon ninety (90) days' written notice to Biocon prior to the end of each calendar year, to amend the Products which are covered by this Agreement and described in Annex 1 .

 

1.10 During the Term of this Agreement, the Parties may expand in any manner the Territory upon mutual agreement by both parties and thirty (30) days' prior written notice.

  

 

2. Order Process, Prices and Payment

 

2.1 For purposes of this Agreement, "Term Year" means the twelve (12) month period beginning on the date that Biocon obtains the first regulatory approval to promote and sell a Product in the Territory, and each subsequent twelve (12) month period throughout the Term of this Agreement. "Term Year 1" means the first Term Year; "Term Year 2" means the second Term Year; and "Term Year 3" means the third Term Year.

 

Page  6  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

2.2 Within thirty (30) days of the Effective Date, Biocon shall be place the first order of Product set forth in the table in Section 9.1. The Parties shall agree that the Products ordered in the said first order will be shipped to Biocon within thirty (30) days of the date of the first order. Notwithstanding anything else in this Agreement to the contrary, Biocon shall pay for the first order in full within thirty (30) days after the Effective Date.

 

2.3 Within ten (10) days after the first day of Term Year 1, Biocon shall provide to CytoSorbents a forecast for the next three (3) calendar months of Biocon's anticipated requirements of the Products and indicating the desired delivery dates. Biocon shall deliver to CytoSorbents a written update to this forecast on a rolling basis within fourteen (14) days after the beginning of each subsequent calendar quarter.

 

2.4 Biocon shall order Products from CytoSorbents by submitting a written purchase order identifying the Products ordered, requested delivery date(s) and any export/import information required to enable CytoSorbents to fulfill the order. Biocon may enter into contracts with Purchasers for the purchase of Products and may enter into such contracts at any time during the Term of this Agreement (“Purchaser Contracts”).

 

2.5 Unless CytoSorbents has a commercially reasonable reason (e.g. force majeure (as defined in Section 18.2) etc.) to refuse an order from Biocon, CytoSorbents shall accept orders from Biocon which are in compliance with the provisions of this Agreement. Within fifteen (15) days of the delivery of any forecast that exceeds the total yearly amount of Product described in Section 9.1 for the applicable year in which such forecast is delivered, the Parties shall meet and discuss such forecast. CytoSorbents will honor, to the best of its ability, product volume in excess of the annual minimum order requirement but is not obligated to fulfill the excess volume.

 

Page  7  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

2.6 CytoSorbents shall use commercially reasonable efforts to ship the Product with ***, but in no event *** of ***.

 

2.7 The purchase prices for the Products are set forth in Annex 3 .

 

2.8 If a purchase order is accepted in accordance with Section 2.4 above, delivery of such Products shall be EXW CytoSorbents facility at 7 Deer Park Drive, Suite K, Monmouth Junction, NJ 08852, USA (Incoterms 2010).

 

2.8.1 CytoSorbents shall be responsible for packaging the product and at Biocon’s request coordinating shipping logistics between CytoSorbents New Jersey-based warehouse to Biocon’s destination port in India including documentation required to export from the US.

 

2.8.2 CytoSorbents shall bill Biocon for delivery charges, which Biocon shall reimburse CytoSorbents within thirty (30) days of receipt of such bill.

 

2.8.3 Biocon shall be responsible at its expense for coordinating and costs of Product receipt, import duties / taxes, and other costs related to delivery to final destination.

 

2.9 CytoSorbents obligation to deliver Product to Biocon shall be subject to the right and ability of CytoSorbents to make such sales and obtain required licenses and permits, under all decrees, statutes, rules and regulations and agencies or instrumentalities thereof presently in effect or which may be in effect hereafter. CytoSorbents shall undertake commercially reasonable measures to obtain the licenses and permits required for the shipment of orders of Product.

 

2.10 All payments shall be made by Biocon to CytoSorbents within thirty (30) days of receipt of invoice by Biocon.

 

Page  8  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

2.11 Pricing shall be fixed throughout the Initial Term of this Agreement starting from the Effective Date (as defined in Section 21.1). At the end of Initial Term of this Agreement, CytoSorbents and Biocon will negotiate in good faith any future pricing.

 

2.12 Biocon shall be free to establish its own pricing for Products sold to Purchasers.

 

2.13 If CytoSorbents terminates this Agreement with Biocon or amends the product offering in accordance with Section 1.9 such that any Product is removed from Annex 1 , then CytoSorbents shall continue to supply Biocon with sufficient applicable removed Product to fulfill any Purchaser Contracts (as defined in Section 2.4) for such removed Product that are in effect as of the effective date of such termination or product offering amendment until the earlier of either the expiration of the term of such Purchaser Contract or one (1) year from the termination date of this Agreement. CytoSorbents’ obligations under this Section 2.12 do not apply to any extensions, subsequent renewals automatic or otherwise described in such Purchaser Contract. Biocon shall notify CytoSorbents in writing within fifteen (15) days of the effective date of any such termination or product offering amendment if a Special Extension of Supply Term is required, and shall include a copy of the applicable Purchaser Contract in such written notice.

 

 

3. Stock

 

3.1 Biocon shall exert commercially reasonable efforts to have a sufficient stock of the Products in order to be able fulfill purchase orders from Purchasers within 2 days from receipt of such purchase orders, and shall store at a minimum five percent (5%) of the minimum purchase requirements described in Section 9.1 for the applicable year. Unexpected mass orders are not subject to this provision.

 

Page  9  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

3.2 Biocon shall store the Products consistent with product labeling and in accordance with the highest healthcare industry practices and rules and regulations in India in order to prevent deterioration of the Products and in accordance with Annex 1.

 

3.3 Upon CytoSorbents' written direction, associated with a required regulatory or compliance action, and within twenty (20) days receipt of such written direction, Biocon shall destroy, return to CytoSorbents or make such other disposition of Product as CytoSorbents shall direct that is permitted under applicable law of any portion of the Products determined by CytoSorbents. In the event of such return, destruction or other disposition CytoSorbents shall either replace the Products at no cost to Biocon (provided that the cost of shipping and customs and duties shall be borne by the party responsible for causing the regulatory or compliance action) or, at Biocon's option, reimburse Biocon in an amount equal to the price paid by Biocon to CytoSorbents for the Products including the costs of return or destruction. Biocon’s obligations under this Section 3.3 shall also apply to Product that has any remaining shelf life. In addition, Biocon shall destroy all Products that have passed applicable expiration dates.

 

3.4 Except as expressly set forth herein, Biocon agrees that CytoSorbents owns all right, title, and interest in all of the trade names, inventions, copyrights, know-how, and trade secrets relating to the design, manufacture, operation or service of the Products. The use by Biocon of any of these property rights is authorized only for the purposes herein set forth, and upon expiration or termination of this Agreement for any reason such authorization shall cease. Biocon shall not file, nor permit or encourage others to file, any patent applications covering any Product or component thereof, any process used by any Product, or any method of use of any Product.

 

Page  10  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

4. Packaging and Labeling

 

4.1 CytoSorbents shall provide Products that are single packed and comply with all applicable labeling requirements; provided, however, that Biocon shall inform CytoSorbents in writing of all applicable national labeling requirements in writing and well in advance in order to allow CytoSorbents timely delivery of the Products.

 

4.2 Biocon shall not package or label the Products or alter any Products or any package or label used in connection with any Products, except as specifically authorized in writing by CytoSorbents.

 

4.3 Biocon shall always comply in all respects with the packaging and labeling instructions of CytoSorbents.

 

4.4 CytoSorbents shall ensure that the Products are packed for delivery and transportation in such a manner to avoid risk of damage, loss, or other detrimental effects.

 

4.5 CytoSorbents shall dispatch the Product along with the required documents to ensure un-interrupted transport and safe delivery of the Product.

