UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
DC 20549
FORM
10-Q
(Mark
One)
☒
QUARTERLY
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For
the quarterly period ended September 30, 2022
OR
☐
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: 001-40901
LUCID DIAGNOSTICS INC.
(Exact
Name of Registrant as Specified in Its Charter)
Delaware
82-5488042
(State
or Other Jurisdiction of
(IRS
Employer
Incorporation
or Organization)
Identification
No.)
One
Grand Central Place
60
E. 42nd Street
Suite
4600
New
York , NY 10165
10165
(Address
of Principal Executive Offices)
(Zip
Code)
(212)
949-4319
(Registrant’s
Telephone Number, Including Area Code)
Securities
registered under Section 12(b) of the Exchange Act:
Title
of each Class
Trading
Symbol(s)
Name
of each Exchange on which Registered
Common
Stock, $0.001 par value per share
LUCD
The
NASDAQ Stock Market LLC
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 ☒
No ☐
Indicate
by check mark whether the registrant has submitted electronically Interactive Data File required to be submitted pursuant to Rule 405
of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was
required to submit such files). Yes ☒ 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
filed
☐
Non-accelerated
filer
☒
Smaller
reporting company
☒
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(c) of the Exchange Act ☐
Indicate
by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
As
of November 10, 2022 there were 39,108,245 shares of the registrant’s Common Stock, par value $0.001 per share, issued and outstanding
(with such number of shares inclusive of shares of common stock underlying unvested restricted stock awards granted under the Lucid
Diagnostics Inc. 2018 Long-Term Incentive Equity Plan as of such date).
TABLE
OF CONTENTS
Page
Part
I - Financial Information
Item
1.
Financial
Statements
Condensed
Consolidated Balance Sheets (unaudited) as of September 30, 2022 and December 31, 2021
1
Condensed
Consolidated Statements of Operations (unaudited) for the three and nine months ended September 30, 2022 and 2021
2
Condensed
Consolidated Statements of Changes in Stockholders’ Equity (Deficit) (unaudited) for the three and nine months ended September
30, 2022 and 2021
3
Condensed
Consolidated Statements of Cash Flows (unaudited) for the nine months ended September 30, 2022 and 2021
5
Notes
to Unaudited Condensed Consolidated Financial Statements
6
Item
2.
Management’s
Discussion and Analysis of Financial Condition and Results of Operations
18
Item
4.
Controls
and Procedures
26
Part
II - Other Information
Item
1.
Legal
Proceedings
26
Item
5.
Other
Information
26
Item
6.
Exhibits
26
Signature
27
Exhibit
Index
28
i
Part
I. Financial Information
Item
1. Financial Statements
LUCID
DIAGNOSTICS INC.
and
SUBSIDIARIES
(a
majority-owned subsidiary of PAVmed Inc.)
CONDENSED
CONSOLIDATED BALANCE SHEETS
(in
thousands except number of shares and per share data - unaudited)
September
30, 2022
December
31, 2021
Assets:
Current assets:
Cash
$ 26,934
$ 53,656
Accounts receivable
31
200
Prepaid
expenses, deposits, and other current assets
2,882
3,447
Total current assets
29,847
57,303
Fixed assets, net
1,499
971
Operating lease right-of-use assets
2,002
—
Intangible assets, net
3,950
—
Other assets
1,078
725
Total
assets
$ 38,376
$ 58,999
Liabilities, Preferred Stock
and Stockholders’ Equity
Current liabilities:
Accounts payable
$ 1,102
$ 1,490
Accrued expenses and other
current liabilities
1,128
1,113
Operating lease liabilities,
current portion
860
—
Due
To: PAVmed Inc. - MSA Fee and operating expenses
6,610
1,657
Total
current liabilities
9,700
4,260
Operating
lease liabilities, less current portion
1,143
—
Total
liabilities
10,843
4,260
Commitments and contingencies
Stockholders’ Equity:
Preferred stock, $ 0.001 par value, 20,000,000
shares authorized; no shares issued and outstanding as of September 30, 2022 and December 31, 2021
—
—
Common stock, $ 0.001 par value, 100,000,000
shares authorized; 37,016,225 and 34,917,907 shares issued and outstanding as of September 30, 2022 and December 31, 2021, respectively
37
35
Additional paid-in capital
110,643
96,608
Accumulated
deficit
( 83,147 )
( 41,904 )
Total
Stockholders’ Equity
27,533
54,739
Total Liabilities and
Stockholders’ Equity
$ 38,376
$ 58,999
See
accompanying notes to the unaudited condensed consolidated financial statements.
1
LUCID
DIAGNOSTICS INC.
and
SUBSIDIARIES
(a
majority-owned subsidiary of PAVmed Inc.)
CONDENSED
CONSOLIDATED STATEMENTS OF OPERATIONS
(in
thousands except number of shares and per share data - unaudited)
2022
2021
2022
2021
Three
Months Ended
September
30,
Nine
Months Ended
September
30,
2022
2021
2022
2021
Revenue
$ 76
$ 200
$ 265
$ 200
Operating expenses:
Cost of revenue
1,626
144
1,996
144
Sales and marketing
3,930
918
11,121
2,627
General and administrative
5,660
3,458
18,223
7,793
Amortization of acquired intangible assets
505
—
1,144
—
Research
and development
2,704
2,190
9,024
5,814
Total
operating expenses
14,425
6,710
41,508
16,378
Net loss from operations
( 14,349 )
( 6,510 )
( 41,243 )
( 16,178 )
Other income (expense):
Interest
expense - Senior Unsecured Promissory Note
—
( 447 )
—
( 594 )
Other
income (expense), net
—
( 447 )
—
( 594 )
Loss before provision for income tax
( 14,349 )
( 6,957 )
( 41,243 )
( 16,772 )
Provision for income
taxes
—
—
—
—
Net loss
$ ( 14,349 )
$ ( 6,957 )
$ ( 41,243 )
$ ( 16,772 )
Net loss per share -
basic and diluted
$ ( 0.39 )
$ ( 0.49 )
$ ( 1.15 )
$ ( 1.19 )
Weighted average common
shares outstanding, basic and diluted
36,405,945
14,114,707
35,767,857
14,114,707
See
accompanying notes to the unaudited condensed consolidated financial statements.
2
LUCID
DIAGNOSTICS INC.
and
SUBSIDIARIES
(a
majority-owned subsidiary of PAVmed Inc.)
CONDENSED
CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS’ EQUITY (DEFICIT)
for
the THREE AND NINE MONTHS ENDED September 30, 2022
(in
thousands except number of shares and per share data - unaudited)
Shares
Amount
Capital
Deficit
Total
Common
Stock
Additional
Paid-In
Accumulated
Shares
Amount
Capital
Deficit
Total
Balance as of June 30, 2022
35,994,667
$ 36
$ 105,003
$ ( 68,798 )
$ 36,241
Exercise - stock options - Lucid Diagnostics
Inc. 2018 Equity Plan
5,327
—
6
—
6
Stock-based compensation - Lucid Diagnostics
Inc.
—
—
3,280
—
3,280
Stock-based compensation - PAVmed Inc.
