10-K
1
form10-k.htm
UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
FORM
10-K
(Mark
One)
[X]
ANNUAL
REPORT UNDER SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR
THE FISCAL YEAR ENDED DECEMBER 31, 2020
[ ]
TRANSITION
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR
THE TRANSITION PERIOD FROM TO
Commission
File Number 001-37603
BIORESTORATIVE
THERAPIES, INC.
(Exact
name of registrant as specified in its charter)
Delaware
91-1835664
(State
or other jurisdiction
of
incorporation or organization)
(I.R.S.
Employer
Identification
No.)
40
Marcus Drive, Melville, New York
11747
(Address
of principal executive offices)
(Zip
Code)
(631)
760-8100
(Registrant’s
telephone number, including area code)
Securities
registered pursuant to Section 12(b) of the Act:
Title
of each class
Trading
Symbol(s)
Name
of each exchange on which registered
None
Not
applicable
Not
applicable
Securities
registered pursuant to Section 12(g) of the Act:
Common
Stock, par value $0.0001 per share
(Title
of Class)
Indicate
by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes [ ] No
[X]
Indicate
by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Exchange Act. Yes [ ]
No [X]
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. Yes [X] No [ ]
Indicate
by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule
405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).
Yes [X] No [ ]
Indicate
by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting
company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,”
“smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large
accelerated filer [ ]
Accelerated
filer [ ]
Non-accelerated
filer [X]
Smaller
reporting company [X]
Emerging
growth company [ ]
If
an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying
with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. [ ]
Indicate
by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness
of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered
public accounting firm that prepared or issued its audit report. [ ]
Indicate
by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes [ ] No [X]
State
the aggregate market value of the voting and non-voting common equity held by non-affiliates computed by reference to the price at which
the common equity was last sold, or the average bid and asked price of such common equity, as of the last business day of the registrant’s
most recently completed second fiscal quarter.
As
of June 30, 2020, the aggregate market value of the registrant’s common stock held by non-affiliates of the registrant was $159,424
based on the closing sale price as reported on the OTC market.
APPLICABLE
ONLY TO REGISTRANTS INVOLVED IN BANKRUPTCY
PROCEEDINGS
DURING THE PRECEDING FIVE YEARS:
Indicate
by check mark whether the registrant has filed all documents and reports required to be filed by Section 12, 13 or 15(d) of the Securities
Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court. Yes [X] No [ ]
As
of April 27, 2021, there were 3,175,977,710 shares of common stock outstanding.
DOCUMENTS
INCORPORATED BY REFERENCE
None
INDEX
Page
No.
Forward-Looking
Statements
3
PART I
Item 1.
Business.
3
Item 1A.
Risk Factors.
27
Item 1B.
Unresolved Staff Comments.
27
Item 2.
Properties.
27
Item 3.
Legal Proceedings.
27
Item 4.
Mine Safety Disclosures.
27
PART II
Item 5.
Market for Registrant’s
Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities.
28
Item 6.
Selected Financial Data.
38
Item 7.
Management’s Discussion
and Analysis of Financial Condition and Results of Operations.
29
Item 7A.
Quantitative and Qualitative
Disclosures About Market Risk.
57
Item 8.
Financial Statements and Supplementary
Data.
57
Item 9.
Changes in and Disagreements
With Accountants on Accounting and Financial Disclosure.
57
Item 9A.
Controls and Procedures.
57
Item 9B.
Other Information.
58
PART III
Item 10.
Directors, Executive Officers
and Corporate Governance.
59
Item 11.
Executive Compensation.
62
Item 12.
Security Ownership of Certain
Beneficial Owners and Management and Related Stockholder Matters.
66
Item 13.
Certain Relationships and
Related Transactions, and Director Independence.
67
Item 14.
Principal Accountant Fees
and Services.
68
PART IV
Item 15.
Exhibits and Financial Statement
Schedules.
69
Item 16.
Form 10-K Summary.
71
Signatures
72
2
PART
I
Forward-Looking
Statements
This
Annual Report contains forward-looking statements as that term is defined in the federal securities laws. The events described in forward-looking
statements contained in this Annual Report may not occur. Generally these statements relate to business plans or strategies, projected
or anticipated benefits or other consequences of our plans or strategies, projected or anticipated benefits from acquisitions to be made
by us, or projections involving anticipated revenues, earnings or other aspects of our operating results. The words “may,”
“will,” “expect,” “believe,” “anticipate,” “project,” “plan,”
“intend,” “estimate,” and “continue,” and their opposites and similar expressions are intended to
identify forward-looking statements. We caution you that these statements are not guarantees of future performance or events and are
subject to a number of uncertainties, risks and other influences, many of which are beyond our control, that may influence the accuracy
of the statements and the projections upon which the statements are based. Factors which may affect our results include, but are not
limited to, the risks and uncertainties discussed in Item 7 of this Annual Report (“Management’s Discussion and Analysis
of Financial Condition and Results of Operations - “Factors That May Affect Future Results and Financial Condition”).
Any
one or more of these uncertainties, risks and other influences could materially affect our results of operations and whether forward-looking
statements made by us ultimately prove to be accurate. Our actual results, performance and achievements could differ materially from
those expressed or implied in these forward-looking statements. We undertake no obligation to publicly update or revise any forward-looking
statements, whether from new information, future events or otherwise.
Intellectual
Property
This
Annual Report includes references to our federally registered trademarks, BioRestorative Therapies and Dragonfly design , BRTX-100,
ThermoStem and Stem Pearls . We also own an allowed trademark application for BRTX . The Dragonfly Logo is also registered with
the U.S. Copyright Office. This Annual Report also includes references to trademarks, trade names and service marks that are the property
of other organizations. Solely for convenience, trademarks and trade names referred to in this Annual Report appear without the ®,
SM or ™ symbols, and copyrighted content appears without the use of the symbol ©, but the absence of use of these
symbols does not reflect upon the validity or enforceability of the intellectual property owned by us or third parties.
ITEM
1.
BUSINESS .
(a)
Business
Development
As
used in this Annual Report on Form 10-K (the “Annual Report”), references to the “Company”, “we”,
“us”, or “our” refer to BioRestorative Therapies, Inc. and its subsidiaries.
We
were incorporated in Nevada on June 13, 1997. On August 15, 2011, we changed our name from “Stem Cell Assurance, Inc.” to
“BioRestorative Therapies, Inc.” Effective January 1, 2015, we reincorporated in Delaware.
In
January 2017, we submitted an Investigational New Drug (“IND”) application to the U.S. Food and Drug Administration (the
“FDA”) to obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 , our lead cell
therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease. In February 2017, we received
such authorization from the FDA.
Material
Events During 2020
In
March 2020, our collaboration with the University of Pennsylvania resulted in a publication in Cell Reports , a respected peer
reviewed journal, with regard to our ThermoStem Program .
In
March 2020, a United States patent related to our ThermoStem Program was issued to us.
In
April 2020, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in Belgium,
France, Germany, Italy, Poland, Spain, Sweden, Switzerland, and the United Kingdom.
3
In
May 2020, an Israeli patent related to our ThermoStem Program was issued to us.
During
the period from January 1, 2020 through March 19, 2020 (prior to the commencement of the Chapter 11 reorganization discussed below),
we received aggregate equity and debt financing of $10,000 and $441,762, respectively.
During
the Chapter 11 reorganization proceeding, we received debtor-in-possession financing of $1,189,413 as well as debt financing in the aggregate
amount of $3,848,548 at the effective date of our plan of reorganization. We have not received any equity financing since the commencement
of our Chapter 11 reorganization proceeding and have not received any debt financing following the effective date of our plan of reorganization.
Material
Events During 2021
In
January 2021, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in France,
Germany, Italy, Spain, and the United Kingdom.
In
March 2021, a United States patent related to our ThermoStem Program was issued to us.
In
March 2021, a notice of allowance was issued for a separate United States patent application in the ThermoStem Program . This application
is expected to issue as a United States patent in the next few months.
On
March 18, 2021, Nickolay Kukekov, Ph.D. was elected as one of our directors.
Chapter
11 Reorganization
On
March 20, 2020 (the “Petition Date”), we filed a voluntary petition commencing a case under chapter 11 of title 11 of the
U.S. Code in the United States Bankruptcy Court for the Eastern District of New York (the “Bankruptcy Court”).
On
August 7, 2020 we and Auctus Fund, LLC (“Auctus”), our largest unsecured creditor and a stockholder as of the Petition Date,
filed an Amended Joint Plan of Reorganization (the “Plan”) and on October 30, 2020, the Bankruptcy Court entered an order
(the “Confirmation Order”) confirming the Plan, as amended. Amendments to the Plan are reflected in the Confirmation Order.
On November 16, 2020 (the “Effective Date”), the Plan became effective.
Reference
is made to Item 1.03 of our Current Report on Form 8-K, filed with the Securities and Exchange Commission on November 20, 2020 ( https://www.sec.gov/Archives/edgar/data/1505497/000102177120000081/0001021771-20-000081-index.htm )
for a description of the Plan, as amended and confirmed by the Confirmation Order, and the events that had occurred as of the filing
date, which Item 1.03 is incorporated herein by reference.
Effective
as of the Effective Date, as contemplated by the Plan, Mark Weinreb, A. Jeffrey Radov, Paul Jude Tonna and Robert B. Catell resigned
as directors of the Company and Mr. Weinreb resigned as our President, Chief Executive Officer and Chairman of the Board.
Effective
as of the Effective Date, as contemplated by the Plan, Lance Alstodt was elected President, Chief Executive Officer, Chairman of the
Board and a director of the Company and Francisco Silva, our Vice President, Research and Development, was elected a director of the
Company. See Item 10 of this Annual Report (“Directors, Executive Officers and Corporate Governance”).
4
(b)
Business
General
We
are a life sciences company focused on the development of regenerative medicine products and therapies using cell and tissue protocols,
primarily involving adult (non-embryonic) stem cells. Our two core developmental programs, as described below, relate to the treatment
of disc/spine disease and metabolic disorders:
●
Disc/Spine
Program (brtxDisc). Our lead cell therapy candidate, BRTX-100 , is a product formulated from autologous (or a person’s
own) cultured mesenchymal stem cells (“MSCs”) collected from the patient’s bone marrow. We intend that the product
will be used for the non-surgical treatment of painful lumbosacral disc disorders or as a complimentary therapeutic to a surgical
procedure. The BRTX-100 production process involves collecting bone marrow and whole blood from a patient, isolating and culturing
(in a proprietary method) stem cells from the bone marrow and cryopreserving the cells in an autologous carrier. In an outpatient
procedure, BRTX-100 is to be injected by a physician into the patient’s painful disc. The treatment is intended for
patients whose pain has not been alleviated by non-surgical procedures or conservative therapies and who potentially face the prospect
of highly invasive surgical procedures. We submitted an IND application to the FDA to obtain authorization to commence a Phase 2
clinical trial investigating the use of BRTX-100 in the treatment of chronic lower back pain arising from degenerative disc
disease. We have received such authorization from the FDA. We intend to commence such clinical trial during 2021 (assuming the receipt
of necessary funding). See “Disc/Spine Program” below.
●
Metabolic
Program (ThermoStem) . We are developing a cell-based therapy candidate to target obesity and metabolic disorders using brown
adipose (fat) derived stem cells (“BADSC”) to generate brown adipose tissue (“BAT”). We refer to this as
our ThermoStem Program . BAT is intended to mimic naturally occurring brown adipose depots that regulate metabolic homeostasis
in humans. Initial preclinical research indicates that increased amounts of brown fat in animals may be responsible for additional
caloric burning, as well as reduced glucose and lipid levels. Researchers have found that people with higher levels of brown fat
may have a reduced risk for obesity and diabetes. See “Metabolic Brown Adipose (Fat) Program” below.
We
have also licensed an investigational curved needle device designed to deliver cells and/or other therapeutic products or material to
the spine and discs (and other parts of the body). We anticipate that FDA approval or clearance will be necessary for this device prior
to commercialization. We do not intend to utilize this device in connection with our contemplated Phase 2 clinical trial with regard
to BRTX-100 . See “Curved Needle Device” below.
The
patents and patent applications for the Disc/Spine Program , the ThermoStem Program and the curved needle device are listed
below under “Technology; Research and Development.”
Overview
Every
human being has stem cells in his or her body. These cells exist from the early stages of human development until the end of a person’s
life. Throughout our lives, our body continues to produce stem cells that regenerate to produce differentiated cells that make up various
aspects of the body such as skin, blood, muscle and nerves. These are generally referred to as adult (non-embryonic) stem cells. These
cells are important for the purpose of medical therapies aiming to replace lost or damaged cells or tissues or to otherwise treat disorders.
Regenerative
cell therapy relies on replacing diseased, damaged or dysfunctional cells with healthy, functioning ones or repairing damaged or diseased
tissue. A great range of cells can serve in cell therapy, including cells found in peripheral and umbilical cord blood, bone marrow and
adipose (fat) tissue. Physicians have been using adult stem cells from bone marrow to treat various blood cancers for more than 60 years
(the first successful bone marrow transplant was performed in 1956). Recently, physicians have begun to use stem cells to treat various
other diseases. We intend to develop cell and tissue products and regenerative therapy protocols, primarily involving adult stem cells,
to allow patients to undergo cellular-based treatments.
We
intend to concentrate initially on therapeutic areas in which risk to the patient is low, recovery is relatively easy, results can be
demonstrated through sufficient clinical data, and patients and physicians will be comfortable with the procedure. We believe that there
will be readily identifiable groups of patients who will benefit from these procedures. We also believe that these procedures will be
significantly less expensive than the most common surgical procedure alternatives and will compare favorably, over the long-term, to
conservative treatment costs which may persist for years.
Accordingly,
we have focused our initial developmental efforts on cellular-based therapeutic products and clinical development programs in selective
areas of medicine for which the treatment protocol is minimally invasive. Such areas include the treatment of the disc and spine and
metabolic-related disorders. Upon regulatory approval, we will seek to obtain third party reimbursement for our products and procedures;
however; patients may be required to pay for our products and procedures out of pocket in full and without the ability to be reimbursed
by any governmental and other third party payers.
5
We
have undertaken research and development efforts in connection with the development of investigational therapeutic products and medical
therapies using cell and tissue protocols, primarily involving adult stem cells. See “Disc/Spine Program,” “Metabolic
Brown Adipose (Fat) Program” and “Curved Needle Device” below. As a result of these programs, we have obtained five
United States patents and seven foreign patents related to research regarding our ThermoStem Program , we have obtained licenses
for one patent application related to our Disc/Spine Program and we have obtained a license for one United States patent related
to a curved needle device.
We
have established a laboratory facility and will seek to further develop cellular-based treatments, products and protocols, stem cell-related
intellectual property (“IP”) and translational research applications. See “Laboratory” below.
We
have not generated any significant revenues from our operations. The implementation of our business plan, as discussed below, will require
the receipt of sufficient equity and/or debt financing to purchase necessary equipment, technology and materials, fund our research and
development efforts, including our contemplated clinical trials, retire our outstanding debt (if such debt is not converted into equity)
(see Item 7 of this Annual Report - “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Liquidity
and Capital Resources—Availability of Additional Funds”) and otherwise fund our operations. We intend to seek such financing
from current stockholders and debtholders as well as from other investors. We also intend to seek to raise capital through investment
bankers and from biotech funds, strategic partners and other financial institutions. We anticipate that we will require approximately
$12,000,000 in financing to complete a Phase 2 clinical trial investigating the use of BRTX-100 in the treatment of chronic lower
back pain arising from degenerative disc disease and that we will require approximately $45,000,000 in further additional funding to
complete such clinical trials, as further described in this section (assuming the receipt of no revenues from operations). We will also
require a substantial amount of additional funding to implement our other programs described in this section, repay our outstanding debt
(assuming such debt is not converted into equity) and fund general operations. No assurance can be given that the anticipated amounts
of required funding are correct or that we will be able to accomplish our goals within the timeframes projected. In addition, no assurance
can be given that we will be able to obtain any required financing on commercially reasonable terms or otherwise. We may also seek to
have our debtholders convert all or a portion of their debt into equity. No assurance can be given that debtholders will convert such
debt into equity. If we are unable to obtain adequate funding, we may be required to significantly curtail or discontinue our proposed
operations. See Item 7 of this Annual Report (“Management’s Discussion and Analysis of Financial Condition and Results of
Operations - Factors That May Affect Future Results and Financial Condition – We will need to obtain a significant amount of financing
to initiate and complete our clinical trials and implement our business plan. – We may need to obtain additional financing to satisfy
debt obligations. An event of default pursuant to our outstanding debt obligations could trigger an acceleration of the due date of such
obligations, including our secured debt . ”).
Disc/Spine
Program
General
Among
the initiatives that we are currently pursuing is our Disc/Spine Program , with our initial product candidate being called BRTX-100 .
We have obtained a license (see “License” below) that permits us to use technology for adult stem cell treatment of disc
and spine conditions. The technology is an advanced stem cell culture and injection procedure into the intervertebral disc (“IVD”)
that may offer relief from lower back pain, buttock and leg pain, and numbness and tingling in the leg and foot.
6
Lower
back pain is the most common, most disabling, and most costly musculoskeletal ailment faced worldwide. According to a recent market report,
of the 250 million American adults, nearly 25 million have chronic lower back pain of which approximately 12 million have been diagnosed
with and treated for disc degeneration and approximately 5.6 million have pain caused by a protruding or injured disc. We believe that
between 500,000 and 1 million invasive surgical procedures are performed each year to try to alleviate the pain associated with these
lower back conditions and that such procedures cost approximately $40 billion. Clinical studies have documented that the source of the
pain is most frequently damage to the IVD. This can occur when forces, whether a single load or repetitive microtrauma, exceed the IVD’s
inherent capacity to resist those loads. Aging, obesity, smoking, lifestyle, and certain genetic factors may predispose one to an IVD
injury. Current surgical approaches to back pain are extremely invasive (often altering the spine’s biomechanics unfavorably and
predisposing it to further disc degeneration) and are associated with unacceptably low success rates (with a second operation occurring
10% to 20% of the time). In addition, current surgical approaches are costly with spinal fusion surgery costing approximately $110,000,
discectomy costing approximately $20,000 to $50,000 and disc replacement surgery costing approximately $80,000 to $150,000. Even conservative
treatments can be costly, with oral medications costing between $1,000 and $2,000 per year, injection treatments costing approximately
$8,000 per year and physical therapy costing approximately $20,000 annually. We anticipate that the cost of a single treatment using
BRTX-100 will compare favorably to conservative treatments which may continue for years and will be less expensive than the most common
surgical procedures.
While
once thought to be benign, the natural history of lower back pain is often one of chronic recurrent episodes of pain leading to progressive
disability. This is believed to be a direct result of the IVD’s poor healing capacity after injury. The IVD is the largest avascular
(having few or no blood vessels) structure in the body and is low in cellularity. Therefore, its inherent capacity to heal after injury
is poor. The clinical rationale of BRTX-100 is to deliver a high concentration of the patient’s own cultured MSCs into the
site of pathology to promote healing and relieve pain.
We
have developed a mesenchymal stem cell product candidate, BRTX-100, derived from autologous (or a person’s own) human bone
marrow, cultured and formulated, in a proprietary method, specifically for introduction into a painful lumbar disc. As described below
under “ BRTX-100 ” and “ Production and Delivery ,” BRTX-100 is a hypoxic (low oxygen) stem
cell product. In order to enhance the survivability of our bone marrow-derived MSCs in the avascular environment of the damaged disc,
BRTX-100 is designed to expand under hypoxic conditions. This process is intended to result in a large cell count population with
enhanced viability and therapeutic potential following injection into the injured disc.
We
submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 ,
our lead cell therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease. We received such
authorization from the FDA in February 2017. We intend to commence such clinical trial during 2021 (assuming the receipt of necessary
funding).
In
addition to developing BRTX-100 , we may also seek to sublicense the technology to a strategic third party, who may assist in gaining
FDA approval for a lumbar disc indication, or third parties for use in connection with cellular-based developmental programs with regard
to disc and spine related conditions.
We
have established a laboratory, which includes a clean room facility, to perform the production of cell products (possibly including BRTX-100 )
for use in our clinical trials, for third party cell products or for general research purposes. We may also use this laboratory to develop
our pipeline of future products and expand our stem cell-related IP. See “Laboratory” and “Technology; Research and
Development” below.
BRTX-100
Our
lead product candidate , BRTX-100, is an autologous hypoxic (low oxygen) cultured mesenchymal stem cell product derived from a
patient’s own bone marrow and formulated with a proprietary biomaterial carrier (platelet lysate) to increase potency, viability
and survivability. We have designed the cryopreserved sterile cellular product candidate to be provided in vials for injection into painful
lumbar discs. We anticipate the product candidate will be delivered using a standard 20 gauge 3.5 inch introducer needle and a 25 gauge
6 inch needle that will extend into the disc center upon delivery. Upon regulatory approval, we plan to provide training to medical practitioners
with regard to the approved injection procedure. It is anticipated that the delivery of the product candidate will be a 30 minute procedure.
Mesenchymal
stem cells used in BRTX-100 are similar to other MSCs under development by others; however, in order to enhance the survivability
of our bone marrow-derived MSCs in the avascular environment of the damaged disc, BRTX-100 is designed to expand under hypoxic
conditions for a period of approximately three weeks. This process is intended to result in an approximate 40 million cell count population
with enhanced viability and therapeutic potential following injection locally into injured spinal discs. Publications and scientific
literature have indicated that MSCs preconditioned in hypoxic environment show enhanced skeletal muscle regeneration properties and improved
impacts upon circulation and vascular formation compared to MSCs cultured under normoxic (normal oxygen) conditions.
7
In
August 2018, the Journal of Translational Medicine published the results of our study evaluating the benefits of long-term hypoxic
culturing of human bone marrow-derived MSCs.
Production
and Delivery
The
production of our product candidate, BRTX-100, begins with the physician collecting bone marrow from the patient under local anesthesia.
Peripheral blood is also collected from the patient. The physician will then send the patient’s bone marrow and blood samples to
our laboratory (or a contract laboratory) for culturing and formulation. The hypoxic culturing process is intended to result in the selection
of a cell population that is suitable for an improved possibility of survival in the internal disc environment. We anticipate that the
cell culturing process and product formulation will take approximately three weeks, with an additional two weeks required for quality
control testing required to meet product release criteria. We will then send the therapeutic cryopreserved stem cells ( BRTX-100 )
in a sterile vial back to the physician’s offices where it will undergo a controlled thaw prior to the procedure. The price structure
for the procedure and our services has not been determined and no assurances can be given as to the effect that such price structure
will have on the marketability of such procedure and services. The following illustrates the process:
License
Pursuant
to our license agreement with Regenerative Sciences, LLC (“Regenerative”) that became effective in April 2012 (the “Regenerative
License Agreement”) we have obtained, among other things, a worldwide (excluding Asia and Argentina), exclusive, royalty-bearing
license from Regenerative to utilize or sublicense a certain method for culturing cells for use in our developmental program involving
disc and spine conditions, including protruding or painful discs and the treatment of avascular zones. The investigational technology
that has been licensed is an advanced stem cell culture and injection procedure that may offer relief from lower back pain, buttock and
leg pain, and numbness and tingling in the leg and foot. Pursuant to the Regenerative License Agreement, we have also obtained a worldwide,
exclusive, royalty-bearing license from Regenerative to utilize or sublicense a certain investigational curved needle device for the
administration of specific cells and/or cell products to the disc and/or spine (and other parts of the body). It will be necessary to
advance the design of this investigational device to facilitate the delivery of substances, including living cells, to specific locations
within the body and minimize the potential for damage to nearby structures.
The
Regenerative License Agreement currently provides for the requirement that we complete our Phase 2 clinical trial by a certain date (which
we believe to be February 2022) in order to maintain the exclusive nature of the licenses. The Regenerative License Agreement also provides
for a royalty-bearing sublicense of certain aspects of the technology to Regenerative for use for certain purposes, including in the
United States and the Cayman Islands. Further, the Regenerative License Agreement requires that Regenerative furnish certain training,
assistance and consultation services with regard to the licensed technology. The patents that are the subject of the Regenerative License
Agreement have been assigned to Regenexx, LLC which we have been advised is an affiliate of Regenerative.
8
Animal
Study
The
efficacy and safety of our product candidate, BRTX-100, has been tested in a degenerative intervertebral rabbit disc model. In
this study, 80 rabbits underwent surgery to create a puncture in the discs. Four weeks post surgery, each rabbit had either contrast,
a biomaterial carrier or BRTX-100 injected into the discs. In order to study the biodistribution and efficacy of BRTX-100 ,
the rabbits were evaluated at day 56 and day 120.
The
key safety findings of the animal study are as follows:
●
There
was no evidence or observation of gross toxicity related to the administration of BRTX-100 at either time point. The clinical
pathology across both groups and time points were within expected normal historical ranges and under the conditions of the test.
No abnormalities (including fractures or overt signs of lumbar disc disease) were identified after review of the radiographic images
taken at both endpoints for both groups. No toxicity or adverse finding was evident in the systemic tissues or the discs of animals
receiving BRTX-100 .
●
There
was no detectable presence of human cells ( BRTX-100 ) observed at the day 56 interim time point. This is consistent with the
proposed mechanism of action that BRTX-100 acts through a paracrine effect of secreted growth and immunomodulation factors.
The
key efficacy findings of the animal study are as follows:
●
BRTX-100
showed a statistically significant DHI (disc height increase) over the control group at day 120.
●
BRTX-100
showed a statistically significant improvement in disc histology over the control group at day 120 as graded by a validated histology
scale. BRTX-100 showed a significant improvement in the cellularity and matrix of the disc when compared to the control at
day 120.
Clinical
Trial
We
submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 ,
our lead cell therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease. We have received
such authorization from the FDA. We intend to commence such clinical trial during 2021 (assuming the receipt of necessary funding).
The
following describes the Phase 2 clinical trial authorized by the FDA:
A
Phase 2 Prospective, Double-Blinded, Placebo Controlled, Randomized Study
●
General
●
99
patients; randomized 2:1, BRTX-100 to control, 40 million cells/dose
●
10-20
clinical trial sites
●
Primary
efficacy endpoint at 12 months
●
Patient
safety and efficacy follow up at 24 months
●
Included
subjects must have only one symptomatic diseased disc
●
Included
subjects must have current diagnosis of chronic lumbar disc disease typical pain with degeneration of a single disc confirmed by
history, exam, radiography, or other acceptable means
●
Included
subjects must have exhausted previous conservative non-operative therapies
●
Primary
Efficacy Endpoint
●
Responder
endpoint - % of patients that meet the improvement in function and reduction in pain threshold
●
Improvement
in function defined as at least a 30% increase in function based on the Oswestry questionnaires (ODI)
9
●
Reduction
of pain defined as at least a 30% decrease in pain as measured using the Visual Analogue Scale (VAS)
●
Additional
or Secondary Endpoints
●
Clinical
response at 12 months
●
Changes
from baseline in pain as assessed with the VAS score and ODI at weeks 2, 12, 26, 52 and 104
●
Changes
from baseline in function as assessed with the ODI at weeks 2, 12, 26, 52 and 104
●
Changes
from baseline in function as assessed by Roland Morris Disability Questionnaire (RMDQ) at weeks 26, 52 and 104
●
Changes
from baseline function as assessed by Functional Rating Index (FRI) at weeks 12, 52 and 104
●
Changes
from baseline Quality of Life assessment (SF-12 questionnaire) scores at weeks 2, 12, 26, 52 and 104
The
FDA approval process can be lengthy, expensive and uncertain and there is no guarantee that the clinical trial(s) will be commenced or
completed or that the product will ultimately receive approval or clearance. See “Government Regulation” below and Item 7
of this Annual Report (“Management’s Discussion and Analysis of Financial Condition and Results of Operations - Factors That
May Affect Future Results and Financial Condition – Risks Related to Our Cell Therapy Product Development Efforts; and –
Risks Related to Government Regulation.”).
As
an alternative to undertaking the Phase 3 clinical trial ourselves, we may explore the licensing of our rights with respect to our product
candidate, BRTX-100, to a strategic partner. Such an arrangement could possibly eliminate or significantly reduce the need to
raise the substantial capital needed to commence and complete the clinical trials and undertake the commercialization of BRTX-100
and would provide licensing-related revenue to us. No assurance can be given that any licensing agreement will be entered into, whether
upon commercially reasonable terms or otherwise.
Defined
Health Report
In
March 2018, we engaged Defined Health, a business development and strategy consulting firm, to conduct an independent review of BRTX-100 .
Defined Health has worked with many of the leading companies in the pharmaceutical, biotech and healthcare industries for over 25 years.
The
review was intended to collect informed, independent opinions regarding BRTX-100 among key opinion leaders (“KOLs”)
(i.e., orthopedic surgeons specializing in back and spine surgery with experience in stem cell therapy), who, upon studying applicable
clinical material, could offer opinions regarding the future therapeutic potential of BRTX-100 .
As
noted in the Defined Health report, the KOLs indicated that stem cell therapies have great potential to treat chronic lumbar disc disease
and other therapeutic areas. The KOLs reacted positively to the value proposition of our product candidate, BRTX-100, and were
optimistic that the clinical data presented to date is likely to be mirrored in future clinical investigations. Given the opportunity,
the KOLs indicated that they would likely participate in a clinical trial should it be offered at their center and that they would recommend
the study to appropriately eligible patients. The report indicated that, if BRTX-100 were to be granted FDA approval, the KOLs
anticipate that it would be integrated into the standard of care for eligible chronic lumbar disc disease patients.
10
Similar
Therapies
Human
data from studies of therapies comparative to BRTX-100 have shown reduced pain, increased function, and an absence of significant
safety issues with a durable response, as shown below:
Impact
on Public Health
The
United States is the world’s leading consumer of hydrocodone (99%) and oxycodone (83%) and leads the world in per capital consumption
of such drugs (twice as much as second ranked Canada). Each year 42,000 Americans die from overdoses and in 2012 there were enough pain
prescriptions in the United States for every adult to obtain a bottle of pills.
Total
annual healthcare and lost productivity costs in the United States related to pain, including headache, back pain and neck pain, are
estimated to be $600 billion, which is twice the annual costs related to heart disease and greater than the combined annual costs related
to cancer and diabetes.
Metabolic
Brown Adipose (Fat) Program
Since
June 2011, we have been engaging in pre-clinical research efforts with respect to an investigational platform technology utilizing brown
adipose (fat) derived stem cells (“BADSCs”) for therapeutic purposes. We have labeled this initiative our ThermoStem Program .
11
Brown
fat is a specialized adipose (fat) tissue found in the human body that plays a key role in the evolutionarily conserved mechanisms underlying
thermogenesis (generation of non-shivering body heat) and energy homeostasis in mammals - long known to be present at high levels in
hibernating mammals and human newborns. Recent studies have demonstrated that brown fat is present in the adult human body and may be
correlated with the maintenance and regulation of healthy metabolism, thus potentially being involved in caloric regulation. The pre-clinical
ThermoStem Program involves the use of a cell-based (brown adipose tissue construct) treatment for metabolic disease, such as
type 2 diabetes, obesity, hypertension and other metabolic disorders, as well as cardiac deficiencies. The diseases, disorders and syndromes
that may be targeted by our ThermoStem Program are as follows:
We
have had initial success in transplanting the brown adipose tissue construct in animals, and we are currently exploring ways to deliver
into humans. Even though present, BAT mass is very low in healthy adults and even lower in obese populations. Therefore, it may not be
sufficient to either naturally impact whole body metabolism, or to be targeted by drugs intended to increase its activity in the majority
of the population. Increasing BAT mass is crucial in order to benefit from its metabolic activity and this is what our ThermoStem
Program seeks to accomplish. We may also identify other naturally occurring biologics and chemically engineered molecules that may
enhance brown adipose tissue performance and activity.
Obesity,
the abnormal accumulation of white fat tissue, leads to a number of metabolic disorders and is the driving force behind the rise of type
2 diabetes and cardiovascular diseases worldwide. Pharmacological efforts to alter metabolic homeostasis through modulating central control
of appetite and satiety have had limited market penetration due to significant psychological and physiological safety concerns directly
attributed to modulating these brain centers. Adipose tissue is one of the largest organs in the human body and plays a key role in central
energy balance and lipid homeostasis. White and brown adipose tissues are found in mammals. White adipose tissue’s function is
to store energy, whereas BAT specializes in energy expenditure. Recent advancements in unraveling the mechanisms that control the induction,
differentiation, proliferation, and thermogenic activity of BAT, along with the application of imaging technologies for human BAT visualization,
have generated optimism that these advances may provide novel strategies for targeting BAT activation/thermogenesis, leading to efficacious
and safe obesity targeted therapies.
We
are developing a cell-based product candidate to target obesity and metabolic disorders using BADSCs. Our goal is to develop a bioengineered
implantable brown adipose tissue construct intended to mimic ones naturally occurring in the human body. We have isolated and characterized
a human multipotent stem cell population that resides within BAT depots. We have expanded these stem cells to clinically relevant numbers
and successfully differentiated them into functional brown adipocytes. We intend to use adult stem cells that may be differentiated into
progenitor or fully differentiated brown adipocytes, or a related cell type, which can be used therapeutically in patients. We are focusing
on the development of treatment protocols that utilize allogeneic cells (i.e., stem cells from a genetically similar but not identical
donor).
12
In
order to deliver these differentiated cells into target locations in vivo , we seeded BADSCs onto 3-dimensional biological scaffolds.
Pre-clinical animal models of diet-induced obesity, that were transplanted with differentiated BADSCs supported by a biological scaffold,
presented significant reductions in weight and blood glucose levels compared to scaffold only controls. We are identifying technology
for in vivo delivery in small animal models. Having completed our proof of concept using our BAT in small animals, we are currently
developing our next generation BAT. It is anticipated that this next version will contain a higher purity of BADSC and a greater percent
of functional brown adipocytes, which is expected to increase the therapeutic effect compared to our first generation product. In addition,
we are exploring the delivery of the therapeutic using encapsulation technology, which will only allow for reciprocal exchange of small
molecules between the host circulation and the BAT implant. We expect that encapsulation may present several advantages over our current
biological scaffolds, including prevention of any immune response or implant rejection that might occur in an immunocompetent host and
an increase in safety by preventing the implanted cells from invading the host tissues. We have developed promising data on the loading
of human stem cell-derived tissue engineered brown fat into an encapsulation device to be used as a cell delivery system for our metabolic
platform program for the treatment of type 2 diabetes, obesity, hyperlipidemia and hypertension. This advancement may lead to successful
transplantation of brown fat in humans. We are evaluating the next generation of BAT constructs that will first be tested in small animal
models. No assurance can be given that this delivery system will be effective in vivo in animals or humans. Our allogeneic brown
adipose derived stem cell platform potentially provides a therapeutic and commercial model for the cell-based treatment of obesity and
related metabolic disorders.
In
June 2012, we entered into an Assignment Agreement with the University of Utah Research Foundation (the “Foundation”) and
a Research Agreement with the University of Utah (the “Utah Research Agreement”). Pursuant to the Assignment Agreement, which
provides for royalty payments, we acquired the rights to two provisional patent applications that relate to human brown fat cell lines.
No royalty amounts are payable to date. The applications have been converted to a utility application in the United States and several
foreign jurisdictions. Pursuant to the Utah Research Agreement, the University of Utah provided research services relating to the identification
of brown fat tissue and the development and characterization of brown fat cell lines. The Utah Research Agreement provides that all inventions,
discoveries, patent rights, information, data, methods and techniques, including all cell lines, cell culture media and derivatives thereof,
are owned by us. In February 2019, we entered into a Services Agreement with the University of Utah pursuant to which the university
has been retained to provide research services with regard to the ThermoStem Program . Pursuant to this agreement, we will initiate
preclinical models to study the efficacy of our generation 2 encapsulated brown adipose tissue construct.
In
February 2014, our research with regard to the identification of a population of brown adipose derived stem cells was published in Stem
Cells , a respected stem cell journal.
In
March 2014, we entered into a Research Agreement with Pfizer Inc., a global pharmaceutical company (“Pfizer”). Pursuant to
the Research Agreement with Pfizer, we were engaged to provide research and development services with regard to a joint study of the
development and validation of a human brown adipose cell model. The Research Agreement with Pfizer provided for an initial payment to
us of $250,000 and the payment of up to an additional $525,000 during the two-year term of the Agreement, all of which has been received.
In
August 2015, we entered into a one year research collaboration agreement with the University of Pennsylvania with regard to the understanding
of brown adipose biology and its role in metabolic disorders. In September 2018, we entered into a one year material transfer agreement
with the University of Pennsylvania pursuant to which the university was provided access to our proprietary brown adipose tissue cells
for research purposes. No amounts were payable by or to us pursuant to either agreement.