 

4.6 Biocon shall inform CytoSorbents in writing of any Product for which the labeling and / or packaging does not comply with the requirements within the Territory (“Non-Compliance”) as soon as possible but in no event later than ten (10)days after the discovery of such Non-Compliance. Biocon and CytoSorbents shall negotiate in good faith to come to a solution to correct such Non-Compliance and implement a solution as jointly agreed upon.

 

 

5. Product Registration

 

5.1 Biocon shall, at its expense, register the Products with the appropriate governmental agency(s) in the Territory, reflecting CytoSorbents as the manufacturer of the Product and the Biocon as the marketing authorization holder. The Biocon shall not, without written permission from CytoSorbents, undertake any such Product registration in any other name including in Biocon's own name, provided that such registration complies with the technical and legal requirements in the Territories and provided further that Biocon may be the marketing authorization holder in the Territory. Biocon shall submit all necessary applicable regulatory applications for registering the Product as follows: (a) within the India Territory no later than two (2) months after the Effective Date, and (b) within the Sri Lanka Territory no later than six (6) months after the Effective Date, subject to CytoSorbents providing Biocon the documents described in Annex 8 at least three (3) months prior to regulatory application. Biocon shall deliver to CytoSorbents copies of all such proposed applications prior to the Biocon filing such applications with the applicable regulatory authority. CytoSorbents shall have the right to comment on such applications. If such comments are received before filing, then Biocon shall modify such applications based on such comments. CytoSorbents shall assist in obtaining such registrations and give Biocon power of attorney for purposes of registration and shall provide reasonably necessary technical support to Biocon to meet all applicable regulatory requirements in the Territory. If the applicable regulatory agency in the Sri Lanka Territory requires that additional human clinical trials of the Product be conducted before granting marketing approval for sale of the Product in the Sri Lanka Territory, then the Parties shall discuss in good faith whether to amend this Agreement to delete Sri Lanka from the Territory and substitute another country or region that will not require additional human clinical trials of the Product.

 

Page  11  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

5.2 Biocon shall be responsible for maintaining adequate lot traceability to assure recall of Products, if necessary, as detailed in Section 10.1.2.3.

 

5.3 Upon expiration and termination for any reason of this Agreement Biocon shall, at CytoSorbents' option and at the sole expense of CytoSorbents, either (a) de-register the Product from all government and regulatory authorities within 30 days, or (b) transfer any and all registrations, import licenses, permits or certificates for the Products to CytoSorbents or CytoSorbents designee within 30 days. Biocon agrees to affect such transfer and deregistration in accordance with all applicable local laws. Notwithstanding the foregoing in case of termination of this Agreement by CytoSorbents for breach of the Agreement by Biocon, Biocon shall be solely responsible for all de-registration expenses.

 

Page  12  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

6. Other Obligations of Biocon

 

6.1 Biocon shall be responsible for promotion, marketing and sales of the Product in the Territories and Applications.

 

6.2 Biocon shall employ competent and experienced personnel and maintain an adequate stock of Products as stated in Section 3 so as to ensure timely delivery of the Products to the Purchasers of the Products in the Territory.

 

6.3 Biocon shall translate, at its own expense, all user and technical manuals and advertising and marketing information into the languages of Purchasers and provide CytoSorbents with advance copies of all such materials for approval by CytoSorbents. Biocon shall assign, and hereby assigns, all copyrights in such translations to CytoSorbents. Biocon shall have a non-exclusive right to use such translations during the Term of this Agreement in connection with its activities pursuant to this Agreement.

 

  

7. CytoSorbents' Obligations

 

7.1 CytoSorbents shall provide Biocon with such marketing and technical assistance and Product samples as CytoSorbents reasonably determines is necessary to assist with the promotion of the Products.

 

 

Page  13  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

7.2 CytoSorbents will provide Biocon *** in support of marketing promotions of CytoSorbents in the *** and up to *** in total *** of the agreement ***.

 

7.3 CytoSorbents shall provide reasonable initial training to Biocon's personnel in connection with the marketing, sale, installation and support of the Products. CytoSorbents will not charge Biocon for such training. CytoSorbents and Biocon shall jointly agree on the details of the training.

 

7.4 CytoSorbents shall designate support personnel to assist Biocon's support personnel in providing support services; provided, however, that CytoSorbents' personnel spend no more than an aggregate of 16 hours per calendar month of their time in providing such assistance.

 

7.5 CytoSorbents agrees to provide reasonable amounts of support to Biocon at medical congresses when possible.

 

 

8. Relationship of the Parties

 

8.1 Each Party shall be considered to be an independent contractor. The relationship between CytoSorbents and Biocon shall not be construed to be that of employer and employee nor to constitute a partnership, joint venture or agency of any kind.

 

8.2 Biocon shall have no right to enter into any contracts or commitments in the name of, or on behalf of, CytoSorbents, or to bind CytoSorbents in any respect whatsoever without written prior consent of CytoSorbents.

 

8.3 CytoSorbents shall have no right to enter into any contracts or commitments in the name of, or on behalf of, Biocon, or to bind Biocon in any respect whatsoever without prior written consent of Biocon.

 

8.4 Biocon shall not be entitled to issue or make any affirmations, representations, warranties or guarantees with respect to the Products to any third party beyond those provided by CytoSorbents. CytoSorbents warrants the products as defined in the “Instructions For Use” (IFU) and Product Warranty ( Annex 4 ).

 

 

Page  14  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

9. Best Efforts

 

9.1 Biocon shall purchase a sufficient amount of Products from CytoSorbents so as to meet or exceed the minimum purchase requirements set forth below.

 

Calendar Year Minimum Purchase Requirements
Upon Effective Date ***
Term Year 2 ***
Term Year 3 ***

 

9.2 For Term Year 1, the annual minimum order payment is due in full as set forth in Section 2.2. This represents the Initial Stocking order. For each of Term Year 2 and Term Year 3, the annual minimum order for such years should be divided into three equal orders per Term Year, unless the Biocon advances a part of the annual minimum order, with the consent of CytoSorbents, which consent shall not be unreasonably withheld. Biocon shall place such orders at four-month intervals during such Term Years commencing on the first day of each Term Year.

 

9.3 In the first Term Year that the applicable minimum is not met, Biocon will have one additional quarter (Q1 of the next Term Year) to meet minimum requirements of the previous Term Year. Failure to meet such minimum requirements shall constitute a material breach of this Agreement for the purposes of Section 21 hereof.

 

Page  15  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

9.4 At least ninety (90) day advance notice is required for any product volume above one hundred twenty percent (120%) of the applicable annual minimum described in Section 9.1.

 

9.5 If actual sales volumes exceed forecast value by one hundred fifty percent (150%) and if Biocon is otherwise in full compliance with its obligations under this Agreement, then both parties agree to evaluate the market pilot and if mutually agreed between the Parties a full scale commercial partnership agreement may be entered between the Parties.

 

 

10. Reporting

 

Biocon shall provide CytoSorbents with written reports upon request, which shall include business trends and other reports requested by CytoSorbents on justifiable grounds. Biocon shall provide quarterly and annual market forecasts in accordance with this Agreement and upon CytoSorbents' request.

 

10.1 In particular, but not limited to, Biocon shall give its best efforts to provide the following information:

 

10.1.1 Technical information: Biocon shall forward promptly to CytoSorbents all technical questions with respect to the Products which it may receive from the Territory and Applications and complaints related to technical or medical issues that comply with regulatory requirements related to medical products in the Territories.

 

10.1.2 Post Market Surveillance: Biocon shall appoint a qualified person for post market surveillance (PMS). PMS includes the following:

 

10.1.2.1 Product complaints: Complaints shall be recorded in the complaint form provided by CytoSorbents ( Annex 5 ). Biocon shall report to CytoSorbents in writing and without undue delay any potential serious device related adverse events.