—
—
291
—
291
Vest - restricted stock awards
169,320
—
—
—
—
APA-RDx - Installment Payment
82,618
—
188
—
188
Issuance - Committed Equity Facility, net of
deferred financing charges
680,263
1
1,766
—
1,767
Purchase - Employee Stock Purchase Plan
84,030
—
109
—
109
Net loss
—
—
—
( 14,349 )
( 14,349 )
Balance as of September 30, 2022
37,016,225
$ 37
$ 110,643
$ ( 83,147 )
$ 27,533
Common
Stock
Additional
Paid-In
Accumulated
Shares
Amount
Capital
Deficit
Total
Balance as of December 31, 2021
34,917,907
$ 35
$ 96,608
$ ( 41,904 )
$ 54,739
Exercise - stock options - Lucid Diagnostics
Inc. 2018 Equity Plan
964,716
1
693
—
694
Stock-based compensation - Lucid Diagnostics
Inc.
—
—
10,371
—
10,371
Stock-based compensation - PAVmed Inc.
—
—
880
—
880
Vest - restricted stock awards
169,320
—
—
—
—
CapNostics, LLC transfer
—
—
( 211 )
—
( 211 )
APA-RDx - Installment Payment
199,989
—
427
—
427
Issuance - Committed Equity Facility, net of
deferred financing charges
680,263
1
1,766
—
1,767
Purchase - Employee Stock Purchase Plan
84,030
—
109
—
109
Net loss
—
—
—
( 41,243 )
( 41,243 )
Balance as of September 30, 2022
37,016,225
$ 37
$ 110,643
$ ( 83,147 )
$ 27,533
See
accompanying notes to the unaudited condensed consolidated financial statements.
3
LUCID
DIAGNOSTICS INC.
and
SUBSIDIARIES
(a
majority-owned subsidiary of PAVmed Inc.)
CONDENSED
CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS’ EQUITY (DEFICIT)
for
the THREE AND NINE MONTHS ENDED September 30, 2021
(in
thousands except number of shares and per share data - unaudited)
Common
Stock
Additional
Paid-In
Accumulated
Shares
Amount
Capital
Deficit
Total
Balance as of June 30, 2021
14,114,707
$ 14
$ 3,677
$ ( 23,641 )
$ ( 19,950 )
Stock-based compensation - Lucid Diagnostics
Inc.
—
—
2,717
—
2,717
Stock-based compensation - PAVmed Inc.
—
—
56
—
56
Net loss
—
—
—
( 6,957 )
( 6,957 )
Balance as of September 30, 2021
14,114,707
$ 14
$ 6,450
$ ( 30,598 )
$ ( 24,134 )
Common
Stock
Additional
Paid-In
Accumulated
Shares
Amount
Capital
Deficit
Total
Balance as of December 31, 2020
14,114,707
$ 14
$ 294
$ ( 13,826 )
$ ( 13,518 )
Stock-based compensation - Lucid Diagnostics
Inc.
—
—
6,045
—
6,045
Stock-based compensation - PAVmed Inc.
—
—
111
—
111
Net loss
—
—
—
( 16,772 )
( 16,772 )
Balance as of September 30, 2021
14,114,707
$ 14
$ 6,450
$ ( 30,598 )
$ ( 24,134 )
See
accompanying notes to the unaudited condensed consolidated financial statements.
4
LUCID
DIAGNOSTICS INC.
and
SUBSIDIARIES
(a
majority-owned subsidiary of PAVmed Inc.)
CONDENSED
CONSOLIDATED STATEMENTS OF CASH FLOWS
(in
thousands except number of shares and per share data - unaudited)
2022
2021
Nine
Months Ended September 30,
2022
2021
Cash flows from operating
activities
Net loss
$ ( 41,243 )
$ ( 16,772 )
Adjustments to reconcile net loss to net cash
used in operating activities
Depreciation and amortization
expense
1,321
3
Stock-based compensation
- Lucid Diagnostics Inc.
10,371
6,045
Stock-based compensation
- PAVmed Inc.
880
111
APA-RDx: Issue common stock
- settle installment payment
427
—
Changes in operating assets
and liabilities:
Accounts receivable
169
( 200 )
Prepaid expenses and other
current assets
171
( 954 )
Accounts payable
( 388 )
781
Accrued expenses and other
current liabilities
16
136
Accrued CWRU License Agreement
Fee
—
( 223 )
Due To: PAVmed Inc. - operating
expenses, employee related costs, MSA Fee
2,849
2,688
Due
To: PAVmed Inc. - Interest Expense - Senior Unsecured Promissory Note
—
594
Net cash flows used
in operating activities
( 25,427 )
( 7,791 )
Cash flows from investing
activities
Purchase of equipment
( 705 )
( 38 )
Payments - Acquisition
( 3,200 )
—
Net cash flows used
in investing activities
( 3,905 )
( 38 )
Cash flows from financing
activities
Proceeds – issue of common stock –
Committed Equity Facility
1,807
—
Proceeds – exercise of stock options
694
—
Proceeds – issue common stock –
Employee Stock Purchase Plan
109
—
Proceeds – Due
To: PAVmed Inc. - working capital cash advances
—
7,739
Net cash flows provided
by financing activities
2,610
7,739
Net increase (decrease) in cash
( 26,722 )
( 90 )
Cash, beginning of period
53,656
111
Cash, end of period
$ 26,934
$ 21
See
accompanying notes to the unaudited condensed consolidated financial statements.
5
LUCID
DIAGNOSTICS INC.
and
SUBSIDIARIES
(a
majority-owned subsidiary of PAVmed Inc.)
NOTES
TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(amounts
in these accompanying notes are presented in thousands, except number of shares and per-share amounts.)
Note
1 — Summary Description of the Company
Lucid
Diagnostics Inc. and Subsidiaries, referred to herein as “Lucid Diagnostics” or the “Company” is comprised of
Lucid Diagnostics Inc. and its wholly-owned subsidiaries, inclusive of LucidDx Labs, Inc. and CapNostics LLC. Lucid Diagnostics Inc.
is a majority-owned subsidiary of PAVmed Inc., as discussed below.
The
Company operates in one segment as a commercial-stage medical diagnostics technology company focused on the millions of patients with
gastroesophageal reflux disease - “GERD” - which is also known variously as chronic heartburn, acid reflux or simply reflux
- who are at risk for developing esophageal precancer and cancer, specifically highly lethal esophageal adenocarcinoma (“EAC”).
Lucid
Diagnostics Inc. entered into a patent license agreement with Case Western Reserve University (“CWRU”), captioned the Amended
and Restated License Agreement, dated August 23, 2021 (“Amended CWRU License Agreement”). The Amended CWRU License Agreement
is a successor to and replaced in its entirety the previous CWRU License Agreement, dated May 12, 2018. The Amended CWRU License Agreement
terminates upon the expiration of certain related patents, or on May 12, 2038 in countries where no such patents exist, or upon expiration
of any exclusive marketing rights granted by the FDA or other U.S. government agency, whichever comes later.
The
Amended CWRU License Agreement (as did the predecessor CWRU License Agreement) provides for the exclusive worldwide license of the intellectual
property rights for the proprietary technologies of two distinct technology components - the “EsoCheck Cell Collection Device”
referred to as “EsoCheck®”; and a panel of proprietary methylated DNA biomarkers, a laboratory developed test (“LDT”),
referred to as “EsoGuard®”; and together are collectively referred to as the “EsoGuard Technology”. See the
Company’s consolidated financial statements for the year ended December 31, 2021, Note 3, Patent License Agreement - Case Western
Reserve University , as included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021 as filed with
the SEC on April 6, 2022, for a further discussion of the Amended CWRU License Agreement.