In
September 2015, a United States patent related to the ThermoStem Program was issued to us.
In
April 2017, an Australian patent related to the ThermoStem Program was issued to us.
In
December 2017, a Japanese patent related to the ThermoStem Program was issued to us.
In
January 2019, a United States patent related to the ThermoStem Program was issued to us.
In
October 2019, an Australian patent related to the ThermoStem Program was issued to us.
In
October 2019, an Israeli patent related to the ThermoStem Program was issued to us.
In
March 2020, a United States patent related to our ThermoStem Program was issued to us.
In
March 2020, our collaboration with the University of Pennsylvania resulted in a publication in Cell Reports , a respected peer
reviewed journal, with regard to our ThermoStem Program .
13
In
April 2020, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in Belgium,
France, Germany, Italy, Poland, Spain, Sweden, Switzerland, and the United Kingdom.
In
May 2020, an Israeli patent related to our ThermoStem Program was issued to us.
In
January 2021, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in France,
Germany, Italy, Spain, and the United Kingdom.
In
March 2021, a United States patent related to our ThermoStem Program was issued to us.
In
March 2021, a notice of allowance was issued for a separate United States patent application in the ThermoStem Program . This application
is expected to issue as a United States patent in the next few months.
We
have completed proof of concept preclinical animal studies using our first generation brown adipose derived stem cells. We intend to
undertake additional preclinical animal studies in order to optimize delivery and explore the feasibility of targeting additional indications.
Such studies are planned to begin by the third quarter of 2021 (assuming the receipt of necessary financing). Following the completion
of such studies, we intend to file an IND with the FDA and initiate a clinical trial. See “Government Regulation” below and
Item 7 of this Annual Report (“Management’s Discussion and Analysis of Financial Condition and Results of Operations - Factors
That May Affect Future Results and Financial Condition – Risks Related to Our Cell Therapy Product Development Efforts; and –
Risks Related to Government Regulation.”). The FDA approval process can be lengthy, expensive and uncertain and there is no guarantee
of ultimate approval or clearance.
We
anticipate that much of our development work in this area will take place at our laboratory facility, outside core facilities at academic,
research or medical institutions, or contractors. See “Laboratory” below.
Curved
Needle Device
Pursuant
to the Regenerative License Agreement discussed under “Disc/Spine Program-License” above, we have licensed and further developed
an investigational curved needle device (“CND”) that is a needle system with a curved inner cannula to allow access to difficult-to-locate
regions for the delivery or removal of fluids and other substances. The investigational CND is intended to deliver stem cells and/or
other therapeutic products or material to the interior of a human intervertebral disc, the spine region, or potentially other areas of
the body. The device is designed to rely on the use of pre-curved nested cannulae that allow the cells or material to be deposited in
the posterior and lateral aspects of the disc to which direct access is not possible due to outlying structures such as vertebra, spinal
cord and spinal nerves. We anticipate that the use of the investigational CND will facilitate the delivery of substances, including living
cells, to specific locations within the body and minimize the potential for damage to nearby structures. The investigational device may
also have more general use applications. In August 2015, a United States patent for the CND was issued to the licensor, Regenerative.
We anticipate that FDA approval or clearance will be necessary for the investigational CND prior to commercialization. We do not intend
to utilize the CND in connection with our contemplated Phase 2 clinical trial with regard to BRTX-100 . See “Government Regulation”
below and Item 7 of this Annual Report (“Management’s Discussion and Analysis of Financial Condition and Results of Operations
- Factors That May Affect Future Results and Financial Condition – Risks Related to Our Cell Therapy Product Development Efforts;
and – Risks Related to Government Regulation.”). The FDA review and approval process can be lengthy, expensive and uncertain
and there is no guarantee of ultimate approval or clearance.
Laboratory
We
have established a laboratory in Melville, New York for research purposes and have built a cleanroom within the laboratory for the possible
production of cell-based product candidates, such as BRTX-100 , for use in a clinical trial, for third party cell products or general
research purposes.
As
operations grow, our plans include the expansion of our laboratory to perform cellular characterization and culturing, protocol and stem
cell-related IP development, translational research and therapeutic outcome analysis. As we develop our business and our stem cell product
candidates and obtain regulatory approval, we will seek to establish ourselves as a key provider of adult stem cells for therapies and
expand to provide cells in other market areas for stem cell therapy. We may also use outside laboratories specializing in cell therapy
services and manufacturing of cell products.
14
Technology;
Research and Development
We
intend to utilize our laboratory or a third party laboratory in connection with cellular research activities. We also intend to obtain
cellular-based therapeutic technology licenses and increase our IP portfolio. We intend to seek to develop potential stem cell delivery
systems or devices. The goal of these specialized delivery systems or devices is to deliver cells into specific areas of the body, control
the rate, amount and types of cells used in a treatment, and populate these areas of the body with sufficient stem cells so that there
is a successful therapeutic result.
We
also intend to perform research to develop certain stem cell optimization compounds, media designed to enhance cellular growth and regeneration
for the purpose of improving pre-treatment and post-treatment outcomes.
In
our Disc/Spine Program , two patent applications have been filed with regard to technology that is the subject of the Regenerative
License Agreement (see “Disc/Spine Program-License” above). Regenerative has been issued a patent from one of these applications
with regard to its curved needle therapeutic delivery device. The other application remains pending. The patents that are the subject
of the Regenerative License Agreement have been assigned to Regenexx, LLC which we have been advised is an affiliate of Regenerative.
In
our ThermoStem Program , we have two pending United States patent applications and five United States patents within three patent
families. With regards to the first patent family in the ThermoStem Program, patent applications have been filed in five foreign
jurisdictions (of which four applications have been granted as foreign patents and one application, which is not listed in the table
below, has lapsed). With regards to the second patent family in the ThermoStem Program, patent applications have been filed in
four foreign jurisdictions (of which three applications have been granted as foreign patents). With regards to the third patent family
in the ThermoStem Program , a U.S. application and PCT application have been filed.
Our
patent applications and those of Regenexx, LLC are currently in prosecution (i.e., we and Regenexx, LLC are seeking issued patents).
A description of the active patent applications and issued patents is set forth in the table below:
Program
Patent
Family
I.D.
Jurisdiction
Title
Disc/Spine
(brtxDisc)
1
16/441,897*
US
Methods
and compositions to facilitate repair of avascular tissue
1
U.S.
Patent No. 9,113,950 B2**
US
Therapeutic
delivery device
Metabolic
2
U.S.
Patent No. 9,133,438
US
Brown
fat cell compositions and methods
(ThermoStem)
2
U.S.
Patent No. 10,597,638
US
2
15/910,625***
US
2
AU
Patent No. 2012275335
Australia
2
EP
Patent No. 2726603
Europe
(validated
in Belgium, France, Germany, Italy, Poland, Spain, Sweden, Switzerland, and the United Kingdom)
2
IL
Patent No. 230237
Israel
2
JP
Patent No. 6243839
Japan
3
U.S.
Patent No. 10,167,449
US
Human
brown adipose derived stem cells and uses
3
U.S.
Patent No. 10,941,383
US
3
17/165,074
US
3
AU
Patent No. 2014253920
Australia
3
2019240634
Australia
3
EP
Patent No. 2986714
(validated
in France, Germany, Italy, Spain, and the United Kingdom)
Europe
3
20204990.4
Europe
3
IL
Patent No. 242150
Israel
3
274995
Israel
3
2016-509105
Japan
3
2019-95972
Japan
4
16/862,226
US
Non-naturally
occurring three-dimensional (3D) brown adipose-derived stem cell aggregates, and methods of generating and using the same
4
PCT/US2020/030520
PCT
*Patent
application filed by licensor assignee, Regenexx, LLC
**Patent
issued to licensor assignee, Regenexx, LLC
***Application
has been allowed, but not yet issued as a US patent.
15
In
March 2014, we entered into a Research and Development Agreement with Rohto Pharmaceutical Co., Ltd., a Japanese pharmaceutical company
(“Rohto”). Pursuant to the Research and Development Agreement with Rohto, we were engaged to provide research and development
services with regard to stem cells.
In
March 2014, we entered into the Research Agreement with Pfizer, as discussed above under “Metabolic Brown Adipose (Fat) Program.”
We
have secured registrations in the U.S. Patent and Trademark Office for the following trademarks:
●
●
BRTX-100
●
THERMOSTEM
●
STEM
PEARLS
We
own an allowed application in the U.S. Patent and Trademark Office for the trademark BRTX . The Dragonfly Logo is also registered
with the U.S. Copyright Office.
We
also have federal common law rights in the trademark BioRestorative Therapies and other trademarks and trade names used in the
conduct of our business that are not registered.
Our
success will depend in large part on our ability to develop and protect our proprietary technology. We intend to rely on a combination
of patent, trade secret and know-how, copyright and trademark laws, as well as confidentiality agreements, licensing agreements, non-compete
agreements and other agreements, to establish and protect our proprietary rights. Our success will also depend upon our ability to avoid
infringing upon the proprietary rights of others, for if we are judicially determined to have infringed such rights, we may be required
to pay damages, alter our services, products or processes, obtain licenses or cease certain activities.
During
the years ended December 31, 2020 and 2019, we incurred $876,829 and $1,722,338, respectively, in research and development expenses.
Scientific
Advisors
We
have established a Scientific Advisory Board whose purpose is to provide advice and guidance in connection with scientific matters relating
to our business. The Scientific Advisory Board has established a Disc Advisory Committee which focuses on matters relating to our Disc/Spine
Program . Our Scientific Advisory Board members are Dr. Wayne Marasco (Chairman), Dr. Naiyer Imam, Dr. Wayne Olan, Dr. Joy Cavagnaro,
Dr. Jason Lipetz, Dr. Harvinder Sandhu, Dr. Christopher Plastaras and Dr. Gerard A. Malanga. The Disc Advisory Committee members are
Dr. Lipetz (Chairman), Dr. Olan, Dr. Sandhu, Dr. Plastaras and Dr. Malanga. See Item 10 of this Annual Report (“Directors, Executive
Officers and Corporate Governance–Scientific Advisors”) for a listing of the principal positions for Drs. Marasco, Imam,
Olan, Cavagnaro, Lipetz, Sandhu, Plastaras and Malanga.
16
Competition
We
will compete with many pharmaceutical, biotechnology and medical device companies, as well as other private and public stem cell companies
involved in the development and commercialization of cell-based medical technologies and therapies.
Regenerative
medicine is rapidly progressing, in large part through the development of cell-based therapies or devices designed to isolate cells from
human tissues. Most efforts involve cell sources, such as bone marrow, adipose tissue, embryonic and fetal tissue, umbilical cord and
peripheral blood and skeletal muscle.
Companies
working in the area of regenerative medicine with regard to the disc and spine include, among others, Mesoblast, SpinalCyte, DiscGenics
and Isto Biologics. Companies that are developing products and therapies to combat obesity and diabetes, including through the use of
brown fat, include, among others, Novo Nordisk, Sanofi, Merck, Eli Lilly, Roche, Pfizer and Regeneron.
Many
of our competitors and potential competitors have substantially greater financial, technological, research and development, marketing
and personnel resources than we do. We cannot, with any accuracy, forecast when or if these companies are likely to bring their products
and therapies to market in competition with those that we are pursuing.
With
the enactment of the Biologics Price Competition and Innovation Act of 2009 (the “BPCIA”), an abbreviated pathway for the
approval of biosimilar and interchangeable biological products was created. For the FDA to approve a biosimilar product, it must find
that there are no clinically meaningful differences between the reference product and the proposed biosimilar product. Interchangeability
requires that a product is biosimilar to the reference product, and the product must demonstrate that it can be expected to produce the
same clinical results as the reference product and, for products administered multiple times, the biologic and the reference biologic
may be switched after one has been previously administered without increasing safety risks or risks of diminished efficacy relative to
exclusive use of the reference biologic. Under the BPCIA, an application for a biosimilar product cannot be submitted to the FDA until
four years following approval of the reference product, and it may not be approved by the FDA until 12 years after the original branded
product is approved under a biologics license application (“BLA”).
We
believe that, if any of our product candidates are approved as a biological product under a BLA, it should qualify for the 12-year period
of exclusivity. However, there is a risk that the FDA could permit biosimilar applicants to reference approved biologics other than our
therapeutic candidates, thus circumventing our exclusivity and potentially creating the opportunity for competition sooner than anticipated.
Additionally, this period of regulatory exclusivity does not apply to companies pursuing regulatory approval via their own traditional
BLA, rather than via the abbreviated pathway. Moreover, the extent to which a biosimilar, once approved, will be substituted for any
one of our reference products in a way that is similar to traditional generic substitution for non-biological products is not yet clear,
and will depend on a number of marketplace and regulatory factors that are still developing.
17
Set
forth below is a comparison of BRTX-100 to Mesoblast’s adult stem cell biologic:
We
believe that BRTX-100 has competitive advantages to Mesoblast’s product for the following reasons:
●
The
use of autologous cells results in low to no risk of rejection, greater safety profile (introduction of viral/genetic) and streamlined
regulatory path
●
Hypoxic
culturing creates increased cell proliferation, greater plasticity, increased paracrine effect and increased cell survival after
application
●
Autologous
platelet lysate provides growth factors that interact with the cells, allowing for better cell survival
●
Low
to no risk of safety concerns related to immunological and zoonotic (animal to human) transmission
●
Strong
runway for value creation with successful clinical results
Customers
Upon
regulatory approval, our cell product candidates are intended to be marketed to physicians, other health care professionals, hospitals,
research institutions, pharmaceutical companies and the military. It is anticipated that physicians who are trained and skilled in performing
spinal injections will be the physicians most likely to treat discs with injections of BRTX-100 upon regulatory approval. These
physicians would include interventional physiatrists (physical medicine physicians), pain management anesthesiologists, interventional
radiologists and neurosurgeons.
Governmental
Regulation
U.S.
Government Regulation
The
health care industry is highly regulated in the United States. The federal government, through various departments and agencies, state
and local governments, and private third-party accreditation organizations, regulate and monitor the health care industry, associated
products, and operations. The FDA and comparable regulatory agencies in state and local jurisdictions and in foreign countries impose
substantial requirements upon the clinical development, approval, manufacture, distribution and marketing of medical products, including
drugs, biologics, and medical devices. These agencies and other federal, state and local entities regulate research and development activities
and the testing, manufacture, quality control, safety, effectiveness, labeling, packaging, storage, distribution, record keeping, approval,
post-approval monitoring, advertising, promotion, sampling and import and export of medical products. The following is a general overview
of the laws and regulations pertaining to our business.
18
FDA
Regulation of Stem Cell Treatment and Products
The
FDA regulates the manufacture of human stem cell treatments and associated products under the authority of the Public Health Service
Act (“PHSA”) and the Federal Food, Drug, and Cosmetic Act (“FDCA”). Stem cells can be regulated under the FDA’s
Human Cells, Tissues, and Cellular and Tissue-Based Products Regulations (“HCT/Ps”) or may also be subject to the FDA’s
drug, biologic, or medical device regulations, each as discussed below.
Human
Cells, Tissues, and Cellular and Tissue-Based Products Regulation
Under
Section 361 of the PHSA, the FDA issued specific regulations governing the use of HCT/Ps in humans. Pursuant to Part 1271 of Title 21
of the Code of Federal Regulations (“CFR”) (the “HCT/P Regulations”), the FDA established a unified registration
and listing system for establishments that manufacture and process HCT/Ps. The regulations also include provisions pertaining to donor
eligibility determinations; current good tissue practices covering all stages of production, including harvesting, processing, manufacture,
storage, labeling, packaging, and distribution; and other procedures to prevent the introduction, transmission, and spread of communicable
diseases.
The
HCT/P Regulations define HCT/Ps as articles “containing or consisting of human cells or tissues that are intended for implantation,
transplantation, infusion or transfer into a human recipient.” The HCT/P Regulations strictly constrain the types of products that
may be regulated solely as HCT/P. Factors considered include the degree of manipulation, whether the product is intended for a homologous
function, whether the product has been combined with noncellular or non-tissue components, and the product’s effect or dependence
on the body’s metabolic function. In those instances where cells, tissues, and cellular and tissue-based products have been only
minimally manipulated, are intended strictly for homologous use, have not been combined with noncellular or nontissue substances, and
do not depend on or have any effect on the body’s metabolism, the manufacturer is only required to register with the FDA, submit
a list of manufactured products, and adopt and implement procedures for the control of communicable diseases. If one or more of the above
factors has been exceeded, the product would be regulated as a drug, biological product, or medical device rather than an HCT/P.
Because
we are an enterprise in the early stages of operations and have not generated significant revenues from operations, it is difficult to
anticipate the likely regulatory status of the array of products and services that we may offer. We believe that some of the adult autologous
(self-derived) stem cells that will be used in our cellular therapy products and services, including the brown adipose (fat) tissue that
we intend to use in our ThermoStem Program , may be regulated by the FDA as HCT/Ps under the HCT/P Regulations. However, the FDA
may disagree with this position or conclude that some or all of our stem cell therapy products or services do not meet the applicable
definitions and exemptions to the regulation. In July 2020, the FDA issued an updated guidance document entitled “Regulatory Considerations
for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use” that provides additional
guidance on how FDA interprets the HCT/P Regulations, particularly the definition of the terms “minimally manipulated” and
“homologous use.” In the guidance, FDA stated it will exercise enforcement discretion until May 31, 2021 for products that
do not comply with the HCT/P Regulations. After that date, manufacturers of products marketed as HCT/Ps that do not comply with the HCT/P
Regulations will be subject to immediate FDA enforcement action. If we are not regulated solely under the HCT/P Regulations, we would
need to expend significant resources to comply with the FDA’s broad regulatory authority under the FDCA. Third party litigation
concerning the autologous use of a stem cell mixture to treat musculoskeletal and spinal injuries has increased the likelihood that some
of our products and services are likely to be regulated as a drug or biological product and require FDA approval. In past litigation,
the FDA asserted that the defendants’ use of cultured stem cells without FDA approval is in violation of the FDCA, claiming that
the defendants’ product is a drug. The defendants asserted that their procedure is part of the practice of medicine and therefore
beyond the FDA’s regulatory authority. The District Court ruled in favor of the FDA, and in February 2014 the Circuit Court affirmed
the District Court’s holding.
If
regulated solely under the FDA’s HCT/P statutory and regulatory provisions, once our laboratory in the United States becomes operational,
it will need to satisfy the following requirements, among others, to process and store stem cells:
●
registration
and listing of HCT/Ps with the FDA;
●
donor
eligibility determinations, including donor screening and donor testing requirements;
●
current
good tissue practices, specifically including requirements for the facilities, environmental controls, equipment, supplies and reagents,
recovery of HCT/Ps from the patient, processing, storage, labeling and document controls, and distribution and shipment of the HCT/Ps
to the laboratory, storage, or other facility;
19
●
tracking
and traceability of HCT/Ps and equipment, supplies, and reagents used in the manufacture of HCT/Ps;
●
adverse
event reporting;
●
FDA
inspection; and
●
abiding
by any FDA order of retention, recall, destruction, and cessation of manufacturing of HCT/Ps.
Non-reproductive
HCT/Ps and non-peripheral blood stem/progenitor cells that are offered for import into the United States and regulated solely under Section
361 of the PHSA must also satisfy the requirements under 21 C.F.R. § 1271.420. Section 1271.420 requires that the importer of record
of HCT/Ps notify the FDA prior to, or at the time of, importation and provide sufficient information for the FDA to make an admissibility
decision. In addition, the importer must hold the HCT/P intact and under conditions necessary to prevent transmission of communicable
disease until an admissibility decision is made by the FDA.
If
the FDA determines that we have failed to comply with applicable regulatory requirements, it can impose a variety of enforcement actions
including public warning letters, fines, consent decrees, orders of retention, recall or destruction of product, orders to cease manufacturing,
and criminal prosecution. If any of these events were to occur, it could materially adversely affect us.
To
the extent that our cellular therapy activities are limited to developing products and services outside the United States, as described
in detail below, the products and services would not be subject to FDA regulation, but will be subject to the applicable requirements
of the foreign jurisdiction. We intend to comply with all applicable foreign governmental requirements.
Drug
and Biological Product Regulation
An
HCT/P product that does not meet the criteria for being solely regulated under Section 361 of the PHSA will be regulated as a drug, device
or biological product under the FDCA and/or Section 351 of the PHSA, and applicable FDA regulations. The FDA has broad regulatory authority
over drugs and biologics marketed for sale in the United States. The FDA regulates the research, clinical testing, manufacturing, safety,
effectiveness, labeling, storage, recordkeeping, promotion, distribution, and production of drugs and biological products. The FDA also
regulates the export of drugs and biological products manufactured in the United States to international markets in certain situations.
The
process required by the FDA before a drug or biologic may be marketed in the United States generally involves the following:
●
completion of non-clinical laboratory tests, animal studies and formulation studies conducted according to Good Laboratory Practice (“GLP”)
or other applicable regulations;
●
submission of an IND, which allows clinical trials to begin unless the FDA objects within 30 days;
●
performance of adequate and well-controlled human clinical trials to establish the safety and efficacy of the proposed drug or biologic
for its intended use or uses conducted in accordance with FDA regulations and Good Clinical Practices (“GCP”), which are
international ethical and scientific quality standards meant to ensure that the rights, safety and well-being of trial participants are
protected and that the integrity of the data is maintained;
●
registration of clinical trials of FDA-regulated products and certain clinical trial information;
●
preparation and submission to the FDA of a new drug application (“NDA”), in the case of a drug or BLA in the case of a biologic;
20
●
review of the product by an FDA advisory committee, where appropriate or if applicable;
●
satisfactory completion of pre-approval inspection of manufacturing facilities and clinical trial sites at which the product, or components
thereof, are produced to assess compliance with Good Manufacturing Practice, or cGMP, requirements and of selected clinical trial sites
to assess compliance with GCP requirements; and
●
FDA approval of an NDA or BLA which must occur before a drug or biologic can be marketed or sold.
Approval
of an NDA requires a showing that the drug is safe and effective for its intended use and that the methods, facilities, and controls
used for the manufacturing, processing, and packaging of the drug are adequate to preserve its identity, strength, quality, and purity.
To obtain a BLA, a manufacturer must show that the proposed product is safe, pure, and potent and that the facility in which the product
is manufactured, processed, packed, or held meets established quality control standards.
For
purposes of an NDA or BLA approval by the FDA, human clinical trials are typically conducted in the following phases (which may overlap):
●
Phase 1: The investigational product is initially given to healthy human subjects or patients and tested for safety, dosage tolerance,
absorption, metabolism, distribution and excretion. These trials may also provide early evidence on effectiveness. During Phase 1 clinical
trials, sufficient information about the investigational product’s pharmacokinetics and pharmacologic effects may be obtained to
permit the design of well-controlled and scientifically valid Phase 2 clinical trials.
●
Phase 2: These clinical trials are conducted in a limited number of human subjects in the target population to identify possible adverse
effects and safety risks, to determine the efficacy of the investigational product for specific targeted diseases and to determine dosage
tolerance and dosage levels. Multiple Phase 2 clinical trials may be conducted by the sponsor to obtain information prior to beginning
larger and more costly Phase 3 clinical trials.
●
Phase 3: Phase 3 clinical trials are undertaken after Phase 2 clinical trials demonstrate that a dosage range of the investigational
product appears effective and has a tolerable safety profile. The Phase 2 clinical trials must also provide sufficient information for
the design of Phase 3 clinical trials. Phase 3 clinical trials are conducted to provide statistically significant evidence of clinical
efficacy and to further test for safety risks in an expanded human subject population at multiple clinical trial sites. These clinical
trials are intended to further evaluate dosage, effectiveness and safety, to establish the overall benefit-risk profile of the investigational
product and to provide an adequate basis for product labeling and approval by the FDA. In most cases, the FDA requires two adequate and
well-controlled Phase 3 clinical trials to demonstrate the efficacy of an investigational drug or biologic.
All
clinical trials must be conducted in accordance with FDA regulations, GCP requirements and their protocols in order for the data to be
considered reliable for regulatory purposes. Progress reports detailing the results of the clinical trials must be submitted at least
annually to the FDA and more frequently if serious adverse events occur. Phase 1, Phase 2 and Phase 3 clinical trials may not be completed
successfully within any specified period, or at all. These government regulations may delay or prevent approval of product candidates
for a considerable period of time and impose costly procedures upon our business operations.
The
FDA may require, or companies may pursue, additional clinical trials, referred to as Phase 4 clinical trials, after a product is approved.
Such trials may be made a condition to be satisfied for continuing drug approval. The results of Phase 4 clinical trials can confirm
the effectiveness of a product candidate and can provide important safety information. In addition, the FDA has authority to require
sponsors to conduct post-marketing trials to specifically address safety issues identified by the agency.
21
Under
the Pediatric Research Equity Act (“PREA”), certain NDAs and BLAs and certain supplements to an NDA or BLA must contain data
to assess the safety and efficacy of the drug for the claimed indications in all relevant pediatric subpopulations and to support dosing
and administration for each pediatric subpopulation for which the product is safe and effective. The FDA may grant deferrals for submission
of pediatric data or full or partial waivers. The Food and Drug Administration Safety and Innovation Act (“FDASIA”) amended
the FDCA to require that a sponsor who is planning to submit a marketing application for a drug that includes a new active ingredient,
new indication, new dosage form, new dosing regimen, or new route of administration submit an initial Pediatric Study Plan (“PSP”)
within 60 days of an end-of-Phase 2 meeting or, if there is no such meeting, as early as practicable before the initiation of the Phase
3 or Phase 2/3 study. The initial PSP must include an outline of the pediatric study or studies that the sponsor plans to conduct, including
study objectives and design, age groups, relevant endpoints and statistical approach, or a justification for not including such detailed
information, and any request for a deferral of pediatric assessments or a full or partial waiver of the requirement to provide data from
pediatric studies along with supporting information. The FDA and the sponsor must reach an agreement on the PSP. A sponsor can submit
amendments to an agreed-upon initial PSP at any time if changes to the pediatric plan need to be considered based on data collected from
preclinical studies, early phase clinical trials, and/or other clinical development programs.
Changes
to some of the conditions established in an approved application, including changes in indications, labeling, manufacturing processes
or facilities, require submission and FDA approval of a new NDA or BLA, or an NDA or BLA supplement, before the change can be implemented.
An NDA or BLA supplement for a new indication typically requires clinical data similar to that in the original application, and the FDA
uses the same procedures and actions in reviewing NDA and BLA supplements as it does in reviewing NDAs and BLAs.
Drug
and biological products must also comply with applicable requirements, including monitoring and recordkeeping activities, manufacturing
requirements, reporting to the applicable regulatory authorities of adverse experiences with the product, providing the regulatory authorities
with updated safety and efficacy information, product sampling and distribution requirements, and complying with promotion and advertising
requirements, which include, among others, standards for direct-to-consumer advertising, restrictions on promoting drugs for uses or
in patient populations that are not described in the drug’s approved labeling, or off-label use, limitations on industry-sponsored
scientific and educational activities and requirements for promotional activities involving the internet. Although physicians may, in
their independent professional medical judgment, prescribe legally available drugs for off-label uses, manufacturers typically may not
market or promote such off-label uses. Modifications or enhancements to the product or its labeling, or changes of the site of manufacture,
are often subject to the approval of the FDA and other regulators, who may or may not grant approval or may include a lengthy review
process.
In
the event that the FDA does not regulate our product candidates in the United States solely under the HCT/P regulation, our products
and activities could be regulated as drug or biological products under the FDCA. If regulated as drug or biological products, we will
need to expend significant resources to ensure regulatory compliance. If an IND and NDA or BLA are required for any of our product candidates,
there is no assurance as to whether or when we will receive FDA approval of the product candidate. The process of designing, conducting,
compiling and submitting the non-clinical and clinical studies required for NDA or BLA approval is time-consuming, expensive and unpredictable.
The process can take many years, depending on the product and the FDA’s requirements.
In
addition, even if a product candidate receives regulatory approval, the approval may be limited to specific disease states, patient populations
and dosages, or might contain significant limitations on use in the form of warnings, precautions or contraindications, or in the form
of onerous risk management plans, restrictions on distribution or use, or post-marketing trial requirements. Further, even after regulatory
approval is obtained, later discovery of previously unknown problems with a product may result in restrictions on the product, including
safety labeling or imposition of a Risk Evaluation and Mitigation Strategy (“REMS”), the requirement to conduct post-market
studies or clinical trials or even complete withdrawal of the product from the market. Delay in obtaining, or failure to obtain, regulatory
approval for our products, or obtaining approval but for significantly limited use, would harm our business. Further, we cannot predict
what adverse governmental regulations may arise from future United States or foreign governmental action.
If
the FDA determines that we have failed to comply with applicable regulatory requirements, it can impose a variety of enforcement actions
from public warning letters, fines, injunctions, consent decrees and civil penalties to suspension or delayed issuance of approvals,
seizure of our products, total or partial shutdown of our production, withdrawal of approvals, and criminal prosecutions. If any of these
events were to occur, it could materially adversely affect us.
22
FDA
Expedited Review Programs
The
FDA is authorized to expedite the review of NDAs and BLAs in several ways. Under the Fast Track program, the sponsor of a drug or biologic
product candidate may request the FDA to designate the product for a specific indication as a Fast Track product concurrent with or after
the filing of the IND. Drug and biologic products are eligible for Fast Track designation if they are intended to treat a serious or
life-threatening condition and demonstrate the potential to address unmet medical needs for the condition. Fast Track designation applies
to the combination of the product candidate and the specific indication for which it is being studied.
In
addition to other benefits, such as the ability to have greater interactions with the FDA, the FDA may initiate review of sections of
a Fast Track NDA or BLA before the application is complete, a process known as rolling review.
Any
product submitted to the FDA for marketing, including under a Fast Track program, may also be eligible for the following other types
of FDA programs intended to expedite development and review:
●
Breakthrough therapy designation. To qualify for the breakthrough therapy program, product candidates must be intended to treat a serious
or life-threatening disease or condition, and preliminary clinical evidence must indicate that such product candidates may demonstrate
substantial improvement on one or more clinically significant endpoints over existing therapies. The FDA will seek to ensure the sponsor
of a breakthrough therapy product candidate receives intensive guidance on an efficient drug development program, intensive involvement
of senior managers and experienced staff on a proactive, collaborative and cross-disciplinary review, and rolling review.
●
Priority review. A product candidate is eligible for priority review if it treats a serious condition and, if approved, it would be a
significant improvement in the safety or effectiveness of the treatment, diagnosis or prevention of a serious condition compared to marketed
products. The FDA aims to complete its review of priority review applications within six months as opposed to ten months for standard
review.
●
Accelerated approval. Drug or biologic products studied for their safety and effectiveness in treating serious or life-threatening illnesses
and that provide meaningful therapeutic benefit over existing treatments may receive accelerated approval. Accelerated approval means
that a product candidate may be approved on the basis of adequate and well-controlled clinical trials establishing that the product candidate
has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit, or on the basis of an effect on a clinical
endpoint other than survival or irreversible morbidity or mortality or other clinical benefit, taking into account the severity, rarity
and prevalence of the condition and the availability or lack of alternative treatments. As a condition of approval, the FDA may require
that a sponsor of a drug or biologic product candidate receiving accelerated approval perform adequate and well-controlled post-marketing
clinical trials. In addition, the FDA currently requires as a condition for accelerated approval pre-approval of promotional materials.
Fast
Track designation, breakthrough therapy designation, priority review and accelerated approval do not change the standards for approval
but may expedite the development or approval process.
Further,
with the passage of the 21st Century Cures Act (the “Cures Act”) in December 2016, Congress authorized the FDA to accelerate
review and approval of products designated as regenerative advanced therapies. A product is eligible for this designation if it is a
regenerative medicine advanced therapy (“RMAT”) (which may include a cell therapy) that is intended to treat, modify, reverse
or cure a serious or life-threatening disease or condition, and preliminary clinical evidence indicates that the drug has the potential
to address unmet medical needs for such disease or condition. The benefits of a RMAT designation include early interactions with the
FDA to expedite development and review, benefits available to breakthrough therapies, potential eligibility for priority review and accelerated
approval based on surrogate or intermediate endpoints.
Medical
Device Regulation
The
FDA also has broad authority over the regulation of medical devices marketed for sale in the United States. The FDA regulates the research,
clinical testing, manufacturing, safety, labeling, storage, recordkeeping, premarket clearance or approval, promotion, distribution,
and production of medical devices. The FDA also regulates the export of medical devices manufactured in the United States to international
markets.
Under
the FDCA, medical devices are classified into one of three classes, Class I, Class II, or Class III, depending upon the degree of risk
associated with the medical device and the extent of control needed to ensure safety and effectiveness. Class I devices are subject to
the lowest degree of regulatory scrutiny because they are considered low risk devices and need only comply with the FDA’s General
Controls. The General Controls include compliance with the registration, listing, adverse event reporting requirements, and applicable
portions of the Quality System Regulation as well as the general misbranding and adulteration prohibitions.
23
Class
II devices are subject to the General Controls as well as certain Special Controls such as 510(k) premarket notification. Class III devices
are subject to the highest degree of regulatory scrutiny and typically include life supporting and life sustaining devices and implants.
They are subject to the General Controls and Special Controls that include a premarket approval application (“PMA”). “New”
devices are automatically regulated as Class III devices unless they are shown to be low risk, in which case they may be subject to de
novo review to be moved to Class I or Class II. Clinical research of an investigational device is subject to the FDA’s Investigational
Device Exemption (“IDE”) regulations. Nonsignificant risk devices are subject to abbreviated requirements that do not require
a submission to the FDA but must have Institutional Review Board (IRB) approval and comply with other requirements pertaining to informed
consent, labeling, recordkeeping, reporting, and monitoring. Significant risk devices require the submission of an IDE application to
the FDA and the FDA’s approval of the IDE application.
The
FDA premarket clearance and approval process can be lengthy, expensive and uncertain. It generally takes three to twelve months from
submission to obtain 510(k) premarket clearance, although it may take longer. Approval of a PMA could take one to four years, or more,
from the time the application is submitted and there is no guarantee of ultimate clearance or approval. Securing FDA clearances and approvals
may require the submission of extensive clinical data and supporting information to the FDA. Additionally, the FDA actively enforces
regulations prohibiting marketing and promotion of devices for indications or uses that have not been cleared or approved by the FDA.
In addition, modifications or enhancements of products that could affect the safety or effectiveness or effect a major change in the
intended use of a device that was either cleared through the 510(k) process or approved through the PMA process may require further FDA
review through new 510(k) or PMA submissions.
In
the event we develop processes, products or services which qualify as medical devices subject to FDA regulation, we intend to comply
with such regulations. If the FDA determines that our products are regulated as medical devices and we have failed to comply with applicable
regulatory requirements, it can impose a variety of enforcement actions from public warning letters, application integrity proceedings,
fines, injunctions, consent decrees and civil penalties to suspension or delayed issuance of approvals, seizure of our products, total
or partial shutdown of our production, withdrawal of approvals, and criminal prosecutions. If any of these events were to occur, it could
materially adversely affect us.
Current
Good Manufacturing Practices and other FDA Regulations of Cellular Therapy Products
Products
that fall outside of the HCT/P regulations and are regulated as drugs, biological products, or devices must comply with applicable cGMP
regulations. These cGMPs and related quality standards are designed to ensure the products that are processed at a facility meet the
FDA’s applicable requirements for identity, strength, quality, sterility, purity, and safety. In the event that our domestic United
States operations are subject to the FDA’s drug, biological product, or device regulations, we intend to comply with the applicable
cGMPs and quality regulations.
If
the FDA determines that we have failed to comply with applicable regulatory requirements, it can impose a variety of enforcement actions
from public warning letters, fines, injunctions, consent decrees and civil penalties to suspension or delayed issuance of approvals,
seizure of our products, total or partial shutdown of our production, withdrawal of approvals, and criminal prosecutions. If any of these
events were to occur, it could materially adversely affect us.
Promotion
of Foreign-Based Cellular Therapy Treatment— “Medical Tourism”
We
may establish, or license technology to third parties in connection with their establishment of, adult stem cell therapy facilities outside
the United States. We also intend to work with hospitals and physicians to make the stem cell-based therapies available for patients
who travel outside the United States for treatment. “Medical tourism” is defined as the practice of traveling across international
borders to obtain health care.
24
The
Federal Trade Commission (the “FTC”) has the authority to regulate and police advertising of medical treatments, procedures,
and regimens in the United States under the Federal Trade Commission Act (the “FTCA”). The FTC has regulatory authority to
prevent unfair and deceptive practices and false advertising. Specifically, the FTC requires advertisers and promoters to have a reasonable
basis to substantiate and support claims. The FTC has many enforcement powers, one of which is the power to order disgorgement by promoters
deemed in violation of the FTCA of any profits made from the promoted business and can order injunctions from further violative promotion.