 

Page  16  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

10.1.2.2 Marketing and sales data: Biocon shall complete and return the marketing and sales data reporting form ( Annex 6 ) within fourteen (14) days from the end of each calendar quarter upon request

 

10.1.2.3 Traceability of batch numbers: In order to fulfill the GMP standard related to product recall, Biocon shall ensure that all CytoSorbents Products sold by the Biocon can be tracked to the end user. The term "GMP" means current good manufacturing practices, as defined as described by applicable laws and regulations in the United States and the European Union, together with any guidance documents issued by the regulatory authorities in such jurisdictions.

 

10.1.3 Customer data: Unless required by applicable law, Biocon is under no obligation whatsoever to provide to CytoSorbents names of Purchasers or any other information which may allow CytoSorbents to identify Purchasers.

 

10.2 Additional market research performance data is to be collected by Biocon and shared with CytoSorbents. Market research shall include, but not limited to, quantitative measures such as sales volume, price point, time to sale, etc. and qualitative measures such as physician survey, case study report for first 20 patients where data is available. This data to be shared with CytoSorbents no later than end of the second term year.

 

Page  17  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

11. Product Returns

 

11.1 Biocon shall examine Products promptly following delivery. Obvious defects to Products shall be reported by Biocon to CytoSorbents in writing within sixty (60) days from delivery and hidden defects within sixty (60) days from the date when the defect was discovered. If CytoSorbents agrees with Biocon’s determination regarding such defect, then CytoSorbents shall replace such defective Product at no cost to Biocon; provided, however that replacement of Product for which Biocon has discovered a defect after the applicable sixty (60) day period shall be at the sole discretion of CytoSorbents.

 

11.2 In case CytoSorbents disagrees with the Biocon’s determination regarding such defects, the Parties shall submit the samples retained from the applicable batch of the Product to a mutually agreed upon independent competent laboratory or institution selected by the Parties, whose adjudication as to whether the Product has defect, or not, shall be final and binding on the Parties. The expenses incurred for such third party determination shall be borne by the Party against whom the findings are made. If the defect or poor quality of the Product is confirmed by the independent test all expenses borne by such test shall be covered by CytoSorbents.

 

11.3 Except in case of Product defects, regulatory recall or compliance action, CytoSorbents shall only accept returns of product with more than ***, subject to the Product having a remaining *** of minimum of *** at the time of shipping, in the event this Agreement is terminated by CytoSorbents.

 

11.4 Regarding product recalls or defective product, CytoSorbents costs will be limited to either provide a credit for the defective product or replace it directly. In the case of recalled product, CytoSorbents at its discretion may request the product be shipped back to the US at its expense. Biocon at its expense will be responsible for recalling and recovering product involved in a recall in the Territory.

 

 

Page  18  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

12. Field Assistance

 

12.1 CytoSorbents shall provide, in its discretion, appropriate field technical assistance to Biocon and Purchasers.

 

 

13. Trademarks, Service Marks and Trade Names; Promotion on Internet

 

13.1 Right to Use. Biocon may use CytoSorbents' trademarks, trade names and service marks listed in Annex 7 (hereinafter referred to as the "Trademarks") on a non-exclusive basis in the Territory only for the Term of this Agreement and for the purpose of this Agreement. Biocon shall not at any time do or permit any act to be done which may in any way impair the rights of CytoSorbents in the Trademarks. All goodwill arising from Biocon’s use of the Trademarks shall inure to the benefit of CytoSorbents. CytoSorbents shall have the right to request examples or specimens of the use of the Trademarks to confirm that they comply with CytoSorbents usage policies and guidelines. Biocon agrees that it shall revise any use of the Trademarks as CytoSorbents may require in order to comply with CytoSorbents usage policies and guidelines. All Trademarks remain owned by CytoSorbents and Biocon shall not take any action that may adversely affect CytoSorbents rights in the Trademarks. Notwithstanding anything in this Agreement to the contrary, all intellectual property rights owned or controlled by Biocon prior to the Effective Date remain the property of Biocon.

 

13.2 Quality Control: In order to comply with CytoSorbents' quality control standards, Biocon shall: (i) use the Trademarks in compliance with all relevant laws and regulations; (ii) accord CytoSorbents the right to inspect during normal business hours, by giving the Biocon prior written notice, Biocon's facilities used in connection with efforts to sell the Products in order to confirm that Biocon's use of such Trademarks is in compliance with this Section; and (iii) not modify any of the Trademarks in any way and not use any of the Trademarks on or in connection with any goods or services other than the Products.

 

Page  19  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

13.3 Biocon shall follow CytoSorbents’ instructions with respect to each of the following: (i) use of any information about CytoSorbents or the Products available on the Internet; (ii) linking of any site on the Internet to any site on the Internet established, operated or sponsored by CytoSorbents; and (iii) use of any of the Trademarks on any site on the Internet. Biocon acknowledges that it shall cease the activities described in (i), (ii) and/or (iii) above within reasonable time, if so instructed by CytoSorbents and immediately in case of termination. In no event shall Biocon establish, operate, sponsor or contribute content to any site on the Internet which incorporates the CytoSorbents' domain name @ as its URL address or any part of such address. Biocon shall discuss in advance with CytoSorbents the use of CytoSorbents' company name, product name or any Trademark held by CytoSorbents’ in any promotional material.

 

 

14. Covenant Not To Compete

 

14.1 During the Term of this Agreement and, to the extent permissible under applicable law, for six (6) months thereafter, Biocon shall not market and or sell directly or indirectly assist third parties to market or sell products that are competing the Product, for the Application with in the Territory . This provision shall not cover the products distributed or sold by Biocon before signing this Agreement.

 

14.2 CytoSorbents shall not appoint directly or indirectly by itself or through its affiliates any distributor in the Territory to sell or offer for sale any competitive product during the term of this agreement and for six (6) months following the termination of this Agreement.

 

Page  20  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

14.3 Biocon agrees to review future product offerings from other suppliers for the treatment of conditions mediated by the inflammatory response and used in extracorporeal therapy with CytoSorbents at least 3 months before introduction. The Biocon agrees not sell new product offering related to extracorporeal treatment of inflammatory conditions without CytoSorbents’ prior written approval.

 

14.4 Biocon shall disclose all partnerships, product offerings and potential competitive conflicts of interest to CytoSorbents in writing prior to execution of an agreement for such partnerships and product offerings.

 

 

15. Representations and Warranties

 

15.1 Mutual Representations and Warranties . Each Party hereby represents and warrants that (a) this Agreement is a legal and valid obligation binding upon such Party and is enforceable in accordance with its terms, except as enforceability may be limited by bankruptcy and by general equitable principles and public policy; (b) such Party is duly organized and validly existing under the laws of the state of its incorporation and has full corporate power and authority to enter into this Agreement and to carry out the provisions hereof; (c) such Party is duly authorized to execute and deliver this Agreement and to perform its obligations hereunder, and the person executing this Agreement on its behalf has been duly authorized to do so by all requisite corporate actions; (d) the execution, delivery and performance of this Agreement by such Party does not conflict with any agreement, instrument or understanding, oral or written, to which it is a Party or by which it may be bound, nor violate any applicable law.

 

15.2 Representations, Warranties and Covenants Regarding Anti-Corruption/Anti-Bribery

 

Page  21  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

15.2.1 Compliance with Anti-Corruption/Anti-Bribery Laws: Each Party represents, warrants and agrees that it has been at all times and will continue to be in compliance with all potentially applicable anti-corruption/anti-bribery laws, including but not limited to the U.S. Foreign Corrupt Practices Act of 1977, the U.K.’s Bribery Act 2010, and any anti-corruption/anti-bribery laws in the Territory. Each Party represents, warrants and agrees that no bribes, payments, kickbacks, gifts, hospitality, donations, loans, or anything of value have been or will be made or received, offered, promised, or authorized, directly or indirectly, to improperly influence any act or decision of any person or entity, induce any person or entity to do or omit to do any act in violation of any person’s or entities’ lawful duties, or secure any improper advantage.