On
February 25, 2022, LucidDx Labs, Inc. entered into an asset purchase agreement (“APA”) with ResearchDx, Inc. (“RDx”),
an unrelated third-party - “APA-RDx”. Under the APA-RDx, LucidDx Labs Inc. acquired certain assets from RDx to be combined
with LucidDx Labs Inc. purchased and leased property and equipment to establish a Company-owned Commercial Lab Improvements Act (“CLIA”)
certified, College of American Pathologists (“CAP”) accredited commercial clinical laboratory capable of performing the EsoGuard®
Esophageal DNA assay, inclusive of DNA extraction, next generation sequencing (“NGS”) and specimen storage. See Note 6, Asset
Purchase Agreement and Management Services Agreement , for a further discussion of the APA-RDx.
Since
its inception, the Company has advanced the proprietary technologies underlying EsoGuard and EsoCheck from the academic research laboratory
to commercial diagnostic tests and devices with scalable manufacturing capacity. The Company is presently focused on expanding commercialization
across multiple sales channels, including: the communication and education of medical practitioners and clinicians of EsoGuard; and establishing
“Lucid Diagnostics Test Centers” for the collection of cell samples using EsoCheck. Recently, the American Gastroenterological
Association (“AGA”) and the American College of Gastroenterology (“ACG”) updated its clinical practice guidelines
to now support Lucid’s EsoCheck Cell Collection Device and EsoGuard Esophageal DNA Test as an acceptable alternative to endoscopy.Both
guidelines expand the addressable market opportunity for these products to now affirmatively include screening women. The AGA updated
guideline further expands the target population for the first time to include asymptomatic patients who otherwise present with the certain
risk factors. Additionally, the Company is developing expanded clinical evidence to support insurance reimbursement adoption by government
and private insurers. Further, the Company is also pursuing development of other products and services, including EsoCure™, an
esophageal ablation device. The ability of the Company to generate revenue depends upon the Company’s ability to successfully advance
the commercialization of EsoGuard, while also completing its clinical studies to accelerate the adoption of insurance reimbursement.
There are no assurances, however, the Company will be able to obtain an adequate level of financial resources required for the long-term
commercialization and development of its products and services.
Prior
to its initial public offering (“IPO”) of its common stock, the operations of the Company were funded by PAVmed Inc., inclusive
of providing working capital cash advances and the payment of certain operating expenses on-behalf-of the Company. Additionally, certain
operations of Lucid Diagnostics Inc. continue to be managed by personnel of PAVmed Inc., for which Lucid Diagnostics Inc. incurs expense
according to the provisions of a Management Services Agreement between Lucid Diagnostics Inc. and PAVmed Inc. See Note 4, Related
Party Transactions , for information with respect to the Management Services Agreement; and Note 5, Due To PAVmed Inc. , for
further information with respect to amounts owed to PAVmed Inc. by Lucid Diagnostics Inc.
The
Company is subject to all of the risks and uncertainties typically faced by medical device and diagnostic companies that devote substantially
all of their efforts to the commercialization of their initial product and services and ongoing research and development activities and
conducting clinical trials. The Company expects to continue to experience recurring losses from operations and will continue to fund
its operations with debt and equity financing transactions. Notwithstanding, however, with the cash on-hand as of the date hereof and
committed equity sources of financing, the Company expects to be able to fund its operations and meet its financial obligations as they
become due for the one year period from the date of the issue of the Company’s unaudited condensed consolidated financial statements,
as included herein in this Quarterly Report on Form 10-Q for the period ended September 30, 2022.
6
Note
2 — Summary of Significant Accounting Policies
Significant
Accounting Policies
The
Company’s significant accounting policies are as disclosed in the Company’s Annual Report on Form 10-K for the year ended
December 31, 2021 as filed with the SEC on April 6, 2022, except as otherwise noted herein below.
Basis
of Presentation
The
accompanying unaudited condensed consolidated financial statements of Lucid Diagnostics Inc. and Subsidiaries have been prepared in accordance
with accounting principles generally accepted in the United States of America (“U.S. GAAP”), and applicable rules and regulations
of the United States Securities and Exchange Commission (“SEC”), and include the accounts of the Company and its wholly-owned
subsidiaries. All intercompany transactions and balances have been eliminated in consolidation. Lucid Diagnostics Inc. is a majority-owned
consolidated subsidiary of PAVmed Inc., which has a majority equity ownership interest and has financial control of Lucid Diagnostics
Inc. The Company manages its operations as a single operating segment for the purposes of assessing performance and making operating
decisions.
As
permitted under SEC rules, certain footnotes or other financial information normally required by U.S. GAAP have been condensed or omitted.
The balance sheet as of December 31, 2021 has been derived from audited consolidated financial statements at such date. The accompanying
unaudited condensed consolidated financial statements have been prepared on the same basis as the Company’s annual consolidated
financial statements, and in the opinion of management, include all adjustments, consisting only of routine recurring adjustments, necessary
for a fair presentation of the Company’s unaudited condensed consolidated financial information.
The
consolidated results of operations for the three and nine months ended September 30, 2022 are not necessarily indicative of the consolidated
results to be expected for the year ending December 31, 2022 or for any other interim period or for any other future periods. The accompanying
unaudited condensed consolidated financial statements and related unaudited condensed consolidated financial information should be read
in conjunction with the Lucid Diagnostics Inc. and Subsidiaries audited consolidated financial statements and related notes thereto as
of and for the year ended December 31, 2021 included in the Company’s Annual Report on Form 10-K as filed with the SEC on April
6, 2022.
All
amounts in the accompanying unaudited condensed consolidated financial statements and these notes thereto are presented in thousands
of dollars, if not otherwise noted as being presented in millions of dollars, except for shares and per share amounts.
Reclassifications
Certain prior-year amounts
have been reclassified to conform to the current year presentation, which includes presenting costs of revenue within operating
expenses on the statements of operations, in the unaudited condensed consolidated financial statements and accompanying notes to the
unaudited condensed consolidated financial statements. The impact of the reclassifications made to prior year amounts is not
material and did not affect net loss.
Use
of Estimates
In
preparing the unaudited condensed consolidated financial statements in conformity with U.S. GAAP, management is required to make estimates
and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent losses, as of the date of
the consolidated financial statements, as well as the reported amounts of revenue and expenses during the reporting period. Significant
estimates in these unaudited condensed consolidated financial statements include those related to the estimated fair value of stock-based
equity awards and intangible assets. Other significant estimates include the estimated incremental borrowing rate, the provision or benefit
for income taxes and the corresponding valuation allowance on deferred tax assets. Additionally, management’s assessment of the
Company’s ability to continue as a going concern involves the estimation of the amount and timing of future cash inflows and outflows.
On an ongoing basis, the Company evaluates its estimates and assumptions. The Company bases its estimates on historical experience and
on various other assumptions believed to be reasonable. Due to inherent uncertainty involved in making estimates, actual results reported
in future periods may be affected by changes in these estimates.
Leases
The
Company adopted FASB ASC Topic 842, Leases , (“ASC 842”) effective December 31, 2021.
All
significant lease agreements and contractual agreements with embedded lease agreements are accounted for under the provisions of ASC
842, wherein, if the contractual arrangement: involves the use of a distinct identified asset; provides for the right to substantially
all the economic benefits from the use of the asset throughout the contractual period; and, provides for the right to direct the use
of the asset. A lease agreement is accounted for as either a finance lease (generally with respect real estate) or an operating lease
(generally with respect to equipment). Under both a finance lease and an operating lease, the Company recognizes as of the lease commencement
date a lease right-of-use (“ROU”) asset and a corresponding lease payment liability.