Advertising that we may utilize in connection with our medical tourism operations will be subject to FTC regulatory authority, and we
intend to comply with such regulatory régime. Similar laws and requirements are likely to exist in other countries and we intend
to comply with such requirements.
Federal
Regulation of Clinical Laboratories
Congress
passed the Clinical Laboratory Improvement Amendments (“CLIA”) in 1988, which provided the Centers for Medicare and Medicaid
Services (“CMS”) authority over all laboratory testing, except research, that is performed on humans in the United States.
The Division of Laboratory Services, within the Survey and Certification Group, under the Center for Medicaid and State Operations (“CMSO”)
has the responsibility for implementing the CLIA program.
The
CLIA program is designed to establish quality laboratory testing by ensuring the accuracy, reliability, and timeliness of patient test
results. Under CLIA, a laboratory is a facility that does laboratory testing on specimens derived from humans and used to provide information
for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of health. Laboratories that handle stem cells and
other biologic matter are, therefore, included under the CLIA program. Under the CLIA program, laboratories must be certified by the
government, satisfy governmental quality and personnel standards, undergo proficiency testing, be subject to inspections, and pay fees.
To the extent that our business activities require CLIA certification, we intend to obtain and maintain such certification. If we are
subject to CLIA, the failure to comply with CLIA standards could result in suspension, revocation, or limitation of a laboratory’s
CLIA certificate. In addition, fines or criminal penalties could also be levied. If any of these events were to occur, it could impact
our business operations.
Health
Insurance Portability and Accountability Act—Protection of Patient Health Information
We
may be subject to data privacy and security regulation by both the federal government and the states in which we conduct our business.
The Health Insurance Portability Act of 1996 (“HIPAA”), as amended by the Health Information Technology for Economic and
Clinical Health Act (“HITECH”) and their respective implementing regulations, including the Final Omnibus Rule published
on January 25, 2013, imposes specified requirements relating to the privacy, security and transmission of individually identifiable health
information on certain types of individuals and organizations. In addition, certain state laws govern the privacy and security of health
information in certain circumstances, many of which differ from each other and from HIPAA in significant ways and may not have the same
effect, thus complicating compliance efforts. Further, we may need to also comply with additional federal or state privacy laws and regulations
that may apply to certain diagnoses, such as HIV/AIDS, to the extent that they apply to us.
The
Department of Health and Human Services (“HHS”), through its Office for Civil Rights, investigates breach reports and determines
whether administrative or technical modifications are required and whether civil or criminal sanctions should be imposed. Companies failing
to comply with HIPAA and the implementing regulations may also be subject to civil money penalties or in the case of knowing violations,
potential criminal penalties, including monetary fines, imprisonment, or both. In some cases, the State Attorneys General may seek enforcement
and appropriate sanctions in federal court.
Other
Applicable U.S. Laws
In
addition to the above-described regulation by United States federal and state government, the following are other federal and state laws
and regulations that could directly or indirectly affect our ability to operate the business:
●
state
and local licensure, registration, and regulation of the development of pharmaceuticals and biologics;
●
state
and local licensure of medical professionals;
●
state
statutes and regulations related to the corporate practice of medicine;
●
laws
and regulations administered by U.S. Customs and Border Protection related to the importation of biological material into the United
States;
25
●
other
laws and regulations administered by the FDA;
●
other
laws and regulations administered by HHS;
●
state
and local laws and regulations governing human subject research and clinical trials;
●
the
federal physician self-referral prohibition, also known as Stark Law, and any state equivalents to Stark Law;
●
the
federal False Claims Act (“FCA”);
●
the
federal Anti-Kickback Statute (“AKS”) and any state equivalent statutes and regulations;
●
federal
and state coverage and reimbursement laws and regulations;
●
state
and local laws and regulations for the disposal and handling of medical waste and biohazardous material;
●
Occupational
Safety and Health Administration (“OSHA”) regulations and requirements;
●
the
Intermediate Sanctions rules of the IRS providing for potential financial sanctions with respect to “excess benefit transactions”
with tax-exempt organizations;
●
the
Physician Payments Sunshine Act (in the event that our products are classified as drugs, biologics, devices or medical supplies and
are reimbursed by Medicare, Medicaid or the Children’s Health Insurance Program);
●
state
and other federal laws addressing the privacy of health information; and
●
state
and foreign law equivalents of each of the above federal laws, such as anti-kickback and false claims laws which may apply to items
or services reimbursed by any third-party payer, including commercial insurers, state laws that require pharmaceutical companies
to comply with the pharmaceutical industry’s voluntary compliance guidelines and the relevant compliance guidance promulgated
by the federal government or otherwise restrict payments that may be made to healthcare professionals and other potential referral
sources, state laws that require drug manufacturers to report information related to payments and other transfers of value to physicians
and other healthcare professionals or marketing expenditures, and state laws governing the privacy and security of health information
in certain circumstances, many of which differ from each other in significant ways and may not have the same effect, thus complicating
compliance efforts.
Violation
of any of the laws described above or any other governmental laws and regulations may result in penalties, including civil and criminal
penalties, damages, fines, the curtailment or restructuring of operations, the exclusion from participation in federal and state healthcare
programs and imprisonment. Furthermore, efforts to ensure that business activities and business arrangements comply with applicable healthcare
laws and regulations can be costly for manufacturers of branded prescription products.
Foreign
Government Regulation
In
general, we will need to comply with the government regulations of each individual country in which our therapy centers are located and
products are to be distributed and sold. These regulations vary in complexity and can be as stringent, and on occasion even more stringent,
than FDA regulations in the United States. Due to the fact that there are new and emerging cell therapy regulations that have recently
been drafted and/or implemented in various countries around the world, the application and subsequent implementation of these new and
emerging regulations have little to no precedence. Therefore, the level of complexity and stringency is not always precisely understood
for each country, creating greater uncertainty for the international regulatory process. Furthermore, government regulations can change
with little to no notice and may result in up-regulation of our product(s), thereby creating a greater regulatory burden for our cell
processing technology products. We have not yet thoroughly explored the applicable laws and regulations that we will need to comply with
in foreign jurisdictions. It is possible that we may not be permitted to expand our business into one or more foreign jurisdictions.
We
do not have any definitive plans or arrangements with respect to the establishment by us of stem cell therapy clinics in any country.
We intend to explore any such opportunities as they arise.
26
Offices
Our
principal executive offices are located at 40 Marcus Drive, Suite One, Melville, New York, and our telephone number is (631) 760-8100.
Our website is www.biorestorative.com. Our internet website and the information contained therein or connected thereto are not intended
to be incorporated by reference into this Annual Report.
Employees
We
currently have five employees, all of whom are full-time employees. We believe that our employee relations are good.
ITEM
1A .
RISK
FACTORS .
Not
applicable. See, however, Item 7 of this Annual Report (“Management’s Discussion and Analysis of Financial Condition and
Results of Operations - Factors That May Affect Future Results and Financial Condition”).
ITEM
1B .
UNRESOLVED
STAFF COMMENTS .
Not
applicable.
ITEM
2.
PROPERTIES .
Our
principal executive offices and laboratory are located at 40 Marcus Drive, Suite One, Melville, New York. We occupy 6,800 square feet
of space at the premises pursuant to a lease that expires in December 2024. The lease provides for an annual base rental during the five
year period ending in December 2024 ranging between $153,748 and $173,060. Our premises are suitable and adequate for our current operations.
ITEM
3.
LEGAL
PROCEEDINGS .
Not
applicable. See, however, Item 1 of this Annual Report (“Business – Business Development – Chapter 11 Reorganization”)
for a discussion of a voluntary petition filed by us in March 2020 commencing a case under chapter 11 of title 11 of the U.S. Code in
the United States Bankruptcy Court for the Eastern District of New York. The Amended Joint Plan of Reorganization filed in connection
with the proceeding became effective on November 16, 2020.
ITEM
4.
MINE
SAFETY DISCLOSURES.
Not
applicable.
27
PART II
ITEM
5.
MARKET
FOR REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES .
Market
Information
Transactions
in our common stock are currently reported under the symbol “BRTX” on the OTC markets. Any over-the-counter market quotations
reflect inter-dealer prices, without retail mark-up, mark-down or commission, and may not necessarily represent actual transactions.
Holders
As
of April 27, 2021, there were 367 record holders of our shares of common stock.
Dividends
Not
applicable.
Recent
Sales of Unregistered Securities
During
the three months ended December 31, 2020, we issued the following securities in transactions not involving any public offering. For each
of the following transactions, we relied upon Section 4(a)(2) of the Securities Act of 1933, as amended (the “Securities Act”),
as transactions by an issuer not involving any public offering or Section 1145 of the Bankruptcy Code as a security exchanged by an issuer
for a claim against the issuer in a bankruptcy plan of reorganization. For each such transaction, we did not use general solicitation
or advertising to market the securities, the securities were offered to a limited number of persons, the investors had access to information
regarding us (including information contained in our Annual Report on Form 10-K for the year ended December 31, 2018, Quarterly
Reports on Form 10-Q for the periods ended March 31, 2019, June 30, 2019 and September 30, 2019 and Current Reports
on Form 8-K filed with the Securities and Exchange Commission, press releases made by us and information contained in filings with the
bankruptcy court), and we were available to answer questions by prospective investors. We reasonably believe that each of the investors
is an accredited investor. The proceeds were used to reduce our working capital deficiency and for other corporate purposes.
Warrants
Date
Issued
Common
Stock
Shares
Exercise
Price
Term
(Years)
Purchaser(s)
Consideration (1)
11/16/2020
1,049,726,797
-
-
-
(2)
$ 14,381,259 (4)
11/16/2020
-
9,453,802,480
$ 0.0005
5.00
(2)
$ 2,565,699 (3)
11/16/2020
-
4,726,901,240
$ 0.001
5.00
(2)
$ 1,282,849
(3)
10/20/2020
81,796,200
-
-
-
(2)
$ 1,382,356 (5)
12/21/2020
136,000,000
-
-
-
(2)
$ 775,200 (5)
(1)
The
value of the non-cash consideration was estimated to be the fair value of our restricted common stock. Since our shares are thinly
traded in the open market, the fair value of our equity instruments was estimated by management based on observations of the cash
sale prices of both restricted shares and freely tradeable shares.
(2)
Accredited
investor.
(3)
Issued
in connection with the issuance of Secured Convertible Notes pursuant to the Plan.
(4)
Issued
in exchange for allowed unsecured claims pursuant to the Plan.
(5)
Issued
on a cashless net exercise basis pursuant to the exercise of warrants.
Issuer
Purchases of Equity Securities
During
the quarter ended December 31, 2020, there were no purchases of common stock made by us or any “affiliated purchaser”.
ITEM
6 .
SELECTED
FINANCIAL DATA .
Not
applicable.
28
ITEM
7 .
MANAGEMENT’S
DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS .
The
following discussion and analysis of the consolidated results of operations and financial condition of BioRestorative Therapies, Inc.
and its subsidiary as of December 31, 2020 and 2019 and for the years ended December 31, 2020 and 2019 should be read in conjunction
with our financial statements and the notes to those financial statements that are included elsewhere in this Annual Report following
Item 16 (“Form 10-K Summary”). References in this “Management’s Discussion and Analysis of Financial Condition
and Results of Operations” to “us,” “we,” “our,” and similar terms refer to BioRestorative
Therapies, Inc.. This Annual Report contains forward-looking statements as that term is defined in the federal securities laws. The events
described in forward-looking statements contained in this Annual Report may not occur. Generally these statements relate to business
plans or strategies, projected or anticipated benefits or other consequences of our plans or strategies, projected or anticipated benefits
from acquisitions that may be made by us, or projections involving anticipated revenues, earnings or other aspects of our operating results.
The words “may,” “will,” “expect,” “believe,” “anticipate,” “project,”
“plan,” “intend,” “estimate,” and “continue,” and their opposites and similar expressions,
are intended to identify forward-looking statements. We caution you that these statements are not guarantees of future performance or
events and are subject to a number of uncertainties, risks and other influences, many of which are beyond our control, which may influence
the accuracy of the statements and the projections upon which the statements are based. Reference is made to “Factors That May
Affect Future Results and Financial Condition” in this Item 7 for a discussion of some of the uncertainties, risks and assumptions
associated with these statements.
Overview
We
develop therapeutic products and medical therapies using cell and tissue protocols, primarily involving adult (non-embryonic) stem cells.
We are currently pursuing our Disc/Spine Program with our initial investigational therapeutic product being called BRTX-100 .
We submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 ,
our lead cell therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease. We have received
such authorization from the FDA. We intend to commence such clinical trial during 2021 (assuming the receipt of necessary funding). We
have obtained a license to use technology for investigational adult stem cell treatment of disc and spine conditions, including protruding
and bulging lumbar discs. The technology is an advanced stem cell injection procedure that may offer relief from lower back pain, buttock
and leg pain, and numbness and tingling in the leg and foot. We are also developing our ThermoStem Program . This pre-clinical
program involves the use of brown adipose (fat) in connection with the cell-based treatment of type 2 diabetes and obesity as well as
hypertension, other metabolic disorders and cardiac deficiencies. United States patents related to the ThermoStem Program were
issued in September 2015, January 2019, March 2020 and March 2021; a notice of allowance was also issued in March 2021 for a separate
United States patent application in the ThermoStem Program and is expected to issue in the next few months; Australian patents
related to the ThermoStem Program were issued in April 2017 and October 2019; a Japanese patent related to the ThermoStem Program
was issued in December 2017; Israeli patents related to the ThermoStem Program were issued in October 2019 and May 2020; and
European patents related to the ThermoStem Program were issued in April 2020 and January 2021.
We
have licensed a patented curved needle device that is a needle system designed to deliver cells and/or other therapeutic products or
materials to the spine and discs or other potential sites. We anticipate that FDA approval or clearance will be necessary for this device
prior to commercialization. We do not intend to utilize this device in connection with our contemplated Phase 2 clinical trial with regard
to BRTX-100 .
Our
offices are located in Melville, New York where we have established a laboratory facility in order to increase our capabilities for the
further development of possible cellular-based treatments, products and protocols, stem cell-related intellectual property and translational
research applications.
As
of December 31, 2020, our accumulated deficit was $89,842,833 and our stockholders’ deficit was $1,331,492. We have
historically only generated a modest amount of revenue, and our losses have principally been operating expenses incurred in research
and development, marketing and promotional activities in order to commercialize our products and services, plus costs associated with
meeting the requirements of being a public company. We expect to continue to incur substantial costs for these activities over at least
the next year.
29
Based
upon our forecast for continued operating losses, as of December 31, 2020, we required equity and/or debt financing to continue our operations.
As of December 31, 2020, our outstanding debt of $9,637,102, together with interest at rates ranging between 5% and 7% per annum, was
due on November 16, 2023. As of December 31, 2020, the outstanding debt amount of $9,637,102 did not include $657,598 of estimated
DIP and Plan costs associated with the DIP Funding and the Plan (the “Auctus Costs”). As of December 31, 2020,
the Auctus Costs were not finalized and, of which, $500,000 and $157,598 are recorded in debt discount and accrued expenses,
respectively, on the consolidated balance sheets.
As
discussed in Item 1 of this Annual Report (“Business – Business Development”), on March 20, 2020, we filed a voluntary
petition commencing a case under chapter 11 of title 11 of the U.S. Code in the United States Bankruptcy Court for the Eastern District
of New York. On October 30, 2020, the Bankruptcy Court entered an order confirming the plan of reorganization and, on November 16, 2020,
the plan became effective. As a result of the confirmed plan of reorganization $14,796,000 in outstanding debt and liabilities were exchanged
for (i) shares of common stock, (ii) new convertible debt or (iii) new convertible debt and warrants to purchase common stock.
We
anticipate that we will require approximately $12,000,000 in financing to complete a Phase 2 clinical trial with regard to our Disc/Spine
Program . We anticipate that we will require approximately $45,000,000 in further additional funding to complete such clinical trials
(assuming the receipt of no revenues). We will also require a substantial amount of additional funding to implement our other programs
described in Item 1 of this Annual Report (“Business”), including our metabolic ThermoStem Program, repay our outstanding
debt (assuming such debt is not converted into equity) and fund general operations. No assurance can be given that the anticipated amounts
of required funding are correct or that we will be able to accomplish our goals within the timeframes projected. In addition, no assurance
can be given that we will be able to obtain any required financing on commercially reasonable terms or otherwise.
We
are currently seeking several different financing alternatives to support our future operations. The plan of reorganization provides
that, at such time as we are current in our periodic SEC filings (which will be the case upon the filing of this Annual Report), subject
to certain customary conditions, Auctus Fund, LLC (“Auctus”), which provided debtor-in-possession (“DIP”) financing
to us during the reorganization process, is to provide a loan to us, as needed, in an amount equal to $3,500,000 less the sum of the
DIP loans previously made by Auctus to us (inclusive of accrued interest, of $1,226,901) and the DIP costs incurred by Auctus
as the DIP lender. In addition, Auctus and others provided debt financing in the aggregate principal amount of $3,848,548 at the effective
date of our plan of reorganization. If we are unable to obtain such financing on a timely basis or other required financing as needed,
we may have to curtail our development, marketing and promotional activities, which would have a material adverse effect on our business,
financial condition and results of operations, and ultimately we could be forced to discontinue our operations and liquidate. See “Liquidity
and Capital Resources” below.
Consolidated
Results of Operations
Year
Ended December 31, 2020 Compared with Year Ended December 31, 2019
The
following table presents selected items in our consolidated statements of operations for the year ended December 31, 2020 and 2019, respectively:
For
The Years Ended
December
31,
2020
2019
Revenues
$
77,000
$
130,000
Operating
Expenses:
Marketing
and promotion
28,281
321,280
Consulting
137,250
1,912,683
Research
and development
876,829
1,722,338
General
and administrative
1,786,716
4,605,704
Total
Operating Expenses
2,829,076
8,562,005
Loss
From Operations
(2,752,076)
(8,432,005
)
Other
(Expense) Income:
Interest
expense
(362,041)
(1,467,952
)
Amortization
of debt discount
(1,278,104)
(3,671,087
)
Loss
on extinguishment of notes payable, net
(658,152)
(1,895,116
)
Change
in fair value of derivative liabilities
(2,141,069)
788,970
Reorganization
items, net
(4,081,245)
-
Other
income
-
29,300
Total
Other Expense
(8,520,611)
(6,215,885
)
Net
Loss
$
(11,272,687)
(14,647,890
)
30
Revenues
For
the years ended December 31, 2020 and 2019, we generated $77,000 and $130,000, respectively, of royalty revenue in connection with our
sublicense agreement.
Marketing
and promotion
Marketing
and promotion expenses include advertising and promotion, marketing and seminars, meals, entertainment and travel expenses. For the year
ended December 31, 2020, marketing and promotion expenses decreased by $292,999, or 91%, from $321,280 to $28,281 as compared to the
year ended December 31, 2019, due to the Company’s reduced spending on marketing prior to and during the Company’s Chapter
11 reorganization.
We
expect that marketing and promotion expenses will increase in the future as we increase our marketing activities following full commercialization
of our products and services.
Consulting
Consulting
expenses consist of consulting fees and stock-based compensation to consultants. For the year ended December 31, 2020, consulting expenses
decreased by $1,775,433, or 93%, from $1,912,683 to $137,250, as compared to the year ended December 31, 2019, due to the Company’s
reduced usage of consultants prior to and during the Company’s Chapter 11 reorganization.
Research
and development
Research
and development expenses include cash and non-cash compensation of (a) our Vice President of Research and Development; (b) our Scientific
Advisory Board members; and (c) laboratory staff and costs related to our brown fat and disc/spine initiatives. Research and development
expenses are expensed as they are incurred. For the year ended December 31, 2020, research and development expenses decreased by $845,509,
or 49%, from $1,722,338 to $876,829, as compared to the year ended December 31, 2019. The decrease was primarily a result of the Company’s
reduced spending on research and development prior to and during the Company’s Chapter 11 reorganization.
We
expect that our research and development expenses will increase with the continuation of the aforementioned initiatives.
General
and administrative
General
and administrative expenses consist primarily of salaries, bonuses, payroll taxes, severance costs and stock-based compensation to employees
(excluding any cash or non-cash compensation of our Vice President of Research and Development and our laboratory staff), as well as
corporate expenses such as legal and professional fees, investor relations and occupancy related expenses. For the year ended December
31, 2020, general and administrative expenses decreased by $2,818,988, or 61%, from $4,605,704 to $1,786,716, as compared to the year
ended December 31, 2019. The decrease is primarily due to the Company’s reduced incurrence of general and administrative expenses
prior to and during the Company’s Chapter 11 reorganization.
We
expect that our general and administrative expenses will increase as we expand our staff, develop our infrastructure and incur additional
costs to support the growth of our business.
31
Interest
expense
For
the year ended December 31, 2020, interest expense decreased $1,105,911, or 75%, as compared to the year ended December 31, 2019. The
decrease was due to the prepetition outstanding notes payable being reclassified to liabilities subject to compromise at the Petition
Date and, as a result, pursuant to ASC 852, Reorganizations , the Company did not accrue any new interest related to these notes.
Certain of these notes were converted into shares of the Company’s common stock at November 16, 2020. All new accrued interest
was related to secured and unsecured convertible notes payable that resulted from the Plan.
Amortization
of debt discount
For
the year ended December 31, 2020, amortization of debt discount decreased $2,392,983, or 65%, as compared to the year ended December
31, 2019. The decrease was primarily due to the prepetition outstanding notes payable being reclassified to liabilities subject to compromise
at the Petition Date and as a result, pursuant to ASC 852, Reorganizations , the remaining debt discount was written off to reorganization
items on the consolidated statements of operations.
Loss
on extinguishment of notes payable, net
For
the year ended December 31, 2020, we recorded a loss on extinguishment of notes payable, net, of $658,152, as compared to a loss on extinguishment
of notes payable, net of $1,895,116 for the year ended December 31, 2019. The decrease is associated with debtholders’ exchanges
of debt into equity securities.
Change
in fair value of derivative liabilities
For
the year ended December 31, 2020, we recorded a loss related to the change in fair value of derivative liabilities of $2,141,069 due
to the decrease in time value of embedded conversion options within certain convertible notes payable, as compared to a gain related
to the change in fair value of derivative liabilities of $788,970 for the year ended December 31, 2019.
Reorganization
items, net
Reorganization
items, net consists primarily of costs associated the post-petition Chapter 11 bankruptcy. For the year ended December 31, 2020, reorganization
items, net decreased $4,081,245, or 100%, as compared to the year ended December 31, 2019. The decrease was due to, pursuant to
ASC 852, Reorganizations ¸ legal fees associated with the Chapter 11 reorganization, the write-off of the outstanding debt
discount at the date of the bankruptcy, the exchange of common stock and unsecured convertible debt for allowable claims, and the write-off
of derivative liabilities related to the convertible notes included in the Chapter 11 reorganization allowable claims.
Liquidity
and Capital Resources
Liquidity
We
measure our liquidity in a number of ways, including the following:
December
31,
2020
2019
Cash
$
3,064,610
$
1,664
Working
Capital (Deficiency)
$
2,142,227
$
(13,651,716
)
Notes
Payable (Gross)
$
9,637,102
$
8,393,327
Availability
of Additional Funds
Based
upon our accumulated deficit and stockholders’ deficit as of December 31, 2020 of $89,842,833 and $1,331,492, respectively,
along with our forecast for continued operating losses and our need for financing to fund our contemplated clinical trials, as of
such date, we required additional equity and/or debt financing to continue our operations.
32
As
of December 31, 2020, our outstanding debt of $9,637,102, together with interest at rates ranging between 5% and 7% per annum, was due
on November 16, 2023. As of December 31, 2020, the outstanding debt
amount of $9,637,102 did not include $657,598 of estimated DIP and Plan costs associated with the DIP Funding and the Plan (the “Auctus
Costs”). As of December 31, 2020, the Auctus Costs were not finalized and, of which, $500,000 and $157,598 are recorded in debt
discount and accrued expenses, respectively, on the consolidated balance sheets.
Our
operating needs include the planned costs to operate our business, including amounts required to fund working capital and capital expenditures.
Our future capital requirements and the adequacy of our available funds will depend on many factors, including our ability to successfully
commercialize our products and services, competing technological and market developments, and the need to enter into collaborations with
other companies or acquire other companies or technologies to enhance or complement our product and service offerings.
We
may be unable to raise sufficient additional capital when we need it or raise capital on favorable terms. We have granted a security
interest in all of our assets to certain lenders, including Auctus, in connection with our Chapter 11 plan of reorganization. This may
impede our ability to raise additional debt financing. In addition, future financing may require us to pledge certain assets and enter
into covenants that could restrict certain business activities or our ability to incur further indebtedness and may contain other terms
that are not favorable to our stockholders or us. If we are unable to obtain adequate funds on reasonable terms, we may be required to
significantly curtail or discontinue operations or obtain funds by entering into financing agreements on unattractive terms.
Our
consolidated financial statements included elsewhere in this Annual Report have been prepared in conformity with accounting principles
generally accepted in the United States of America, or U.S. GAAP, which contemplate our continuation as a going concern and the realization
of assets and satisfaction of liabilities in the normal course of business. The carrying amounts of assets and liabilities presented
in the financial statements do not necessarily purport to represent realizable or settlement values. The financial statements do not
include any adjustment that might result from the outcome of this uncertainty.
The
following events have mitigated the above factors with regards to our ability to continue as a going concern: (i) as part of our Chapter
11 reorganization approximately $14,700,000 in outstanding debt and other liabilities were exchanged for (a) shares of common stock,
(b) new convertible notes with three year terms or (c) new convertible notes with three year terms and warrants to purchase shares of
common stock; (ii) we secured DIP financing during our Chapter 11 reorganization in the aggregate amount of $1,189,413, and $3,848,548
in debt financing as part of our Chapter 11 reorganization to sustain operations; and (iii) pursuant to the plan of reorganization, Auctus
is required to loan to us, as needed and subject to our becoming current in our SEC reporting obligations (which will be the case upon
the filing of this Annual Report), an additional amount equal to $3,500,000, less the amount of Auctus’ DIP financing ($1,226,901,
inclusive of accrued interest) and its DIP costs. As a result of the above, we have sufficient cash to fund operations for the twelve
months subsequent to the filing date. In addition, the Company will need to obtain further funding of at least $12,000,000 to commence
and complete a Phase 2 clinical study of the use of BRTX-100 .
During
the years ended December 31, 2020 and 2019, our sources and uses of cash were as follows:
Net
Cash Used in Operating Activities
We
experienced negative cash flows from operating activities for the years ended December 31, 2020 and 2019 in the amounts of $1,964,265
and $6,918,734, respectively. The net cash used in operating activities for the year ended December 31, 2020 was primarily due to
cash used to fund a net loss of $11,272,687, adjusted for non-cash expenses in the aggregate amount of $8,736,072 and partially
offset by $572,350 of cash generated by changes in the levels of operating assets and liabilities, primarily as a result of increases
in accrued expenses. The net cash used in operating activities for the year ended December 31, 2019 was primarily due to cash used to
fund a net loss of $14,647,890, adjusted for non-cash expenses in the aggregate amount of $7,189,303 and partially offset by $539,853
of cash generated by changes in the levels of operating assets and liabilities, primarily as a result of increases in accrued interest,
expenses, and other current liabilities, partially offset by an increase in accounts payable.
Net
Cash Used in Investing Activities
During
the years ended December 31, 2020 and 2019, cash used in investing activities was $- and $35,631, respectively.
33
Net
Cash Provided by Financing Activities
Net
cash provided by financing activities during the years ended December 31, 2020 and 2019 was $5,027,211 and $6,838,505, respectively.
During the year ended December 31, 2020, $5,517,211 of net proceeds were from debt financings. During the year ended December 31, 2019,
$10,888,339 of net proceeds were from debt financings, $1,658,500 of net proceeds were from equity financings, partially offset by $5,708,334
of repayments on debt financings and prepayment premiums.
We
anticipate that the costs to complete our Phase 2 clinical trials with regard to our Disc/Spine Program will be at least $12,000,000.
In addition, we anticipate approximately $45,000,000 in additional funding will be needed to complete the clinical trials using BRTX-100
(assuming the receipt of no revenues). As noted above in “Availability of Additional Funds” we secured additional funding
as part of Chapter 11 reorganization in the aggregate amount of $5,037,961 as well as approximately $14,700,000 in outstanding debt and
other liabilities being exchanged for (a) shares of common stock, (b) new convertible notes with three year terms or (c) new convertible
notes with three year terms and warrants to purchase shares of common stock. Additionally, pursuant to the plan of reorganization, Auctus
is required to loan to us, as needed and subject to our becoming current in our SEC reporting obligations (which will be the case upon
the filing of this Annual Report), an additional amount equal to $3,500,000, less the amount of Auctus’ DIP financing ($1,226,901,
inclusive of accrued interest) and its DIP costs. As a result of the above, we have sufficient cash to fund operations for the twelve
months subsequent to the filing date.
Critical
Accounting Policies and Estimates
Use
of Estimates
The
preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the
reported amounts of assets and liabilities and disclosure of contingent liabilities at dates of the financial statements and the reported
amounts of revenue and expenses during the periods. Our significant estimates and assumptions include the recoverability and useful lives
of long-lived assets, the fair value of our common stock, stock-based compensation, warrants issued in connection with notes payable,
derivative liabilities and the valuation allowance related to our deferred tax assets. Certain of our estimates, including the carrying
amount of the intangible assets, could be affected by external conditions, including those unique to us and general economic conditions.
It is reasonably possible that these external factors could have an effect on our estimates and could cause actual results to differ
from those estimates.
Intangible
Assets
Intangible
assets are comprised of trademarks and licenses with original estimated useful lives of 10 and 17 years, respectively. Once placed into
service, we amortize the cost of the intangible assets over their estimated useful lives on a straight-line basis.
Impairment
of Long-lived Assets
We
review for the impairment of long-lived assets whenever events or changes in circumstances indicate that the carrying amount of an asset
may not be recoverable. An impairment loss would be recognized when estimated future cash flows expected to result from the use of the
asset and its eventual disposition are less than its carrying amount. While our near term liquidity is tight, historically we have been
successful in raising capital as needed (although there can be no assurance that we will continue to be successful in raising capital
as needed). We continue to progress our scientific agenda and meet related milestones. We have not identified any impairment losses.
Income
Taxes
We
recognize deferred tax assets and liabilities for the expected future tax consequences of items that have been included or excluded in
our financial statements or tax returns. Deferred tax assets and liabilities are determined on the basis of the difference between the
tax basis of assets and liabilities and their respective financial reporting amounts, or temporary differences, at enacted tax rates
in effect for the years in which the temporary differences are expected to reverse.
We
adopted the provisions of Accounting Standards Codification, or ASC, Topic 740-10, which prescribes a recognition threshold and measurement
process for financial statements recognition and measurement of a tax position taken or expected to be taken in a tax return.
34
Stock-Based
Compensation
We
measure the cost of services received in exchange for an award of equity instruments based on the fair value of the award. For employees
and directors, the fair value of the award is measured on the grant date and for non-employees, the fair value of the award is generally
re-measured on vesting dates and interim financial reporting dates until the service period is complete. The fair value amount is then
recognized over the period during which services are required to be provided in exchange for the award, usually the vesting period. Since
the shares underlying our 2010 Equity Participation Plan were registered on May 27, 2014, we estimate the fair value of the awards granted
under the Plan based on the market value of our freely tradable common stock as reported on the OTC. The fair value of our restricted
equity instruments was estimated by management based on observations of the cash sales prices of both restricted shares and freely tradable
shares. Awards granted to directors are treated on the same basis as awards granted to employees.
Derivative
Financial Instruments
We
evaluate our convertible instruments to determine if those contracts or embedded components of those contracts qualify as derivative
financial instruments to be separately accounted for in accordance with Topic 815 of the Financial Accounting Standards Board (“FASB”)
ASC. The accounting treatment of derivative financial instruments requires that we record embedded conversion options (“ECOs”)
and any related freestanding instruments at their fair values as of the inception date of the agreement and at fair value as of each
subsequent balance sheet date. Any change in fair value is recorded as non-operating, non-cash income or expense for each reporting period
at each balance sheet date. Conversion options are recorded as a discount to the host instrument and are amortized as amortization of
debt discount on the consolidated financial statements over the life of the underlying instrument. We reassess the classification of
our derivative instruments at each balance sheet date. If the classification changes as a result of events during the period, the contract
is reclassified as of the date of the event that caused the reclassification.
The
Multinomial Lattice Model and Black-Scholes Model were used to estimate the fair value of the ECOs of convertible notes payable, the
warrants, and stock options that are classified as derivative liabilities on the consolidated balance sheets. The models include subjective
input assumptions that can materially affect the fair value estimates. The expected volatility is estimated based on the actual volatility
during the most recent historical period of time equal to the weighted average life of the instruments.
Recently
Issued Accounting Pronouncements
See
Note 3 to our consolidated financial statements for the years ended December 31, 2020 and 2019 included elsewhere in this Annual Report
following Item 16 (“Form 10-K Summary”).
Off-Balance
Sheet Arrangements
We
have no off-balance sheet arrangements that have or are reasonably likely to have a current or future effect on our financial condition,
changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures or capital resources that
is material to investors.
Factors
That May Affect Future Results and Financial Condition
The
risk factors listed in this section provide examples of risks, uncertainties and events that may cause our actual results to differ materially
from the expectations we describe in our forward-looking statements. Readers should be aware that the occurrence of any of the events
described in these risk factors could have a material adverse effect on our business, results of operations and financial condition.
We undertake no obligation to update or revise publicly any forward-looking statements, whether as a result of new information, future
events, or otherwise.
35
Risks
Related to Our Business Generally
We
have a limited operating history; we have incurred substantial losses since inception; we expect to continue to incur losses for the
near term; as of December 31, 2020, we had a stockholders’ deficiency.
We
have a limited operating history. Since our inception, we have incurred net losses. As of December 31, 2020, we had a working
capital of $2,142,229 and a stockholders’ deficit of $1,331,492. On October 30, 2020, the Bankruptcy
Court confirmed the plan of reorganization pursuant to the Chapter 11 Case (the “Plan of Reorganization”) and on November
16, 2020, the Plan of Reorganization became effective.
We
will need to obtain a significant amount of financing to initiate and complete our clinical trials and implement our business plan.
Since
our inception, we have not generated significant revenues from our operations and have funded our operations through the sale of our
equity securities and debt securities. The implementation of our business plan, as discussed in Item 1 of this Annual Report (“Business”),
will require the receipt of sufficient equity and/or debt financing to purchase necessary equipment, technology and materials, fund our
clinical trials and other research and development efforts, retire our outstanding debt and otherwise fund our operations. We anticipate
that we will require approximately $12,000,000 in financing to complete a Phase 2 clinical trial using BRTX-100. We anticipate
that we will require approximately $45,000,000 in further additional funding to complete our clinical trials using BRTX-100 (assuming
the receipt of no revenues). We will also require a substantial amount of additional funding to implement our other programs described
in Item 1 of this Annual Report (“Business”), including our metabolic ThermoStem Program, repay our outstanding debt
(assuming such debt is not converted into equity) and fund general operations. We received debtor-in-possession (“DIP”) funding
of $1,189,413 during the Chapter 11 Case and debt financing of $3,848,548 on the effective date of the Chapter 11 Case. The Plan of Reorganization
provides for additional debt funding of $3,500,000 (less our DIP funding obligation, including accrued interest, of $1,226,901 at the
effective date of the Chapter 11 Case, less DIP costs incurred by the DIP lender) as needed, from our DIP lender upon our becoming current
in our SEC periodic report filings (which will be the case upon the filing of this Annual Report). Such additional funding from the DIP
lender, if received, will not be sufficient to satisfy our needs. No assurance can be given that the anticipated amounts of required
funding are correct or that we will be able to accomplish our goals within the timeframes projected. In addition, no assurance can be
given that we will be able to obtain any required financing on commercially reasonable terms or otherwise. In the event we do not obtain
the financing required for the above purposes, we may have to curtail our development, marketing and promotional activities, which would
have a material adverse effect on our business, financial condition and results of operations, and ultimately we could be forced to discontinue
our operations and liquidate.
We
may need to obtain additional financing to satisfy debt obligations. An event of default pursuant to our outstanding debt obligations
could trigger an acceleration of the due date of such obligations, including our secured debt.