 

15.2.2 Compliance Program and Policies: Each Party agrees to have and enforce anti-corruption/anti-bribery compliance policies and programs applicable to all employees and other persons acting on their respective behalf. In case of change in the applicable anti-corruption/anti-bribery laws, the Parties agree to update each other and comply with the said changes in the applicable laws.

 

15.2.3 Documentary Support for Fees and Expenses: Biocon will maintain accurate and complete documentary support for all fees and expenses it incurs related to CytoSorbents or this Agreement based on the Biocons internal accounting practice.

 

15.2.4 The Biocon shall provide all documentary support to enable CytoSorbents to respond to any regulatory requirements and investigation under the applicable laws.

 

15.2.5 Use of Sub-distributor, Affiliates, Agents and Other Third Parties: Biocon cannot bind CytoSorbents to any third parties, and cannot engage sub-distributor, affiliates or agents to perform services related to this Agreement without CytoSorbents’ prior written consent. If Biocon does engage, with CytoSorbents’ prior written consent, any sub-distributor, affiliates or agents to perform services related to this Agreement, Biocon agrees to the following:

 

Page  22  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

15.2.5.1 Biocon agrees to require the proposed sub-distributor, affiliate or agent to be bound by the same obligations imposed on Biocon under this Section 15.2 and its subsections regarding compliance with anti-corruption/anti-bribery laws, and

 

15.2.5.2 Biocon hereby agrees to indemnify, defend and hold harmless CytoSorbents, its affiliates and all officers, directors, employees and agents thereof from all liabilities, claims, damages, losses, costs, expenses, demands, suits and actions (including without limitation attorneys' fees, expenses and settlement costs) arising from or in connection with the acts or omissions of any sub-distributor, affiliate or agent. Notwithstanding anything to the contrary contained in any agreement between Biocon and any sub-distributor, affiliate or agent, all rights of a sub-distributor, affiliate or agent related to this Agreement shall terminate upon the expiration or termination of this Agreement.

 

15.2.6 Form of Payments Under the Agreement: All payments contemplated by this Agreement will be made by via electronic wire to the following account:

 

Electronic Wire Instructions
***



 

Page  23  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

15.2.7 Suspected Violations: Biocon agrees to immediately notify CytoSorbents of any actual, suspected or reported violation of any potentially applicable anti-corruption/anti-bribery law by Biocon or any employee or other person acting on behalf of Biocon, or that relates in any way to this Agreement or CytoSorbents.

 

15.2.8 Termination: Either Parties failure to strictly comply with this Section 15.2 and its subsections will constitute a material breach of this Agreement.

 

15.3 Additional Representations, Warranties and Covenants of Biocon . Biocon represents, warrants and covenants to CytoSorbents that:

 

15.3.1 Biocon shall comply with all applicable laws and regulations in performing its obligations under this Agreement;

 

15.3.2 Biocon shall not modify or alter any Product, including any packaging or labeling, that is received by Biocon under this Agreement, except pursuant to CytoSorbents' express prior written authorization;

 

15.3.3 Biocon shall obtain and at all times during the Term of this Agreement shall maintain, (a) all licenses and permits necessary for Biocon to promote and sell Products in the Territory. As of the Effective Date of this Agreement the Biocon has sufficient resources and personnel to perform Biocon's obligations under this Agreement in a professional and competent manner.

 

 

15.4 Product Warranty

 

15.4.1 CytoSorbents' warranties with respect to the Products are set out in Annex 4 hereto. EXCEPT AS SET FORTH IN Annex 4 , CYTOSORBENTS DISCLAIMS ALL OTHER WARRANTIES RELATED TO THE PRODUCT, INCLUDING WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT.

 

Page  24  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

15.4.2 The warranties set forth in Annex 4 shall only apply to any Product which has been used as per the written Instruction For Use provided by CytoSorbents on the Product. Notwithstanding any other provision in this Agreement, CytoSorbents shall not be held responsible for any damage which may result from a defective product except for the replacement of such product as set forth in Annex 4 .

 

15.4.3 In case of defective Products, CytoSorbents costs will be limited to either provide a credit for the defective product or replace it directly. In the case of defective product, CytoSorbents will evaluate complaint samples and determine if the product is defective and provide replacement, free of cost to the Biocon. CytoSorbents represents and warrants that the Product delivered and supplied to the Biocon under this Agreement are supplied and sold free from any liens or encumbrances or the like, and

 

15.4.3.1 The manufacturing facility is approved by the applicable regulatory authorities and has the requisite licenses and approvals to be operated for the manufacturing of pharmaceutical products and specifically the Product

 

15.4.3.2 Products is CE Mark approved and manufactured under ISO 113485 certified facilities. Polymer beads conform to ISO 10993 standards.

 

15.4.4 CytoSorbents hereby further represents and warrants to the Biocon, without any obligation to inquire, as of the Effective Date that CytoSorbents is not aware that the importing, distribution or sale of the Product in the Territory as permitted under this Agreement would infringe issued patent rights of any third party.

 

Page  25  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

15.4.5 The provisions of the foregoing warranties and the warranties contained elsewhere in this Agreement are in lieu of any other warranty, whether express or implied, written or oral (including any warranty of merchantability or fitness for particular purpose). Written warranties in effect at the time product(s) are purchased shall remain in effect until those materials are used or expiration dating is surpassed.

 

15.5 Disclaimer. EXCEPT AS SET FORTH IN THIS SECTION 15, THE PARTIES DISCLAIM ALL OTHER REPRESENTATIONS AND WARRANTIES.

 

 

16. Limitations on Liability

 

16.1 In no event shall either Party be liable to the other Party or any other person or entity for punitive, exemplary, special, incidental or consequential damages (including, but not limited to, loss of profits, loss of data or loss of use damages) arising out of the manufacture, sale or supplying of the Products, even that Party has been advised of the possibility of such damages or losses.

 

16.2 Section 16.1 shall not apply to damages caused by intent or gross negligence of CytoSorbents or Biocon.

 

 

17. Indemnifications

 

17.1 Indemnification of CytoSorbents

 

17.1.1 Biocon hereby agrees to indemnify, defend and hold harmless CytoSorbents, its affiliates and all officers, directors, employees and agents thereof from all liabilities, claims, damages, losses, costs, expenses, demands, suits and actions made by a third party (including without limitation attorneys' fees, expenses and settlement costs) (collectively, "Damages") arising from (i) any willful act or gross negligence of Biocon whether related to damage or injury to property or to persons, (ii) any failure of Biocon to comply with applicable law, rules, and regulations, and (iii) Biocon’s breach of this Agreement.

 

Page  26  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

17.2 Indemnification of Biocon

 

17.2.1 CytoSorbents hereby agrees to indemnify, defend and hold harmless Biocon, its affiliates and all officers, directors, employees and agents thereof from all Damages arising out of:

 

(i) CytoSorbents' failure to comply with relevant laws and regulations after receiving proper notice of same from Biocon as required herein; (ii) Biocon's importing, storing or reselling of the Products in the Territory infringing on the intellectual property rights of third parties or constituting a misappropriation of any third party's trade secrets, provided that Biocon notifies CytoSorbents in writing immediately after becoming aware of any potential infringement or misappropriation claims, permits CytoSorbents to control the defense and settlement of such claims and cooperates with CytoSorbents in the defense of such claims, at CytoSorbents sole cost; (iii) CytoSorbents’ breach of this Agreement, (iv) any actual or alleged injury to person or property or death resulting from the possession, use by any person of any Product or sample supplied by CytoSorbents under this Agreement to the Biocon that is caused by improper manufacturing, packaging or wrong labeling of the Product by CytoSorbents, whether such claims are based on negligence, warranty, strict liability, failure to warn or any other theory (v) CytoSorbents' grossly negligent act or omission; (vi)  failure of CytoSorbents to comply with applicable laws, rules, regulations, ordinances, permits or licenses, including the cGMPs and (vii) a regulatory enforcement action, inspection of the Product or recall of the Product, to the extent resulting from or based upon the acts of CytoSorbents

 

Page  27  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

17.2.2 The limitations on and exclusions of warranty or liability set forth in Section 16 above shall not apply to claims against Biocon from third parties that arise from fraudulent conduct, willful misconduct, or gross negligence.