7
Note 2 — Summary
of Significant Accounting Policies - continued
A
lease ROU asset represents the Company’s right to use an underlying asset for the lease term, and the lease liability represents
its contractual obligation to make lease payments. The lease ROU asset is measured at the lease commencement date as the present value
of the future lease payments plus initial direct costs incurred. The Company recognizes lease expense of the amortization of the lease
ROU asset for an operating lease on a straight-line basis over the lease term; and for financing leases on a straight-line basis unless
another basis is more representative of the pattern of economic benefit. The operating ROU asset also includes any lease incentives received
for improvements to leased property, when the improvements are lessee owned. For improvements to leased property that are lessor owned,
the Company includes amounts the Company incurred for the improvements as ROU assets which are amortized on a straight-line basis over
the life of the lease.
The
lease liability is measured at the lease commencement date with the discount rate generally based on the Company’s incremental
borrowing rate (to the extent the lease implicit rate is not known nor determinable), with interest expense recognized using the interest
method for financing leases.
Certain
leases may include options to extend or terminate the agreement. The Company does not assume renewals in determination of the lease term
unless the renewals are deemed to be reasonably certain at lease commencement. As well, an option to terminate is considered unless it
is reasonably certain the Company will not exercise the option. The Company elected the practical expedient to not recognize a lease
ROU asset and lease payment liability for leases with a term of twelve months or less (“short-term leases”), resulting in
the aggregate lease payments being recognized on a straight line basis over the lease term. The Company’s leases with a commencement
date prior to January 1, 2022 were short-term leases and therefore did not require recording a ROU asset or lease liability at December
31, 2021. Additionally, the Company elected the practical expedient to not separate lease and non-lease components.
Revenue
Recognition
Revenues
are recognized when the satisfaction of the performance obligation occurs, in an amount that reflects the consideration the Company expects
to collect in exchange for those services. The Company’s revenue is primarily generated by its laboratory testing services utilizing
its EsoGuard Esophageal DNA tests. The services are completed upon release of a patient’s test result to the ordering healthcare
provider. Revenue recognized is inclusive of both variable consideration in connection with an individual patient’s third-party
insurance coverage policy and fixed consideration in connection with a contracted services arrangement with an unrelated third party legal
entity. To determine revenue recognition for the arrangements that the Company determines are within the scope of ASC 606, Revenue
from Contracts with Customers, the Company performs the following five steps: (1) identify the contract(s) with a customer, (2) identify
the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance
obligations in the contract and (5) recognize revenue when (or as) the entity satisfies a performance obligation.
The
key aspects considered by the Company include the following:
Contracts —The
Company’s customer is primarily the patient, but the Company does not enter into a formal reimbursement contract with a patient.
The Company establishes a contract with a patient in accordance with other customary business practices, which is the point in time an
order is received from a provider and a patient specimen has been returned to the laboratory for testing. Payment terms are a function
of a patient’s existing insurance benefits, including the impact of coverage decisions with Center for Medicare & Medicaid
Services (“CMS”) and applicable reimbursement contracts established between the Company and payers. However, when a patient
is considered self-pay, the Company requires payment from the patient prior to the commencement of the Company’s performance obligations.
The Company’s consideration can be deemed variable or fixed depending on the structure of specific payer contracts, and the Company
considers collection of such consideration to be probable to the extent that it is unconstrained.
Performance
obligations —A performance obligation is a promise in a contract to transfer a distinct good or service (or a bundle of goods
or services) to the customer. The Company’s contracts have a single performance obligation, which is satisfied upon rendering of
services, which culminates in the release of a patient’s test result to the ordering healthcare provider. The Company elects the
practical expedient related to the disclosure of unsatisfied performance obligations, as the duration of time between providing testing
supplies, the receipt of a sample, and the release of a test result to the ordering healthcare provider is far less than one year.
Transaction
price —The transaction price is the amount of consideration that the Company expects to collect in exchange for transferring
promised goods or services to a customer, excluding amounts collected on behalf of third parties (for example, some sales taxes). The
consideration expected to be collected from a contract with a customer may include fixed amounts, variable amounts, or both.
If the
consideration derived from the contracts is deemed to be variable, the Company estimates the amount of consideration to which it will be entitled
in exchange for the promised goods or services. The Company limits the amount of variable consideration included in the transaction price to the unconstrained
portion of such consideration. In other words, the Company recognizes revenue up to the amount of variable consideration that is not
subject to a significant reversal until additional information is obtained or the uncertainty associated with the additional
payments or refunds is subsequently resolved.
8
Note
2 — Summary of Significant Accounting Policies - continued
When
the Company does not have significant historical experience or that experience has limited predictive value, the constraint over estimates
of variable consideration may result in no revenue being recognized upon delivery of patient EsoGuard test results to the ordering healthcare provider. As such, the Company recognizes revenue up to the amount of variable consideration not subject to a significant
reversal until additional information is obtained or the uncertainty associated with additional payments or refunds, if any, is subsequently
resolved. Differences between original estimates and subsequent revisions, including final settlements, represent changes in estimated
expected variable consideration, with the change in estimate recognized in the period of such revised estimate. With respect to a contracted
service arrangement, the fixed consideration revenue is recognized on an as-billed basis upon delivery of the laboratory test report with
realization of such fixed consideration deemed probable based upon actual historical experience
Allocate
transaction price —The transaction price is allocated entirely to the performance obligation contained within the contract with
a customer on the basis of the relative standalone selling prices of each distinct good or service.
Practical
Expedients —The Company does not adjust the transaction price for the effects of a significant financing component, as at contract
inception, the Company expects the collection cycle to be one year or less.
Note
3 — Revenue from Contracts with Customers
EsoGuard
Commercialization Agreement
The
Company entered into the EsoGuard Commercialization Agreement, dated August 1, 2021, with its former commercial laboratory service
provider, ResearchDx Inc. (“RDx”), an unrelated third-party. The EsoGuard Commercialization Agreement was on a month-to-month
basis and was terminated on February 25, 2022 upon the execution of an asset purchase agreement (“APA”) dated February 25,
2022, between LucidDx Labs Inc., a wholly-owned subsidiary of Lucid Diagnostics Inc., and RDx, with such agreement further discussed
in Note 6, Asset Purchase Agreement and Management Services Agreement .
Revenue
Recognized
In
the three months and nine months ended September 30, 2022, the Company recognized total revenue of $ 76 and $ 265 , respectively. For the
three month period ended September 30, 2022, the Company recognized revenue resulting from the delivery of patient EsoGuard test results. Revenue recognized from customer contracts deemed to include a variable consideration transaction price is limited
to the unconstrained portion of the variable consideration as the Company did not estimate expected variable consideration given the lack
of historical experience and objective reliable actual reimbursement data. In addition to the revenue recognized during the three month
period ended September 30, 2022, the Company’s revenue for the nine month period ended September 30, 2022 includes $ 189 of revenue
recognized under the EsoGuard Commercialization Agreement, which represented the minimum fixed monthly fee of $ 100 for the period January
1, 2022 to the February 25, 2022 termination date as discussed above. The monthly fee was deemed to be collectible for such period as
RDx has timely paid the applicable respective monthly fee. In the three and nine months ended September 30, 2021, the Company recognized
total revenue of $ 200 and $ 200 , respectively, under the EsoGuard Commercialization Agreement.
Cost
of Revenue
The
cost of revenues principally includes the costs related to the Company’s laboratory operations (excluding estimated costs associated
with research activities), the costs related to the EsoCheck cell collection device, cell sample mailing kits and license royalties.