As
described in this Item 7 (“Management’s Discussion and Analysis of Financial Condition and Results of Operations –
Liquidity and Capital Resources – Availability of Additional Funds”), as of December 31, 2020, our outstanding debt of $9,634,104,
together with interest at rates ranging between 5% and 7% per annum, was due on November 16, 2023. As of December 31, 2020, the outstanding
debt amount of $9,637,102 did not include $657,598 of estimated DIP and Plan costs associated with the DIP Funding and the Plan (the
“Auctus Costs”). As of December 31, 2020, the Auctus Costs were not finalized and, of which, $500,000 and $157,598 are recorded
in debt discount and accrued expenses, respectively, on the consolidated balance sheets. The DIP lender is required, pursuant to
the Plan of Reorganization as discussed above, to lend us an additional $3,500,000 (less our DIP funding obligation, including accrued
interest, of $1,226,901 at the effective date of the Chapter 11 Case, less the DIP costs incurred by the DIP lender), as needed.
Although our outstanding debt is repayable on November 16, 2023 (unless sooner converted into equity), an event of default pursuant to
the secured and unsecured promissory notes evidencing such indebtedness could trigger an acceleration of the due dates of all of the
notes. We do not have the financial resources to satisfy such debt obligations. Since the repayment of a substantial portion of our outstanding
debt is secured by a security interest in all of our assets, in the event of a default, and foreclosure upon our assets, we could be
forced to cease operations and liquidate.
Our
business strategy is high risk.
We
are focusing our resources and efforts primarily on the development of cellular-based products and services which will require extensive
cash for research, development and commercialization activities. This is a high-risk strategy because there is no assurance that our
products and services, including our Disc/Spine Program and our ThermoStem metabolic brown fat research initiative, will
ever become commercially viable (commercial risk), that we will prevent other companies from depriving us of market share and profit
margins by offering services and products based on our inventions and developments (legal risk), that we will successfully manage a company
in a new area of business, regenerative medicine, and on a different scale than we have operated in the past (operational risk), that
we will be able to achieve the desired therapeutic results using stem and regenerative cells (scientific risk), or that our cash resources
will be adequate to develop our products and services until we become profitable, if ever (financial risk). We are using our cash in
one of the riskiest industries in the economy (strategic risk). This may make our securities an unsuitable investment for many investors.
36
We
will need to enter into agreements in order to implement our business strategy.
Except
for a certain license agreement with Regenerative Sciences, LLC described in Item 1 of this Annual Report (“Business – Disc/Spine
Program - License”), we do not have any material agreements or understandings in place with respect to the implementation of our
business strategy. No assurances can be given that we will be able to enter into any necessary agreements with respect to the development
of our business. Our inability to enter into any such agreements would have a material adverse effect on our results of operations and
financial condition.
We
depend on our executive officers and on our ability to attract and retain additional qualified personnel; we do not currently have a
Chief Financial Officer.
Our
performance is substantially dependent on the performance of Lance Alstodt, our Chief Executive Officer. We rely upon him for strategic
business decisions and guidance. We are also dependent on the performance of Francisco Silva, our Vice President of Research and Development.
Each of Messrs. Alstodt and Silva is subject to an employment agreement with us. We do not have any key-man insurance policies on the
lives of either of our executive officers. We do not currently have a Chief Financial Officer. Pending the hiring of a Chief Financial
Officer, we are utilizing financial consultants with regard to the preparation of our financial statements. We believe that our future
success in developing marketable products and services and achieving a competitive position will depend in large part upon whether we
can attract and retain additional qualified management and scientific personnel, including a Chief Financial Officer. Competition for
such personnel is intense, and there can be no assurance that we will be able to attract and retain such personnel. The loss of the services
of Mr. Alstodt and/or Mr. Silva or the inability to attract and retain additional personnel, including a Chief Financial Officer, and
develop expertise as needed would have a substantial negative effect on our results of operations and financial condition.
The
impact of COVID-19 and related risks could materially affect our results of operations and prospects .
Beginning
in March 2020, the global pandemic related to the novel coronavirus COVID-19 began to impact the global economy. Because of the size
and breadth of this pandemic, all of the direct and indirect consequences of COVID-19 are not yet known and may not emerge for some time.
Risks presented by the ongoing effects of COVID-19 include, among others, the following:
Clinical
Trials. We anticipate that the COVID-19 pandemic may negatively impact our contemplated clinical trials. Due to the worldwide efforts
being taken to combat COVID-19 and the increased clinical work being done in this respect, we believe that it may be difficult for certain
needed laboratory supplies, equipment and other materials to be obtained in order to conduct our clinical trials. We also anticipate
that, due to a fear of COVID-19 transmission, there may be a hesitancy on the part of certain individuals to become clinical trial participants.
We hope that these possible negative effects will lessen as more of the population becomes vaccinated; however, the impact that the vaccinations
will have is uncertain at this time.
Adverse
Legislative and/or Regulatory Action. Federal, state and local government actions to address and contain the impact of COVID-19 may
adversely affect us. For example, we may be subject to legislative and/or regulatory action that negatively impacts the manner in which
the clinical trials may be conducted.
Operational
Disruptions and Heightened Cybersecurity Risks. Our operations could be disrupted if key members of our senior management or a significant
percentage of our workforce are unable to continue to work because of illness, government directives or otherwise. In addition, in connection
with increased remote working arrangements, we face a heightened risk of cybersecurity attacks or data security incidents and are more
dependent on internet and telecommunications access and capabilities.
37
Risks
Related to Our Cell Therapy Product Development Efforts
Our
future success is significantly dependent on the timely and successful development and commercialization of BRTX-100, our lead product
candidate for the treatment of chronic lumbar disc disease; if we encounter delays or difficulties in the development of this product
candidate, as well as any other product candidates, our business prospects would be significantly harmed.
We
are dependent upon the successful development, approval and commercialization of our product candidates. Before we are able to seek regulatory
approval of our product candidates, we must conduct and complete extensive clinical trials to demonstrate their safety and efficacy in
humans. Our lead product candidate, BRTX-100 , is in early stages of development and we have not yet commenced a Phase 2 clinical
trial using BRTX-100 to treat chronic lower back pain due to degenerative disc disease related to protruding/bulging discs.
Clinical
testing is expensive, difficult to design and implement, and can take many years to complete. Importantly, a failure of one or more of
these or any other clinical trials can occur at any stage of testing. We may experience numerous unforeseen events during, or as a result
of, clinical trials that could delay or prevent our ability to complete our clinical studies, receive regulatory approval or commercialize
our cell therapy product candidates, including the following:
●
suspensions,
delays or changes in the design, initiation, enrollment, implementation or completion of required clinical trials; adverse changes
in our financial position or significant and unexpected increases in the cost of our clinical development program; changes or uncertainties
in, or additions to, the regulatory approval process that require us to alter our current development strategy; clinical trial results
that are negative, inconclusive or less than desired as to safety and/or efficacy, which could result in the need for additional
clinical studies or the termination of the product’s development; delays in our ability to manufacture the product in quantities
or in a form that is suitable for any required clinical trials;
●
intellectual
property constraints that prevent us from making, using, or commercializing any of our cell therapy product candidates;
●
the
supply or quality of our product candidates or other materials necessary to conduct clinical trials of these product candidates may
be insufficient or inadequate; the inability to generate sufficient pre-clinical, toxicology, or other in vivo or in vitro data,
to support the initiation of clinical studies;
●
delays
in reaching agreement on acceptable terms with prospective CROs and clinical study sites, the terms of which can be subject to extensive
negotiation and may vary significantly among different CROs and clinical study sites;
●
delays
in obtaining required Institutional Review Board (“IRB”) approval at each clinical study site;
●
imposition
of a temporary or permanent clinical hold by regulatory agencies for a number of reasons, including after review of an IND application
or amendment, or equivalent application or amendment; as a result of a new safety finding that presents unreasonable risk to clinical
trial participants; a negative finding from an inspection of our clinical study operations or study sites; developments on trials
conducted by competitors or approved products post-market for related technology that raise FDA concerns about risk to patients of
the technology broadly; or if the FDA finds that the investigational protocol or plan is clearly deficient to meet its stated objectives;
●
difficulty
collaborating with patient groups and investigators;
●
failure
by our CROs, other third parties, or us to adhere to clinical study requirements;
●
failure
to perform in accordance with the FDA’s current Good Clinical Practices (“GCP”) requirements, or applicable regulatory
guidelines in other countries;
●
delays
in having patients qualify for or complete participation in a study or return for post-treatment follow-up;
●
patients
dropping out of a study;
●
occurrence
of adverse events associated with the product candidate that are viewed to outweigh its potential benefits;
38
●
changes
in the standard of care on which a clinical development plan was based, which may require new or additional trials;
●
transfer
of manufacturing processes from any academic collaborators to larger-scale facilities operated by either a contract manufacturing
organization (“CMO”) or by us, and delays or failure by our CMOs or us to make any necessary changes to such manufacturing
process;
●
delays
in manufacturing, testing, releasing, validating, or importing/exporting sufficient stable quantities of our product candidates for
use in clinical studies or the inability to do any of the foregoing;
●
the
FDA may not accept clinical data from trials that are conducted at clinical sites in countries where the standard of care is potentially
different from the United States; and
●
failure
to raise sufficient funds to complete our clinical trials.
Any
inability to successfully complete pre-clinical and clinical development could result in additional costs to us or impair our ability
to generate revenue. In addition, if we make manufacturing or formulation changes to our product candidates, we may be required, or we
may elect, to conduct additional studies to bridge our modified product candidates to earlier versions. Clinical study delays could also
shorten any periods during which our products have patent protection and may allow our competitors to bring products to market before
we do, which could impair our ability to successfully commercialize our product candidates and may harm our business and results of operations.
Even
if we are able to successfully complete our clinical development program for our product candidates, and ultimately receive regulatory
approval to market one or more of the products, we may, among other things:
●
obtain
approval for indications that are not as broad as the indications we sought;
●
have
the product removed from the market after obtaining marketing approval;
●
encounter
issues with respect to the manufacturing of commercial supplies;
●
be
subject to additional post-marketing testing requirements; and/or
●
be
subject to restrictions on how the product is distributed or used.
We
anticipate that we will not be able to commercialize our BRTX-100 product candidate for at least five years.
We
may experience delays and other difficulties in enrolling a sufficient number of patients in our clinical trials which could delay or
prevent the receipt of necessary regulatory approvals.
We
may not be able to initiate or complete as planned any clinical trials if we are unable to identify and enroll a sufficient number of
eligible patients to participate in the clinical trials required by the FDA or other regulatory authorities. We also may be unable to
engage a sufficient number of clinical trial sites to conduct our trials.
We
may face challenges in enrolling patients to participate in our clinical trials due to the novelty of our cell-based therapies, the size
of the patient populations and the eligibility criteria for enrollment in the trial. In addition, some patients may have concerns regarding
cell therapy that may negatively affect their perception of therapies under development and their decision to enroll in the trials. Furthermore,
patients suffering from diseases within target indications may enroll in competing clinical trials, which could negatively affect our
ability to complete enrollment of our trials. Enrollment challenges in clinical trials often result in increased development costs for
a product candidate, significant delays and potentially the abandonment of the clinical trial.
39
We
may have other delays in completing our clinical trials and we may not complete them at all.
We
have not commenced the clinical trials necessary to obtain FDA approval to market our product candidate, BRTX-100 , or any of our
other product candidates in development. Since our Company lacks significant experience in completing clinical trials and bringing a
drug through commercialization, we have hired outside consultants with such experience. Clinical trials for BRTX-100 and other
product candidates in development may be delayed or terminated as a result of many factors, including the following:
●
patients failing to complete
clinical trials due to dissatisfaction with the treatment, side effects or other reasons;
●
failure by regulators to
authorize us to commence a clinical trial;
●
suspension or termination
by regulators of clinical research for many reasons, including concerns about patient safety, the failure of study sites and/or investigators
in our clinical research program to comply with GCP requirements, or our failure, or the failure of our contract manufacturers, to
comply with current cGMP requirements;
●
delays or failure to obtain
clinical supply for our products necessary to conduct clinical trials from contract manufacturers;
●
treatment candidates demonstrating
a lack of efficacy during clinical trials;
●
treatment candidates demonstrating
significant safety signals; and/or
●
inability to continue to
fund clinical trials or to find a partner to fund the clinical trials.
Any
delay or failure to complete clinical trials and obtain FDA approval for our product candidates could have a material adverse effect
on our cost to develop and commercialize, and our ability to generate revenue from, a particular product candidate.
The
development of our cell therapy product candidates is subject to uncertainty because autologous cell therapy is inherently variable.
When
manufacturing an autologous cell therapy, the number and composition of the cell population varies from patient to patient. Such variability
in the number and composition of these cells could adversely affect our ability to manufacture autologous cell therapies in a cost-effective
or profitable manner and meet acceptable product release specifications for use in a clinical trial or, if approved, for commercial sale.
As a consequence, the development and regulatory approval process for autologous cell therapy products could be delayed or may never
be completed.
Any
disruption to our access to the media (including cell culture media) and reagents we are using in the clinical development of our cell
therapy product candidates could adversely affect our ability to perform clinical trials and seek future regulatory submissions.
Certain
media (including cell culture media) and reagents, as well as devices, materials and systems, that we intend to use in our planned clinical
trials, and that we may need or use in commercial production, are provided by unaffiliated third parties. Any lack of continued availability
of these media, reagents, devices, materials and systems for any reason would have a material adverse effect on our ability to complete
these studies and could adversely impact our ability to achieve commercial manufacture of our planned therapeutic products. Although
other available sources for these media, reagents, devices, materials and systems may exist in the marketplace, we have not evaluated
their cost, effectiveness, or intellectual property foundation and therefore cannot guarantee the suitability or availability of such
other potential sources.
Products
that appear promising in research and development may be delayed or may fail to reach later stages of clinical development.
The
successful development of cellular based products is highly uncertain. Product candidates that appear promising in preclinical and early
research and development may be delayed or fail to reach later stages of development. Decisions regarding the further development of
product candidates must be made with limited and incomplete data, which makes it difficult to ensure or even accurately predict whether
the allocation of limited resources and the expenditure of additional capital on specific product candidates will result in desired outcomes.
Pre-clinical and clinical data can be interpreted in different ways, and negative or inconclusive results or adverse events during a
clinical trial could delay, limit or prevent the development of a product candidate. Positive preclinical data may not continue or occur
for future subjects in our clinical studies and may not be repeated or observed in ongoing or future studies involving our product candidates.
Furthermore, our product candidates may also fail to show the desired safety and efficacy in later stages of clinical development despite
having successfully advanced through initial clinical studies. In addition, regulatory delays or rejections may be encountered as a result
of many factors, including changes in regulatory policy during the period of product development.
40
Our
clinical trials may fail to demonstrate adequately the safety and efficacy of our product candidates, which would prevent or delay regulatory
approval and commercialization.
The
clinical trials of our product candidates are, and the manufacturing and marketing of our products will be, subject to extensive and
rigorous review and regulation by numerous government authorities in the United States and in other countries where we intend to test
and market our product candidates. Before obtaining regulatory approvals for the commercial sale of any of our product candidates, we
must demonstrate through lengthy, complex and expensive preclinical testing and clinical trials that our product candidates are both
safe and effective for use in each target indication. In particular, because our product candidates are subject to regulation as biological
drug products, we will need to demonstrate that they are safe, pure, and potent for use in their target indications. Each product candidate
must demonstrate an adequate risk versus benefit profile in its intended patient population and for its intended use. The risk/benefit
profile required for product licensure will vary depending on these factors and may include decrease or elimination of pain, adequate
duration of response, a delay in the progression of the disease, an improvement in function and/or decrease in disability.
In
addition, even if such trials are successfully completed, we cannot guarantee that the FDA will interpret the results as we do, and more
trials could be required before we submit our product candidates for approval. To the extent that the results of the trials are not satisfactory
to the FDA for support of a marketing application, we may be required to expend significant resources, which may not be available to
us, to conduct additional trials in support of potential approval of our product candidates.
Even
if we complete the necessary clinical trials, we cannot predict when, or if, we will obtain regulatory approval to commercialize a product
candidate, and the approval may be for a narrower indication than we seek.
We
cannot commercialize a product candidate until the appropriate regulatory authorities have reviewed and approved the product candidate.
Even if our product candidates meet their safety and efficacy endpoints in clinical trials, the regulatory authorities may not complete
their review processes in a timely manner, or we may not be able to obtain regulatory approval. Additional delays may result if an FDA
Advisory Committee or other regulatory authority recommends non-approval or restrictions or conditions on approval. In addition, we may
experience delays or rejections based upon additional government regulation from future legislation or administrative action, or changes
in regulatory authority policy during the period of product development, clinical trials and the review process. Regulatory authorities
also may approve a product candidate for more limited indications than requested or they may impose significant limitations in the form
of narrow indications, contraindications or a Risk Evaluation and Mitigation Strategy (“REMS”). These regulatory authorities
may require warnings or precautions with respect to conditions of use or they may grant approval subject to the performance of costly
post-marketing clinical trials. In addition, regulatory authorities may not approve the labeling claims or allow the promotional claims
that are necessary or desirable for the successful commercialization of our product candidates. Any of the foregoing scenarios could
materially harm the commercial prospects for our product candidates and materially and adversely affect our business, financial condition,
results of operations and prospects.
We
may never obtain FDA approval for any of our product candidates in the United States and, even if we do, we may never obtain approval
for or commercialize any of our product candidates in any foreign jurisdiction, which would limit our ability to realize our full market
potential.
In
order to eventually market any of our product candidates in any particular foreign jurisdiction, we must establish and comply with numerous
and varying regulatory requirements regarding safety and efficacy on a jurisdiction-by-jurisdiction basis. Approval by the FDA in the
United States, if obtained, does not ensure approval by regulatory authorities in other countries or jurisdictions. In addition, preclinical
studies and clinical trials conducted in one country may not be accepted by regulatory authorities in other countries, and regulatory
approval in one country does not guarantee regulatory approval in any other country.
Approval
processes vary among countries and can involve additional product testing and validation and additional administrative review periods.
Seeking foreign regulatory approval could result in difficulties and costs for us and require additional preclinical studies or clinical
trials which could be costly and time consuming. Regulatory requirements can vary widely from country to country and could delay or prevent
the introduction of our product candidates in those countries. The foreign regulatory approval process involves similar risks to those
associated with FDA approval. We do not have any product candidates approved for sale in any jurisdiction, including international markets,
nor have we attempted to obtain such approval. If we fail to comply with regulatory requirements in international markets or to obtain
and maintain required approvals, or if regulatory approvals in international markets are delayed, our target market will be reduced and
our ability to realize the full market potential of our products may be unrealized.
41
We
presently lack manufacturing capabilities to produce our product candidates at commercial scale quantities and do not have an alternate
manufacturing supply, which could negatively impact our ability to meet any future demand for the products.
Currently,
we expect our laboratory (or a contract laboratory) to provide the cell processing services necessary for clinical production of BRTX-100
for our disc clinical trial. To date, we have not produced any products at our laboratory. We expect that we would need to significantly
expand our manufacturing capabilities to meet potential commercial demand for BRTX-100 and any other of our product candidates,
if approved, as well as any of our other product candidates that might attain regulatory approval. Such expansion would require additional
regulatory approvals. Even if we increase our manufacturing capabilities, it is possible that we may still lack sufficient capacity to
meet demand. Ultimately, if we are unable to supply our products to meet commercial demand, whether because of processing constraints
or other disruptions, delays or difficulties that we experience, sales of the products and their long-term commercial prospects could
be significantly damaged.
We
do not presently have a third-party manufacturer for BRTX-100 or any of our other product candidates. If our facilities at which
these product candidates would be manufactured or our equipment were significantly damaged or destroyed, or if there were other disruptions,
delays or difficulties affecting manufacturing capacity, our planned and future clinical studies and commercial production for these
product candidates would likely be significantly disrupted and delayed. It would be both time consuming and expensive to replace this
capacity with third parties, particularly since any new facility would need to comply with the regulatory requirements.
Ultimately,
if we are unable to supply our cell therapy product candidates to meet commercial demand (assuming commercial approval is obtained),
whether because of processing constraints or other disruptions, delays or difficulties that we experience, our production costs could
dramatically increase and sales of the product and its long-term commercial prospects could be significantly damaged.
The
commercial potential and profitability of our products are unknown and subject to significant risk and uncertainty.
Even
if we successfully develop and obtain regulatory approval for our cell therapy product candidates, the market may not understand or accept
the products, which could adversely affect both the timing and level of future sales. Ultimately, the degree of market acceptance of
our product candidates (or any of our future product candidates) will depend on a number of factors, including:
●
the
clinical effectiveness, safety and convenience of the product particularly in relation to alternative treatments;
●
our
ability to distinguish our products (which involve adult cells) from any ethical and political controversies associated with stem
cell products derived from human embryonic or fetal tissue; and
●
the
cost of the product, the reimbursement policies of government and third-party payors and our ability to obtain sufficient third-party
coverage or reimbursement.
Even
if we are successful in achieving sales of our product candidates, it is not clear to what extent, if any, the products will be profitable.
The costs of goods associated with production of cell therapy products are significant. In addition, some changes in manufacturing processes
or procedures generally require FDA or foreign regulatory authority review and approval prior to implementation. We may need to conduct
additional pre-clinical studies and clinical trials to support approval of any such changes. Furthermore, this review process could be
costly and time-consuming and could delay or prevent the commercialization of product candidates.
We
may have difficulties in sourcing brown adipose (fat) tissue.
We
use brown adipose (fat) tissue to identify and characterize brown adipose derived stem cells for use in our pre-clinical ThermoStem
Program. There is no certainty that we will be able to continue to collect brown adipose samples through any relationships that we
have, have had or may establish with potential sources of brown adipose tissue. The inability to procure brown fat tissue would have
a material adverse effect upon our ability to advance our ThermoStem Program.
42
We
are required to complete a certain milestone to maintain our exclusive license rights with regard to the disc/spine technology. The loss
of such exclusive rights would have a material adverse effect upon us.
Pursuant
to our license agreement with Regenerative Sciences, LLC, we must complete our Phase 2 clinical trial by a certain date (which we believe
to be February 2022) in order to maintain our exclusive rights with regard to the disc/spine technology. We will not be able to achieve
such milestone. Any loss of such exclusive rights would have a material adverse effect upon our business, results of operations and financial
condition. See “Business-Disc/Spine Program – License.”
If
safety problems are encountered by us or others developing new stem cell-based therapies, our stem cell initiatives could be materially
and adversely affected.
The
use of stem cells for therapeutic indications is still in the very early stages of development. If an adverse event occurs during clinical
trials related to one of our proposed products and/or services or those of others, the FDA and other regulatory authorities may halt
clinical trials or require additional studies. The occurrence of any of these events would delay, and increase the cost of, our development
efforts and may render the commercialization of our proposed products and/or services impractical or impossible.
We
are vulnerable to competition and technological change, and also to physicians’ inertia.
We
will compete with many domestic and foreign companies in developing our technology and products, including biotechnology, medical device
and pharmaceutical companies. Many current and potential competitors have substantially greater financial, technological, research and
development, marketing, and personnel resources. There is no assurance that our competitors will not succeed in developing alternative
products and/or services that are more effective, easier to use, or more economical than those which we may develop, or that would render
our products and/or services obsolete and non-competitive. In general, we may not be able to prevent others from developing and marketing
competitive products and/or services similar to ours or which perform similar functions or which are marketed before ours.
Competitors
may have greater experience in developing products, therapies or devices, conducting clinical trials, obtaining regulatory clearances
or approvals, manufacturing and commercialization. It is possible that competitors may obtain patent protection, approval or clearance
from the FDA or achieve commercialization earlier than we can, any of which could have a substantial negative effect on our business.
We
will compete against cell-based therapies derived from alternate sources, such as bone marrow, adipose tissue, umbilical cord blood and
potentially embryos. Doctors historically are slow to adopt new technologies like ours, whatever the merits, when older technologies
continue to be supported by established providers. Overcoming such inertia often requires very significant marketing expenditures or
definitive product performance and/or pricing superiority.
We
expect that physicians’ inertia and skepticism will also be a significant barrier as we attempt to gain market penetration with
our future products and services. We may need to finance lengthy time-consuming clinical studies (so as to provide convincing evidence
of the medical benefit) in order to overcome this inertia and skepticism.
We
may form or seek collaborations or strategic alliances or enter into additional licensing arrangements in the future, and we may not
realize the benefits of such alliances or licensing arrangements.
We
may form or seek strategic alliances, create joint ventures or collaborations, or enter into additional licensing arrangements with third
parties that we believe will complement or augment our development and commercialization efforts with respect to our product candidates
and any future product candidates that we may develop. Any of these relationships may require us to incur non-recurring and other charges,
increase our near and long-term expenditures, issue securities that dilute the shares of our existing stockholders, or disrupt our management
and business. In addition, we face significant competition in seeking appropriate strategic partners and the negotiation process is time-consuming
and complex. Moreover, we may not be successful in our efforts to establish a strategic partnership or other alternative arrangements
for our product candidates because they may be deemed to be at too early of a stage of development for collaborative effort and third
parties may not view our product candidates as having the requisite potential to demonstrate safety and efficacy. To date, such efforts
have not been successful.
43
Further,
collaborations involving our product candidates, such as our collaborations with third-party research institutions, are subject to numerous
risks, which may include the following:
●
collaborators
have significant discretion in determining the efforts and resources that they will apply to a collaboration;
●
collaborators
may not pursue development and commercialization of our product candidates or may elect not to continue or renew development or commercialization
programs based on clinical trial results, changes in their strategic focus due to the acquisition of competitive products, availability
of funding, or other external factors, such as a business combination that diverts resources or creates competing priorities;
●
collaborators
may delay clinical trials, provide insufficient funding for a clinical trial, stop a clinical trial, abandon a product candidate,
repeat or conduct new clinical trials, or require a new formulation of a product candidate for clinical testing;
●
collaborators
could independently develop, or develop with third parties, products that compete directly or indirectly with our products or product
candidates;
●
a
collaborator with marketing and distribution rights to one or more products may not commit sufficient resources to their marketing
and distribution;
●
collaborators
may not properly maintain or defend our intellectual property rights or may use our intellectual property or proprietary information
in a way that gives rise to actual or threatened litigation that could jeopardize or invalidate our intellectual property or proprietary
information or expose us to potential liability;
●
disputes
may arise between us and a collaborator that cause the delay or termination of the research, development or commercialization of
our product candidates, or that result in costly litigation or arbitration that diverts management attention and resources;
●
collaborations
may be terminated and, if terminated, may result in a need for additional capital to pursue further development or commercialization
of the applicable product candidates; and
●
collaborators
may own or co-own intellectual property covering our products that results from our collaborating with them, and in such cases, we
would not have the exclusive right to commercialize such intellectual property.
As
a result, if we enter into collaboration agreements and strategic partnerships or license our products or businesses, we may not be able
to realize the benefit of such transactions if we are unable to successfully integrate them with our existing operations and company
culture, which could delay our timelines or otherwise adversely affect our business. We also cannot be certain that, following a strategic
transaction or license, we will achieve the revenue or specific net income that justifies such transaction. Any delays in entering into
new collaborations or strategic partnership agreements related to our product candidates could delay the development and commercialization
of our product candidates in certain geographies for certain indications, which would harm our business prospects, financial condition,
and results of operations.
We
have limited experience in the development and marketing of cell therapies and may be unsuccessful in our efforts to establish a profitable
business.
Our
business plan has been focused historically on capturing a piece of the burgeoning field of cell therapy. We have limited experience
in the areas of cell therapy product development and marketing, and in the related regulatory issues and processes. Although we have
recruited a team that has experience with designing and conducting clinical trials and have hired FDA consultants, as a company, we have
limited experience in conducting clinical trials and no experience in conducting clinical trials through to regulatory approval of any
product candidate. In part because of this lack of experience, we cannot be certain that planned clinical trials will begin or be completed
on time, if at all. We cannot assure that we will successfully achieve our clinical development goals or fulfill our plans to capture
a piece of the cell therapy market.
44
Our
cell therapy business is based on novel technologies that are inherently expensive, risky and may not be understood by or accepted in
the marketplace, which could adversely affect our future value.
The
clinical development, commercialization and marketing of cell and tissue-based therapies are at an early-stage, substantially research-oriented,
and financially speculative. To date, very few companies have been successful in their efforts to develop and commercialize a cell therapy
product. In general, cell-based or tissue-based products may be susceptible to various risks, including undesirable and unintended side
effects, unintended immune system responses, inadequate therapeutic efficacy, or other characteristics that may prevent or limit their
approval or commercial use. In addition, BRTX-100 is a cell-based candidate that is produced by using a patient’s own stem
cells derived from bone marrow. Regulatory approval of novel product candidates such as BRTX-100 , which is manufactured using
novel manufacturing processes, can be more complex and expensive and take longer than other, more well-known or extensively studied pharmaceutical
or biopharmaceutical products, due to the FDA’s lack of experience with them. To our knowledge, the FDA has not yet approved a
disc related stem cell therapy product. This lack of experience may lengthen the regulatory review process, require us to conduct additional
studies or clinical trials, which would increase our development costs, lead to changes in regulatory positions and interpretations,
delay or prevent approval and commercialization of these product candidates or lead to significant post-approval limitations or restrictions.
Furthermore, the number of people who may use cell or tissue-based therapies is difficult to forecast with accuracy. Our future success
is dependent on the establishment of a large global market for cell- and tissue-based therapies and our ability to capture a share of
this market with our product candidates.
Our
cell therapy product candidates for which we intend to seek approval as biologic products may face competition sooner than anticipated.
The
enactment of the Biologics Price Competition and Innovation Act of 2009 (“BPCIA”) created an abbreviated regulatory pathway
for the approval of products demonstrated to be biosimilar, or “highly similar,” to or “interchangeable” with
an FDA-approved innovator (original) biologic product. The abbreviated regulatory pathway establishes legal authority for the FDA to
review and approve biosimilar biologics, including the possible designation of a biosimilar as “interchangeable” based on
its similarity to an existing reference product. Under the BPCIA, an application for a biosimilar product cannot be approved by the FDA
until 12 years after the original branded product is approved under a biologics license application (“BLA”). Although the
FDA has approved several biosimilar products, complex provisions of the law are still being implemented by the FDA and interpreted by
the federal courts. As a result, the ultimate impact, implementation, and meaning of the BPCIA are still subject to some uncertainty
and FDA actions and court decisions concerning the law could have a material adverse effect on the future commercial prospects for our
biological products.
We
believe that, if any of our product candidates are approved as a biological product under a BLA, it should qualify for the 12-year period
of exclusivity. However, there is a risk that the FDA could approve biosimilar applicants for other reference products that no longer
have such exclusivity, thus potentially creating the opportunity for greater competition sooner than anticipated. Moreover, the extent
to which a biosimilar, once approved, will be substituted for any one of our reference products in a way that is similar to traditional
generic substitution for non-biological products is not yet clear, and will depend on a number of marketplace and regulatory factors
that are still developing.
The
FDA’s regulation of regenerative medicine products remains unpredictable and we are not certain what impact this will have on the
potential approval of our products.
The
FDA’s regulation of therapies derived from stem cell products and technologies is evolving and may continue to evolve. In December
2016, the 21st Century Cures Act (the “Cures Act”) was signed into law in the United States to advance access to medical
innovations. Among other things, the Cures Act established a new FDA regenerative medicine advanced therapy (“RMAT”) designation.
This designation offers a variety of benefits to product candidates, including enhanced FDA support during clinical development, priority
review on application filing, accelerated approval based on potential surrogate endpoints, and the potential use of patient registry
data and other forms of real world evidence for post-approval confirmatory studies. There is no certainty that any of our product candidates
will receive RMAT designation or any other type of expedited review program designation from the FDA. In any event, the receipt of an
FDA RMAT designation or other expedited review program designation may not result in a faster development process, review or approval
compared to products considered for approval under conventional FDA procedures and does not assure ultimate approval by the FDA.
We
may be subject to significant product liability claims and litigation, including potential exposure from the use of our product candidates
in human subjects, and our insurance may be inadequate to cover claims that may arise.
Our
business exposes us to potential product liability risks inherent in the testing, processing and marketing of cell therapy products.
Such liability claims may be expensive to defend and result in large judgments against us. We face an inherent risk of product liability
exposure related to the testing of our current and any future product candidates in human clinical trials and will face an even greater
risk with respect to any commercial sales of our products should they be approved. No product candidate has been widely used over an
extended period of time, and therefore safety data is limited. Cell therapy companies derive the raw materials for manufacturing of product
candidates from human cell sources, and therefore the manufacturing process and handling requirements are extensive, which increases
the risk of quality failures and subsequent product liability claims.
45
We
will need to maintain insurance coverage adequate to cover our clinical trials and increase that coverage before commercializing product
candidates, if ever. At any time during our clinical trials or after commercialization, if that occurs, we may not be able to obtain
or maintain product liability insurance on acceptable terms with adequate coverage or at all, or if claims against us substantially exceed
our coverage, then our financial position could be significantly impaired.
Whether
or not we are ultimately successful in any product liability litigation that may arise, such litigation could consume substantial amounts
of our financial and managerial resources, result in decreased demand for our products and injure our reputation.
We
seek to maintain errors and omissions, directors and officers, workers’ compensation and other insurance at levels we believe to
be appropriate to our business activities. If, however, we were subject to a claim in excess of this coverage or to a claim not covered
by our insurance and the claim succeeded, we would be required to pay the claim from our own limited resources, which could have a material
adverse effect on our financial condition, results of operations and business. Additionally, liability or alleged liability could harm
our business by diverting the attention and resources of our management and damaging our reputation.
Our
internal computer systems, or those that are expected to be used by our clinical investigators, clinical research organizations or other
contractors or consultants, may fail or suffer security breaches, which could result in a material disruption of development programs
for our product candidates.
We
rely on information technology systems to keep financial records, maintain laboratory and corporate records, communicate with staff and
external parties and operate other critical functions. Any significant degradation or failure of these computer systems could cause us
to inaccurately calculate or lose data. Despite the implementation of security measures, these internal computer systems and those used
by our clinical investigators, clinical research organizations, and other contractors and consultants are vulnerable to damage from computer
viruses, unauthorized access, natural disasters, terrorism, war, and telecommunication and electrical failures. The techniques that could
be used by criminal elements or foreign governments to attack these computer systems are sophisticated, change frequently and may originate
from less regulated and remote areas of the world. While we have not experienced any such system failure, theft of information, accident
or security breach to date, if such an event were to occur and cause interruptions in our operations, it could result in a material disruption
of our clinical development activities. For example, the loss of clinical trial data from historical or future clinical trials could
result in delays in regulatory approval efforts and significantly increase costs to recover or reproduce the data. To the extent that
any disruption, theft of information, or security breach were to result in a loss of or damage to data or applications, or inappropriate
disclosure of confidential or proprietary information, we could incur liability and the clinical development and the future development
of our product candidates could be delayed.
To
operate and sell in international markets carries great risk.
We
intend to market our products and services both domestically and in foreign markets. A number of risks are inherent in international
transactions. In order for us to market our products and services in non-U.S. jurisdictions, we need to obtain and maintain required
regulatory approvals or clearances in these countries and must comply with the country specific regulations regarding safety, manufacturing
processes and quality. These regulations, including the requirements for approvals or clearances to market, may differ from the FDA regulatory
scheme. International operations and sales also may be limited or disrupted by political instability, price controls, trade restrictions
and changes in tariffs. Additionally, fluctuations in currency exchange rates may adversely affect demand for our services and products
by increasing the price of our products and services in the currency of the countries in which the products and services are offered.
There
can be no assurance that we will obtain regulatory approvals or clearances in all of the countries where we intend to market our products
and services, or that we will not incur significant costs in obtaining or maintaining foreign regulatory approvals or clearances, or
that we will be able to successfully commercialize our products and services in various foreign markets. Delays in receipt of approvals
or clearances to market our products and services in foreign countries, failure to receive such approvals or clearances or the future
loss of previously received approvals or clearances could have a substantial negative effect on our results of operations and financial
condition.
46
Our
inability to obtain reimbursement for our products and services from private and governmental insurers could negatively impact demand
for our products and services.
Market
acceptance and sales of our product candidates may depend on coverage and reimbursement policies and health care reform measures. Decisions
about formulary coverage as well as levels at which government authorities and third-party payors, such as private health insurers and
health maintenance organizations, reimburse patients for the price they pay for our product candidates, as well as levels at which these
payors pay directly for our product candidates, where applicable, could affect whether we are able to successfully commercialize these
products. We cannot guarantee that reimbursement will be available for any of our product candidates. We also cannot guarantee that coverage
or reimbursement amounts will not reduce the demand for, or the price of, our product candidates.
If
coverage and reimbursement are not available or are available only at limited levels, we may not be able to successfully commercialize
our products. The Patient Protection and Affordable Care Act (“PPACA”) and other health reform proposals include measures
that would limit or prohibit payments for certain medical treatments or subject the pricing of drugs to government control. In addition,
in many foreign countries, particularly the countries of the European Union (the “EU”), the pricing of drugs and biologics
is subject to government control. If our products are or become subject to government regulation that limits or prohibits payment for
our products, or that subjects the price of our products to government control, we may not be able to generate revenue, attain profitability
or commercialize our products.