 

17.3 In the event that any Product imported, promoted, distributed or sold in the Territory in compliance with this Agreement is held in a suit or proceeding to infringe any intellectual property rights of a third party and the use or reselling of such Product in the Territory under this agreement is enjoined, or CytoSorbents reasonably believes that it is likely to be found to infringe or likely to be enjoined, then CytoSorbents shall, at its sole cost and expense without limiting CytoSorbents obligations under 17.2.1, either (1) procure for Biocon the right to continue reselling such Product; or (2) modify such Product so that it becomes non-infringing. If neither (1) nor (2) is practicable, then without prejudice to any other rights or remedies that the Biocon may have under law or contract or tort, CytoSorbents may, in its sole discretion, remove such Product from this Agreement upon repurchasing Biocon's inventory of such Product which are in the original packages. If CytoSorbents notifies Biocon that any such Product(s) shall be removed from this Agreement, then Biocon shall (a) cease all importation, promotion and sales of such Product(s) immediately upon receipt of such notice, and (b) require that all of Biocon's affiliates, sub-distributors or agents; (i) immediately cease importation, promotion and sales of such Product(s) and (ii) return to Biocon all inventory of such Product(s) as promptly as possible but in no event later than thirty (30) days after Biocon receives CytoSorbent's notice. Any such repurchase of Biocon's inventory of Products shall be at the price paid to CytoSorbents' at the time of the purchase by the Biocon and the applicable duties and levies paid by the Biocon for importing the Product. Such repurchased inventory shall be shipped by Biocon freight prepaid, according to CytoSorbents' instructions. CytoSorbents shall pay Biocon for such repurchased Products within thirty (30) days after CytoSorbents receives those Products in one of its facilities. If all Products are removed from this Agreement under this Section 17.3, then CytoSorbents may terminate the Agreement immediately upon written notice to Biocon.

 

 

Page  28  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

17.3.1 CytoSorbents shall have no obligation for any claim of infringement arising from: (1) any combination of Products with products not supplied or approved in writing by CytoSorbents, where such infringement would not have occurred but for such combination; (2) the adaptation or modification of Products, where such infringement would not have occurred but for such adaptation or modification; or (3) the use of a Product in an application for which it was not designed or intended, where such infringement would not have occurred but for such use.

 

 

18. Force Majeure

 

18.1 Neither CytoSorbents nor Biocon shall be liable in damages, or shall be subject to termination of this Agreement by the other party, for any delay or default in performing any obligation hereunder if that delay or default is due to any cause beyond the reasonable control and without fault or negligence of that party; provided that, in order to excuse its delay or default hereunder, a party shall notify the other of the occurrence or the cause, specifying the nature and particulars thereof and the expected duration thereof; and provided, further, that within fifteen (15) days after the termination of such occurrence or cause, such party shall give notice to the other party specifying the date of termination thereof. All obligations of both parties shall return to being in full force and effect upon the termination of such occurrence or cause (including without limitation any payments which became due and payable hereunder prior to the termination of such occurrence or cause). If a Force Majeure continues for more than 6 months either party may terminate this Agreement.

 

Page  29  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

18.2 For the purposes of this Section 18, "force majeure" or a "cause beyond the reasonable control" of a party shall include, without limiting the generality of the phrase, any act of God, act of any government or other authority or statutory undertaking, industrial dispute, fire, explosion, accident, power failure, flood, riot, act of terrorism, or war (declared or undeclared).

 

 

19. Confidentiality

 

19.1 The Party receiving Proprietary Information (as defined below) agrees and acknowledges that the disclosing Party has a proprietary interest in any information provided to the receiving Party, whether in connection with this Agreement or otherwise, whether in written, oral or visual form, which is (i) a trade secret, confidential or proprietary information, (ii) not publicly known, and (iii) annotated by a legend, stamp or other written identification as confidential or proprietary information, or if disclosed orally or visually, is followed by a written statement within thirty (30) days after its disclosure that it is confidential or proprietary (hereinafter referred to as "Proprietary Information"). The receiving Party shall disclose the Proprietary Information only to those of its agents and employees to whom it is necessary in order properly to carry out their duties as limited by the terms and conditions hereof. Both during and after the Term of this Agreement, all disclosures by the receiving Party to its agents and employees shall be held in strict confidence by such agents and employees. During the Term and for a period of ten (10) years after the expiration or termination of this Agreement, the receiving Party, its agents and employees shall not use the Proprietary Information for any purpose other than in connection with the sale and distribution of the Products in the Territory pursuant to this Agreement. The receiving Party shall, at its expense, return to the disclosing Party the Proprietary Information as soon as practicable after the termination or expiration of this Agreement. All such Proprietary Information shall remain the exclusive property of the disclosing Party during the Term of this Agreement and thereafter. This Section 19 shall also apply to any consultants or subcontractors that the receiving Party may engage in connection with its obligations under this Agreement. The terms of this Agreement shall be considered Proprietary Information.

 

Page  30  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

19.2 Notwithstanding anything contained in this Agreement to the contrary, the receiving Party shall not be liable for a disclosure of the Proprietary Information, if the information so disclosed: (i) was in the public domain at the time of disclosure without breach of this Agreement; or (ii) was known to or contained in the records of the receiving Party from a source other than the disclosing Party at the time of disclosure by the disclosing Party to the receiving Party and can be so demonstrated; or (iii) was independently developed and is so demonstrated promptly upon receipt of the documentation and technology by the receiving Party; or (iv) becomes known to the receiving Party from a source other than the disclosing Party without breach of this Agreement by the receiving Party and can be so demonstrated; or (v) must be disclosed pursuant to a contract or subcontract with a governmental agency in order to obtain/retain a procurement contract; or (vi) was disclosed pursuant to court order or as otherwise compelled by law.

 

19.3 The receiving party agrees that any threatened or actual breach of the terms of Section 19 of this Agreement by the receiving party may cause irreparable loss to the disclosing party and the said loss may not be compensated by monetary compensation and, in addition to all other rights and remedies that the disclosing party may have under law and equity, the disclosing party will have the right to seek appropriate injunctive relief and/or specific performance of the receiving party’s obligations from Courts of competent jurisdiction.

 

 

Page  31  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

20. Publicity

 

Biocon agrees that any publicity or advertising which shall be released by it in which CytoSorbents is identified in connection with the Products shall be in accordance with the terms of this Agreement and with any information or data which CytoSorbents has furnished in connection with this Agreement. Copies of all such publicity and advertising shall be forwarded promptly to CytoSorbents.

 

 

21. Term and Termination

 

21.1 The term of this Agreement shall begin on the Effective Date and shall continue until the date that is 36 months from the first day of the first Term Year ("Initial Term") or such longer period as may be mutually agreed in writing by both parties (the "Term"), unless terminated earlier by either Party pursuant to the terms of this Section.

 

21.2 Either Party may terminate this Agreement upon the occurrence of a material breach or default as to any obligation hereunder by the other party and the failure of the breaching party to (within thirty (30) days after receiving written notice thereof from the non-breaching party) cure such material breach or default, such termination being immediately effective upon the delivery of such notice of termination.