In
the three months ended September 30, 2022, the cost of revenue was $ 1,626 and was primarily related to costs for our laboratory operations
and EsoCheck device supplies. For the nine months ended September 30, 2022, the cost of revenue was $ 1,996 , including $ 369 reflecting
costs attributable to delivering the services under the EsoGuard Commercialization Agreement for the period January 1, 2022 to February
25, 2022. In the three and nine months ended September 30, 2021, the cost of revenue was $ 144 and $ 144 , respectively, which
solely related to the EsoGuard Commercialization Agreement.
9
Note
4 — Related Party Transactions
Case
Western Reserve University and Physician Inventors - Amended CWRU License Agreement
Case
Western Reserve University (“CWRU”) and each of the three physician inventors (“Physician Inventors”) of the
intellectual property licensed under the amended and restated patent license agreement with CWRU, dated August 23, 2021 (the “Amended
CWRU License Agreement”), each hold a minority equity ownership interest in Lucid Diagnostics Inc. The expenses incurred with respect
to the Amended CWRU License Agreement and the three Physician Inventors, as classified in the accompanying consolidated statement of
operations for the periods indicated are summarized as follows:
Schedule
of Incurred Expenses of Minority Shareholders
2022
2021
2022
2021
Three
Months Ended
September
30,
Nine
Months Ended
September
30,
2022
2021
2022
2021
Cost of Revenue
CWRU –
Royalty Fee
$ 4
$ 10
$ 13
$ 10
General and Administrative
Expense
CWRU – License Agreement
- Amendment Fee - Milestone III
—
10
—
10
Stock-based compensation
expense – Physician Inventors’ restricted stock awards
275
273
819
637
Research and Development
Expense
CWRU License Agreement
- reimbursement of patent legal fees
—
82
209
195
Fees - Physician Inventors’
consulting agreements
15
8
32
22
Sponsored research agreement
4
—
6
—
Stock-based
compensation expense – Physician Inventors’ stock options
52
56
151
114
Total Related Party
Expenses
$ 350
$ 439
$ 1,230
$ 988
PAVmed
Inc. - Management Services Agreement
The
Company’s daily operations of are managed by personnel employed by PAVmed Inc., for which Lucid Diagnostics Inc. incurs a service
fee, referred to as the “MSA Fee”, according to the provisions of a Management Services Agreement (“MSA”) with
PAVmed Inc. The MSA does not have a termination date, but may be terminated by the Lucid Diagnostics Inc. board of directors. The MSA
Fee is charged on a monthly basis and is subject-to periodic adjustment corresponding with changes in the services provided by PAVmed
Inc. personnel to the Company, with any such change in the MSA Fee being subject to approval of the boards of directors of each of Lucid
Diagnostics Inc. and PAVmed Inc. On August 11, 2022, the respective Company’s boards of directors approved a sixth amendment to
the MSA to increase the MSA Fee to $ 550 per month from $ 390 per month, with such increase effective on a prospective basis that commenced
July 1, 2022. Pursuant to the sixth amendment, the parties agreed PAVmed Inc. may elect to receive payment of the monthly MSA Fee in
cash or in shares of common stock of the Company, with such shares valued at the volume weighted average price (“VWAP”) during
the final ten trading days of the applicable month (subject to a floor price of $ 0.70 per share). However, in no event will PAVmed Inc.
be entitled to receive under the MSA, as amended, more than 7,709,836 shares of common stock the Company (representing 19.99% of our
outstanding shares of common stock as of immediately prior to the execution of the sixth amendment). The shares that may be issued under
the MSA, as amended, are being offered and sold in transactions exempt from registration under the Securities Act of 1933, as amended,
in reliance on the exemption afforded under Section 4(a)(2) thereof.
The
MSA Fee expense classification in the unaudited condensed consolidated statement of operations for the periods noted is as follows:
Schedule
of MSA Fee Expense Classification in Unaudited Condensed Statement of Operations
2022
2021
2022
2021
Three
Months Ended
September
30,
Nine
Months Ended
September
30,
2022
2021
2022
2021
Cost of Revenues
$ —
$ 40
$ —
$ 40
Sales & Marketing
330
352
713
971
General & Administrative
891
254
2,175
872
Research & Development
429
224
1,102
627
Total
MSA Fee
$ 1,650
$ 870
$ 3,990
$ 2,510
10
Note
4 — Related Party Transactions - continued
The
classification of the MSA Fee as presented above is based on the PAVmed Inc. classification of employee salary expense. In this regard,
PAVmed Inc. classifies employee salary expense as cost-of-revenue for employees engaged in service delivery under the EsoGuard Commercialization
Agreement, and sales and marketing expenses for employees performing sales, marketing, and reimbursement activities and functions, general
and administrative, and research and development except for those employees who are engaged in product and services engineering development
and design and /or clinical trials activities, for which such employee salary is classified as research and development expense.
Other
Related Party Transactions
Lucid
Diagnostics Inc. previously entered into a consulting agreement with Stanley N. Lapidus, effective June 2020 with such consulting agreement
providing for compensation on a contractual rate per hour for consulting services provided. In July 2021, Mr. Lapidus was appointed as
Vice Chairman of the Board of Directors of Lucid Diagnostics Inc. Lucid Diagnostics Inc. recognized general and administrative expense
of $ 8 and $ 21 in the three and nine months ended September 30, 2021 in connection with the consulting agreement.
Note
5 — Due To PAVmed Inc .
The
aggregate Due To: PAVmed Inc. for the periods indicated is summarized as follows:
Schedule
of Senior Unsecured Promissory Note
CapNostics,
LLC Transfer
PAVmed
Inc. OBO Payments
Employee-Related
Costs
MSA
Fees
Total
Balance - December 31, 2021
$ —
$ 620
$ 1,037
$ —
$ 1,657
MSA fees
—
—
—
3,990
3,990
On Behalf Of (OBO) activities
—
1,114
—
—
1,114
ERC - Payroll & Benefits
—
—
7,178
—
7,178
CapNostics, LLC transfer
2,105
—
—
—
2,105
Cash payments to PAVmed
Inc.
—
( 1,598 )
( 5,496 )
( 2,340 )
( 9,434 )
Balance - September 30, 2022
$ 2,105
$ 136
$ 2,719
$ 1,650
$ 6,610
CapNostics,
LLC
On
October 5, 2021, PAVmed Subsidiary Corp, a wholly-owned subsidiary of PAVmed Inc., acquired 100 % of the outstanding membership interest
of CapNostics, LLC (“CapNostics”), an unrelated third-party, for total (gross) purchase consideration of approximately $ 2.1
million in cash, paid at the closing of the transaction. Subsequently, effective April 1, 2022, PAVmed Subsidiary Corp and the Company
entered into an agreement pursuant to which PAVmed Subsidiary Corp assigned to Lucid Diagnostics Inc. 100 % of the membership interest
in CapNostics, LLC, resulting in the recognition by the Company principally of an acquired defensive technology intangible asset, and
a $ 2.1 million payment obligation Due To: PAVmed Inc. Additionally, Lucid Diagnostics Inc. was also assigned on a prospective basis effective April 1, 2022, the
consulting agreement with the previous principal owner of CapNostics, LLC. The transfer was accounted for as entities under common control.
See Note 9 - Intangible Assets, net, with respect to the transferred intangible asset.
EsoCure
License Agreement with PAVmed Inc.