In
addition, third-party payors are increasingly limiting both coverage and the level of reimbursement of new drugs and biologics. They
may also impose strict prior authorization requirements and/or refuse to provide any coverage of uses of approved products for medical
indications other than those for which the FDA has granted market approvals. As a result, significant uncertainty exists as to whether
and how much third-party payors will reimburse patients for their use of newly-approved drugs and biologics. If we are unable to obtain
adequate levels of reimbursement for our product candidates, our ability to successfully market and sell our product candidates will
be harmed.
Risks
Related to Our Intellectual Property
We
may not be able to protect our proprietary rights.
Our
commercial success will depend in large part upon our ability to protect our proprietary rights. There is no assurance, for example,
that any additional patents will be issued based on our or our licensor’s pending applications or, if issued, that such patents
will not become the subject of a re-examination, will provide us with competitive advantages, will not be challenged by any third parties,
or that the patents of others will not prevent the commercialization of products and services incorporating our technology. Furthermore,
there can be no guarantee that others will not independently develop similar products and services, duplicate any of our products and
services, or design around any patents we obtain.
Our
commercial success will also depend upon our ability to avoid infringing patents issued to others. If we were judicially determined to
be infringing on any third-party patent, we could be required to pay damages, alter our products, services or processes, obtain licenses,
or cease certain activities. If we are required in the future to obtain any licenses from third parties for some of our products and/or
services, there can be no guarantee that we would be able to do so on commercially favorable terms, if at all. United States and foreign
patent applications are not immediately made public, so we might be surprised by the grant to someone else of a patent on a technology
we are actively using. Although we conducted a freedom to operate (“FTO”) search on the licensed technology associated with
our Disc/Spine Program , modifications made, and/or further developments that may be made, to that technology may not be covered
by the initial FTO. No FTO has been undertaken with respect to our ThermoStem brown fat initiative.
Litigation,
which would result in substantial costs to us and the diversion of effort on our part, may be necessary to enforce or confirm the ownership
of any patents issued or licensed to us, or to determine the scope and validity of third-party proprietary rights. If our competitors
claim technology also claimed by us and prepare and file patent applications in the United States, we may have to participate in interference
proceedings declared by the U.S. Patent and Trademark Office (the “Patent Office”) or a foreign patent office to determine
priority of invention, which could result in substantial costs and diversion of effort, even if the eventual outcome is favorable to
us. Any such litigation or interference proceeding, regardless of outcome, could be expensive and time-consuming.
47
Successful
challenges to our patents through oppositions, re-examination proceedings or interference proceedings could result in a loss of patent
rights in the relevant jurisdiction. If we are unsuccessful in actions we bring against the patents of other parties, and it is determined
that we infringe upon the patents of third parties, we may be subject to litigation, or otherwise prevented from commercializing potential
products and/or services in the relevant jurisdiction, or may be required to obtain licenses to those patents or develop or obtain alternative
technologies, any of which could harm our business. Furthermore, if such challenges to our patent rights are not resolved in our favor,
we could be delayed or prevented from entering into new collaborations or from commercializing certain products and/or services, which
could adversely affect our business and results of operations.
Furthermore,
because of the substantial amount of discovery required in connection with intellectual property litigation, there is a risk that some
of our confidential or sensitive information could be compromised by disclosure in the event of litigation. In addition, during the course
of litigation there could be public announcements of the results of hearings, motions or other interim proceedings or developments. If
securities analysts or investors perceive these results to be negative, it could have a substantial adverse effect on the price of our
common stock.
In
addition to patents, we rely on unpatented trade secrets and proprietary technological expertise. Some of our intended future cell-related
therapeutic products and/or services may fit into this category. We also rely, in part, on confidentiality agreements with our partners,
employees, advisors, vendors, and consultants to protect our trade secrets and proprietary technological expertise. There can be no guarantee
that these agreements will not be breached, or that we will have adequate remedies for any breach, or that our unpatented trade secrets
and proprietary technological expertise will not otherwise become known or be independently discovered by competitors.
Failure
to obtain or maintain patent protection, failure to protect trade secrets, third-party claims against our patents, trade secrets, or
proprietary rights or our involvement in disputes over our patents, trade secrets, or proprietary rights, including involvement in litigation,
could divert our efforts and attention from other aspects of our business and have a substantial negative effect on our results of operations
and financial condition.
We
may not be able to protect our intellectual property in countries outside of the United States.
Intellectual
property law outside the United States is uncertain and, in many countries, is currently undergoing review and revisions. The laws of
some countries do not protect our patent and other intellectual property rights to the same extent as United States laws. Third parties
may attempt to oppose the issuance of patents to us in foreign countries by initiating opposition proceedings. Opposition proceedings
against any of our patent filings in a foreign country could have an adverse effect on our corresponding patents that are issued or pending
in the United States. It may be necessary or useful for us to participate in proceedings to determine the validity of our patents or
our competitors’ patents that have been issued in countries other than the United States. This could result in substantial costs,
divert our efforts and attention from other aspects of our business, and could have a material adverse effect on our results of operations
and financial condition.
Changes
to United States patent law may have a material adverse effect on our intellectual property rights.
The
Leahy-Smith America Invents Act (“AIA”), which was signed into law in 2011, significantly changes United States patent law.
It may take some time to establish what the law means, since it is just being interpreted by the lower courts, Federal Circuit Courts
of Appeal, and the Supreme Court. The effects of these decisions are still not known. The first major change is that AIA switches the
United States patent system from a “first to invent” system to a “first to file” system. Now that the first to
file system is in effect, there is a risk that another company may independently develop identical or similar patents at approximately
the same time, and be awarded the patents instead of us. Further, for the second major change, AIA abolished interference proceedings,
and establishes derivation proceedings to replace interference proceedings in all cases in which the time period for instituting an interference
proceeding has not lapsed where an inventor named in an earlier application derived the claimed invention from a named inventor. Now
that the derivation proceedings are in effect, there is a risk that the inventorship of any pending patent application can be challenged
for reasons of derivation. The third major change is that AIA established post-grant opposition proceedings that will apply only to patent
applications filed after “first to file” became effective. Post-grant opposition will enable a person who is not the patent
owner to initiate proceedings in the Patent Office within nine months after the grant of a patent that can result in cancellation of
a patent as invalid. In addition to AIA, recent court decisions have created uncertainty with regard to our ability to obtain and maintain
patents. Therefore there is a risk that any of our patents once granted may be subject to post-grant opposition, which will increase
uncertainty on the validity of any newly granted patent or may ultimately result in cancellation of the patent.
48
In
addition, the Supreme Court has recently taken more limiting positions as to what constitutes patentable subject matter. As a result,
many patents covering what were previously patentable inventions are now determined to cover inventions which are deemed non-statutory
subject matter and are now invalid. As a result of this and subsequent opinions by the Court of Appeals for the Federal Circuit, the
Patent Office is now applying more stringent limitations to claims in patent applications and is refusing to grant patents in areas of
technology where patents were previously deemed available. Therefore there is a risk that we will be unable to acquire patents to cover
our products and if such patents are granted they may subsequently be found to be invalid.
In
certain countries, patent holders may be required to grant compulsory licenses, which would likely have a significant and detrimental
effect on any future revenues in such country.
Many
countries, including some countries in Europe, have compulsory licensing laws under which a patent owner may be compelled to grant licenses
to third parties. In addition, most countries limit the enforceability of patents against government agencies or government contractors.
In these countries, the patent owner may be limited to monetary relief and may be unable to enjoin infringement, which could materially
diminish the value of the patent. Compulsory licensing of life-saving products is also becoming increasingly common in developing countries,
either through direct legislation or international initiatives. Such compulsory licenses could be extended to our product candidates,
which may limit our potential revenue opportunities, including with respect to any future revenues that may result from our product candidates.
Risks
Related to Government Regulation
Even
if we obtain regulatory approval for a product candidate, our products will remain subject to regulatory oversight.
Our
product candidates for which we obtain regulatory approval will be subject to ongoing regulatory requirements for manufacturing, labeling,
packaging, storage, advertising, promotion, record-keeping and submission of safety and other post-market information. Any regulatory
approvals that we receive for our product candidates also may be subject to a REMS or the specific obligations imposed as a condition
for marketing authorization by equivalent authorities in a foreign jurisdiction, limitations on the approved indicated uses for which
the product may be marketed or to the conditions of approval, or contain requirements for potentially costly post-marketing testing,
including Phase 4 clinical trials, and surveillance to monitor the quality, safety and efficacy of the product. For example, in the United
States, the holder of an approved new drug application (“NDA”) or BLA is obligated to monitor and report adverse events and
any failure of a product to meet the specifications in the NDA or BLA. The holder of an approved NDA or BLA also must submit new or supplemental
applications and obtain FDA approval for certain changes to the approved product, product labeling or manufacturing process. Advertising
and promotional materials must comply with the Federal Food, Drug and Cosmetic Act (“FDCA”) and implementing regulations
and are subject to FDA oversight and post-marketing reporting obligations, in addition to other potentially applicable federal and state
laws.
In
addition, product manufacturers and their facilities may be subject to payment of application and program fees and are subject to continual
review and periodic inspections by the FDA and other regulatory authorities for compliance with cGMP requirements and adherence to commitments
made in the NDA, BLA or foreign marketing application. If we or a regulatory authority discover previously unknown problems with a product,
such as adverse events of unanticipated severity or frequency, or problems with the facility where the product is manufactured, or if
a regulatory authority disagrees with the promotion, marketing or labeling of our product, a regulatory authority may impose restrictions
relative to that product, the manufacturing facility or us, including requiring recall or withdrawal of the product from the market or
suspension of manufacturing.
If
we fail to comply with applicable regulatory requirements for any product candidate following approval, a regulatory authority may:
●
issue
a warning or untitled letter asserting that we are in violation of the law;
●
seek
an injunction or impose administrative, civil or criminal penalties or monetary fines;
●
suspend
or withdraw regulatory approval;
●
suspend
any ongoing clinical trials;
49
●
refuse
to approve a pending BLA or comparable foreign marketing application (or any supplements thereto) submitted by us or our strategic
partners;
●
restrict
the marketing or manufacturing of the product;
●
seize
or detain the product or otherwise demand or require the withdrawal or recall of the product from the market;
●
refuse
to permit the import or export of products;
●
request
and publicize a voluntary recall of the product; or
●
refuse
to allow us to enter into supply contracts, including government contracts.
Any
government enforcement action or investigation of alleged violations of law could require us to expend significant time and resources
in response and could generate negative publicity. The occurrence of any event or penalty described above may inhibit our ability to
commercialize our product candidates and adversely affect our business, financial condition, results of operations and prospects.
We
may be subject, directly or indirectly, to federal and state healthcare fraud and abuse laws, false claims laws and health information
privacy and security laws. If we are unable to comply, or have not fully complied, with such laws, we could face substantial penalties.
In
the United States, the research, manufacturing, distribution, sale, and promotion of drugs and biologic products are subject to regulation
by various federal, state, and local authorities, including the FDA, the Centers for Medicare and Medicaid Services (“CMS”),
other divisions the Department of Health and Human Services (“HHS”) (e.g., the Office of Inspector General), the United States
Department of Justice offices of the United States Attorney, the Federal Trade Commission and state and local governments. Our operations
are directly, or indirectly through our prescribers, customers and purchasers, subject to various federal and state fraud and abuse laws
and regulations, including the federal Anti-Kickback Statute (“AKS”), the federal civil and criminal False Claims Act (“FCA”),
the Physician Payments Sunshine Act and regulations and equivalent provisions in other countries. In addition, we may be subject to patient
privacy laws by both the federal government and the states in which we conduct our business.
State
and federal regulatory and enforcement agencies continue actively to investigate violations of health care laws and regulations, and
the United States Congress continues to strengthen the arsenal of enforcement tools. Most recently, the Bipartisan Budget Act of 2018
increased the criminal and civil penalties that can be imposed for violating certain federal health care laws, including the AKS. Enforcement
agencies also continue to pursue novel theories of liability under these laws. Government agencies have recently increased regulatory
scrutiny and enforcement activity with respect to programs supported or sponsored by pharmaceutical companies, including reimbursement
and co-pay support, funding of independent charitable foundations and other programs that offer benefits for patients. Several investigations
into these programs have resulted in significant civil and criminal settlements.
Because
of the breadth of these laws and the narrowness of the statutory exceptions and safe harbors available, it is possible that some of our
business activities could be subject to challenge under one or more of such laws. If our operations are found to be in violation of any
of the laws described above or any other government regulations that apply to us, we may be subject to penalties, including civil and
criminal penalties, damages, fines, exclusion from participation in government health care programs, such as Medicare and Medicaid, imprisonment
and the curtailment or restructuring of our operations, any of which could adversely affect our ability to operate our business and our
results of operations. Even if we are not determined to have violated these laws, government investigations into these issues typically
require the expenditure of significant resources and generate negative publicity, which could harm our financial condition and divert
the attention of our management from operating our business.
Further,
in the event we determine to operate in foreign jurisdictions, including conducting clinical trials, we will need to comply with the
United States Foreign Corrupt Practices Act of 1977 (the “FCPA”). The FCPA prohibits a corporation, including its subsidiaries,
third-party contractors, distributors, consultants and employees, from corruptly making or offering to make payments to foreign officials
for the purpose of obtaining or enhancing business. Under the law, “foreign officials” include employees of health systems
operated by government entities. The FCPA also establishes specific record-keeping and internal accounting controls. Violations of the
FCPA can result in the imposition of civil penalties or criminal prosecution. Failure to comply with the FCPA will adversely affect our
business.
50
In
addition to the FCPA, we will also need to comply with the foreign government laws and regulations of each individual country in which
any therapy centers that we may establish are located and products are to be distributed and sold. These regulations vary in complexity
and can be as stringent, and on occasion even more stringent, than FDA regulations in the United States. Due to the fact that there are
new and emerging stem cell and cell therapy regulations that have recently been drafted and/or implemented in various countries around
the world, the application and subsequent implementation of these new and emerging regulations have little to no precedence. Therefore,
the level of complexity and stringency is not always precisely understood today for each country, creating greater uncertainty for the
international regulatory process. Furthermore, there can be no guarantee that laws and regulations will not be implemented, amended and/or
reinterpreted in a way that will negatively affect our business. Likewise, there can be no assurance that we will be able, or will have
the resources, to maintain compliance with all such healthcare laws and regulations. Failure to comply with such healthcare laws and
regulations, as well as the costs associated with such compliance or with enforcement of such healthcare laws and regulations, may have
a material adverse effect on our operations or may require restructuring of our operations or impair our ability to operate profitably.
Our
current and future employees, consultants and advisors and our future principal investigators, medical institutions and commercial partners
may engage in misconduct or other improper activities, including non-compliance with regulatory standards and requirements.
We
are exposed to the risk of fraud or other misconduct by our current and future employees, consultants and advisors and our future principal
investigators, medical institutions and commercial partners, including contract laboratories, and CROs. Misconduct by these parties could
include intentional failures to comply with FDA regulations or the regulations applicable in other jurisdictions, provide accurate information
to the FDA and other regulatory authorities, comply with healthcare fraud and abuse laws and regulations in the United States and abroad,
report financial information or data accurately or disclose unauthorized activities to us.
We
currently do not and in the future may not independently conduct all aspects of our product candidate research and preclinical and clinical
testing and product candidate manufacturing. If we rely on third parties, including CROs, medical institutions, and contract laboratories
to monitor and manage data for our ongoing preclinical and clinical programs, we will still maintain responsibility for ensuring their
activities are conducted in accordance with the applicable study protocol, legal, regulatory and scientific standards. We and our third-party
vendors will be required to comply with current cGMP, GCP, and Good Laboratory Practice (“GLP”) requirements, which are a
collection of laws and regulations enforced by the FDA, the EU and comparable foreign authorities for all of our product candidates in
clinical development.
In
addition, sales, marketing and business arrangements in the healthcare industry are subject to extensive laws and regulations intended
to prevent fraud, misconduct, kickbacks, self-dealing and other abusive practices. These laws and regulations restrict or prohibit a
wide range of pricing, discounting, marketing and promotion, sales commission, customer incentive programs and other business arrangements.
Such misconduct also could involve the improper use of information obtained in the course of clinical trials or interactions with the
FDA or other regulatory authorities, which could result in regulatory sanctions and cause serious harm to our reputation.
The
precautions we take to detect and prevent employee and third-party misconduct may not be effective in controlling unknown or unmanaged
risks or losses or in protecting us from government investigations or other actions or lawsuits stemming from a failure to comply with
these laws or regulations. If any such actions are instituted against us, and we are not successful in defending ourselves or asserting
our rights, those actions could have a significant impact on our business, financial condition, results of operations and prospects,
including the imposition of significant fines or other sanctions.
51
The
failure to receive regulatory approvals for our cell therapy product candidates would likely have a material and adverse effect on our
business and prospects.
To
date, we have not received regulatory approval to market any of our product candidates in any jurisdiction. If we seek approval of any
of our cell therapy product candidates, we will be required to submit to the FDA and potentially other regulatory authorities extensive
pre-clinical and clinical data supporting its safety and efficacy, as well as information about the manufacturing process and to undergo
inspection of our manufacturing facility or other contract manufacturing facilities, if utilized, among other things. The process of
obtaining FDA and other regulatory approvals is expensive, generally takes many years and is subject to numerous risks and uncertainties,
particularly with complex and/or novel product candidates such as our cell-based product candidates. Changes in regulatory approval requirements
or policies may cause delays in the approval or rejection of an application or may make it easier for our competitors to gain regulatory
approval to enter the marketplace. Ultimately, the FDA and other regulatory agencies have substantial discretion in the approval process
and may refuse to accept any application or may decide that our product candidate data are insufficient for approval without the submission
of additional preclinical, clinical or other studies. In addition, varying agency interpretations of the data obtained from preclinical
and clinical testing could delay, limit or prevent regulatory approval of a product candidate. Any difficulties or failures that we encounter
in securing regulatory approval for our product candidates would likely have a substantial adverse impact on our ability to generate
product sales, and could make any search for a collaborative partner more difficult. Similarly, any regulatory approval we ultimately
obtain may be limited or subject to restrictions or post-approval commitments that render the approved product not commercially viable.
If
we are unable to conduct clinical studies in accordance with regulations and accepted standards, we may be delayed in receiving, or may
never receive, regulatory approvals of our product candidates from the FDA and other regulatory authorities.
To
obtain marketing approvals for our product candidates in the United States and abroad, we must, among other requirements, complete adequate
and well-controlled clinical trials sufficient to demonstrate to the FDA and other regulatory bodies that the product candidate is safe
and effective for each indication for which approval is sought. If the FDA finds that patients enrolled in the trial are or would be
exposed to an unreasonable and significant risk of illness or injury, due to, among other things, occurrence of a serious adverse event
in an ongoing clinical trial, the FDA can place one or more of our clinical trials on hold. If safety concerns develop, we may, or the
FDA or an institutional review board may require us to, stop the affected trials before completion.
The
completion of our clinical trials also may be delayed or terminated for a number of other reasons, including if:
●
third-party
clinical investigators do not perform the clinical trials on the anticipated schedule or consistent with the clinical trial protocol,
good clinical practices required by the FDA and other regulatory requirements, or other third parties do not perform data collection
and analysis in a timely or accurate manner;
●
inspections
of clinical trial sites by the FDA or other regulatory authorities reveal violations that require us to undertake corrective action,
suspend or terminate one or more sites, or prohibit use of some or all of the data in support of marketing applications; or
●
the
FDA or one or more institutional review boards suspends or terminates the trial at an investigational site, or precludes enrollment
of additional subjects.
Our
development costs will increase if there are material delays in our clinical trials, or if we are required to modify, suspend, terminate
or repeat a clinical trial. If we are unable to conduct our clinical trials properly, we may never receive regulatory approval to market
our product candidates.
Health
care companies have been the subjects of federal and state investigations, and we could become subject to investigations in the future.
Both
federal and state government agencies have heightened civil and criminal enforcement efforts. There are numerous ongoing investigations
of health care companies, as well as their executives and managers. In addition, amendments to the federal FCA, including under healthcare
reform legislation, have made it easier for private parties to bring “ qui tam ” (or whistleblower) lawsuits against
companies under which the whistleblower may be entitled to receive a percentage of any money paid to the government. The FCA provides,
in part, that an action can be brought against any person or entity that has knowingly presented, or caused to be presented, a false
or fraudulent request for payment from the federal government, or who has made a false statement or used a false record to get a claim
approved. The government has taken the position that claims presented in violation of the federal AKS, Stark Law or other healthcare-related
laws, including laws enforced by the FDA, may be considered a violation of the FCA. Penalties include substantial fines for each false
claim, plus three times the amount of damages that the federal government sustained because of the act of that person or entity and/or
exclusion from the Medicare program. In addition, a majority of states have adopted similar state whistleblower and false claims provisions.
We
are not aware of any government investigations involving any of our facilities or management. While we believe that we are in compliance
with applicable governmental healthcare laws and regulations, any future investigations of our business or executives could cause us
to incur substantial costs, and result in significant liabilities or penalties, as well as damage to our reputation.
52
It
is uncertain to what extent the government, private health insurers and third-party payors will approve coverage or provide reimbursement
for the therapies and products to which our services relate. Availability for such reimbursement may be further limited by reductions
in Medicare, Medicaid and other federal healthcare program funding in the United States.
To
the extent that health care providers cannot obtain coverage or reimbursement for our products and therapies, they may elect not to provide
such products and therapies to their patients and, thus, may not need our services. Further, as cost containment pressures are increasing
in the health care industry, government and private payors may adopt strategies designed to limit the amount of reimbursement paid to
health care providers.
Similarly,
the trend toward managed health care and bundled pricing for health care services in the United States, could significantly influence
the purchase of healthcare products and services, resulting in lower prices and reduced demand for our therapeutic products under development.
We
may directly or indirectly receive revenues from federal health care programs, such as Medicare. Federal health care programs are subject
to changes in coverage and reimbursement rules and procedures, including retroactive rate adjustments. These contingencies could materially
decrease the range of services covered by such programs or the reimbursement rates paid directly or indirectly for our products and services.
To the extent that any health care reform favors the reimbursement of other therapies over our therapeutic products under development,
such reform could affect our ability to sell our services, which may have a material adverse effect on our revenues.
The
limitation on reimbursement available from private and government payors may reduce the demand for, or the price of, our products and
services, which could have a material adverse effect on our revenues. Additional legislation or regulation relating to the health care
industry or third-party coverage and reimbursement may be enacted in the future which could adversely affect the revenues generated from
the sale of our products and services.
Furthermore,
there has been a trend in recent years towards reductions in overall funding for Medicare, Medicaid and other federal health care programs.
There has also been an increase in the number of people who are not eligible for or enrolled in Medicare, Medicaid or other governmental
programs. The reduced funding of governmental programs could have a negative impact on the demand for our services to the extent it relates
to products and services which are reimbursed by government and private payors.
Unintended
consequences of healthcare reform in the United States may adversely affect our business.
The
healthcare industry is undergoing fundamental changes resulting from political, economic and regulatory influences. In the United States,
the PPACA was signed into law in 2010 under the Obama administration. By implementing comprehensive reforms, the law seeks to, among
other things, increase access to healthcare for the uninsured and control the escalation of healthcare expenditures within the economy.
While we do not believe this law will have a direct impact on our business, the law requires the adoption of various implementing regulations,
which may have unintended consequences or indirectly impact our business.
In
addition, other legislative changes have been adopted since the PPACA was enacted. These changes include aggregate reductions in Medicare
payments to providers of 2% per fiscal year, which went into effect on April 1, 2013 and, following passage of the Bipartisan Budget
Act of 2018, will remain in effect through 2027 unless additional Congressional action is taken. In January 2013, President Obama signed
into law the American Taxpayer Relief Act of 2012, which, among other things, further reduced Medicare payments to several types of providers
and increased the statute of limitations period for the government to recover overpayments to providers from three to five years. In
the past two years, Congress has considered additional reductions in Medicare reimbursement for drugs and devices as part of legislation
to reduce the budget deficit. Similar legislation could be enacted in the future. The Medicare regulations and interpretive determinations
that determine how drugs, devices and services are covered and reimbursed also are subject to change. These laws may result in additional
reductions in Medicare and other health care funding, which could impact our business.
53
Healthcare
reform measures that may be adopted in the future, may result in more rigorous coverage criteria and decreased reimbursement. Under the
Trump administration, Congress passed certain legislation to alter the PPACA. In addition, Congress and select states have proposed legislation
to alter and/or repeal the PPACA and/or transform certain aspects of existing federal and state health programs. The implementation of
cost containment measures or other healthcare reforms may prevent us from being able to generate revenue, attain profitability or commercialize
our product candidates. It is difficult to predict how enforcement initiatives under the PPACA and/or additional legislation or regulation
enacted in the future may impact our business. If the PPACA and/or additional legislation or regulation enacted in the future cause such
unintended consequences or indirect impact, they could have a material adverse effect on our business, financial condition and results
of operations.
Competitor
companies or hospitals in the EU may be able to take advantage of EU rules permitting sales of unlicensed medicines for individual patients
to sell competing products without a marketing authorization.
The
EU medicines rules allow individual member states to permit the supply of a medicinal product without a marketing authorization to fulfill
special needs, where the product is supplied in response to a bona fide unsolicited order, formulated in accordance with the specifications
of a healthcare professional and for use by an individual patient under his direct personal responsibility. This may, in certain countries,
also apply to products manufactured in a country outside the EU and imported to treat specific patients or small groups of patients.
In addition, advanced therapy medicinal products do not need a marketing authorization if they are prepared on a non-routine basis and
are used within the same EU member state in a hospital in accordance with a medical prescription for an individual patient.
These
exemptions could allow our competitors to make sales in the EU without having obtained a marketing authorization and without undergoing
the expense of clinical trials, especially if those competitors have cell processing facilities in the relevant EU member state. Similarly,
certain hospitals may be able to compete with us on the basis of these rules.
Risks
Related to and Our Common Stock
We
pay no dividends.
We
have never paid cash dividends in the past, and currently do not intend to pay any cash dividends in the foreseeable future.
There
is no assurance that an active trading market for our securities will be sustained.
No
assurance can be given that an active market for our shares will be sustained. In addition, although there have been market makers in
our common stock, we cannot assure that these market makers will continue to make a market in our securities or that other factors outside
of our control will not cause them to stop market making in our securities. Making a market in securities involves maintaining bid and
ask quotations and being able to effect transactions in reasonable quantities at those quoted prices, subject to various securities laws
and other regulatory requirements. Furthermore, the maintenance of a public trading market depends upon the existence of willing buyers
and sellers, the presence of which is not within our control or that of any market maker. Market makers are not required to maintain
a continuous two-sided market, are required to honor firm quotations for only a limited number of securities, and are free to withdraw
firm quotations at any time. Even with a market maker, factors such as our past losses from operations and the small size of our company
mean that there can be no assurance that an active and liquid market for our securities will be sustained or that stockholders will be
able to resell their securities at any price.
Stockholders
who hold unregistered shares of our common stock are subject to resale restrictions pursuant to Rule 144 due to our former status as
a “shell company.”
We
previously were a “shell company” pursuant to Rule 144, promulgated under the Securities Act (“Rule 144”), and,
as such, sales of our securities pursuant to Rule 144 cannot be made unless, among other things, we continue to remain subject to Section
13 or 15(d) of the Exchange Act, and we file all of our required periodic reports with the SEC under the Exchange Act. Because our unregistered
securities cannot be sold pursuant to Rule 144 unless we continue to meet such requirements, any unregistered securities we sell in the
future or issue to consultants or employees, in consideration for services rendered or for any other purpose, will have no liquidity
unless we continue to comply with such requirements. As a result, it may be more difficult for us to obtain financing to fund our operations
and pay our consultants and employees with our securities instead of cash.
54
We
have incurred, and will continue to incur, increased costs as a result of being an SEC reporting company.
The
Sarbanes-Oxley Act of 2002, as well as a variety of related rules implemented by the SEC, have required changes in corporate governance
practices and generally increased the disclosure requirements of public companies. As a reporting company, we incur significant legal,
accounting and other expenses in connection with our public disclosure and other obligations. Based upon SEC regulations currently in
effect, we are required to establish, evaluate and report on our internal control over financial reporting. We believe that compliance
with the myriad of rules and regulations applicable to reporting companies and related compliance issues will continue to require a significant
amount of time and attention from our management.
Our
stock prices may fluctuate significantly and be highly volatile and this may make it difficult for a stockholder to resell our securities
at the volume, prices and times the stockholder finds attractive.
The
market price of our common stock may be subject to significant fluctuations and be highly volatile, which may make it difficult for a
stockholder to resell our securities at the volume, prices and times the stockholder finds attractive. There are many factors that will
impact our stock price and trading volume, including, but not limited to, the factors listed above under “Risks Related to Our
Business Generally,” “Risks Related to Our Cell Therapy Product Development Efforts,” “Risks Related to Our Intellectual
Property,” “Risks Related to Government Regulation” and “Risks Related to Our Common Stock”.
Stock
markets, in general, experience significant price and volume volatility, and the market price of our securities may continue to be subject
to such market fluctuations that may be unrelated to our operating performance and prospects. Increased market volatility and fluctuations
could result in a substantial decline in the market price of our securities.
There
may be significant future issuances or resales of our common stock which may materially and adversely dilute stockholders’ ownership
interest and affect the market price of our securities.
We
have authorization to issue up to 300,000,000,000 shares of common stock of which, as of April 27, 2021, 3,175,977,710 shares
were issued and outstanding. We are not restricted from issuing additional shares of our common stock in the future, including securities
convertible into, or exchangeable or exercisable for, shares of our common stock. Pursuant to the Plan of Reorganization, we issued warrants
for the purchase of an aggregate of 15,226,346,970 shares of our common stock. In addition, pursuant to the Plan of Reorganization,
we issued or will be issuing convertible notes in the aggregate estimated principal amount of $11,794,700. Such notes are or will
be convertible into shares of our common stock at prices related to the market price of our common stock at the time of conversion. Our
issuance of additional shares of common stock in the future will dilute the ownership interests of our then existing stockholders.
Pursuant
to the Plan of Reorganization, an aggregate of 1,049,726,797 shares of common stock were issued to holders of unsecured claims. Such
shares are freely tradeable in the public market, except for shares held by affiliates.
We
have effective registration statements on Form S-8 under the Securities Act registering an aggregate of 19,955,000 shares of our common
stock issuable under our 2010 Equity Participation Plan (the “2010 Plan”). As of April 27, 2021, options to purchase
4,879,617 shares of our common stock were outstanding under the 2010 Plan. In addition, as of such date, 45,000 shares of common stock
were issued as stock grants pursuant to the 2010 Plan. The 2010 Plan terminated on November 17, 2020 and accordingly no further grants
may be made under the 2010 Plan.
Immediately
following the filing of this Annual Report, we intend to file a registration statement on Form S-8 under the Securities Act registering
4,700,000,000 shares of our common stock issuable under our 2021 Stock Incentive Plan (the “2021 Plan”). As of April 27,
2021, options to purchase 2,347,835,948 shares of our common stock were outstanding under the 2021 Plan. In addition, as of such
date, 1,173,917,974 restricted stock units were outstanding under the 2021 Plan. All of such options and restricted stock units are held
by our senior management team, Messrs. Alstodt and Silva.
The
shares issuable pursuant to the registration statements on Form S-8 will be freely tradable in the public market, except for shares held
by affiliates. We intend to include a resale prospectus in our registration statement on Form S-8 with regard to the 2021 Plan covering
the resale of the shares issuable to Messrs. Alstodt and Silva upon their exercise of the above described options and the vesting of
the above described RSUs. The resale of such shares will be currently subject to the volume limitations imposed by Rule 144.
55
The
sale of a substantial number of shares of our common stock or securities convertible into, or exchangeable or exercisable for, shares
of our common stock, whether directly by us in future offerings or by our existing stockholders in the secondary market, the perception
that such issuances or resales could occur or the availability for future issuances or resale of shares of our common stock or securities
convertible into, or exchangeable or exercisable for, shares of our common stock could materially and adversely affect the market price
of our securities and our ability to raise capital through future offerings of equity or equity-related securities on attractive terms
or at all.
In
addition, our Board of Directors is authorized to designate and issue preferred stock without further stockholder approval, and we may
issue other equity and equity-related securities that are senior to our common stock in the future for a number of reasons, including,
without limitation, to support operations and growth, and to comply with any future changes in regulatory standards.
Anti-takeover
provisions and the regulations to which we may be subject may make it more difficult for a third party to acquire control of us, even
if the change in control would be beneficial to our securityholders.
We
are incorporated in Delaware. Anti-takeover provisions in Delaware law and our certificate of incorporation and bylaws could make it
more difficult for a third party to acquire control of us and may prevent stockholders from receiving a premium for their securities.
Our certificate of incorporation provides that our Board of Directors may issue up to 20,000,000 shares of preferred stock, in one or
more series, without stockholder approval and with such terms, preferences, rights and privileges as the Board of Directors may deem
appropriate. These provisions and other factors may hinder or prevent a change in control, even if the change in control would be perceived
as beneficial to, or sought by, our other stockholders.
Our
common stock is classified as a “penny stock;” the restrictions of the penny stock regulations of the SEC may result in less
liquidity for our common stock.
The
SEC has adopted regulations which define a “penny stock” to be any equity security that has a market price (as therein defined)
of less than $5.00 per share or an exercise price of less than $5.00 per share, subject to certain exceptions. Unless exempt, the rules
require the delivery, prior to any transaction involving a penny stock by a retail customer, of a disclosure schedule prepared by the
SEC relating to the penny stock market. Disclosure is also required to be made about commissions payable to both the broker/dealer and
the registered representative and current quotations for the securities. Finally, monthly statements are required to be sent disclosing
recent price information for the penny stock held in the account and information on the limited market in penny stocks. Our common stock
is classified as a penny stock. As a result of the penny stock restrictions, brokers or potential investors may be reluctant to trade
in our securities, which may result in less liquidity for our securities.
Substantial
future sales of shares of our common stock in the public market could cause our stock price to fall.
Shares
of our common stock that we have issued or are issuable upon the exercise of warrants or upon the conversion of convertible debt may
be covered by registration statements which permit the public sale of stock. Other holders of shares of common stock that we have issued,
including shares issuable upon the exercise of warrants and the conversion of convertible debt, may be entitled to dispose of their shares
subject to the requirements of Rule 144 or other applicable exemption from registration under the Securities Act. Pursuant to the Plan
of Reorganization, the shares of our common stock issuable pursuant to the conversion of convertible promissory notes in the aggregate
principal amount of $3,644,279 are subject to certain lock-up restrictions over the 180 day period following the November 16, 2020 effective
date of the Plan of Reorganization. As those lock-up restrictions expire during said 180 day period, the shares of common stock issuable
pursuant to the conversion of such notes will become eligible for resale in the open market (subject to Rule 144 volume limitations applicable
to affiliates), resulting in more shares eligible for sale and potentially causing sales in the market to increase and our stock price
to decline. In addition, effective February 17, 2021, certain lock-up restrictions imposed by the Plan of Reorganization with regard
to the resale of the 1,049,726,797 shares of common stock issued to holders of unsecured claims expired. The unrestricted eligibility
of such shares for resale in the open market (subject to Rule 144 volume limitations applicable to affiliates) could also have a negative
effect upon our stock price. Additional sales of a substantial number of our shares of our common stock in the public market, or the
perception that sales could occur, could have a material adverse effect on the price of our stock.
56
ITEM
7A .
QUANTITATIVE
AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK .
Not
applicable.
ITEM
8.
FINANCIAL
STATEMENTS AND SUPPLEMENTARY DATA .
The
financial statements required by this Item 8 of this Annual Report are included in this Annual Report following Item 16 (“Form
10-K Summary”). As a smaller reporting company, we are not required to provide supplementary financial information.
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
We
maintain disclosure controls and procedures (as that term is defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act
of 1934, as amended (the “Exchange Act”)) that are designed to ensure that information required to be disclosed in our reports
under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and
forms, and that such information is accumulated and communicated to our management, including our principal executive officer and principal
financial officer, as appropriate, to allow timely decisions regarding required disclosures. In designing disclosure controls and procedures,
our management necessarily was required to apply its judgment in evaluating the cost-benefit relationship of possible disclosure controls
and procedures. The design of any disclosure controls and procedures also is based in part upon certain assumptions about the likelihood
of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future
conditions. Any controls and procedures, no matter how well designed and operated, can provide only reasonable, not absolute, assurance
of achieving the desired control objectives.