 

21.3 After the first twelve months of this Agreement, either Party may terminate this Agreement for convenience upon sixty (60) days’ written notice.

 

21.4 Upon the filing of a petition in bankruptcy, insolvency or reorganization against or by either party, or either party becoming subject to a composition for creditors, whether by law or agreement, or either party going into receivership or otherwise becoming insolvent (such party hereinafter referred to as the "insolvent party"), this Agreement may be terminated by the other party by giving written notice of termination to the insolvent party, such termination immediately effective upon the giving of such notice of termination.

 

Page  32  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

21.5 Upon the occurrence of a change in control or management or operating personnel of either party (the "changed party"), which has, or in the reasonable opinion of the other party could have, a material adverse effect on the business, prospects or operations, this Agreement may be terminated by the other party by giving written notice of termination to the changed party, such termination being immediately effective upon the giving of such notice of termination.

 

21.6 In the event that Either Party is suspected of violating any potentially applicable laws, including but not limited to the U.S. Foreign Corrupt Practices Act of 1977, the U.K.’s Bribery Act 2010, or any other potentially applicable anti-corruption/anti-bribery law, or otherwise fails to strictly comply with Section 15.3 and its subsections, the other party may terminate this Agreement immediately upon written notice and without any further obligations.

 

21.7 In the event of a termination pursuant to any of subsections 21.3 (if terminated by CytoSorbents) through 21.6 or upon expiration of this Agreement, CytoSorbents shall not have any obligation to Biocon, or to any employee of Biocon, for compensation or for damages of any kind, whether on account of the loss by Biocon or such employee of present or prospective sales, investments, compensation or goodwill. Termination of this Agreement shall not affect the obligation of Biocon to pay CytoSorbents all amounts owing or to become owing as a result of Products tendered or delivered to Biocon on or before the date of such termination, as well as interest thereon to the extent any such amounts are paid after the date they became or will become due pursuant to this Agreement.

 

 

Page  33  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

22. Selling Off of Inventory: Repurchase of Inventory

 

Upon termination or expiration of this Agreement(other than termination covered by section 21.6), Biocon shall have the right to market and sell off its remaining inventory of Products for a period of six (6) months after expiration or sooner termination of this Agreement ("Sell-Off-Period"); provided, however, that Biocon shall comply with all terms and conditions of this Agreement. Within thirty (30) days after the said period of 6 (six) months, CytoSorbents shall have the option, at its sole discretion, to either (a) repurchase the remaining stock of the Product from the Biocon at the applicable Repurchase Price (defined below), or b) extend the Sell Off Period by a period mutually agreed in writing by the parties but not to exceed three (3) additional months. Under no circumstances is CytoSorbents obligated to extend the Sell-Off Period to more than nine (9) months in total. Nothing in this Agreement shall obligate CytoSorbents to repurchase any inventory of Products in Biocon's possession or control at the end of the Sell-Off Period. CytoSorbents shall neither directly nor indirectly market or sell the Products in the Territory during the Sell-Off-Period without Biocon's consent. For purposes of repurchasing Product under this Section 22, the price shall be as follows (the "Repurchase Price"):

 

(a) the transfer price paid by Biocon to CytoSorbents including applicable taxes, duties, levies and shipping costs in case of (i) termination by CytoSorbents other than for breach of this Agreement by Biocon, or (ii) termination by Biocon for breach of this Agreement by CytoSorbents; or

 

(b) the transfer price paid by Biocon to CytoSorbents excluding applicable taxes, duties, levies and shipping costs in case of (i) expiration, (ii) termination by Biocon other than for breach of this Agreement by CytoSorbents, or (iii) termination by CytoSorbents for breach of this Agreement by Biocon.

 

 

Page  34  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

23. Notices

 

23.1 All notices given under this Agreement shall be in writing and shall be addressed to the parties at their respective addresses set forth below:

 

23.1.1 If to Biocon:

 

BIOCON

Contact person: Shukrit Chimote

Title: Vice President, Branded Formulations

Address: Biocon House, Semicon Park, Electronic City, Phase II, Bangalore-560100, India

 

Copy to : Head, Legal

Address:  20th KM, Hosur Road

                  Electronics City, Bangalore- 560 100, India

 

Phone: 91 80 6775 6775, extn: 1101

Fax: 91 80 6775 7028

URL: www.biocon.com

Email: shukrit.chimote@biocon.com

 

23.1.2 If to CytoSorbents:

 

Contact person: Chris Cramer

Title: Vice President, Business Development

 

Address: 7 Deer Park Drive, Suite K

                  Monmouth Junction, NJ 08852

 

Phone: 732-329-8885, ext: *835

Fax: 732-329-8650

URL: www.cytosorbents.com

Email: ccramer@cytosorbents.com

Skype: chris.m.cramer

 

Copy to : CEO CytoSorbents, Phil Chan

ext: *823

URL: www.cytosorbents.com

Email: pchan@cytosorbents.com

 

 

 

Page  35  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

23.2 Either party may change its address or its contact information for purposes of this Agreement by giving the other party written notice or by email its new address or contact information. Any such notice if given or made by registered or recorded delivery international air mail letter shall be deemed to have been received on the earlier of the date actually received and the date fifteen (15) days after the same was posted (and in proving such it shall be sufficient to prove that the envelope containing the same was properly addressed and posted as aforesaid) and if given or made by telecopy transmission shall be deemed to have been received at the time of dispatch, unless such date of deemed receipt is not a business day, in which case the date of deemed receipt shall be the next such succeeding business day.

 

 

24. Modification

 

No modification or change may be made in this Agreement, including any modification or change to this Section 4, except by written instrument duly signed by Biocon and by a duly authorized representative of CytoSorbents.

 

 

25. Assignment

 

This Agreement and the rights and obligations hereunder may not be assigned, delegated or transferred by either party without the prior written consent of the other party. This Agreement shall inure to the benefit of the permitted successors and assigns of CytoSorbents. The Biocon may assign a part of whole of its obligations under this Agreement to its affiliate on the prior written consent of CytoSorbents, which consent of which shall not be unreasonably withheld.

 

 

Page  36  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

26. Waiver

 

26.1 None of the conditions or provisions of this Agreement shall be held to have been waived by any act or knowledge on the part of either party, except by an instrument in writing signed by a duly authorized officer or representative of such party.

 

26.2 Further, the waiver by either party of any right hereunder or the failure to enforce at any time any of the provisions of this Agreement, or any rights with respect thereto, shall not be deemed to be a waiver of any other rights hereunder or any breach or failure of performance of the other party.

 

 

27. Validity

 

CytoSorbents and Biocon covenant and warrant that they will each advise the other of any changes in their respective laws of which they become aware if such changes might or will impair the validity of all or any part of this Agreement.

 

 

28. Governing Law

 

This Agreement and all rights and obligations there under shall be exclusively governed and exclusively construed in accordance with the laws of the United Kingdom, without regard to the choice of law under explicit exclusion of the United Nations Convention on Contracts for the International Sale of Goods (CISG).

 

 

Page  37  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

29. Dispute Resolution

 

The Parties agree that they shall in good faith work towards implementation of this Agreement and any dispute arising out of or in relation to this Agreement shall be first attempted to be resolved amicably by mutual negotiations. Failing which such dispute shall be finally settled exclusively under the Rules of Arbitration of the International Chamber of Commerce by one or more arbitrators appointed in accordance with said Rules. The place of arbitration shall be London. The language of arbitration shall be English. The arbitral award shall be final, conclusive and binding on the Parties and shall be enforceable in any court of competent jurisdiction.

 

 

30. Entire Agreement

 

This Agreement supersedes and cancels any previous agreements or understandings, whether oral, written or implied, heretofore in effect and sets forth the entire agreement between CytoSorbents and Biocon with respect to the subject matter hereof. All agreements related to confidentiality and or non-disclosure shall remain in force.