EsoCure
has been in development as an esophageal ablation device by PAVmed Inc., with the intent to allow a clinician to treat dysplastic BE
before it can progress to EAC, a highly lethal esophageal cancer, and to do so without the need for complex and expensive capital equipment.
In April 2022, following the approval from both the Company’s and PAVmed Inc.’s boards of directors, the companies entered
into an intercompany license agreement (“EsoCure License Agreement”), pursuant to which the Company was granted the rights
to commercialize EsoCure, a technology under development intended for the treatment of dysplastic Barrett’s Esophagus. The EsoCure
License Agreement, includes a royalty arrangement whereby the Company will pay PAVmed Inc. a 5 % royalty on all EsoCure sales up to $ 100
million per calendar year, and an 8.0 % royalty on annual sales in excess of $ 100 million per calendar year. The Company is obligated
to reimburse PAVmed Inc. for any ongoing development costs and cumulative patent expenses associated with the licensed technology.
11
Note
6 — Asset Purchase Agreement and Management Services Agreement
Asset
Purchase Agreement - ResearchDx Inc.
Through
its wholly-owned subsidiary, LucidDx Labs Inc., the Company entered into an asset purchase agreement (“APA”) dated February
25, 2022, with ResearchDx, Inc. (“RDx”), an unrelated third-party - “APA-RDx”. Under the APA-RDx, LucidDx Labs
Inc. acquired certain assets from RDx which were combined with LucidDx Labs Inc. purchased and leased property and equipment to establish
a Company-owned CLIA certified, CAP accredited commercial clinical laboratory capable of performing the EsoGuard® Esophageal DNA
assay, inclusive of DNA extraction, next generation sequencing (“NGS”) and specimen storage. Prior to February 25, 2022,
RDx provided such laboratory services at its owned CLIA-certified, CAP-accredited clinical laboratory.
The
total purchase price consideration payable under the APA-RDx is a face value of $ 3,200 comprised of three contractually specified periodic
payments. The APA-RDx is being accounted for as an asset acquisition, with the recognition of an intangible asset of approximately $ 3,200 ,
which is included in “Intangible assets, net” on the accompanying unaudited condensed consolidated balance sheet, as further
discussed in Note 9, Intangible Assets, net. In the three and nine months ended September 30, 2022, a total of $ 1,000 and $ 3,200 ,
respectively, of cash was paid with respect to the periodic payments.
Additionally,
the APA-RDx requires the Company to pay a total of $ 3,000 to be paid as twelve (12) equal installment payments commencing May 25, 2022
and then on each three month anniversary thereof, inclusive of a final installment payment on February 25, 2025, with such installment
payments recognized as current period expense as incurred. In the three and nine months ended September 30, 2022, as provided for in
the APA-RDx, installment payments were settled with the issuances of 82,618 and 199,989 shares of common stock of Lucid Diagnostics Inc.,
with such shares having fair values of $ 188 and $ 427 , respectively, (with the fair value measured as the quoted closing price on the
dates the shares were issued), which was recognized as a current period expense included in general and administrative expenses in the
accompanying unaudited condensed consolidated statement of operations.
The
APA-RDx provides for each of an acceleration and a cancellation of the remaining unpaid installment payments, summarized as follows:
● The
payment of the remaining unpaid installment payments will be accelerated as immediately due
and payable as of the date the “MSA-RDx” (as such agreement is discussed below)
is either terminated by LucidDx Labs Inc. without cause or if it is terminated by mutual
agreement between the Company and RDx.
● The
payment of the remaining unpaid installment payments will be cancelled if the MSA-RDx is
terminated by LucidDx Labs Inc. for cause, defined as the occurrence of any one of: (i) a
material breach by RDx which is not cured within thirty days of LucidDx Labs Inc. written
notice; (ii) RDx becomes insolvent and /or bankrupt; or (ii) RDx fails to comply with applicable
statutes, is barred from participating in federal health care programs, or by action of changes
in law or regulation, or by action of judicial interpretation of law, or by judicial civil
proceedings decisions.
Management
Services Agreement - Research Dx Inc
LucidDx
Labs Inc. and RDx entered into a separate management services agreement (“MSA-RDx”), dated and effective February 25, 2022,
with such agreement having a term of three years commencing on the agreement’s effective date, and an initial fee of $ 150 per quarter.
The MSA-RDx provides for the cancellation of the remaining unpaid installment payments upon termination of the MSA-RDx for any reason
or no reason by either party thereto.
Note
7 — Prepaid Expenses, Deposits, and Other Current Assets
Prepaid
expenses and other current assets consisted of the following as of:
Schedule
of Prepaid Expenses and Other Current Assets
September
30, 2022
December
31, 2021
Advanced payments to service providers
and suppliers
$ 363
$ 260
Prepaid insurance
26
1,578
Deposits
2,389
1,116
EsoCheck cell collection supplies
55
434
EsoGuard mailer supplies
49
59
Total prepaid expenses,
deposits and other current assets
$ 2,882
$ 3,447
12
Note
8 — Leases
During
the nine months ended September 30, 2022, the Company entered into additional lease agreements that have commenced and are classified
as operating leases and short-term leases, including for each of: a commercial clinical laboratory and additional Lucid Test Centers.
The
Company’s future lease payments as of September 30, 2022, which are presented as operating lease liabilities, current portion and
operating lease liabilities, less current portion on the Company’s unaudited condensed consolidated balance sheets are as follows:
Schedule
Of Future Lease Payments Of Operating Lease Liabilities
2022 (remainder of year)
$ 246
2023
980
2024
928
2025
24
Total lease payments
$ 2,178
Less: imputed interest
( 175 )
Present value of lease
liabilities
$ 2,003
Supplemental
disclosure of cash flow information related to the Company’s cash and non-cash activities with its leases are as follows:
Schedule
Of Cash Flow Supplemental Information
Nine
Months Ended September 30,
2022
2021
Cash paid for amounts included in the measurement
of lease liabilities
Operating cash
flows from operating leases
$ 689
$ —
Non-cash investing and financing activities
Right-of-use assets obtained
in exchange for new operating lease liabilities
$ 2,567
$ —
Weighted-average remaining lease term - operating
leases (in years)
2.24
—
Weighted-average discount rate - operating
leases
7.875 %
— %
As
of September 30, 2022, the Company’s right-of-use assets from operating leases are $ 2,002 , which are reporting in right-of-use
assets - operating leases in the unaudited condensed consolidated balance sheets. As of September 30, 2022, the Company has outstanding
operating lease obligations of $ 2,003 , of which $ 860 is reported in operating lease liabilities, current portion and $ 1,143 is reporting
in operating lease liabilities less current portion in the Company’s unaudited condensed consolidated balance sheets. The Company
did not have operating leases as of December 31, 2021. The Company calculates its incremental borrowing rates for specific lease terms,
used to discount future lease payments, as a function of the financing terms the Company would likely receive on the open market.