Under
the supervision and with the participation of our management, including our principal executive officer, who is also our principal financial
officer, we are required to perform an evaluation of our disclosure controls and procedures, as such term is defined in Rule 13a-15(e)
under the Exchange Act, as of December 31, 2020. Management has not completed such evaluation and, as such, has concluded that our disclosure
controls and procedures were not effective to provide reasonable assurance that information required to be disclosed by us in reports
we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s
rules and forms, and is accumulated and communicated to our management, including our principal executive officer, who is also our principal
financial officer, as appropriate to allow timely decisions regarding required disclosures. As a result of the material weakness in internal
controls over financial reporting described below, we concluded that our disclosure controls and procedures as of December 31, 2020 were
not effective.
Management’s
Annual Report on Internal Control Over Financial Reporting
Management
is responsible for establishing and maintaining adequate internal control over financial reporting. Our internal control over financial
reporting is a process designed under the supervision of our principal executive and principal financial officer and effected by our
Board of Directors, management and other personnel, to provide reasonable assurance regarding the reliability of financial reporting
and the preparation of our consolidated financial statements for external reporting purposes in accordance with GAAP.
Because
of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. In addition, projections
of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in
conditions or that the degree of compliance with the policies or procedures may deteriorate.
57
Material
Weaknesses in Internal Control over Financial Reporting
Management
assessed the effectiveness of our internal control over financial reporting as of December 31, 2020 based on the framework established
in Internal Control—Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission.
Based on this assessment, management has determined that our internal control over financial reporting as of December 31, 2020 was not
effective.
A
material weakness, as defined in the standards established by the Sarbanes-Oxley is a deficiency, or a combination of deficiencies, in
internal control over financial reporting such that there is a reasonable possibility that a material misstatement of our annual or interim
consolidated financial statements will not be prevented or detected on a timely basis.
The
ineffectiveness of our internal control over financial reporting was due to the following material weaknesses:
●
Inadequate
segregation of duties due to limited personnel consistent with control objectives;
●
Adherence
to formal policies and procedures post-bankruptcy; and
●
Lack
of risk assessment procedures on internal controls to detect financial reporting risks on a timely manner.
Management’s
Plan to Remediate the Material Weakness
Management
has been implementing and continues to implement measures designed to ensure that control deficiencies contributing to the material weakness
are remediated, such that these controls are designed, implemented, and operating effectively. The remediation actions include:
●
New
management personnel, including our new principal executive officer, who is executing on our business plan moving forward and analyzing
new controls;
●
Identify
gaps in our skills base and the expertise of our staff required to meet the financial reporting requirements of a public company;
and
●
Engagement
of external financial consulting firm in the fourth quarter of 2020 to assist us with our financial reporting, financial operations
and internal controls moving forward.
Management
will continue to monitor and evaluate the effectiveness of our internal controls and procedures over financial reporting on an ongoing
basis and is committed to taking further action and implementing additional enhancements or improvements, as necessary and as funds allow.
This
Annual Report does not include an attestation report of our independent registered public accounting firm regarding internal control
over financial reporting. Management’s report was not subject to attestation by our independent registered public accounting firm
pursuant to rules of the Securities and Exchange Commission that exempt smaller reporting companies from this requirement.
Changes
in Internal Control Over Financial Reporting
Other
than described above there have been no changes in our internal control over financial reporting that occurred during our fourth quarter
of 2020 that have materially affected, or that are reasonably likely to materially affect, our internal control over financial reporting.
ITEM
9B.
OTHER
INFORMATION .
None.
58
PART
III
ITEM
10.
DIRECTORS,
EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE .
Directors
and Executive Officers
Information
regarding our directors and executive officers is set forth below. Each of our officers devotes his full business time in providing services
on our behalf.
Name
Age
Positions
Held
Lance
Alstodt
50
Chief
Executive Officer, President and Chairman of the Board
Francisco
Silva
46
Vice
President of Research and Development, Secretary and Director
Nickolay
Kukekov, Ph.D.
47
Director
Lance
Alstodt
Lance
Alstodt has served as our Chief Executive Officer, President and Chairman of the Board since November 2020. He served as our Executive
Vice President and Chief Strategy Officer from October 2018 to February 2020. Since 2013, Mr. Alstodt has served as Chief Executive Officer
of MedVest Consulting Corporation, an advisory and capital firm that focuses exclusively on the healthcare industry. Prior to MedVest,
he was an investment banker with over 23 years of experience with respect to healthcare investment banking, including mergers and acquisitions.
From 2011 to 2013, Mr. Alstodt was a Managing Director at Leerink Partners where he helped lead its medical technology sector. From 2009
to 2011, he was a Managing Director and Head of Medical Technology at Oppenheimer & Co. From 2000 to 2009, Mr. Alstodt was a Managing
Director in the Healthcare Group and Global Mergers and Acquisitions Group at Bank of America Merrill Lynch. He previously spent seven
years as a Vice President in the Global Mergers and Acquisitions Group at J.P. Morgan Chase, where he worked extensively on acquisitions,
leveraged buyouts, private and public financings, exclusive sales and general advisory assignments. Mr. Alstodt received a degree in
Economics from the State University of New York at Albany, with a secondary concentration in Finance and Marketing. We believe that Mr.
Alstodt’s executive-level management experience with us and other healthcare businesses and his extensive experience in the investment
banking field relating to the healthcare sector give him the qualifications to serve as one of our directors.
Francisco
Silva
Francisco
Silva has served as our Vice President of Research and Development since March 2013, having also previously served in such position from
April 2011 until March 2012. Mr. Silva was elected our Secretary and a director in November 2020. He served as our Research Scientist
from March 2012 to June 2012 and as our Chief Scientist from June 2012 to March 2013. From 2007 to 2011, Mr. Silva served as Chief Executive
Officer of DV Biologics LLC, and as President of DaVinci Biosciences, LLC, companies engaged in the commercialization of human based
biologics for both research and therapeutic applications. From 2003 to 2007, Mr. Silva served as Vice President of Research and Development
for PrimeGen Biotech LLC, a company engaged in the development of cell based platforms. From 2002 to 2003, he was a Research Scientist
with PrimeGen Biotech and was responsible for the development of experimental designs that focused on germ line reprogramming stem cell
platforms. Mr. Silva has taught courses in biology, anatomy and advanced tissue culture at California State Polytechnic University. He
has obtained a number of patents relating to stem cells and has had numerous articles published with regard to stem cell research. Mr.
Silva graduated from California State Polytechnic University with a degree in Biology. He also obtained a Graduate Presidential Fellowship
and MBRS Fellowship from California State Polytechnic University. We believe that Mr. Silva’s executive-level management experience
with us since April 2011 and his extensive knowledge of the science related to our business give him the qualifications to serve as one
of our directors.
Nickolay
Kukekov, Ph.D.
Nickolay
Kukekov, Ph.D. has served as one of our directors since March 2021. For more than the past fifteen years, Dr. Kukekov has held a number
of healthcare investment banking positions. He has served as Senior Managing Director of Paulson Investment Company, LLC since 2020.
From 2012 to 2020, Dr. Kukekov was a founding partner of Highline Research Advisors LLC. He served as a Managing Director of Summer Street
Research Partners from 2010 to 2012. From 2007 to 2009, Dr. Kukekov was a Managing Director of Paramount Capital. He served as a Vice
President of Rodmen & Renshaw from 2006 to 2007. He serves as a director of Brain Scientific, Inc. and Omnia Wellness Inc. whose
shares are publicly traded. Dr. Kukekov received a Bachelor of Arts degree in molecular, cellular and developmental biology from the
University of Colorado at Boulder and a Ph.D. in neuroscience from Columbia University College of Physicians and Surgeons. We believe
that Dr. Kukekov’s extensive experience in the investment banking field relating to the healthcare sector and his strong background
in regenerative medicine give him the qualifications to serve as one of our directors.
59
Scientific
Advisors
Scientific
Advisory Board
The
following persons are the members of our Scientific Advisory Board:
Name
Principal
Positions
Wayne
Marasco, M.D., Ph.D.
Chairman
Professor,
Department of Cancer Immunology & AIDS, Dana-Farber Cancer Institute;
Professor
of Medicine, Harvard Medical School;
Principal
Faculty Member, Harvard Stem Cell Institute
Naiyer
Imam, M.D.
Chairman
and President, First Medicine, Inc., an international telemedicine corporation dedicated to virtual physician services and chronic
disease management
Wayne
J. Olan, M.D.
Director,
Interventional and Endovascular Neurosurgery;
Associate
Professor, Neurosurgery and Radiology, George Washington University Medical Center;
Consulting
Physician, Department of Radiology, National Institutes of Health
Joy
Cavagnaro, Ph.D., DABT, RAC
President
and Founder, Access BIO, L.C.; Fellow, Academy of Toxicological Sciences and the Regulatory
Professional Society;
Formerly
Senior Pharmacologist and Director of Quality Assurance, Food and Drug Administration’s Center for Biologics Evaluation
and Research
Jason
Lipetz, M.D.
Chairman,
Disc Advisory Committee
Founder,
Long Island Spine Rehabilitation Medicine;
Chief
of Spine Medicine, Northwell Health Spine Center;
Assistant
Professor of Rehabilitation Medicine, Hofstra University School of Medicine
Harvinder
Sandhu, M.D.
Orthopedic
Spine Surgeon, Hospital for Special Surgery;
Formerly
Chief of Spinal Surgery Service, UCLA Medical Center
Christopher
Plastaras, M.D.
Clinical
Director of Musculoskeletal Spine and Sports Rehabilitation Medicine and Physiatrist, MossRehab;
Formerly
Director of The Penn Spine and Rehabilitation Center;
Formerly
Director of Spine, Sports and Musculoskeletal Medicine Fellowship, University of Pennsylvania
Gerard
A. Malanga, M.D.
Founder,
Partner and Physiatrist, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute;
Chair,
American Academy of Physical Medicine and Rehabilitation Task Force on Regenerative Medicine;
President
Elect, Interventional Orthopedic Foundation
Family
Relationships
There
are no family relationships among any of our executive officers and directors.
60
Term
of Office
We
have a classified Board of Directors. The directors will hold office until the respective annual meetings of stockholders indicated below
and until their respective successors are elected and qualified or until their earlier resignation or removal.
Name
Class
Term
Expires
Lance
Alstodt
III
2023
Francisco
Silva
II
2022
Nickolay
Kukekov
I
2021
Each
executive officer will hold office until the initial meeting of the Board of Directors following the next annual meeting of stockholders
and until his successor is elected and qualified or until his earlier resignation or removal.
Audit
Committee
The
Audit Committee of the Board of Directors is responsible for overseeing our accounting and financial reporting processes and the audits
of our financial statements. The sole member of the Audit Committee is Dr. Kukekov.
Audit
Committee Financial Expert
We
do not currently have an “audit committee financial expert,” as that is defined in Item 407(d)(5) of Regulation S-K, as we
are in the process of reconstituting our Board of Directors following our Chapter 11 reorganization.
Delinquent
Section 16(a) Beneficial Ownership Reports
Section
16 of the Exchange Act requires that reports of beneficial ownership of common stock and changes in such ownership be filed with the
Securities and Exchange Commission by Section 16 “reporting persons,” including directors, certain officers, holders of more
than 10% of the outstanding common stock and certain trusts of which reporting persons are trustees. We are required to disclose in this
Annual Report each reporting person whom we know to have failed to file any required reports under Section 16 on a timely basis during
the fiscal year ended December 31, 2020. To our knowledge, based solely on a review of copies of Forms 3, 4 and 5 filed with the Securities
and Exchange Commission, during the fiscal year ended December 31, 2020, our officers, directors and 10% stockholders complied with all
Section 16(a) filing requirements applicable to them.
Code
of Ethics for Senior Financial Officers
Our
Board of Directors has adopted a Code of Ethics for our principal executive officer, principal financial officer, principal accounting
officer or controller, or persons performing similar functions. A copy of the Code of Ethics is posted on our website, www.biorestorative.com.
We intend to satisfy the disclosure requirement under Item 5.05(c) of Form 8-K regarding an amendment to, or a waiver from, our Code
of Ethics by posting such information on our website, www.biorestorative.com.
61
ITEM
11.
EXECUTIVE
COMPENSATION .
Summary
Compensation Table
The
following Summary Compensation Table sets forth all compensation earned in all capacities during the fiscal years ended December 31,
2020 and 2019 by (i) each of our then principal executive officers, and (ii) our most highly compensated executive officer, other than
our then principal executive officers, who was serving as an executive officer as of December 31, 2020 and whose total compensation for
the 2020 fiscal year, as determined by Regulation S-K, Item 402, exceeded $100,000 (the individuals falling within categories (i) and
(ii) are collectively referred to as the “Named Executive Officers”):
Name
and Principal
Position
Year
Salary
All
Other Compensation
Total
Lance Alstodt
2020
$ 64,317
$ -
$ 64,317
Chief Executive Officer (1)
2019
$ 350,000
$ -
$ 350,000 (2)
Francisco Silva
2020
$ 207,553
$ -
$ 207,553
VP, Research and Development
2019
$ 287,500
$ -
$ 287,500 (3)
Mark Weinreb
2020
$ 179,172
$ -
$ 179,172 (4)
Chief Executive Officer (5)
2019
$ 369,952
$ 2,400 (6)
$ 372,352 (6)
(1)
Mr.
Alstodt served as our Executive Vice President and Chief Strategy Officer from October 15, 2018 through February 24, 2020. Mr. Alstodt
has been serving as our President, Chief Executive Officer and Chairman of the Board since November 16, 2020.
(2)
Of
the aggregate $350,000 earned cash compensation during 2019, $340,860 was paid in cash during 2019. Accrued compensation of $9,140
at December 31, 2019 was settled in our bankruptcy case.
(3)
Of
the aggregate $287,500 earned cash compensation during 2019, $263,660 was paid in cash during 2019. Accrued compensation of $23,840
at December 31, 2019 was settled in our bankruptcy case.
(4)
Of
the aggregate $179,172 earned cash compensation during 2020, $172,672 was paid in cash during 2020. The remaining $6,500 in earned
compensation was settled in our bankruptcy case.
(5)
Mr.
Weinreb resigned as our President, Chief Executive Officer and Chairman of the Board in November 2020.
(6)
Of
the aggregate $372,352 earned cash compensation during 2019, $335,852 was paid in cash during 2019. The remaining $36,500 in earned
compensation was settled in our bankruptcy case. All Other Compensation represents an automobile allowance paid to Mr. Weinreb in
2019.
62
Outstanding
Equity Awards at Fiscal Year-End
The
following table provides information on outstanding equity awards as of December 31, 2020 to the Named Executive Officers:
Option
Awards
Stock
Awards
Name
Number
of securities underlying unexercised options exercisable
Number
of securities underlying unexercised options unexercisable
Equity
incentive plan awards: Number of securities underlying unexercised unearned options
Option
exercise price
Option
expiration date
Number
of shares or units of stock that have not vested
Market
value of shares of units that have not vested
Equity
incentive plan awards: Number of unearned shares, units or other rights that have not vested
Equity
incentive plan awards: Market or payout value of unearned shares, units or other rights that have not vested
Lance Alstodt
500,000
-
-
$ 1.42
2/24/2021
-
$ -
-
$ -
Francisco Silva
4,000
-
-
$ 4.70
4/4/2021
-
$ -
-
$ -
Francisco Silva
150
-
-
$ 4.70
6/23/2021
-
$ -
-
$ -
Francisco Silva
1,000
-
-
$ 4.70
11/16/2021
-
$ -
-
$ -
Francisco Silva
2,000
-
-
$ 4.70
2/10/2022
-
$ -
-
$ -
Francisco Silva
4,500
-
3,000 (1)
$ 4.70
5/2/2022
-
$ -
-
$ -
Francisco Silva
4,000
-
-
$ 4.70
12/7/2022
-
$ -
-
$ -
Francisco Silva
5,000
-
-
$ 4.70
10/4/2023
-
$ -
-
$ -
Francisco Silva
12,500
-
-
$ 4.70
2/18/2024
-
$ -
-
$ -
Francisco Silva
2,000
-
-
$ 4.70
3/12/2024
-
$ -
-
$ -
Francisco Silva
37,500
-
-
$ 4.70
10/23/2024
-
$ -
-
$ -
Francisco Silva
25,000
-
-
$ 4.70
9/4/2025
-
$ -
-
$ -
Francisco Silva
60,000
-
-
$ 3.73
6/10/2026
-
$ -
-
$ -
Francisco Silva
80,000
-
-
$ 2.80
7/12/2027
-
$ -
-
$ -
Francisco Silva
66,667
33,333 (2)
-
$ 1.23
10/29/2028
-
$ -
-
$ -
Mark Weinreb
50,000
-
-
$ 4.70
2/10/2022
-
$ -
-
$ -
Mark Weinreb
20,000
-
-
$ 4.70
12/7/2022
-
$ -
-
$ -
Mark Weinreb
12,500
-
-
$ 4.70
10/4/2023
-
$ -
-
$ -
Mark Weinreb
50,000
-
-
$ 4.70
2/18/2024
-
$ -
-
$ -
Mark Weinreb
150,000
-
-
$ 4.70
10/23/2024
-
$ -
-
$ -
Mark Weinreb
208,000
-
-
$ 4.70
9/4/2025
-
$ -
-
$ -
Mark Weinreb
275,000
-
-
$ 3.73
6/10/2026
-
$ -
-
$ -
Mark Weinreb
275,000
-
-
$ 3.35
6/23/2027
-
$ -
-
$ -
Mark Weinreb
275,000
-
-
$ 1.23
10/29/2028
-
$ -
-
$ -
(1)
Option
is exercisable commencing on the date (provided that such date is during Mr. Silva’s employment with us), if any, on which
either (i) the FDA approves a biologics license application made by us with respect to any biologic product or (ii) a 510(k) Premarket
Notification submission is made by us to the FDA with respect to a certain device.
(2)
Option
is exercisable on October 29, 2021.
Employment
Agreements
Lance
Alstodt
2018
Employment Agreement
Effective
October 15, 2018, we entered into an at will employment agreement with Lance Alstodt, our then Executive Vice President and Chief Strategy
Officer. Pursuant to the employment agreement, Mr. Alstodt was entitled to receive a base annual salary of $350,000. Effective January
1, 2020, his salary was $46,800 per annum (in connection with a salary reduction program for senior management). In addition, pursuant
to the employment agreement, Mr. Alstodt was entitled to receive an annual bonus of up to 30% of his annual salary based on the satisfaction
of certain performance goals, as determined by our Compensation Committee. Such goals were not satisfied for 2019 (the first year of
bonus eligibility). The employment agreement also provided for the payment of six months severance under certain circumstances. Mr. Alstodt’s
employment with us as Executive Vice President and Chief Strategy Officer ended effective February 24, 2020. Based upon such termination
of employment, Mr. Alstodt was entitled to receive six months severance based upon his salary of $350,000 per annum. Such amount was
considered an unsecured claim in our Chapter 11 Case and Mr. Alstodt received shares of our common stock in exchange for such claim in
a manner consistent with other unsecured creditors.
63
2021
Employment Agreement
Effective
November 16, 2020, Mr. Alstodt was elected our Chief Executive Officer, President and Chairman of the Board. On March 18, 2021, we entered
into an employment agreement with Mr. Alstodt which provides for a term ending on March 18, 2026. Pursuant to the employment agreement,
Mr. Alstodt is entitled to receive initially an annual salary of $250,000. Mr. Alstodt’s annual salary will increase by $50,000
per year. In addition, in the event certain performance goals are met, Mr. Alstodt’s salary will increase by $150,000. Concurrently
with the execution of the employment agreement, we granted to Mr. Alstodt pursuant to the 2021 Plan (i) a ten year option for the purchase
of 1,173,917,974 shares of our common stock at an exercise price if $0.0119 per share and (ii) 586,958,987 restricted stock units (“RSUs”).
The option vests to the extent of 50% thereof on the date of grant and 25% thereof on each of the first and second anniversaries of the
date of grant. The RSUs vest in three equal annual installments on the first, second and third anniversaries of the date of grant. In
the event that Mr. Alstodt’s employment is terminated by us without “cause”, or Mr. Alstodt terminates his employment
for “good reason” (each as defined in the employment agreement), Mr. Alstodt will be entitled to receive severance in an
amount up to one times his then annual base salary. If Mr. Alstodt’s employment with us is terminated without cause, the option
granted to Mr. Alstodt will vest and become exercisable and such option will remain exercisable until its expiration date notwithstanding
such termination of employment with us. In addition, the RSU’s granted to Mr. Alstodt will vest in the event of the termination
of his employment without cause. Further, in the event of a change in control (as defined in the 2021 Plan), 50% of the unvested RSUs
shall vest as of the date of the change in control and the remainder shall vest upon the earlier of the one year anniversary of the change
in control or the date on which the RSU was scheduled to vest, subject to earlier vesting in the event Mr. Alstodt’s employment
is terminated without cause.
Francisco
Silva
2018
Employment Agreement
Effective
April 5, 2011, we entered into an at will employment agreement with Francisco Silva, our Vice President of Research and Development.
The employment agreement, as amended, provides for a salary of $287,500 per annum except that, between January 1, 2020 and March 19,
2020, Mr. Silva’s salary was $46,800 per annum (in connection with a salary reduction program for senior management) and between
April 16, 2020 and November 15, 2020 (during the Chapter 11 Case), his salary was $200,000 per annum. Mr. Silva is currently receiving
a salary of $225,000 per annum. In addition, pursuant to the employment agreement, as amended, Mr. Silva is entitled to receive an annual
bonus of up to 20% of his annual salary based on the satisfaction of certain performance goals, as determined by our Compensation Committee.
Mr. Silva satisfied such goals in part for 2018 and received a bonus of $23,000. Such goals were not satisfied for 2019. Further, pursuant
to the employment agreement, as amended, in the event that Mr. Silva’s employment with us is terminated without cause, Mr. Silva
would be entitled to receive severance in an amount equal to 50% of his then annual base salary.
2021
Employment Agreement
On
March 18, 2021, we and Mr. Silva entered into an employment agreement which provides for a term ending on March 18, 2026. Pursuant to
the employment agreement, Mr. Silva is entitled to receive initially an annual salary of $225,000. Mr. Silva’s annual salary will
increase by $50,000 per year. In addition, in the event certain performance goals are met, Mr. Silva’s salary will increase by
$150,000. Concurrently with the execution of the employment agreement we granted to Mr. Silva pursuant to the 2021 Plan (i) a ten year
option for the purchase of 1,173,917,974 shares of our common stock at an exercise price of $0.0119 per share and (ii) 586,958,987 RSUs.
The option vests to the extent of 50% thereof on the date of grant and 25% thereof on each of the first and second anniversaries of the
date of grant. The RSUs vest in three equal annual installments on the first, second and third anniversaries of the date of grant. In
the event that Mr. Silva’s employment is terminated by us without “cause”, or Mr. Silva terminates his employment for
“good reason” (each as defined in the employment agreement), Mr. Silva will be entitled to receive severance in an amount
up to one times his then annual base salary. If Mr. Silva’s employment with us is terminated without cause, the option granted
to Mr. Silva will vest and become exercisable and such option will remain exercisable until its expiration date notwithstanding such
termination of employment with us. In addition, the RSU’s granted to Mr. Silva will vest in the event of the termination of his
employment without cause. Further, in the event of a change in control (as defined in the 2021 Plan), 50% of the unvested RSUs shall
vest as of the date of the change in control and the remainder shall vest upon the earlier of the one year anniversary of the change
in control or the date on which the RSU was scheduled to vest, subject to earlier vesting in the event Mr. Silva’s employment is
terminated without cause.
64
Mark
Weinreb
In
March 2015, we entered into an employment agreement with Mark Weinreb, our then Chief Executive Officer, President and Chairman of the
Board. Pursuant to the employment agreement, which expired on September 30, 2020, Mr. Weinreb was entitled to receive a salary of $400,000
per annum, except that, between January 1, 2020 and March 19, 2020, his salary was $46,800 per annum (in connection with a salary reduction
program for senior management) and between April 16, 2020 and November 15, 2020 (during the Chapter 11 Case), his salary was $200,000
per annum. Mr. Weinreb was entitled to receive an annual bonus for 2018 and 2019 of up to 50% of his annual base salary in the event
certain performance goals, as determined by our Compensation Committee, were satisfied. Such goals were not satisfied for such years.
Pursuant to the employment agreement, Mr. Weinreb was entitled to receive severance in an amount equal to one time his then annual base
salary (but not less than $400,000) and certain benefits, plus $100,000 (in lieu of bonus) in the event that, within three months of
the expiration date of his agreement, his employment was terminated by us without “cause” or if Mr. Weinreb terminated his
employment for any reason. Further, in the event that Mr. Weinreb’s employment was terminated by us without “cause”,
or Mr. Weinreb terminated his employment for “good reason”, following a “change in control” (as defined in the
employment agreement), Mr. Weinreb would have been entitled to receive severance in an amount equal to one and one-half times his then
annual base salary (but not less than $400,000 in annual base salary) and certain benefits, plus $300,000 (in lieu of bonus). Pursuant
to the employment agreement, with respect to options granted to Mr. Weinreb during the term of his employment with us, such options would
vest and become exercisable if Mr. Weinreb was entitled to receive severance based upon a termination of his employment as set forth
above. In addition, pursuant to the employment agreement, to the extent that an option granted to Mr. Weinreb during his term of his
employment with us became exercisable (whether due to the passage of time or otherwise), such option would remain exercisable until its
expiration date notwithstanding any termination of employment with us. Mr. Weinreb resigned his employment with us on November 16, 2020,
the effective date of the Chapter 11 reorganization. Based upon such termination of employment, Mr. Weinreb was entitled to receive his
severance of $400,000 and certain benefits plus $100,000, and the option accelerations as discussed above. The severance amount was generally
considered an unsecured claim in our Chapter 11 Case and Mr. Weinreb received shares of our common stock in exchange for such claim in
a manner consistent with other unsecured creditors.
DIRECTOR
COMPENSATION
The
following table sets forth certain information concerning the compensation of our then non-employee directors for the fiscal year ended
December 31, 2020:
Name
Fees
Earned or Paid in Cash
Stock
Awards
Option
Awards
Non-Equity
Incentive Plan Compensation
Nonqualified
Deferred Compensation Earnings
All
Other Compensation
Total
Robert B. Catell (1)
$ -
$ -
$ - (2)
$ -
$ -
$ -
$ -
John M. Desmarais (3)
$ -
$ -
$ - (4)
$ -
$ -
$ -
$ -
A. Jeffrey Radov (5)
$ -
$ -
$ - (6)
$ -
$ -
$ -
$ -
Charles S. Ryan (7)
$ -
$ -
$ - (8)
$ -
$ -
$ -
$ -
Paul Jude Tonna (9)
$ -
$ -
$ - (10)
$ -
$ -
$ -
$ -
(1)
Mr.
Catell resigned as a director effective November 16, 2020.
(2)
As
of December 31, 2020. Mr. Catell held options for the purchase of 219,000 shares of common stock.
(3)
Mr.
Desmarais resigned as a director effective January 10, 2020.
(4)
As
of December 31, 2020, Mr. Desmarais held options for the purchase of 225,000 shares of common stock.
(5)
Mr.
Radov resigned as a director effective November 16, 2020.
(6)
As
of December 31, 2020, Mr. Radov held options for the purchase of 566,000 shares of common stock.
(7)
Dr.
Ryan resigned as a director effective January 10, 2020.
(8)
As
of December 31, 2020, Dr. Ryan held options for the purchase of 231,000 shares of common stock.
(9)
Mr.
Tonna resigned as a director effective November 16, 2020.
(10)
As
of December 31, 2020, Mr. Tonna held options for the purchase of 364,000 shares of common stock.
65
Each
of Messrs. Catell, Desmarais, Radov and Tonna and Dr. Ryan, our then non-employee directors, was entitled to receive, as compensation
for his services as a director, $30,000 per annum plus $10,000 per annum for all committee service, in each case payable quarterly (subject
to our cash needs). Our non-employee directors also received stock options, from time to time, in consideration of their services. There
is no arrangement in place for compensation of our only current non-employee director, Dr. Kukekov.
ITEM
12.
SECURITY
OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS .
Principal
Stockholders
The
following table sets forth certain information regarding the beneficial ownership of our common stock, as of April 27, 2021, known
by us, through transfer agent records and reports filed with the SEC, to be held by: (i) each person who beneficially owns 5% or more
of the shares of common stock then outstanding; (ii) each of our directors; (iii) each of our Named Executive Officers (as defined above);
and (iv) all of our directors and executive officers as a group.
The
information in this table reflects “beneficial ownership” as defined in Rule 13d-3 of the Exchange Act. To our knowledge,
and unless otherwise indicated, each stockholder has sole voting power and investment power over the shares listed as beneficially owned
by such stockholder, subject to community property laws where applicable. Percentage ownership is based on 3,175,977,710 shares
of common stock outstanding as of April 27, 2021.
Beneficial
Owner
Number
of Shares
Beneficially
Owned
Approximate
Percent
of Class
Lance
Alstodt
605,670,653
(1)
16.1
%
Francisco
Silva
595,703,049
(2)
15.8
%
Nickolay
Kukekov
0
-
Mark
Weinreb
1,395,500
(3)
*
All
directors and executive officers as a group (3 persons)
1,201,373,702
(1)(2)
27.6
%
*
Less than 1%
(1)
Includes
586,958,987 shares of common stock issuable upon the exercise of a currently exercisable option.
(2)
Includes
587,259,304 shares of common stock issuable upon the exercise of currently exercisable options and 12,116 shares of common
stock held by Mr. Silva in a retirement account.
(3)
Includes
1,315,500 shares of common stock issuable upon the exercise of currently exercisable options.
Securities
Authorized for Issuance Under Equity Compensation Plans
The
following table sets forth information as of December 31, 2020 with respect to compensation plans (including individual compensation
arrangements) under which our common stock are authorized for issuance, aggregated as follows:
●
All
compensation plans previously approved by security holders; and
●
All
compensation plans not previously approved by security holders.
66
EQUITY
COMPENSATION PLAN INFORMATION
Number
of securities to be issued upon exercise of outstanding options (a)
Weighted-average
exercise price of outstanding options
(b)
Number
of securities remaining available for future issuance under equity compensation plans (excluding securities reflected in column (a))
Equity
compensation plans approved by security holders
4,859,617
$
0.98
5,095,383
Total
4,859,617
$
0.98
5,095,383
ITEM
13.
CERTAIN
RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE .
In
July 2019, we, John Desmarais, one of our then non-employee directors and principal stockholders, and Tuxis Trust, a trust for which
Mr. Desmarais and his wife serve as the trustees and which was established for the benefit of Mr. Desmarais’ immediate family,
agreed that the outstanding principal amounts of promissory notes held by Desmarais and Tuxis Trust in the amounts of $175,000 and $500,000,
respectively, together with accrued interest, would be exchanged for shares of common stock and warrants, as described below, concurrently
with a certain public offering of our securities. The exchange price was to equal 75% of the public offering price of the securities
sold by us. The number of shares of common stock issuable pursuant to the warrants to be issued to Mr. Desmarais and Tuxis Trust was
to be in the same ratio to the number of shares of common stock issued upon exchange of their indebtedness as the number of shares of
common stock subject to the public warrants bore to the number of shares of common stock issued as part of any units of common stock
and warrants offered by us. The exercise price of the warrants was to be 125% of the exchange price and the term of the warrants was
to be the same term as the public warrants. Concurrently with the exchange, the exercise prices of outstanding warrants held by Mr. Desmarais
and Tuxis Trust for the purchase of an aggregate of 1,377,842 shares of common stock were to be reduced from between $1.50 and $4.00
per share to $0.75 per share and the expiration dates of such warrants were to be extended from between December 31, 2019 and March 1,
2022 to December 31, 2023. Concurrently with the exchange, Mr. Desmarais and Tuxis Trust were to release the security interest they held
in our equipment and intellectual property with respect to the payment of the notes. The public offering contemplated by the exchange
agreement did not occur.
In
February 2019, we borrowed $450,000 from Harvey P. Alstodt and Melody Alstodt. The convertible promissory note issued to them provided
for the payment of the principal amount, together with interest at the rate of 15% per annum, six months from the date of issuance. The
note was convertible, at the option of the lenders, into shares of our common stock at a conversion price of $0.60 per share, subject
to adjustment, and a five year warrant for the purchase of a number of shares equal to the number of shares issued upon the conversion
of the principal amount of the note. The warrant provided for an exercise price of $0.80 per share, subject to adjustment. The lenders
are the parents of Lance Alstodt, our then Executive Vice President and Chief Strategy Officer and currently our President, Chief Executive
Officer and Chairman of the Board.
In
August 2019, the Alstodts agreed to an extension of the maturity date of the note to September 30, 2019 and that the outstanding principal
amount of the note, together with accrued interest, would be exchanged for shares of common stock and warrants concurrently with a certain
public offering of our securities. The exchange price was to be equal to the lesser of (i) 75% of the public offering price of the units
offered by us and (ii) $0.60 per share. The number of shares of common stock issuable pursuant to the warrant to be issued to the Alstodts
was to be equal to the number of shares of common stock issued upon conversion of the principal amount of the note. The exercise price
of the warrant was to be equal to the lesser of (i) 125% of the exchange price or (ii) $0.80 per share. The term of the warrant was to
be five years. The public offering contemplated by the exchange agreement did not occur.
In
March 2019, our Board of Directors reduced the exercise price of outstanding options for the purchase of an aggregate of 4,631,700 shares
of our common stock (with exercise prices ranging between $1.00 and $4.70 per share) to $0.75 per share, which was the closing price
for our common stock on the day prior to the determination, as reported by the OTCQB. The exercise price reduction related to options
held by, among others, our Named Executive Officers and directors with respect to the following number of shares: (i) Mark Weinreb, our
then President, Chief Executive Officer and Chairman of the Board: 1,319,500 shares, (ii) A. Jeffrey Radov, one of our then directors:
566,000 shares, (iii) Paul Jude Tonna, one of our then directors: 364,000 shares, (iv) Dr. Charles S. Ryan, one of our then directors:
256,000 shares, (v) Mr. Desmarais: 250,000 shares, (vi) Robert B. Catell, one of our then directors: 219,000 shares, (vii) Mr. Alstodt:
500,000 shares; and (viii) Francisco Silva, our Vice President of Research and Development: 340,650 shares.
In
May 2019, we issued 1,111,111 shares of our common stock to Dale Broadrick, one of our then principal stockholders, at a purchase price
of $0.45 per share. In consideration thereof, we issued to Mr. Broadrick a five year warrant for the purchase of 555,556 shares of our
common stock at an exercise price of $0.85 per share and a one year warrant for the purchase of 555,555 shares of our common stock at
an exercise price of $0.70 per share.
In
October 2019, we issued 3,333,333 shares of our common stock to Mr. Broadrick at a purchase price of $0.15 per share. In consideration
thereof, we issued to Mr. Broadrick a five year warrant for the purchase of 3,333,333 shares of our common stock at an exercise price
of $0.20 per share. In addition, in consideration thereof, we reduced the exercise prices of outstanding warrants held by Mr. Broadrick
for the purchase of 1,055,556 and 1,055,555 shares of our common stock from $0.70 and $0.85 per share, respectively, to $0.15 per share
and extended the expiration dates of warrants held by Mr. Broadrick for the purchase of 500,000 and 555,555 shares of our common stock
from February 19, 2020 and May 7, 2020, respectively, to February 19, 2024 and May 7, 2024, respectively.
67
In
December 2019, we agreed that the exercise price of warrants held by Mr. Broadrick for the purchase of an aggregate of 5,444,444 shares
of our common stock was reduced to the lesser of (i) $0.03 per share or (ii) 80% of fair market value at the time of exercise of the
particular warrant, but in no event less than $0.01 per share (subject to adjustment for stock splits, reverse stock splits, recapitalizations
and similar events).
Director
Independence
Board
of Directors
Our
Board of Directors is currently comprised of Lance Alstodt (Chair), Francisco Silva and Nickolay Kukekov. Dr. Kukekov is an “independent
director” based on the definition of independence in Listing Rule 5605(a)(2) of The Nasdaq Stock Market.
Audit
Committee
Dr.
Kukekov is the sole member of our Board’s Audit Committee. Dr. Kukekov is an “independent director” based on the definition
of independence in Listing Rule 5605(a)(2) of The Nasdaq Stock Market and Rule 10A-3(b)(1) under the Exchange Act.
Nominating
Committee
Dr.
Kukekov is the sole member of our Board’s Nominating Committee. Dr. Kukekov is an “independent director” based on the
definition of independence in Listing Rule 5605(a)(2) of The Nasdaq Stock Market.
Compensation
Committee
Dr.
Kukekov is the sole member of our Board’s Compensation Committee. Dr. Kukekov is an “independent director” based on
the definition of independence in Listing Rule 5605(a)(2) of The Nasdaq Stock Market.
ITEM
14.