 

 

31. No Rights by Implication

 

No rights or licenses with respect to the Products or the Trademarks are granted or deemed granted hereunder or in connection herewith, other than those rights expressly granted in this Agreement.

 

 

Page  38  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

32. Compliance With Laws

 

Each of Biocon and CytoSorbents covenants that all of its activities under or pursuant to this Agreement shall comply with all applicable laws, rules and regulations.

 

33. Insurance

 

CytoSorbents will maintain, for the Term of this Agreement, insurance in an amount adequate to the Product liability, and upon written request of the Biocon will provide a memorandum of insurance showing that such insurance is in place.

 

 

34. Severability

 

If any provision of this Agreement is declared invalid or unenforceable by a court having competent jurisdiction, it is mutually agreed that this Agreement shall endure except for the part declared invalid or unenforceable by order of such court. The parties shall consult and use their best efforts to agree upon a valid and enforceable provision which shall be a reasonable substitute for such invalid or unenforceable provision in light of the intent of this Agreement.

 

 

35. Counterparts

 

This Agreement and any amendments or supplement hereto or thereto, may be executed in any number of counterparts and any party may execute any such counterpart, each of which when executed and delivered shall be deemed to be an original. The execution of any such amendment or supplement by any party will not become effective until counterparts have been executed by all the parties hereto or thereto.

 

(Signature Page to Follow)

 

 

Page  39  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

IN WITNESS WHEREOF , the parties hereto have signed this Agreement.

 

 

 

CytoSorbents, Inc.

 

By: /s/ Phillip Chan                 

 

 

 

Name: Phillip Chan, MD, PhD

 

Title: CEO

 

 

 

Biocon Limited

 

 

 

1) By: /s/ Rakesh Bamzai                     

 

Name: Rakesh Bamzai

 

Title: Authorized Signatory

  

 

 

2) By: /s/ Murali Krishnan K.N.                   

 

Name: Murali Krishnan K. N.

 

Title: Authorized Signatory

 

 

 

Page  40  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 1

 

Product

 

List of Products

 

1. CytoSorb 300 ml Device case of 12 – Part #30-011-03

 

2. Pole Clamp, each – Part #08-09-71

 

3. Female/Female Connector set, 6 pack – Part #30-0031-00

 

 

 

Storage Conditions

 

CytoSorb 300ml: 5˚C to 40˚C

 

 

 

Page  41  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

Annex 2

 

Territory and Applications

  

A. Territory

 

1. India (only as to the following cities):

 

o DELHI

 

o JAIPUR

 

o CHANDIGARH

 

o AMRITSAR

 

o ROHTAK

 

o KOLKOTTA

 

o PUNE

 

o MUMBAI

 

o INDORE

 

o NAGPUR

 

o CHENNAI

 

o BANGALORE

 

o HYDERABAD

 

2. Sri Lanka

 

 

 

B. Application

 

1. Applications Included :

 

o Critical Care including Sepsis

 

 

 

2. Applications Not Included:

 

o Cardiac Surgery, including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation (ECMO), Graft vs. Host Disease, Allogeneic Bone Marrow Transplant, Organ Transplant, and Hemorrhagic Fever.

 

Page  42  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 3

 

Product Prices

 

Product Price (in USD)

CytoSorb 300ml,

 

(12 units per case)

 

***

 

***

 

Pole Clamp ***
Female/Female Connector ***

 

 

 

 

 

 

 

 

(Reminder of the page intentionally left blank)

 

Page  43  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 4

 

CytoSorbents Warranties and Instructions for Use

 

 

 

1. Instructions For Use (Separately Attached)

 

 

 

2. Warranty (Separately Attached)

 

 

 

 

 

(Reminder of the page intentionally left blank)

 

Page  44  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 5

 

Products Complaints Reporting Form

 

(CytoSorbents SOP - 02-028-02)

 

 

 

(Separately Attached)

 

 

 

(Reminder of the page intentionally left blank)

 

Page  45  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 6

 

Marketing and Sales Data Reporting Form

 

 

 

(Separately Attached)

 

 

 

(Reminder of the page intentionally left blank)

 

Page  46  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 7

 

List of Trademarks

 

 

 

 

 

CytoSorb

 

HemoDefend

 

 

 

(Reminder of the page intentionally left blank)

 

 

 

 

 

 

 

 

 

 

Page  47  of 48
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

Annex 8

 

List of Documents

 

 

 

(Separately Attached)

 

 

 

(Reminder of the page intentionally left blank)

 

 

 

 

 

 

 

 

Page  48  of 48

 

Exhibit 10.9

 

CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT.  EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

 

THIS FIRST AMENDMENT EXECUTED ON THE 30TH DAY OF OCTOBER, 2014 (HEREINAFTER “AMENDMENT #1”) TO THE DISTRIBUTION AGREEMENT DATED SEPTEMBER 20TH, 2013 (HEREINAFTER “AGREEMENT”) BY AND BETWEEN:

 

 

CytoSorbents, Inc., a corporation having its offices at 7 Deer Park Drive, Suite K, Monmouth Junction, New Jersey, 08852, United States, existing under the laws of the United States (hereinafter referred to as CytoSorbents ”)

 

And

 

Biocon Limited, a company having its offices at 20th K M, Hosur Road, Electronics City, Bangalore, India, - 560 100, existing under the laws of India ( hereinafter referred to as “ Biocon ”)

 

CytoSorbents and Biocon hereinafter collectively referred to as the “ Parties ” and individually as a “ Party ”.

 

 

WHEREAS , the Parties wish to modify certain terms of the Agreement, as set forth in detail below;

 

NOW, THEREFORE, in consideration of the mutual covenants, premises and agreements set forth herein, the Parties hereby agree as follows:

 

1. This Amendment #1 shall be effective as on October 30, 2014.

 

2. Listing of Territory and Applications as listed in Annex 2, and referenced under Section 1.4 of the Agreement (“Territory”), is hereby deleted in its entirety and replaced with the Annex 2 here attached to this Amendment #1, which shall form an integral part of this Amendment #1.

 

3. A new Section 6.4 is hereby incorporated as below;

 

Subject to Biocon receiving necessary 3 rd party approvals, Biocon shall use commercially reasonable efforts to initiate, at Biocon’s cost, four (4) Investigator Initiated Trials (IIT), in the Territory across any of the IIT Focus Areas listed under Annex 9. At least one (1) such IIT shall be substantial in nature with participation of around 20 (twenty) subjects. The details of such IIT shall be jointly agreed in advance, through deliberation by the Clinical Trial Steering Committee. Without limiting Section 32 of this Agreement, Biocon shall support the investigators in activities to enable all activities related to IITs in accordance with good clinical practices and good laboratory practices and all other laws, rules and regulations applicable to human clinical trials. Biocon shall develop and publish at least two (2) patient case studies in each of four (4) Applications pursuant to the IIT or routine use of CytoSorb in the Territory. Prior to the publication of either an IIT or patient case study, CytoSorbents shall have the opportunity to review and comment on the publication. Biocon shall solely own all data, results, reports and publications with respect to such IIT; provided, that Biocon hereby grants CytoSorbents a perpetual, irrevocable, worldwide, royalty-free and fully paid-up, sublicenseable and transferable right and license to use any such data, results, reports and publications for any and all purposes.

 

1
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

4. A new Section 6.4.1 is hereby incorporated as below;

 

A Clinical Trial Steering Committee (“CSC”) consisting of an equal number of representatives from each Party shall be constituted within 90 (ninety) days of signing of this Amendment #1. CSC shall meet at least once in every calendar quarter to discuss, deliberate and mutually agree upon design and approval of the IIT. In addition, the CSC shall review the progress of and provide suggestions to the management of IITs. Such meetings may be conducted by telephone or video conference as may be agreed between the Parties. Parties agree that in the event of any differences or disputes with respect to designing, approval, publication or otherwise any matter relating to IIT, then Parties shall mutually agree to either proceed or to terminate any such IIT’s.