13
Note
9 — Intangible Assets, net
Intangible
assets, less accumulated amortization, consisted of the following as of:
Schedule
of Intangible Assets Accumulated Amortization
Estimated
Useful Life
September
30, 2022
Defensive technology
60 months
$ 2,105
Laboratory licenses
and certifications and laboratory information management software
24 months
3,200
Total Intangible assets
5,305
Less Accumulated Amortization
( 1,355 )
Intangible Assets, net
$ 3,950
The
defensive technology intangible asset of $ 2.1 million (and approximately $ 0.2 million of accumulated amortization) was recognized by
the Company as of the April 1, 2022 effective date of the intercompany transfer of CapNostics, LLC to the Company from PAVmed Subsidiary
Corp (a wholly-owned subsidiary of PAVmed Inc.). The transfer was accounted for as entities under common control. The defensive technology
intangible asset was recognized by PAVmed Subsidiary Corp upon its acquisition of CapNostics, LLC, an unrelated third-party, for total
purchase consideration paid on the October 5, 2021 acquisition date of approximately $ 2.1 million in cash. The CapNostics LLC transaction
was accounted for as an asset acquisition, resulting in the recognition of the defensive technology intangible asset. The defensive technology
intangible asset is being amortized on a straight-line basis over an expected useful life 60 months commencing on the acquisition date.
See Note 5, Due To PAVmed Inc. , with respect to the transfer of the corresponding $ 2.1 million payment obligation Due To: PAVmed
Inc.
As
noted in Note 6, Asset Purchase Agreement and Management Services Agreement , the asset purchase agreement between the Company
and ResearchDx Inc. (“APA-RDx”), is being accounted for as an asset acquisition. The intangible assets recognized under the
APA-RDx are the laboratory licenses and certifications, (inclusive of a CLIA certification, CAP accreditation, and clinical laboratory
licenses for five (5) U.S. States transfer to the Company from RDx), and a laboratory information management software perpetual-use royalty-free
license granted under the APA-RDx, with such intangible asset having a useful life of twenty-four months commencing on the APA-RDx February
25, 2022 transaction date.
Amortization
expense of the intangible assets discussed above was $ 505 and $ 0 for the three month periods ended September 30, 2022 and 2021, respectively,
and $ 1,144 and $ 0 for the nine month periods ended September 30, 2022 and 2021, respectively, and is included in general and administrative
expenses in the accompanying unaudited condensed consolidated statements of operations. As of September 30, 2022, the estimated future
amortization expense associated with the Company’s finite-lived intangible assets for each of the five succeeding fiscal years
is as follows:
Schedule
of Future Amortization Expense
2022 (remainder of year)
$ 504
2023
2,021
2024
688
2025
421
2026
316
Total
$ 3,950
Note
10 — Stock-Based Compensation
Lucid
Diagnostics Inc. 2018 Long-Term Incentive Equity Plan
The
Lucid Diagnostics Inc. 2018 Long-Term Incentive Equity Plan (“Lucid Diagnostics Inc. 2018 Equity Plan”) is separate and apart
from the PAVmed Inc. 2014 Equity Plan discussed below. The Lucid Diagnostics Inc. 2018 Equity Plan is designed to enable Lucid Diagnostics
Inc. to offer employees, officers, directors, and consultants, as defined, an opportunity to acquire shares of common stock of Lucid
Diagnostics Inc. The types of awards that may be granted under the Lucid Diagnostics Inc. 2018 Equity Plan include stock options, stock
appreciation rights, restricted stock, and other stock-based awards subject to limitations under applicable law. All awards are subject
to approval by the Lucid Diagnostics Inc. board of directors.
A
total of 9,144,000 shares of common stock of Lucid Diagnostics Inc. are reserved for issuance under the Lucid Diagnostics Inc. 2018 Equity
Plan, with 3,754,051 shares available for grant as of September 30, 2022. The share reservation is not diminished by a total of 423,300
stock options and 50,000 restricted stock awards granted outside the Lucid Diagnostics Inc. 2018 Equity Plan, as of September 30, 2022.
14
Note
10 — Stock-Based Compensation - continued
Lucid
Diagnostics Inc. Stock Options
Lucid
Diagnostics Inc. stock options granted under the Lucid Diagnostics Inc. 2018 Equity Plan and stock options granted outside such plan
are summarized as follows:
Schedule
of Stock Options Issued and Outstanding Activities
Number
of Stock Options
Weighted
Average Exercise Price
Remaining
Contractual Term (Years)
Intrinsic
Value (2)
Outstanding stock options at December
31, 2021
1,419,242
$ 0.73
7.0
$ 6,665
Granted (1)
2,320,000
$ 3.71
Exercised
( 964,717 )
$ 0.72
Forfeited
( 141,436 )
$ 4.33
Outstanding
stock options at September 30, 2022 (3)
2,633,089
$ 3.17
8.6
$ 499
Vested and exercisable
stock options at September 30, 2022
960,364
$ 2.33
7.2
$ 499
(1)
Stock
options granted under the Lucid Diagnostics Inc. 2018 Equity Plan and those granted outside such plan generally vest ratably over
twelve quarters, with the vesting commencing with the grant date quarter-end, and have a ten-year contractual term from date-of-grant.
(2)
The
intrinsic value is computed as the difference between the quoted price of the Lucid Diagnostics Inc. common stock on each of September
30, 2022 and December 31, 2021 and the exercise price of the underlying Lucid Diagnostics Inc. stock options, to the extent such
quoted price is greater than the exercise price.
(3)
The
outstanding stock options presented in the table above, are inclusive of 423,300 stock options granted outside the Lucid Diagnostics
Inc. 2018 Equity Plan, as of September 30, 2022 and December 31, 2021.
See
Note 4, Related Party Transactions , for a summary of the stock-based compensation expense recognized with respect to the stock
options granted under the Lucid Diagnostics Inc. 2018 Equity Plan to the Physician Inventors.
Lucid
Diagnostics Inc. Restricted Stock Awards
Lucid
Diagnostics Inc. restricted stock awards granted under the Lucid Diagnostics Inc. 2018 Equity Plan and restricted stock awards granted
outside such plan are summarized as follows:
Schedule
of Restricted Stock Award Activity
Number
of Restricted
Stock
Awards
Weighted
Average Grant
Date
Fair Value
Unvested restricted stock awards as of December 31,
2021
1,940,740
$ 12.76
Granted
320,000
4.53
Vested
( 169,320 )
13.48
Forfeited
—
—
Unvested restricted stock
awards as of September 30, 2022 (1)
2,091,420
$ 11.44
(1)
The
unvested restricted stock awards presented in the table above, are inclusive of 50,000 restricted stock awards granted outside the
Lucid Diagnostics Inc. 2018 Equity Plan as of September 30, 2022 and December 31, 2021.
On
January 7, 2022, 320,000 restricted stock awards were granted under the Lucid Diagnostics Inc 2018 Equity Plan, with such restricted
stock awards having a single vesting date on January 7, 2025, and an aggregate grant date fair value of approximately $ 1.4 million, measured
as the grant date closing price of Lucid Diagnostics Inc. common stock, with such aggregate estimated fair value recognized as stock-based
compensation expense ratably on a straight-line basis over the vesting period, which is commensurate with the service period. The restricted
stock awards are subject to forfeiture if the requisite service period is not completed.
PAVmed
Inc. 2014 Equity Plan
The
PAVmed Inc. 2014 Long-Term Incentive Equity Plan (the “PAVmed Inc. 2014 Equity Plan”), is separate and apart from the Lucid
Diagnostics Inc. 2018 Equity Plan (as such equity plan is discussed above).