PRINCIPAL
ACCOUNTANT FEES AND SERVICES .
Friedman
LLP has served as our independent registered public accountants for the years ended December 31, 2020 and 2019.
The
following is a summary of the fees billed or expected to be billed to us by Friedman LLP, our independent registered public accountants,
for professional services rendered with respect to the fiscal years ended December 31, 2020 and 2019 and by Marcum LLP, our former independent
registered public accountants, for professional services rendered with respect to the fiscal year ended December 31, 2019:
Friedman
LLP
Marcum
LLP
2020
2019
2019
Audit fees (1)
$ 80,000
$ 45,000
$ 92,000
Audit-related fees (2)
-
-
-
Tax fees (3)
-
-
11,000
All other fees (4)
-
-
-
$ 80,000
$ 45,000
$ 103,000
(1)
Audit
Fees consist of fees billed and expected to be billed for services rendered for the audit of our consolidated financial statements
for the fiscal years ended December 31, 2020 and 2019 and, with respect to Marcum, the review of our condensed consolidated financial
statements included in our Quarterly Reports on Form 10-Q and in connection with the filing of Forms S-1 and S-8 registration statements.
(2)
Audit-Related
Fees consist of fees billed for assurance and related services that are reasonably related to the performance of the audit of our
financial statements and are not reported under “Audit Fees.”
(3)
Tax
Fees consist of fees billed for professional services related to preparation of our U.S. federal and state income tax returns and
tax advice.
(4)
All
Other Fees consist of fees billed for products and services provided by our independent registered public accountants, other than
those disclosed above.
The
Audit Committee is responsible for the appointment, compensation and oversight of the work of the independent registered public accountants,
and approves in advance any services to be performed by the independent registered public accountants, whether audit-related or not.
The Audit Committee reviews each proposed engagement to determine whether the provision of services is compatible with maintaining the
independence of the independent registered public accountants. The fees shown above were pre-approved either by our Board or our Audit
Committee.
68
PART
IV
ITEM
15.
EXHIBITS
AND FINANCIAL STATEMENT SCHEDULES .
Exhibit
No.
2.1
Order
of the Bankruptcy Court for the Eastern District of New York Confirming Amended Joint Plan of Reorganization of BioRestorative Therapies,
Inc., and Auctus Fund, LLC (the “Plan of Reorganization”), incorporated by reference to the registrant’s Current
Report on Form 8-K for an event dated October 30, 2020, wherein such document is identified as Exhibit 2.1
2.2
Amended
Disclosure Statement with respect to the Plan of Reorganization, together with exhibits thereto, including the Plan of Reorganization,
incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated October 30, 2020, wherein such
document is identified as Exhibit 2.2
2.3
Plan
Supplement to the Plan of Reorganization, together with forms of Secured Convertible Note, Unsecured Convertible Note, Class A Warrant,
Class B Warrant, Intercreditor Agreement and Security Agreement attached as exhibits thereto, incorporated by reference to the registrant’s
Current Report on Form 8-K for an event dated October 30, 2020, wherein such document is identified as Exhibit 2.3.
3.1
Certificate
of Incorporation, as amended, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December
31, 2019, wherein such document is identified as Exhibit 2.3.
3.2
Bylaws,
incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated December 19, 2014, wherein such
document is identified as Exhibit 3.4
10.1
2010
Equity Participation Plan, as amended, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year
ended December 31, 2019, wherein such document is identified as Exhibit 10.1
10.2
Stock
Option Agreement, dated April 5, 2011, between Stem Cell Assurance, Inc. (now BioRestorative Therapies, Inc.) and Francisco Silva,
incorporated by reference to the registrant’s Form 10, wherein such document is identified as Exhibit 10.24
10.3
License
Agreement, dated as of January 27, 2012, between Regenerative Sciences, LLC and BioRestorative Therapies, Inc. (“License Agreement”),
incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein such
document is identified as Exhibit 10.44
10.4
Amendment
to License Agreement, dated March 21, 2012, incorporated by reference to the registrant’s Annual Report on Form 10-K for the
year ended December 31, 2011, wherein such document is identified as Exhibit 10.45
10.5
Amendment
to License Agreement, dated November 30, 2015, incorporated by reference to the registrant’s Annual Report on Form 10-K for
the year ended December 31, 2015, wherein such document is identified as Exhibit 10.20
10.6
Stock
Option Agreement, dated as of February 10, 2012, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein such document is identified as
Exhibit 10.46
10.7
Stock
Option Agreement, dated as of February 10, 2012, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein such document is identified as
Exhibit 10.49
10.8
Stock
Option Agreement, dated as of December 7, 2012, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2012, wherein such document is identified as
Exhibit 10.58
10.9
Stock
Option Agreement, dated as of December 7, 2012, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2012, wherein such document is identified as
Exhibit 10.61
10.10
Stock
Option Agreement, dated as of October 4, 2013, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2013, wherein such document is identified as
Exhibit 10.59
10.11
Stock
Option Agreement, dated as of October 4, 2013, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2013, wherein such document is identified as
Exhibit 10.62
69
10.12
Stock
Option Agreement, dated as of February 18, 2014, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2013, wherein such document is identified as
Exhibit 10.64
10.13
Stock
Option Agreement, dated as of February 18, 2014, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2013, wherein such document is identified as
Exhibit 10.67
10.14
Stock
Option Agreement, dated as of March 12, 2014, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2013, wherein such document is identified as
Exhibit 10.70
10.15
Lease,
dated as of August 25, 2014, between BioRestorative Therapies, Inc. and 50 Republic Road, LLC, incorporated by reference to the registrant’s
Current Report on Form 8-K for an event dated August 25, 2014, wherein such document is identified as Exhibit 99.1
10.16
Stock
Option Agreement, dated as of October 23, 2014, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2014, wherein such document is identified as
Exhibit 10.65
10.17
Stock
Option Agreement, dated as of October 23, 2014, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2014, wherein such document is identified as
Exhibit 10.67
10.18
Stock
Option Agreement, dated as of September 4, 2015, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference
to the registrant’s Amendment No. 1 to Form S-1 Registration Statement (Registration No. 333-204672), wherein such document
is identified as Exhibit 10.77
10.19
Stock
Option Agreement, dated as of September 4, 2015, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Amendment No. 1 to Form S-1 Registration Statement (Registration No. 333-204672), wherein such document
is identified as Exhibit 10.80
10.20
Stock
Option Agreement, dated as of June 10, 2016, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2016, wherein such document is identified as
Exhibit 10.59
10.21
Stock
Option Agreement, dated as of June 10, 2016, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference to
the registrant’s Annual Report on Form 10-K for the year ended December 31, 2016, wherein such document is identified as Exhibit
10.60
10.22
Stock
Option Agreement, dated as of June 23, 2017, between BioRestorative Therapies, Inc. and Mark Weinreb, incorporated by reference to
the registrant’s Form S-1 Registration Statement (Registration No. 333-220843), wherein such document is identified as Exhibit
10.73
10.23
Stock
Option Agreement, dated as of July 12, 2017, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Form S-1 Registration Statement (Registration No. 333-220843), wherein such document is identified as Exhibit
10.76
10.24
Stock
Option Agreement, dated as of October 29, 2018, between BioRestorative Therapies, Inc., and Mark Weinreb, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2018, wherein such document is identified as
Exhibit 10.94
10.25
Stock
Option Agreement, dated as of October 29, 2018, between BioRestorative Therapies, Inc., and Francisco Silva, incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2018, wherein such document is identified as
Exhibit 10.96
10.26
Lease
Amendment, dated as of June 4, 2019, between 50 Republic Road, LLC and BioRestorative Therapies, Inc., incorporated by reference
to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2019, wherein such document is identified as
Exhibit 10.37
10.27
Form
of Secured Convertible Note issued pursuant to Plan of Reorganization, incorporated by reference to the registrant’s Current
Report on Form 8-K for an event dated October 30, 2020, wherein such document is Exhibit A to the Plan Supplement to the Plan of
Reorganization identified as Exhibit 2.3
10.28
Form
of Unsecured Convertible Note issued pursuant to the Plan of Reorganization, incorporated by reference to the registrant’s
Current Report on Form 8-K for an event dated October 30, 2020, wherein such document is Exhibit B to the Plan Supplement to the
Plan of Reorganization identified as Exhibit 2.3
10.29
Form
of Class A Warrant issued pursuant to the Plan of Reorganization, incorporated by reference to the registrant’s Current Report
on Form 8-K for an event dated October 30, 2020, wherein such document is Exhibit C to the Plan Supplement to the Plan of Reorganization
identified as Exhibit 2.3
10.30
Form
of Class B Warrant issued pursuant to the Plan of Reorganization, incorporated by reference to the registrant’s Current Report
on Form 8-K for an event dated October 30, 2020, wherein such document is Exhibit D to the Plan Supplement to the Plan of Reorganization
identified as Exhibit 2.3
10.31
Form
of Intercreditor Agreement entered into pursuant to the Plan of Reorganization, incorporated by reference to the registrant’s
Current Report on Form 8-K for an event dated October 30, 2020, wherein such document is Exhibit E to the Plan Supplement to the
Plan of Reorganization identified as Exhibit 2.3
70
10.32
Form
of Security Agreement entered into pursuant to the Plan of Reorganization, incorporated by reference to the registrant’s Current
Report on Form 8-K for an event dated October 30, 2020, wherein such document is Exhibit F to the Plan Supplement to the Plan of
Reorganization identified as Exhibit 2.3
10.33
BioRestorative
Therapies, Inc. 2021 Stock Incentive Plan, incorporated by reference to the registrant’s Current Report on Form 8-K for an
event dated October 18, 2020, wherein such document is identified as Exhibit 99.1
10.34
Employment
Agreement, dated as of March 18, 2021, by and between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated by reference
to the registrant’s Current Report on Form 8-K for an event dated October 18, 2020, wherein such document is identified as
Exhibit 99.2
10.35
Employment
Agreement, dated as of March 18, 2021, by and between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference
to the registrant’s Current Report on Form 8-K for an event dated October 18, 2020, wherein such document is identified as
Exhibit 99.3
10.36
Non-Qualified
Stock Option Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated
by reference to the registrant’s Current Report on Form 8-K for an event dated October 18, 2020, wherein such document is identified
as Exhibit 99.4
10.37
Non-Qualified
Stock Option Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated
by reference to the registrant’s Current Report on Form 8-K for an event dated October 18, 2020, wherein such document is identified
as Exhibit 99.5
10.38
Restricted
Stock Unit Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated by
reference to the registrant’s Current Report on Form 8-K for an event dated October 18, 2020, wherein such document is identified
as Exhibit 99.6
10.39
Restricted
Stock Unit Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated
by reference to the registrant’s Current Report on Form 8-K for an event dated October 18, 2020, wherein such document is identified
as Exhibit 99.7
14
Code
of Ethics, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein
such document is identified as Exhibit 14
21
Subsidiaries,
incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2018, wherein such
document is identified as Exhibit 21
23
Independent
Registered Public Accounting Firm’s Consent*
31.1
Principal
Executive Officer Certification*
31.2
Principal
Financial Officer Certification*
32
Section
1350 Certification**
101.INS
XBRL
Instance Document *
101.SCH
XBRL
Schema Document *
101.CAL
XBRL
Calculation Linkbase Document*
101.DEF
XBRL
Definition Linkbase Document*
101.LAB
XBRL
Label Linkbase Document*
101.PRE
XBRL
Presentation Linkbase Document*
*
Filed herewith
**
Furnished herewith
ITEM
16.
FORM
10-K SUMMARY .
Not
applicable
71
SIGNATURES
Pursuant
to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed
on its behalf by the undersigned, thereunto duly authorized.
BIORESTORATIVE
THERAPIES, INC.
Dated:
April 29, 2021
By:
/s/
Lance Alstodt
Lance
Alstodt
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
Capacity
Date
/s/
Lance Alstodt
Chief
Executive Officer, President, Chairman of the Board and Director
April
29, 2021
Lance
Alstodt
(Principal
Executive Officer, Principal Financial Officer and Principal Accounting Officer)
/s/
Francisco Silva
Vice
President, Research and Development and Director
April
29, 2021
Francisco
Silva
/s/
Nickolay Kukekov
Director
April
29, 2021
Nickolay
Kukekov
72
ITEM
8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
FINANCIAL STATEMENTS
TABLE
OF CONTENTS
Page
REPORT
OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
F-2
CONSOLIDATED
FINANCIAL STATEMENTS:
Consolidated
Balance Sheets as of December 31, 2020 and December 31, 2019
F-4
Consolidated
Statements of Operations For the Years Ended December 31, 2020 and December 31, 2019
F-5
Consolidated
Statements of Stockholders’ Deficit For the Years Ended December 31, 2020 and December 31, 2019
F-6
Consolidated
Statements of Cash Flows For the Years Ended December 31, 2020 and December 31, 2019
F-7
Notes
to Consolidated Financial Statements For the Years Ended December 31, 2020 and December 31, 2019
F-8
F- 1
REPORT
OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To
the Board of Directors and
Shareholders
of BioRestorative Therapies, Inc. & Subsidiary.
Opinion
on the Consolidated Financial Statements
We
have audited the accompanying consolidated balance sheets of BioRestorative Therapies, Inc. & Subsidiary (the “Company”)
as of December 31, 2020 and 2019, and the related consolidated statements of operations, changes in stockholders’ deficit, and
cash flows for each of the years in the two-year period ended December 31, 2020, and the related notes (collectively referred to as the
“consolidated financial statements”). In our opinion, the consolidated financial statements present fairly, in all material
respects, the financial position of the Company as of December 31, 2020 and 2019, and the results of its operations and its cash flows
for the years then ended, in conformity with accounting principles generally accepted in the United States of America.
Basis
for Opinion
These
consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion
on the Company’s consolidated financial statements based on our audits. We are a public accounting firm registered with the Public
Company Accounting Oversight Board (United States) (PCAOB) and are required to be independent with respect to the Company in accordance
with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We
conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audits to obtain
reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud.
The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. As part
of our audits, we are required to obtain an understanding of internal control over financial reporting, 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.
Our
audits included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether
due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence
regarding the amounts and disclosures in the consolidated financial statements. Our audits also included evaluating the accounting principles
used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.
We believe that our audits provide a reasonable basis for our opinion.
Critical
Audit Matters
The
critical audit matters communicated below are matters arising from the current period audit of the consolidated financial statements
that were communicated or required to be communicated to the board of directors and that: (1) relate to accounts or disclosures that
are material to the consolidated financial statements and (2) involved our especially challenging, subjective, or complex judgments.
The communication of critical audit matters does not alter in any way our opinion on the consolidated financial statements, taken as
a whole, and we are not, by communicating the critical audit matters below, providing separate opinions on the critical audit matters
or on the accounts or disclosures to which they relate.
Valuation
of Intangible Asset
Description
of the Matter
As
described in Note 3 of the consolidated financial statements, the Company records its intangible asset at cost and amortizes the
asset over an estimated useful life using the straight-line method, which is determined by identifying the period over which the cash
flows from the assets are expected to be generated. The Company reviews long-lived assets, including definite-lived intangible assets,
for impairment whenever events or circumstances indicate that the carrying amount of such assets may not be recoverable. Recoverability
of these assets are determined by comparing the forecasted undiscounted net cash flows of the operation to which the assets relate to
the carrying amount. If the operation is determined to be unable to recover the carrying amount of its assets, then these assets are
written down first, followed by other long-lived assets of the operation to fair value.
F- 2
How
We Addressed the Matter in Our Audit
We
evaluated management’s assessment of impairment. We evaluated the Company’s current performance, and reviewed forecasted
information. We assessed the reasonableness of the forecasted operating results. The testing included inquiries with management, testing
of management’s qualitative assessment of impairment and indicators, and comparison of prior period forecasts to actual results.
Liquidity
– Assessing the Company’s Ability to Continue as a Going Concern
Description
of the Matter
As
described in Note 2 of the consolidated financial statements, the Company has adequate cash on hand, which will provide sufficient liquidity
to finance the operating activities of the Company for twelve months from the issuance of these consolidated financial statements. We
determined that the Company’s ability to continue as a going concern is a critical audit matter due to significant management’s
judgments and assumptions used in estimating future cash flows.
How
We Addressed the Matter in Our Audit
We
reviewed forecasted information, assessed reasonableness of the forecasted operating results and uses and sources of cash used in management’s
assessment. This testing included inquiries with management, comparison of prior period forecasts to actual results, assessment of available
financing, consideration of positive and negative evidence impacting management’s forecasts, market and industry factors.
/s/
Friedman LLP
We
have served as the Company’s auditor since 2020.
Marlton,
New Jersey
April
29, 2021
F- 3
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
BALANCE SHEETS
December 31,
December 31,
2020
2019
ASSETS
Current
Assets:
Cash
$ 3,064,610
$ 1,664
Accounts receivable
17,000
32,000
Prepaid
expenses
105,407
35,199
Total
Current Assets
3,187,017
68,863
Equipment, net
21,914
68,402
Right of use asset
473,849
589,894
Intangible
assets, net
664,268
739,164
Total
Assets
$ 4,347,048
$ 1,466,323
LIABILITIES
AND STOCKHOLDERS’ DEFICIT
Current
Liabilities:
Accounts payable
$ 118,851
$ 1,954,427
Accrued expenses and other
current liabilities
718,259
2,921,164
Accrued interest
49,307
697,658
Lease liability
158,371
85,465
Notes payable, net of debt
discount of $- and $1,247,422, respectively
-
7,145,906
Derivative
liabilities
-
915,959
Total
Current Liabilities
1,044,788
13,720,579
Lease liability, net of
current portion
363,519
521,890
Notes
payable, net of debt discount of $5,366,869
4,270,233
-
Total
Liabilities
5,678,540
14,242,469
Commitments
and Contingencies
Stockholders’
Deficit:
Preferred stock, $0.01
par value; Authorized, 20,000,000 shares; none issued and outstanding at December 31, 2020 and December 31, 2019
-
-
Common stock, $0.0001 par
value; Authorized, 300,000,000,000 shares; Issued and outstanding 2,862,174,380 and 77,851,633, respectively
286,220
7,787
Additional paid in capital
88,225,121
65,786,213
Accumulated
deficit
(89,842,833 )
(78,570,146 )
Total
Stockholders’ Deficit
(1,331,492 )
(12,776,146 )
Total
Liabilities and Stockholders’ Deficit
$ 4,347,048
$ 1,466,323
The
accompanying notes are an integral part of these consolidated financial statements.
F- 4
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF OPERATIONS
For
the Years Ended
December
31, 2020
December
31, 2019
Revenues
$ 77,000
$ 130,000
Operating expenses:
Marketing and promotion
28,281
321,280
Consulting
137,250
1,912,683
Research and development
876,829
1,722,338
General
and administrative
1,786,716
4,605,704
Total operating expenses
2,829,076
8,562,005
Loss from operations
(2,752,076 )
(8,432,005 )
Other expense:
Interest expense
(362,041 )
(1,467,952 )
Amortization of debt discount
(1,278,104 )
(3,671,087 )
Loss on extinguishment
of notes payable, net
(658,152 )
(1,895,116 )
Change in fair value of
derivative liabilites
(2,141,069 )
788,970
Reorganization items, net
(4,081,245 )
-
Other
income
-
29,300
Total other expense
(8,520,611 )
(6,215,885 )
Net loss
$ (11,272,687 )
$ (14,647,890 )
Net Loss Per Share
-
Basic and Diluted
$ (0.01 )
$ (0.66 )
Weighted Average Number of Common Shares Outstanding
-
Basic and Diluted
1,578,818,497
22,277,350
The
accompanying notes are an integral part of these consolidated financial statements.
F- 5
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF STOCKHOLDERS’ DEFICIT
Common
Stock
Additional
Paid-in
Accumulated
Total Shareholders’
Shares
Amount
Capital
Deficit
Deficit
Balance at January 1, 2020
77,851,633
$ 7,787
$ 65,786,213
$ (78,570,146 )
$ (12,776,146 )
Shares and warrants issued for cash
1,000,000
100
9,900
-
10,000
Shares issued in exchange of notes payable
and accrued interest
1,515,799,750
151,580
2,407,352
-
2,558,932
Shares issued in satisfaction of bankruptcy
allowable claims
1,049,726,797
104,973
14,276,286
-
14,381,259
Shares issued in cashless exercise of warrants
217,796,200
21,780
(21,780 )
-
-
Fair market value of beneficial conversion
feature and warrants issued convertible notes payable instruments
-
-
5,075,449
-
5,075,449
Stock-based compensation:
- options
-
-
691,701
-
691,701
Net loss
-
-
-
(11,272,687 )
(11,272,687 )
Balance as of December
31, 2020
2,862,174,380
$ 286,220
$ 88,225,121
$ (89,842,833 )
$ (1,331,492 )
Balance at January 1, 2019
11,728,394
$ 1,175
$ 55,280,043
$ (63,922,256 )
$ (8,641,038 )
Shares and warrants issued for cash
5,663,301
566
254,346
-
254,912
Shares issued in satisfaction of accrued consulting
services
10,000
1
7,199
-
7,200
Shares issued in exchange for notes payable
and accrued interest
60,296,065
6,029
5,715,331
-
5,721,360
Shares issued and recorded as debt discount
in connection with a note payable issuances and extensions
78,873
8
61,212
-
61,220
Reclassification of derivative liabilities
to equity
-
-
2,809,565
-
2,809,565
Stock-based compensation:
- common stock
75,000
8
29,992
-
30,000
- options and warrants
-
-
1,628,525
-
1,628,525
Net loss
-
-
-
(14,647,890 )
(14,647,890 )
Balance as of December
31, 2019
77,851,633
$ 7,787
$ 65,786,213
$ (78,570,146 )
$ (12,776,146 )
The
accompanying notes are an integral part of these consolidated financial statements.
F- 6
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF CASH FLOWS
Years
Ended
December
31, 2020
December
31, 2019
Cash flows from operating
activities:
Net Loss
$ (11,272,687 )
$ (14,647,890 )
Adjustments to reconcile
net loss to net cash used in operating activities:
Amortization of debt discount
1,278,105
3,671,087
Accretion of interest expense
2,810,973
548,026
Depreciation and amortization
121,384
217,359
Stock-based compensation
691,701
1,658,524
Loss on extinguishment
of note payables, net
658,152
1,895,116
Gain on settlement of payables
-
(29,300 )
Reorganization items,
net
527,455
-
Change in fair value of
derivative liabilities
2,141,069
(788,970 )
Professional fees paid
for services related to bankruptcy proceedings
476,653
-
Non-cash effect of right
of use asset
30,580
17,461
Changes in operating assets
and liabilities:
Accounts receivable
15,000
(3,000 )
Security deposit
-
22,100
Prepaid assets and other
current assets
(70,208 )
(735 )
Accounts payable
84,631
97,099
Accrued
interest, expenses and other current liabilities
542,927
424,389
Net
cash used in operating activities
(1,964,265 )
(6,918,734 )
Cash flows from investing
activities:
Purchases
of property and equipment
-
(35,631 )
Net
cash used in investing activities
-
(35,631 )
Cash flows from financing
activities:
Proceeds from notes payable
4,290,310
10,888,339
Payments on notes payable
- principal
-
(4,894,604 )
Payments on notes payable
- prepayment premiums
-
(813,730 )
Proceeds from DIP financiing
1,226,901
-
Financing costs
(500,000 )
-
Sales
of common stock and warrants for cash
10,000
1,658,500
Net
cash provided by financing activities
5,527,211
6,838,505
Net increase (decrease)
in cash and cash equivalents
3,062,946
(115,859 )
Cash
and cash equivalents - beginning of year
1,664
117,523
Cash
and cash equivalents - end of year
$ 3,064,610
$ 1,664
Supplemental cash flow information:
Cash paid for:
Interest
$ -
$ 355,326
Non-cash investing and financing
activities:
Shares issued and recorded
as debt discount in connection with notes payable issuances and extensions
$ -
$ 61,220
Shares issued in exchange
for notes payable and accrured interest
$ 2,558,932
$ 5,721,360
Shares and warrants issued
in satisfaction of accrued consulting services
$ -
$ 7,200
Shares issued in satisfaction
of bankruptcy allowable claims
$ 14,381,259
$ -
Reclassification of derivative
liabilities to equity
$ -
$ 2,809,565
Bifurcated embedded conversion
options and warrants recorded as derivative liability and debt discount
$ 2,377,818
$ 5,216,650
Fair market value of beneficial
conversion feature and warrants issued convertible notes payable instruments
$ 5,075,449
$ -
Sale of warrants recorded
as derivative liabilities
$ 10,000
$ 1,403,588
Write of use asset and
lease liability recorded upon adoption of ASC 842
$ -
$ 638,246
The
accompanying notes are an integral part of these consolidated financial statements.
F- 7
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
NOTES
TO CONSOLIDATED FINANCIAL STATEMENTS
Note
1 – organization and business operations
Corporate
History
BioRestorative
Therapies, Inc. has one wholly-owned subsidiary, Stem Pearls, LLC (“Stem Pearls”). BioRestorative Therapies, Inc. and its
subsidiary are referred to collectively as “BRT” or the “Company”.
On
March 20, 2020 (the “Petition Date”), the Company filed a voluntary petition commencing a case (the “Chapter 11 Case”)
under chapter 11 of title 11 of the U.S. Code in the United States Bankruptcy Court for the Eastern District of New York (the “Bankruptcy
Court”).
On
August 7, 2020 the Company and Auctus Fund, LLC (“Auctus”), the Company’s largest unsecured creditor and a stockholder
as of the Petition Date, filed an Amended Joint Plan of Reorganization (the “Plan”) and on October 30, 2020, the Bankruptcy
Court entered an order (the “Confirmation Order”) confirming the Plan, as amended. Amendments to the Plan are reflected in
the Confirmation Order. On November 16, 2020 (the “Effective Date”), the Plan became effective. See Note 7 – Notes
Payable – Chapter 11 Reorganization.
Business
Operations
BRT
develops therapeutic products and medical therapies using cell and tissue protocols, primarily involving adult stem cells. BRT’s
website is at www.biorestorative.com . BRT is currently developing a Disc/Spine Program referred to as “brtxDISC”.
Its lead cell therapy candidate, BRTX-100 , is a product formulated from autologous (or a person’s own) cultured mesenchymal
stem cells collected from the patient’s bone marrow. The product is intended to be used for the non-surgical treatment of painful
lumbosacral disc disorders or as a complimentary therapeutic to a surgical procedure. BRT is also engaging in research efforts with respect
to a platform technology utilizing brown adipose (fat) for therapeutic purposes to treat type 2 diabetes, obesity and other metabolic
disorders and has labeled this initiative its ThermoStem Program. Further, BRT has licensed a patented curved needle device that is a
needle system designed to deliver cells and/or other therapeutic products or material to the spine and discs or other potential sites.
NOTE
2 – LIQUIDITY
The
accompanying consolidated financial statements have been prepared on the basis that the Company will continue as a going concern, which
contemplates realization of assets and the satisfaction of liabilities in the normal course of business. For the year ended December
31, 2020, the Company had a loss from operations of approximately $2,752,000 and negative cash flows from operations of approximately
$1,964,000. The Company’s operating activities consume the majority of its cash resources. The Company anticipates that
it will continue to incur operating losses as it executes its development plans for 2021, as well as other potential strategic and business
development initiatives. In addition, the Company has had and expects to have negative cash flows from operations, at least into the
near future. The Company has previously funded, and plans to continue funding, these losses primarily through additional infusions of
cash from equity and debt financing.
The
Company believes the following has been able to mitigate the above factors with regards to its ability to continue as a going
concern: (i) as part of its Chapter 11 reorganization approximately $14,700,000 in outstanding debt and other liabilities
were exchanged for (a) shares of common stock, (b) new convertible notes or (c) new convertible notes and warrants to
purchase shares of common stock; (ii) the Company secured DIP financing during its Chapter 11 Case in the amount of
$1,189,413, as well as an aggregate amount of $3,848,548 in debt financing from Auctus and others as part of the
Company’s Chapter 11 reorganization, to sustain operations; and (iii) pursuant to the plan of reorganization, Auctus is
required to loan to the Company, as needed and subject to the Company becoming current in its SEC reporting obligations, an
additional amount equal to $3,500,000, less the amount of Auctus’ DIP financing ($1,226,901, inclusive of accrued
interest) and its DIP costs not to exceed approximately $650,000. As a result of the above, and cash on hand of
approximately $2,455,935 as of April 19, 2021, the Company believes it has sufficient cash to fund operations for the twelve
months subsequent to the filing date. In addition, the Company is seeking further funding to commence and complete a Phase 2
clinical study of the use of BRTX-100.
F- 8
Current
funds on hand will not be sufficient to enable the Company to fully complete its development activities or attain profitable operations.
If the Company is unable to obtain such additional financing on a timely basis the Company may have to curtail its development, marketing
and promotional activities, which would have a material adverse effect on the Company’s business, financial condition and results
of operations, and ultimately the Company could be forced to discontinue its operations and liquidate.
NOTE
3 – SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Basis
of Presentation
The
accompanying audited consolidated financial statements have been prepared in accordance with GAAP. The summary of significant accounting
policies presented below is designed to assist in understanding the Company’s consolidated financial statements. Such consolidated
financial statements and accompanying notes are the representations of Company’s management, who is responsible for their integrity
and objectivity.
Principles
of Consolidation
These
consolidated financial statements include the accounts of the Company and its wholly-owned subsidiary Stem Pearls. Intercompany accounts
and transactions have been eliminated upon consolidation.
Chapter
11 Cases
Chapter
11 Accounting
The
consolidated financial statements included herein have been prepared as if we were a going concern and in accordance with Accounting
Standards Codification (“ASC”) 852, Reorganizations .
Weak
industry conditions in 2019 negatively impacted the Company’s results of operations and cash flows and may continue to do so in
the future. In order to decrease the Company’s indebtedness and maintain the Company’s liquidity levels sufficient to meet
its commitments, the Company undertook a number of actions, including minimizing capital expenditures and further reducing its recurring
operating expenses. The Company believed that even after taking these actions, it would not have sufficient liquidity to satisfy its
debt service obligations and meet its other financial obligations. On March 20, 2020 (the “Petition Date”), the Company filed
a voluntary petition commencing a case under chapter 11 of title 11 of the U.S. Code in the United States Bankruptcy Court for the Eastern
District of New York. On August 7, 2020, the Company and Auctus, the Company’s largest unsecured creditor and a stockholder as
of the Petition Date, filed an Amended Joint Plan of Reorganization (the “Plan”). On November 16, 2020 (the “Effective
Date”), the Plan became effective.
Reorganization
Items, Net
The
Company incurred costs after the Petition Date associated with the reorganization, primarily unamortized debt discount, exchange of common
stock and unsecured convertible notes for allowable claims and post-petition professional fees. In accordance with applicable guidance,
costs associated with the bankruptcy proceedings have been recorded as reorganization items, net within the accompanying consolidated
statements of operations for the year ended December 31, 2020. Reorganization items, net for the year ended December 31, 2020, was $(4,081,245),
representing cash used in operating activities.
F- 9
Reorganization
items, net for the year ended December 31, 2020, consisted of the following:
Year
Ended December 31, 2020
Professional fees
$ (476,652 )
Write-off of derivative liability
4,375,231
Default interest and penalties
(864,125 )
Exchange of common stock for allowable claims
(3,047,417 )
Exchange of secured convertible debt for allowable
claims
(1,488,172 )
Unamortized debt discount
on convertible notes
(2,580,110 )
Total
reorganization items, net
$ (4,081,245 )
Use
of Estimates
The
preparation of the consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that
affect the reported amounts of assets, liabilities, equity-based transactions, revenue and expenses and disclosure of contingent liabilities
at the date of the consolidated financial statements. The Company bases its estimates and assumptions on historical experience, known
or expected trends and various other assumptions that it believes to be reasonable. As future events and their effects cannot be determined
with precision, actual results could differ from these estimates which may cause the Company’s future results to be affected.
The
Company believes the following critical accounting policies affect its more significant judgments and estimates used in the preparation
of the accompanying consolidated financial statements. Significant estimates include the carrying value of intangible assets, deferred
tax asset and valuation allowance, estimated fair value of derivative liabilities stemming from convertible debt securities, and assumptions
used in the Black-Scholes-Merton pricing model, such as expected volatility, risk-free interest rate, and expected divided rate.
Concentrations
Financial
instruments that potentially subject the Company to concentrations of credit risk consist principally of cash deposits. Accounts at each
institution are insured by the Federal Deposit Insurance Corporation (“FDIC”) up to $250,000. As of December 31, 2020 and
2019, the Company had approximately $2,815,000 and $-, respectively, in excess of the FDIC insured limit.
The
royalties related to the Company’s sublicense comprised all of the Company’s revenue during the years ended December 31,
2020 and 2019. See “Revenue” below.
During
the years ended December 31, 2020 and 2019, 84% and 30% of the Company’s debt financings were from one lender.
Revenue
The
Company accounts for revenue in accordance with ASC Topic 606, Revenue from Contracts with Customers, which the Company adopted beginning
on January 1, 2019, utilizing the modified retrospective method. The approach was applied to contracts that were in process as of January
1, 2019. The adoption of ASC Topic 606 did not have an impact on the Company’s reported revenue or contracts in process at January
1, 2019. The reported results for the fiscal year 2019 reflect the application of ASC Topic 606.
F- 10
The
Company derives all of its revenue pursuant to a license agreement between the Company and a stem cell treatment company (“SCTC”)
entered into in January 2012, as amended in November 2015. Pursuant to the license agreement, the SCTC granted to the Company a license
to use certain intellectual property related to, among other things, stem cell disc procedures and the Company has granted to the SCTC
a sublicense to use, and the right to sublicense to third parties the right to use, in certain locations in the United States and the
Cayman Islands, certain of the licensed intellectual property. In consideration of the sublicenses, the SCTC has agreed to pay the Company
royalties on a per disc procedure basis.
The
Company’s contracted transaction price is allocated to each distinct performance obligation and recognized as revenue when, or
as, the performance obligation is satisfied. The Company’s contracts have a single performance obligation which is not separately
identifiable from other promises in the contracts and is, therefore, not distinct. The Company’s performance obligation is satisfied
upon the transfer of risk of loss to the customer. All sales have fixed pricing and there are currently no variable components included
in the Company’s revenue. The timing of the Company’s revenue recognition may differ from the timing of receiving royalty
payments. A receivable is recorded when revenue is recognized prior to receipt of a royalty payment and the Company has an unconditional
right to the royalty payment. Alternatively, when a royalty payment precedes the provision of the related services, the Company records
deferred revenue until the performance obligations are satisfied. During the years ended December 31, 2020 and 2019, the Company recognized
$77,000 and $130,000, respectively, of revenue related to the Company’s sublicenses.
Practical
Expedients
As
part of ASC Topic 606, the Company has adopted several practical expedients including:
●
Significant
Financing Component – the Company does not adjust the promised amount of consideration for the effects of a significant financing
component since the Company expects, at contract inception, that the period between when the Company transfers a promised good or
service to the customer and when the customer pays for that good or service will be one year or less.
●
Unsatisfied
Performance Obligations – all performance obligations related to contracts with a duration for less than one year, the Company
has elected to apply the optional exemption provided in ASC Topic 60 and therefore, is not required to disclose the aggregate amount
of transaction price allocated to performance obligations that are unsatisfied or partially satisfied at the end of the reporting
period.
●
Right
to Invoice – the Company has a right to consideration from a customer in an amount that corresponds directly with the value
to the customer of the Company’s performance completed to date the Company may recognize revenue in the amount to which the
entity has a right to invoice.
Contract
Modifications
There
were no contract modifications during the years ended December 31, 2020 and 2019. Contract modifications are not routine in the performance
of the Company’s contracts.
Cash
The
Company considers all highly liquid investments with maturities of three months or less at the time of purchase to be cash equivalents.
There were no cash equivalents as of December 31, 2020 or 2019.
Accounts
Receivable
Accounts
receivable are reported at their outstanding unpaid principal balances net of allowances for doubtful accounts. The Company periodically
assesses its accounts and other receivables for collectability on a specific identification basis. The Company provides for allowances
for doubtful receivables based on management’s estimate of uncollectible amounts considering age, collection history, and any other
factors considered appropriate. The Company writes off accounts receivable against the allowance for doubtful accounts when a balance
is determined to be uncollectible. The Company did not record an allowance for doubtful accounts as of December 31, 2020 and 2019, respectively.
Property
and Equipment
Property
and equipment are recorded at cost. Depreciation is computed using straight-line method over the estimated useful lives of the related
assets, generally three to fifteen years. Expenditures that enhance the useful lives of the assets are capitalized and depreciated. Computer
equipment costs are capitalized, as incurred, and depreciated on a straight-line basis over a range of 3 – 5 years.