 

5. A new Section 6.4.2 is hereby incorporated as below;

 

Should Biocon require ‘CytoSorb Adsorbers’ (“CytoSorb 300 ml devices”) to conduct an IIT, Biocon shall purchase the CytoSorb Adsorbers at an all-inclusive price of U.S. Dollars 300 (three hundred) per CytoSorb Adsorber, FOB Monmouth Junction, New Jersey. Quantities shall be limited to the number of adsorbers required to meet the patient enrollment target defined by the mutually agreed-to IIT and shall not exceed one hundred (100) adsorbers in total across all studies. Notwithstanding anything mentioned above, in the event that additional quantities of CytoSorb Adsorbers are required for any larger study, both parties shall agree to discuss to increase the current quantities of the discounted CytoSorb Adsorber; provided that nothing herein shall obligate either party to purchase or supply such quantities.

 

6. Section 9.1 (Minimum Purchase Requirements) to the extent it is applicable to quantities mentioned for Term Year 2 and Term Year 3 of the Agreement is hereby amended as below;

 

Calendar Year Minimum Purchase Requirements
Term Year 2 ***
Term Year 3 ***
Term Year 4 ***
Term Year 5 ***

 

2
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

7. Section 21.1 (under Term and Termination) is hereby deleted in its entirety and replaced as below;

 

The term of this Agreement shall begin on the Effective Date and shall be valid for four (4) years from the Effective Date (“ Term ”) unless terminated by either Party pursuant to the terms of this Section.

 

Except as provided herein, all other terms and conditions of the Agreement shall remain in full force and effect, and capitalized terms used but not defined in this Amendment #1 shall continue to have the meaning set forth in the Agreement.

 

 

(Signature page follows)

3
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

IN WITNESS WHEREOF, the Parties hereto have executed this Amendment #1 as of the day and year first above written.

 

Biocon Limited

 

 

By: 1. /s/ Ravindra Kamalkas         

 

Name: Ravindra Kamalkas

 

Title: President, Marketing

 

CytoSorbents, Inc.,

 

 

By: /s/ Phillip Chan            

 

Name: Phillip Chan

Title: CEO

 

 

 

 

By: 2. /s/ Siddharth Mittal         

 

Name: Siddharth Mittal

 

Title: President, Finance

 

 

 

 

 

 

 

 

 

 

 

4
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

Annex 2

 

A. Territory

 

1. India
2. Sri Lanka

 

B. Applications

 

1. Applications included:

 

· Non-surgical, Critical Care Use

 

· Intra-operative Surgical Procedures

 

 

2. Applications not included:

Is deleted in its entirety

 

5
CONFIDENTIAL TREATMENT HAS BEEN REQUESTED AS TO CERTAIN PORTIONS OF THIS DOCUMENT. EACH SUCH PORTION, WHICH HAS BEEN OMITTED HEREIN AND REPLACED WITH AN ASTERISK ***, HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

Annex 9

 

 

IIT Focus Areas

 

(i) Sepsis.
(ii) Lung related diseases such as Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI).
(iii) Intra-abdominal indications such as complicated intra-abdominal infections, Abdominal Compartment Syndrome.
(iv) Severe Acute Pancreatitis.
(v) Liver Disease; infective or non-infective associated ALF.
(vi) Post- operative SIRS.
(vii) Tropical disease; Dengue and Malaria.
(viii) Intra-operative use in Cardiopulmonary Bypass surgery

 

 

 

 

 

6

Exhibit 21.1

 

 

CytoSorbents Corporation

 

List of Subsidiaries

 

Name Jurisdiction
CytoSorbents Medical, Inc.* Delaware
CytoSorbents Europe GmbH* Germany

 

 

* Wholly-owned subsidiary

 

 

 

 

 

 

 

Exhibit 23.1

 
CONSENT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

 

We consent to the incorporation by reference in the Registration Statement (Form S-8 No. 333-199852) of our report dated March 31, 2015 relating to the consolidated financial statements of CytoSorbents Corporation included in this Annual Report (Form 10-K) of CytoSorbents Corporation for the years ended December 31, 2014 and 2013.

 

 

 

WithumSmith+Brown, PC

New Brunswick, New Jersey

March 31, 2015

 

 

 

 

Exhibit 31.1

 

CERTIFICATION OF PRINCIPAL EXECUTIVE OFFICER

PURSUANT TO SECTION 302 OF THE

SARBANES-OXLEY ACT OF 2002

 

I, Phillip Chan, certify that:

 

1.    I have reviewed this annual report on Form 10-K of Cytosorbents Corporation;

 

2.    Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

 

3.    Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

 

4.    The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal controls over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

 

  a) designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

 

  b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

 

  c) evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation;

 

  d) disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting;

 

5.    The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the registrant’s board of directors (or persons performing the equivalent function):

 

  a) all significant deficiencies and material weaknesses in the design or operation of internal controls over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

 

  b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal controls over financial reporting.

 

Dated: March 31, 2015 By: /s/ Phillip Chan  
    Phillip Chan  
    Chief Executive Officer  
    (Principal Executive Officer)  

 

 

  

 

  Exhibit 31.2

CERTIFICATION OF PRINCIPAL FINANCIAL AND ACCOUNTING OFFICER

PURSUANT TO SECTION 302 OF THE

SARBANES-OXLEY ACT OF 2002

 

I, Kathleen P. Bloch, certify that:

 

1.    I have reviewed this annual report on Form 10-K of Cytosorbents Corporation;

 

2.    Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

 

3.    Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

 

4.    The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal controls over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

 

  a) designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

 

  b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

 

  c) evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation;

 

  d) disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting;

 

5.    The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the registrant’s board of directors (or persons performing the equivalent function):

 

  a) all significant deficiencies and material weaknesses in the design or operation of internal controls over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

 

  b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal controls over financial reporting.

 

Dated:  March 31, 2015 By: /s/ Kathleen P. Bloch  
    Kathleen P. Bloch  
    Chief Financial Officer  
    (Principal Financial and Accounting  
    Officer)  

 

 

  

 

Exhibit 32.1

 

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

 

In connection with the Annual Report of Cytosorbents Corporation (the “Company”) on Form 10-K for the year ended December 31, 2014 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), Phillip Chan, Chief Executive Officer of the Company, certifies, pursuant to 18 U.S.C. section 1350 of the Sarbanes-Oxley Act of 2002, that:

 

  (1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

 

  (2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

 

Date: March 31, 2015 By: /s/ Phillip Chan  
    Phillip Chan  
    Chief Executive Officer  
    (Principal Executive Officer)  

 

A signed original of this written statement required by Section 906, or other document authenticating, acknowledging, or otherwise adopting the signature that appears in typed form within the electronic version of this written statement has been provided to the Company and will be retained by the Company and furnished to the Securities and Exchange Commission or its staff upon request.

 

 

  

 

Exhibit 32.2

 

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

 

In connection with the Annual Report of Cytosorbents Corporation (the “Company”) on Form 10-K for the year ended December 31, 2014 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), Kathleen P. Bloch, Chief Financial Officer of the Company, certifies, pursuant to 18 U.S.C. section 1350 of the Sarbanes-Oxley Act of 2002, that:

 

  (1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

 

  (2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

 

Date: March 31, 2015 By: /s/ Kathleen P. Bloch  
    Kathleen P. Bloch  
    Chief Financial Officer  
    (Principal Financial and Accounting Officer)  

 

A signed original of this written statement required by Section 906, or other document authenticating, acknowledging, or otherwise adopting the signature that appears in typed form within the electronic version of this written statement has been provided to the Company and will be retained by the Company and furnished to the Securities and Exchange Commission or its staff upon request.