Leasehold
improvements are amortized over the lesser of (i) the useful life of the asset, or (ii) the remaining lease term. Maintenance and repairs
are charged to expense as incurred. The Company capitalizes cost attributable to the betterment of property and equipment when such betterment
extends the useful life of the assets. At the time of retirement or other disposition of property and equipment, the cost and accumulated
depreciation will be removed from the accounts and the resulting gain or loss, if any, will be reflected in operations.
F- 11
Impairment
of Long-Lived Assets
The
Company reviews long-lived assets, including definite-lived intangible assets, for impairment whenever events or changes in circumstances
indicate that the carrying amount of such assets may not be recoverable. Recoverability of these assets is determined by comparing the
forecasted undiscounted net cash flows of the operation to which the assets relate to the carrying amount. If the operation is determined
to be unable to recover the carrying amount of its assets, then these assets are written down first, followed by other long-lived assets
of the operation to fair value. Fair value is determined based on discounted cash flows or appraised values, depending on the nature
of the assets. For the years ended December 31, 2020 and 2019, we
determined that there was no impairment charge for our intangible assets.
Intangible
Assets
The
Company records its intangible assets at cost in accordance with Accounting Standards Codification (“ASC”) 350, Intangibles
– Goodwill and Other. Definite lived intangible assets are amortized over their estimated useful life using the straight-line method,
which is determined by identifying the period over which the cash flows from the asset are expected to be generated.
Advertising
and Marketing Costs
The
Company expenses advertising and marketing costs as they are incurred. Advertising and marketing expenses were $28,281 and $321,280 for
the years ended December 31, 2020 and 2019, respectively, and are recorded in marketing and promotion on the statement of operations.
Fair
Value Measurements
As
defined in ASC 820, “Fair Value Measurements and Disclosures,” fair value is the price that would be received to sell an
asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date (exit price). The
Company utilizes market data or assumptions that market participants would use in pricing the asset or liability, including assumptions
about risk and the risks inherent in the inputs to the valuation technique. These inputs can be readily observable, market corroborated,
or generally unobservable. ASC 820 establishes a fair value hierarchy that prioritizes the inputs used to measure fair value. The hierarchy
gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (level 1 measurement) and
the lowest priority to unobservable inputs (level 3 measurement). This fair value measurement framework applies at both initial and subsequent
measurement.
Level
1:
Quoted
prices are available in active markets for identical assets or liabilities as of the reporting date. Active markets are those in
which transactions for the asset or liability occur in sufficient frequency and volume to provide pricing information on an ongoing
basis. Level 1 primarily consists of financial instruments such as exchange-traded derivatives, marketable securities and listed
equities.
Level
2:
Pricing
inputs are other than quoted prices in active markets included in Level 1, which are either directly or indirectly observable as
of the reported date. Level 2 includes those financial instruments that are valued using models or other valuation methodologies.
These models are primarily industry-standard models that consider various assumptions, including quoted forward prices for commodities,
time value, volatility factors and current market and contractual prices for the underlying instruments, as well as other relevant
economic measures. Substantially all of these assumptions are observable in the marketplace throughout the full term of the instrument,
can be derived from observable data or are supported by observable levels at which transactions are executed in the marketplace.
Instruments in this category generally include non-exchange-traded derivatives such as commodity swaps, interest rate swaps, options
and collars.
Level
3:
Pricing
inputs include significant inputs that are generally less observable from objective sources. These inputs may be used with internally
developed methodologies that result in management’s best estimate of fair value.
F- 12
See
Note 9 – Derivative Liabilities for additional details regarding the valuation technique and assumptions used in valuing Level
3 inputs.
Fair
Value of Financial Instruments
The
carrying value of cash, accounts receivable, accounts payable and accrued expenses, and other current liabilities approximate their fair
values based on the short-term maturity of these instruments. The carrying amount of notes approximate the estimated fair value for these
financial instruments as management believes that such notes constitute substantially all of the Company’s debt and interest payable
on the notes approximates the Company’s incremental borrowing rate.
Net
Loss per Common Share
Net
loss per share is computed by dividing net loss by the weighted average number of shares of common stock outstanding during the year.
All vested outstanding options and warrants are considered potential common stock. The dilutive effect, if any, of stock options and
warrants are calculated using the treasury stock method. All outstanding convertible notes are considered common stock at the beginning
of the period or at the time of issuance, if later, pursuant to the if-converted method. Since the effect of common stock equivalents
is anti-dilutive with respect to losses, options, warrants, and convertible notes have been excluded from the Company’s computation
of net loss per common share for the years ended December 31, 2020 and 2019.
The
following table summarizes the securities that were excluded from the diluted per share calculation because the effect of including these
potential shares was antidilutive due to the Company’s net loss position even though the exercise price could be less than the
average market price of the common shares:
Year
Ended December 31,
2020
2019
Options
4,859,617
4,879,617
Warrants
15,002,388,203
8,379,177
Convertible notes
436,307,132 (1)
501,549,663 (2)
Total
15,675,232,655
514,808,457
(1)
As
of December 31, 2020 all of the convertible notes had variable conversion prices and the shares issuable were estimated based on
the market conditions. Pursuant to the note agreements, there were 52,292,375,355 shares of common stock reserved for future note
conversions as of December 31, 2020.
(2)
As
of December 31, 2019 many of the convertible notes had variable conversion prices and the shares issuable were estimated based on
the market conditions. Pursuant to the note agreements, there were 225,023,100 shares of common stock reserved for future note conversions
as of December 31, 2019.
Stock-Based
Compensation
The
Company applies the provisions of ASC 718, Compensation—Stock Compensation (“ASC 718”), which requires the measurement
and recognition of compensation expense for all stock-based awards made to employees, including employee stock options, in the statements
of operations.
For
stock options issued to employees and members of the board of directors for their services, the Company estimates the grant date fair
value of each option using the Black-Scholes option pricing model. The use of the Black-Scholes option pricing model requires management
to make assumptions with respect to the expected term of the option, the expected volatility of the common stock consistent with the
expected life of the option, risk-free interest rates and expected dividend yields of the common stock. For awards subject to service-based
vesting conditions, including those with a graded vesting schedule, the Company recognizes stock-based compensation expense equal to
the grant date fair value of stock options on a straight-line basis over the requisite service period, which is generally the vesting
term. Forfeitures are recorded as they are incurred as opposed to being estimated at the time of grant and revised.
F- 13
Pursuant
to ASU 2018-07 Compensation – Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting, the Company
accounts for stock options issued to non-employees for their services in accordance ASC 718. The Company uses valuation methods and assumptions
to value the stock options that are in line with the process for valuing employee stock options noted above.
Since
the shares underlying the Company’s 2010 Equity Participation Plan (the “Plan”) are registered, the Company estimates
the fair value of the awards granted under the Plan based on the market value of its freely tradable common stock as reported on the
OTCQB market. On February 3, 2020, the Company was advised by OTC Markets Group that, based upon the closing bid price of the Company’s
common stock being less than $0.001 per share for five consecutive trading days, the Company’s common stock was moved from the
OTCQB Market to the Pink Market effective at market open on February 10, 2020. The fair value of the Company’s restricted equity
instruments was estimated by management based on observations of the cash sales prices of both restricted shares and freely tradable
shares. Awards granted to directors are treated on the same basis as awards granted to employees. Upon the exercise of an option or warrant,
the Company issues new shares of common stock out of its authorized shares.
Convertible
Instruments
The
Company bifurcates conversion options from their host instruments and accounts for them as free standing derivative financial instruments
according to certain criteria. The criteria include circumstances in which (a) the economic characteristics and risks of the embedded
derivative instrument are not clearly and closely related to the economic characteristics and risks of the host contract, (b) the hybrid
instrument that embodies both the embedded derivative instrument and the host contract is not re-measured at fair value under otherwise
applicable generally accepted accounting principles with changes in fair value reported in earnings as they occur and (c) a separate
instrument with the same terms as the embedded derivative instrument would be considered a derivative instrument. An exception to this
rule is when the host instrument is deemed to be conventional.
When
the Company has determined that the embedded conversion options should not be bifurcated from their host instruments, the Company records,
when necessary, discounts to convertible notes for the intrinsic value of conversion options embedded in debt instruments (the beneficial
conversion feature) based upon the differences between the fair value of the underlying common stock at the commitment date of the note
transaction and the effective conversion price embedded in the note. Debt discounts under these arrangements are amortized over the term
of the related debt to their stated date of redemption.
Income
Taxes
Deferred
tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial
statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets, including tax loss
and credit carry forwards, and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which
those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in
tax rates is recognized in income in the period that includes the enactment date.
The
Company utilizes ASC 740, “Income Taxes,” which requires the recognition of deferred tax assets and liabilities for the expected
future tax consequences of events that have been included in the consolidated financial statements or tax returns. The Company accounts
for income taxes using the asset and liability method to compute the differences between the tax basis of assets and liabilities and
the related financial amounts, using currently enacted tax rates. A valuation allowance is recorded when it is “more likely-than-not”
that a deferred tax assets will not be realized.
For
uncertain tax positions that meet a “more likely than not” threshold, the Company recognizes the benefit of uncertain tax
positions in the consolidated financial statements. The Company’s practice is to recognize interest and penalties, if any, related
to uncertain tax positions in income tax expense in the consolidated statements of operations.
F- 14
Derivative
Financial Instruments
The
Company evaluates its convertible instruments to determine if those contracts or embedded components of those contracts qualify as derivative
financial instruments to be separately accounted for in accordance with Topic 815 of the Financial Accounting Standards Board (“FASB”)
ASC. The accounting treatment of derivative financial instruments requires that the Company record embedded conversion options (“ECOs”)
and any related freestanding instruments at their fair values as of the inception date of the agreement and at fair value as of each
subsequent balance sheet date. Any change in fair value is recorded as non-operating, non-cash income or expense for each reporting period
at each balance sheet date. Conversion options are recorded as a discount to the host instrument and are amortized as amortization of
debt discount on the consolidated financial statements over the life of the underlying instrument. The Company reassesses the classification
of its derivative instruments at each balance sheet date. If the classification changes as a result of events during the period, the
contract is reclassified as of the date of the event that caused the reclassification.
The
Multinomial Lattice Model and Black-Scholes Model were used to estimate the fair value of the ECOs of convertible notes payable, the
warrants, and stock options that are classified as derivative liabilities on the consolidated balance sheets. The models include subjective
input assumptions that can materially affect the fair value estimates. The expected volatility is estimated based on the actual volatility
during the most recent historical period of time equal to the weighted average life of the instruments.
Sequencing
Policy
Under
ASC 815-40-35 (“ASC 815”), the Company has adopted a sequencing policy, whereby, in the event that reclassification of contracts
from equity to assets or liabilities is necessary pursuant to ASC 815 due to the Company’s inability to demonstrate it has sufficient
authorized shares as a result of certain securities with a potentially indeterminable number of shares, shares will be allocated on the
basis of the earliest issuance date of potentially dilutive instruments, with the earliest grants receiving the first allocation of shares.
Pursuant to ASC 815, issuances of securities to the Company’s employees and directors, or to compensate grantees in a share-based
payment arrangement, are not subject to the sequencing policy.
Leases
In
February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). The standard requires all leases that have a term of over 12 months
to be recognized on the balance sheet with the liability for lease payments and the corresponding right-of-use asset initially measured
at the present value of amounts expected to be paid over the term. Recognition of the costs of these leases on the income statement will
be dependent upon their classification as either an operating or a financing lease. Costs of an operating lease will continue to be recognized
as a single operating expense on a straight-line basis over the lease term. Costs for a financing lease will be disaggregated and recognized
as both an operating expense (for the amortization of the right-of-use asset) and interest expense (for interest on the lease liability).
This standard, which the Company adopted on January 1, 2019, was applied on a modified retrospective basis to leases existing at, or
entered into after, the beginning of the earliest comparative period presented in the financial statements. The adoption of ASU 2016
- 02 did not have a material impact on the Company’s financial statements and related disclosures.
A
lease is defined as a contract that conveys the right to control the use of identified property, plant or equipment for a period of time
in exchange for consideration. On January 1, 2019, the Company adopted ASC 842 and it primarily affected the accounting treatment for
operating lease agreements in which the Company is the lessee.
In
accordance with ASC 842, Leases , the Company recognized a right-of-use (“ROU”) asset and corresponding lease liability
on its balance sheets for its office space lease agreement. See Note 12 for further discussion, including the impact on the Company’s
financial statements and related disclosures.
F- 15
ROU
assets include any prepaid lease payments and exclude any lease incentives and initial direct costs incurred. Lease expense for minimum
lease payments is recognized on a straight-line basis over the lease term. The lease terms may include options to extend or terminate
the lease if it is reasonably certain that the Company will exercise that option.
Leases
in which the Company is the lessee are comprised of office rental. All of the leases are classified as operating leases. The Company
has a lease agreement for office space with a remaining term of four years as of December 31, 2020.
Recent
Accounting Pronouncements
All
newly issued but not yet effective accounting pronouncements have been deemed to be not applicable or immaterial to the Company.
NOTE
4 – PROPERTY AND EQUIPMENT
Property
and equipment consists of the following:
December
31, 2020
December
31, 2019
Medical equipment
$ 352,133
$ 352,133
Furniture and fixtures
123,487
123,487
Computer software and equipment
107,648
107,648
Office equipment
12,979
12,979
Leasehold improvements
304,661
304,661
900,908
900,908
Less: accumulated
depreciation
(878,994 )
(832,506 )
Property and equipment,
net
$ 21,914
$ 68,402
Total
depreciation expense for the years ended December 31, 2020 and 2019 was $46,488 and $142,465, respectively. Depreciation expense is reflected
in general and administrative expenses and research and development expenses in the consolidated statement of operations.
NOTE
5 – INTANGIBLE ASSETS
The
Company is a party to a license agreement with the SCTC (as amended) (the “SCTC Agreement”). Pursuant to the SCTC Agreement,
the Company obtained, among other things, a worldwide, exclusive, royalty-bearing license from the SCTC to utilize or sublicense a certain
medical device patent for the administration of specific cells and/or cell products to the disc and/or spine (and other parts of the
body) and a worldwide (excluding Asia and Argentina), exclusive, royalty-bearing license to utilize or sublicense a certain method for
culturing cells. Pursuant to the license agreement with the SCTC, unless certain performance milestones had been or are satisfied, the
Company would have been required to pay to the SCTC $150,000 by April 2017 and an additional $250,000 by April 2019 in order to maintain
its exclusive rights with regard to the disc/spine technology. In February 2017, the Company received authorization from the Food and
Drug Administration (the “FDA”) to proceed with a Phase 2 clinical trial. Based upon such authorization, the Company has
satisfied a performance milestone such that the Company was not required to pay to the SCTC a minimum amount of $150,000 by April 2017
to retain exclusive rights with regard to the disc/spine technology. In addition, the Company believes that it has until February 2022
to complete the Phase 2 clinical trial in order to satisfy the final performance milestone such that the Company was not required to
pay the additional $250,000 by April 2019 pursuant to the SCTC Agreement to maintain its exclusive rights.
F- 16
Intangible
assets consist of the following:
Patents
and Trademarks
Licenses
Accumulated
Amortization
Total
Balance as of January 1, 2019
$ 3,676
$ 1,301,500
$ (491,117 )
$ 814,059
Amortization
expense
-
-
(74,895 )
(74,895 )
Balance as of December 31, 2019
3,676
1,301,500
(566,012 )
739,164
Amortization
expense
-
-
(74,896 )
(74,896 )
Balance as of December 31, 2020
$ 3,676
$ 1,301,500
$ (640,908 )
$ 664,268
Weighted average remaining amortization
period at December 31, 2020 (in years)
-
8.9
Amortization
of intangible assets consists of the following:
Patents
and Trademarks
Licenses
Accumulated
Amortization
Balance as of January 1, 2019
$ 2,944
$ 488,173
$ 491,117
Amortization
expense
368
74,527
74,895
Balance as of December 31, 2019
3,312
562,700
566,012
Amortization
expense
364
74,531
74,895
Balance as of December 31, 2020
$ 3,676
$ 637,231
$ 640,907
NOTE
6 – ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Accrued
expenses and other current liabilities consist of:
December
31, 2020
December
31, 2019
Accrued payroll
$ -
$ 152,308
Accrued research and development expenses
-
806,175
Accrued general and administrative expenses
60,661
1,392,743
Accrued director compensation
-
557,500
Deferred rent
-
12,438
Accrued DIP and Plan
costs related to DIP Funding and Plan
657,598 (1)
-
Total
accrued expenses
$ 718,259
$ 2,921,164
(1)
Amount represents DIP and Plan costs associated with
the Auctus DIP Funding and the Plan. As of December 31, 2020, these amounts were note finalized and, as a result, were recorded
as accrued expenses in the consolidated balance sheets. Subsequent to December 31, 2020, upon finalization, the amount representing the
costs associated with the DIP Funding and the Plan will be converted into a Secured Convertible Note.
F- 17
Note
7 – NOTES PAYABLE & Chapter 11 reorganization
A
summary of the notes payable activity during the years ended December 31, 2020 and 2019 is presented below:
Related
Party Notes
Convertible
Notes
Other
Notes
Debt
Discount
Total
Outstanding,
December 31, 2018
$ 720,000
$ 4,309,415
$ 132,501
$ (1,012,363 )
$ 4,149,553
Issuances
635,000
9,913,339
340,000
-
10,888,339
Exchanges for equity
-
(2,637,323 )
-
634,525
(2,002,798 )
Repayments
(70,000 )
(4,817,105 )
(7,500 )
428,939
(4,465,666 )
Extinguishment of notes
payable
-
-
(148,014 )
6,196
(141,818 )
Recognition of debt
discount
-
-
-
(5,523,830 )
(5,523,830 )
Accretion of interest
expense
-
-
-
548,026
548,026
Accrued interest reclassified
to notes payable principal
-
-
23,013
-
23,013
Amortization
of debt discount
-
-
-
3,671,087
3,671,087
Outstanding, December
31, 2019
1,285,000
6,768,326
340,000
(1,247,420 )
7,145,906
Issuances
353,762
3,936,548
-
-
4,290,310
Third-party purchases
(287,041 )
287,041
-
-
-
Exchanges for equity
-
(813,393 )
-
253,654
(559,739 )
Exchanged for equity
pursuant to Chapter 11 Plan
(998,139 )
(3,592,395 )
(340,000 )
-
(4,930,534 )
Secured and Unsecured
convertible notes payable exchanged pursuant to Chapter 11 Plan, net
(353,582 )
3,050,975
-
-
2,697,393
Recognition of debt
discount
-
-
-
(8,534,245 )
(8,534,245 )
Accretion of interest
expense
-
-
-
2,886,036
2,886,036
Amortization
of debt discount
-
-
1,275,106
1,275,106
Outstanding,
December 31, 2020
$ -
$ 9,637,102
$ -
$ (5,366,869 )
$ 4,270,233
Chapter
11 Reorganization
On
March 20, 2020, the Company filed a voluntary petition commencing a case under chapter 11 of title 11 of the U.S. Code in the United
States Bankruptcy Court for the Eastern District of New York. On August 7, 2020, the Company and Auctus, the Company’s largest
unsecured creditor and a stockholder as of the Petition Date, filed an Amended Joint Plan of Reorganization (the “Plan”).
Pursuant to the Bankruptcy, for any outstanding principal and interest at the date of the Company’s Chapter 11 petition (except
for creditors who provided additional debt financing in connection with the Bankruptcy), 100 shares of the Company’s common stock
were issued for each dollar of allowed claim, with such shares subject to leak-out restrictions prohibiting the holder from selling,
without the consent of the Company, more than 33% of the issued shares during each of the three initial 30 day periods following the
Effective Date. As a result of the Chapter 11 petition, the conversion rights for the notes described in this Note 7 – Notes Payable
– Convertible Notes – Embedded Conversion Options and Note Provisions were rescinded and were subject to the conversion rights
outlined above. As a result of the Chapter 11 reorganization, pursuant to ASC 852, Reorganizations , the Company has recorded all
prepetition liabilities at the expected allowable claim amounts as of December 31, 2020. This resulted in the Company amortizing the
remaining debt discount of $2,580,110 to reorganization items on the consolidated statements of operations.
On
October 30, 2020, the Bankruptcy Court entered an order (the “Confirmation Order”) confirming the Plan, as amended. Amendments
to the Plan are reflected in the Confirmation Order. On November 16, 2020 (the “Effective Date”), the Plan became effective.
The
material features of the Plan, as amended and confirmed by the Confirmation Order, are as follows:
i.
Treatment
of the financing to the Company by Auctus of up to $7,000,000 which Auctus has provided or committed to provide consisting of the
debtor-in-possession loans made to the Company by Auctus during the Chapter 11 Case (the “DIP Funding”) and additional
funding as described below.
ii.
Auctus
has provided $3,500,000 in funding to the Company (the “Initial Auctus Funding”) and is to provide, subject to certain
conditions, additional funding to the Company, as needed, in an amount equal to $3,500,000, less the sum of the debtor-in-possession
loans made to the Company by Auctus during the Chapter 11 Case (inclusive of accrued interest) (approximately $1,227,000 as of the
Effective Date) and the costs incurred by Auctus as the debtor-in-possession lender (the “DIP Costs”). As of December
31, 2020, the DIP Costs and additional Plan costs were not finalized and recorded. The DIP Costs and the additional
Plan costs in the aggregate are estimated to total $657,598, of which $500,000 and $157,598 were recorded in debt
discount and accrued expenses, respectively, on the consolidated balance sheets. In addition, four other persons and entitles
(collectively, the “Other Lenders”) who held allowed general unsecured claims provided funding to the Company in the
aggregate amount of approximately $348,000 (the “Other Funding” and together with the Initial Auctus Funding, the “Funding”).
In consideration of the Funding, the Company has issued the following:
a.
Secured
convertible notes of the Company (each, a “Secured Convertible Note”) in the principal amount equal to the Funding; the
payment of the Secured Convertible Notes is secured by the grant of a security interest in substantially all of the Company’s
assets; the Secured Convertible Notes have the following features:
●
Maturity
date of three years following the Effective Date;
F- 18
●
Interest
at the rate of 7% per annum;
●
The
right of the holder to convert the indebtedness into shares of common stock of the Company at a price equal to the volume weighted
average price for the common stock over the five trading days immediately preceding the conversion; and
●
Mandatory
conversion of all indebtedness at such time as the common stock is listed on the Nasdaq Capital Market or another senior exchange
on the same terms as provided to investors in connection with a public offering undertaken in connection with such listing;
b.
Warrants
(each, a “Class A Warrant”) to purchase a number of shares of common stock equal to the amount of the Funding provided
divided by $0.0005 (a total of 7,000,000,000 Class A Warrants in consideration of the Initial Auctus Funding and a total of approximately
697,000,000 Class A Warrants in the aggregate in consideration of the Other Funding), such Class A Warrants having an exercise price
of $0.0005 per share; and
c.
Warrants
(each, a “Class B Warrant” and together with the Class A Warrants, the “Plan Warrants”) to purchase a number
of shares of common stock equal to the Funding provided divided by $0.001 (a total of 3,500,000,000 Class B Warrants in consideration
of the Initial Auctus Funding and a total of approximately 348,500,000 Class B Warrants in the aggregate in consideration of the
Other Funding), such Class B Warrants having an exercise price of $0.001 per share.
iii.
The
obligation to Auctus with respect to the DIP Funding has been exchanged for the following:
a.
A
Secured Convertible Note in the principal amount of approximately $1,349,591 (110% DIP Funding) with a maturity date of November
16, 2023;
b.
A
Class A Warrant to purchase 2,453,802,480 shares of common stock; and
c.
A
Class B Warrant to purchase 1,226,901,240 shares of common stock (as to which 544,697,452 shares of common stock have been exercised
on a net exercise basis, pursuant to the terms of the Class B Warrant, with respect to the issuance of 512,124,200 shares of common
stock, of which 217,796,200 and 294,328,000 were issued during 2020 and 2021, respectively).
In
addition, Auctus shall be entitled to receive a Secured Convertible Note in exchange for its allowed DIP Costs and allowed Plan costs
in a manner in which the DIP Funding was treated and may be entitled to a Class A Warrant and a Class B Warrant in consideration of
such costs.
The
claim arising from the secured promissory notes of the Company, dated February 20, 2020 and February 26, 2020, in the original principal
amounts of $320,200 and $33,562, respectively, issued to John Desmarais (“Desmarais”) (collectively, the “Desmarais
Notes”), was treated as an allowed secured claim in the aggregate amount of $490,699 and was exchanged for a Secured Convertible
Note in such amount.
F- 19
iv.
The
claim arising from the promissory note issued in June 2016 by the Company to Desmarais in the original principal amount of $175,000
was treated as an allowed general unsecured claim in the amount of $245,192 and was satisfied and exchanged for 24,519,200 shares
of common stock.
v.
The
claim arising from the promissory note issued in June 2016 by the Company to Tuxis Trust, an entity related to Desmarais, in the
original principal amount of $500,000 was treated as follows:
a.
$444,534,43
was treated as an allowed general unsecured claim in such amount and exchanged for 44,453,400 shares of common stock; and
b.
$309,301
was treated as an allowed secured claim in such amount and exchanged for a Secured Convertible Note in such amount with a maturity
date of November 16, 2023.
vi.
Holders
of allowed general unsecured claims (other than Auctus and the Other Lenders) received an aggregate of 1,049,726,797 shares of common
stock where were valued at the fair market value of the stock at issuance date of $14,381,259 with an associated loss of $3,883,991
recognized in Reorganization Items, net on the accompanying consolidated statement of operations in exchange for approximately
$10,497,268 outstanding accounts payable and convertible debt (including accrued interest), with such shares being subject
to a leak-out restriction prohibiting each holder from selling, without consent of the Company, more than 33% of its shares during
each of the three initial 30 day periods following the Effective Date.
vii.
Auctus
and the Other Lenders have been issued, in respect of their allowed general unsecured claims ($3,261,819 in the case of Auctus and
an aggregate of approximately $382,400 in the case of the Other Lenders), a convertible promissory note of the Company (each, an
“Unsecured Convertible Note”) in the allowed amount of the claim, which Unsecured Convertible Notes have the following
material features:
a.
Maturity
date of three years from the Effective Date;
b.
Interest
at the rate of 5% per annum;
c.
The
right of the holder to convert the indebtedness into shares of common stock at a price equal to the volume weighted average for the
common stock over the five trading days immediately preceding the conversion;
d.
Mandatory
conversion of all outstanding indebtedness at such time as the common stock listed on the Nasdaq Capital Market or another senior
exchange on the same terms as provided to investors in connection with a public offering undertaken in connection with such listing;
and
e.
A
leak-out restriction prohibiting each holder from selling, without the consent of the Company, more than 16.6% of the underlying
shares received upon conversion during each of the six initial 30 day periods following the Effective Date.
viii.
The
issuance of (a) the shares of common stock and the Unsecured Convertible Notes to the holders of allowed general unsecured claims
and (b) the Secured Convertible Notes and Plan Warrants to Auctus in exchange for the DIP Funding and any common stock into which
those Secured Convertible Notes and those Plan Warrants may be converted is exempt from the registration requirements of the Securities
Act of 1933, as amended, pursuant to the Bankruptcy Code Section 1145. Such securities shall be freely transferrable subject to Section
1145(b)(i) of the Bankruptcy Code.
Pursuant
to the Plan, on the Effective Date, the Company filed a Certificate of Amendment to its Certificate of Incorporation pursuant to which,
among other things, the number of shares of common stock authorized to be issued by the Company has been increased to 300,000,000,000
and the par value of the shares of common stock has been reduced to $0.0001 per share.
F- 20
Related
Party Notes
As
of December 31, 2019, related party notes consisted of notes payable issued to certain directors of the Company, family members of an
officer of the Company, and the Tuxis Trust (the “Trust”). A former director and principal stockholder of the Company (the
“Director/Principal Stockholder”) serves as a trustee of the Trust, which was established for the benefit of his immediate
family. As of December 31, 2020, there were no related party notes outstanding.
During
the year ended December 31, 2019, the Company issued to family members of officers of the Company and a Scientific Advisory Board member
(the “SAB Member”) notes payable in the aggregate principal amount of $635,000, which bore interest at the rate of 12% -
15% per annum and provided for original maturity dates between July 2019 and May 2020.
During
the year ended December 31, 2019, the holders of certain related party notes in the aggregate principal amount of $505,000 entered into
agreements with the Company pursuant to which the parties agreed that the maturity of the promissory notes held by such holders would
be extended or further extended from dates from December 2018 and August 2019 to dates between July 2019 and December 2019. In consideration
of the extensions, such notes in the aggregate principal amount of $475,000 provided for an exchange of such notes for shares of common
stock and warrants, as described below, in connection with a public offering of the Company’s securities (a “Public Offering”).
The exchange price for the indebtedness was to be equal to the lesser of (i) 75% of the public offering price of the common stock, or
units of common stock and warrants, as the case may be, offered pursuant to the Public Offering or (ii) $0.60 per share (subject to adjustment
for reverse stock splits and the like) (the “Exchange Price”). The number of shares of common stock issuable pursuant to
the warrants to be issued to such holders was to be equal to the number of shares of common stock issuable to them upon conversion of
the principal amount of their respective notes. The exchange price of the warrants to be issued to such holders was to be the lesser
of (i) 125% of the Exchange Price or (ii) $0.80 per share (subject to adjustment for reverse stock splits and the like). Since the fair
value of the new ECO exceeded 10% of the carrying amount of the debt, the note extensions were accounted for as extinguishments, and
accordingly the Company recognized an aggregate net loss on extinguishment of $145,066 in connection with the derecognition of the net
carrying amount of the extinguished debt of $510,887 (inclusive of $475,000 of principal and $35,887 of accrued interest) and the issuance
of the new convertible notes in the same amount, plus the fair value of the new notes’ ECOs of an aggregate of $145,066. As a result
of the Company’s Chapter 11 reorganization, the exchange did not occur.
During
the year ended December 31, 2019, the Company and a certain related party lender agreed to further extend the maturity date of a certain
related party note with a principal balance of $25,000 from a maturity date in September 2019 to a new maturity date in October 2019,
effective September 30, 2019.
During
the year ended December 31, 2019, the Company, a then director of the Company, and the Trust agreed that promissory notes held by the
director and the Trust in the outstanding principal amounts of $175,000 and $500,000, respectively, would be exchanged for shares of
common stock and warrants, as described below, in connection with a Public Offering. The exchange price for the indebtedness was to be
equal to 75% of the public offering price of the common stock, or units of common stock and warrants, as the case may be, offered pursuant
to the Public Offering (the “Director/Trust Exchange Price”). The number of shares of common stock issuable pursuant to the
warrants to be issued to the director and the Trust was to be in the same ratio to the number of shares of common stock issued upon exchange
of their indebtedness as the number of shares of common stock subject to any warrants included as part of units offered pursuant to the
Public Offering (the “Public Warrants”) bore to the number of shares of common stock issued as part of the Public Offering
units. The exercise price of the warrants to be issued to the director and the Trust was to be 125% of the Director/Trust Exchange Price
and the term of the warrants was to be the same term as the Public Warrants. Concurrently with the exchange, the exercise prices of outstanding
warrants held by the director and the Trust for the purchase of an aggregate of 1,377,842 shares of common stock of the Company was to
be reduced from between $1.50 and $4.00 per share to $0.75 per share and the expiration dates of such warrants was to be extended from
between December 2019 and March 2022 to December 2023. The exchange agreements were submitted for approval by the stockholders of the
Company, which was obtained in August 2019. As a result of the Company’s Chapter 11 reorganization the exchange did not occur.
F- 21
As
of December 31, 2019, certain related party notes in the aggregate principal amount of $485,000 were convertible into shares of common
stock of the Company at a conversion price of $0.60 per share, subject to adjustment, and a five-year warrant for the purchase of a number
of shares equal to the number of shares issued upon the conversion of the principal amounts of the notes.
During
the years ended December 31, 2020 and 2019, the Company partially repaid certain related party notes in the aggregate principal amount
of $- and $70,000, respectively.
During
the year ended December 31, 2020, the Company issued to a former board member notes payable in the aggregate principal amount of $353,762,
which bore interest at the rate of 12% per annum and provided for an original maturity date of March 10, 2020. On November 16, 2020,
pursuant to the Bankruptcy (See Note 7 – Notes Payable – Chapter 11 Reorganization), these notes were exchanged for a Secured
Convertible Note in the principal amount of $490,698 which bears interest at the rate of 7% per annum and has a maturity date of November
16, 2023.
During
the year ended December 31, 2020, pursuant to the Bankruptcy (See Note 7 – Notes Payable – Chapter 11 Reorganization), the
Company’s original promissory note issued to the Director/Principal Stockholder in the principal amount of $175,000 was treated
as an allowed general unsecured claim in the amount of $245,192 and was satisfied and exchanged for 24,519,178 shares of common stock.
During the year ended December 31, 2020, the Director/Principal Stockholder resigned as a director of the Company. As a result,
the Director/Principal Stockholder is not a related party at December 31, 2020.
During
the year ended December 31, 2020, pursuant to the Bankruptcy (See Note 7 – Notes Payable – Chapter 11 Reorganization), the
Company’s original promissory note issued to the Trust in the principal amount of $500,000 was treated as follows: (i) $444,534
was treated as an allowed general unsecured claim in such amount and exchanged for 44,453,443 shares of common stock and (ii) $309,301
was treated as an allowed secured claim in such an amount and exchanged for a secured convertible note which bears interest at a rate
of 7% per annum with a maturity date of November 16, 2023. During the year ended December 31, 2020, the former board member who serves
as the trustee of the Trust resigned as a director. As a result, the Trust is not a related party at December 31, 2020.
Convertible
Notes
Issuances
During
the year ended December 31, 2019, the Company issued certain lenders convertible notes payable in the aggregate principal amount of $9,765,325
for aggregate cash proceeds of $9,086,353. The difference of $678,973 was recorded as a debt discount and will be amortized over the
terms of the respective notes. The convertible notes bore interest at rates ranging between 8% to 15% per annum payable at maturity with
original maturity dates ranging between July 2019 through December 2020. In connection with the issuance of certain convertible notes,
the Company issued the lenders an aggregate of 78,873 shares of the Company’s common stock and the relative fair value of $61,220
was recorded as debt discount and is being amortized over the terms of the respective notes. In connection with the issuance of certain
convertible notes, the Company issued the lenders five-year warrants to purchase an aggregate of 295,000 shares of the Company’s
common stock at exercise prices ranging from $0.45 per share to $1.00 per share. The aggregate grant date value of the warrants was $104,198,
which was recorded as debt discount and is being amortized over the terms of the respective convertible notes. The warrants were subject
to the Company’s sequencing policy and, as a result, were initially recorded as derivative liabilities. See below within this Note
7 – Notes Payable – Convertible Notes – Conversions, Exchanges and Other and Note 9 – Derivative Liabilities
for additional details regarding the ECOs of the convertible notes. During the year ended December 31, 2019, $675,523 in outstanding
principal and $73,485 in accrued interest was converted into 46,158,719 shares of the Company’s common stock. During the year ended
December 31, 2019, the Company made cash payments in the aggregate amount of $2,499,476 towards the outstanding principal on the notes.
F- 22
During
the year ended December 31, 2019, a certain convertible note in the principal amount of $148,014 was issued concurrently with the extinguishment
of a certain other note payable in the same principal amount. See below within this Note 7 – Notes Payable – Convertible
Notes – Conversions, Exchanges and Other for additional details. During the year ended December 31, 2019, $148,014 of outstanding
principal and $1,901 of accrued interest was converted into 513,788 shares of the Company’s common stock.
During
the year ended December 31, 2020, the Company issued to a certain lender a convertible note payable in the principal amount of $88,000
for aggregate cash proceeds of $85,000. The difference was recorded as a debt discount and will be amortized over the term of the note.
The convertible note bore interest at 10% per annum payable at maturity with an original maturity date of January 31, 2021. The outstanding
principal and accrued interest was convertible after 180 days at a conversion price of 61% of the lowest daily volume weighted average
price over the twenty days prior to the conversion date. The convertible note contained a cross-default provision and was in default
at issuance. As a result, the convertible note bore a default interest of 22% per annum. Pursuant to the Bankruptcy (see Note 7 –
Notes Payable – Chapter 11 Reorganization), the convertible note, in the aggregate amount of $155,000 (including principal and
accrued interest), was exchanged for 15,500,000 shares of the Company’s common stock. See below within Note 7- Derivative Liabilities
for additional details regarding the ECO of the convertible note.
On
November 16, 2020, in connection with the Plan, the Company issued to Auctus and the Other Lenders (See Note 7 – Notes Payable
–
Text extracted from the filing as submitted to EDGAR. Formatting, tables and exhibits are simplified for reading; the original document is authoritative for anything you rely on.