15
Note
10 — Stock-Based Compensation - continued
Stock-Based
Compensation Expense
The
stock-based compensation expense recognized by the Company for both the Lucid Diagnostics Inc. 2018 Equity Plan and the PAVmed Inc. 2014
Equity Plan, for the periods indicated, was as follows:
Schedule
of Stock-Based Compensation Expense
2022
2021
2022
2021
Three
Months Ended
September
30,
Nine
Months Ended
September
30,
2022
2021
2022
2021
Lucid Diagnostics Inc 2018 Equity
Plan – cost of revenue
$ 9
$ —
$ 9
$ —
Lucid Diagnostics Inc 2018 Equity Plan –
sales and marketing expenses
253
—
733
—
Lucid Diagnostics Inc 2018 Equity Plan - general
and administrative expenses
2,990
2,695
9,504
5,988
Lucid Diagnostics Inc 2018 Equity Plan - research
and development expenses
28
21
125
57
PAVmed Inc 2014 Equity Plan - sales and marketing
expenses
161
—
497
—
PAVmed Inc 2014 Equity Plan - general and administrative
expenses
78
—
224
—
PAVmed Inc 2014 Equity
Plan - research and development expenses
52
56
159
111
Total stock-based compensation
expense
$ 3,571
$ 2,772
$ 11,251
$ 6,156
The
stock-based compensation expense, as presented above, is inclusive of: stock options and restricted stock awards granted under the Lucid
Diagnostics Inc. 2018 Equity Plan to employees of PAVmed Inc., the Physician Inventors , and members of the board of directors of Lucid
Diagnostics Inc., as well as the stock options granted under the PAVmed Inc. 2014 Equity Plan to the Physician Inventors.
As
of September 30, 2022, unrecognized stock-based compensation expense and weighted average remaining requisite service period with respect
to stock options and restricted stock awards issued under each of the Lucid Diagnostics Inc. 2018 Equity Plan and the PAVmed Inc. 2014
Equity Plan, as discussed above, is as follows:
Schedule
of Unrecognized Compensation Expense and Weighted Average Remaining Service Period
Unrecognized
Expense
Weighted
Average
Remaining
Service
Period
(Years)
Lucid Diagnostics Inc. 2018 Equity Plan
Stock Options
$ 3,791
2.4
Restricted Stock Awards
$ 7,165
0.8
PAVmed Inc. 2014 Equity Plan
Stock Options
$ 1,618
1.7
Restricted Stock Awards
$ 187
1.2
Stock-based
compensation expense recognized with respect to stock options granted under the Lucid Diagnostics Inc. 2018 Equity Plan was based on
a weighted average estimated fair value of such stock options of $ 1.61 per share during the period ended September 30, 2022. The stock-based
compensation was calculated using the following weighted average Black-Scholes valuation model assumptions:
Schedule of Stock-based Compensation Valuation Assumptions
Nine
Months Ended
September
30,
2022
Expected term of stock options
(in years)
5.8
Expected stock price volatility
72 %
Risk free interest rate
3.2 %
Expected dividend yield
— %
16
Note
10 — Stock-Based Compensation - continued
Lucid
Diagnostics, Inc Employee Stock Purchase Plan (“ESPP”)
The
Lucid Diagnostics Inc Employee Stock Purchase Plan (“Lucid Diagnostics Inc ESPP”), initial six-month stock purchase period
was April 1, 2022 to September 30, 2022. A total of 84,030 shares of common stock of Lucid Diagnostics Inc were purchased for proceeds
of approximately $ 109 on September 30, 2022 under the Lucid Diagnostics Inc. ESPP. The Lucid Diagnostics Inc. ESPP has a total reservation
of 500,000 shares of common stock of which 415,970 shares are available-for-issue as of September 30, 2022.
Note
11 — Stockholders’ Equity
Lucid
Diagnostics Inc. Common Stock
As
of September 30, 2022 and December 31, 2021 there were 37,016,225 and 34,917,907 shares of common stock issued and outstanding, respectively.
As of September 30, 2022, PAVmed Inc. holds 27,927,190 shares, representing a majority-interest equity ownership and PAVmed Inc. has
a controlling financial interest in Lucid Diagnostics Inc.
Committed
Equity Facility - March 28, 2022
On
March 28, 2022, Lucid Diagnostics, Inc. entered into a committed equity facility with an affiliate of Cantor Fitzgerald (“Cantor”).
Under the terms of the committed equity facility, Cantor has committed to purchase up to $ 50 million of Lucid Diagnostics Inc. common
stock from time to time at the request of the Company. While there are distinct differences, the facility is structured similarly to
a traditional at-the-market equity facility, insofar as it allows the Company to raise primary equity capital on a periodic basis at
prices based on the existing market price. As of September 30, 2022, under the committed equity facility, a total of 680,263 shares of
common stock of the Company were issued for proceeds of approximately $ 1,807 .
In
connection with the execution of the agreement for the committed equity facility, the Company paid Cantor $ 1.0 million as consideration
for its irrevocable commitment to purchase the shares upon the terms and subject to the satisfaction of the conditions set forth in such
agreement. In addition, pursuant to the agreement, we agreed to reimburse Cantor for certain of its expenses. The Company also entered
into a registration rights agreement with Cantor. The Company has the right to terminate the agreement at any time after initial satisfaction
of the conditions to Cantor’s obligation to purchase shares under the facility, at no cost or penalty, upon three trading days’
prior written notice.
Note
12 — Net Loss Per Share
The
“Net loss per share basic and diluted” for the respective periods indicated - is as follows:
Schedule
of Basic and Fully Diluted Net Loss Per Share
2022
2021
2022
2021
Three
Months Ended
September
30,
Nine
Months Ended
September
30,
2022
2021
2022
2021
Numerator
Net loss
$ ( 14,349 )
$ ( 6,957 )
$ ( 41,243 )
$ ( 16,772 )
Denominator
Weighted average common
shares outstanding, basic and diluted
36,405,945
14,114,707
35,767,857
14,114,707
Net loss per share
Net
loss per share - basic and diluted
$ ( 0.39 )
$ ( 0.49 )
$ ( 1.15 )
$ ( 1.19 )
Basic
weighted-average number of shares of common stock outstanding for the periods ended September 30, 2022 and 2021 include the shares of
the Company issued and outstanding during such periods, each on a weighted average basis. The basic weighted average number of shares
common stock outstanding excludes common stock equivalent incremental shares, while diluted weighted average number of shares outstanding
includes such incremental shares. However, as the Company was in a loss position for all periods presented, basic and diluted weighted
average shares outstanding are the same, as the inclusion of the incremental shares would be anti-dilutive. The common stock equivalents
excluded from the computation of diluted weighted average shares outstanding are as follows:
Schedule
of Anti-dilutive Securities Excluded from Computation of Diluted Earnings Per Share
September
30,
2022
2021
Stock options
2,633,089
1,399,242
Unvested restricted
stock awards
2,091,420
1,806,080
Total
4,724,509
3,205,322
17
Item
2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
The
following discussion and analysis of our unaudited condensed consolidated financial condition and results of operations should be read
together with our Annual Report on Form 10-K for the year ended December 31, 2021 (the “Form 10-K”), as filed with the Securities
and Exchange Commission (the “SEC”). We are a majority-owned consolidated subsidiary of PAVmed Inc. (“PAVmed”).
Unless
the context otherwise requires, references herein to “we”, “us”, and “our”, and to the “Company”
or “Lucid Diagnostics” are to Lucid Diagnostics Inc and its subsidiaries LucidDx Labs Inc. (“LucidDx Labs”) and
CapNostics, LLC (“CapNostics”).
FORWARD-LOOKING
STATEMENTS
This
Quarterly Report on Form 10-Q (this “Form 10-Q”), including the following discussion and analysis of our (unaudited) condensed
consolidated financial condition and results of operations, contains forward-looking statements that involve substantial risks and uncertainties.
All statements, other than statements of historical facts, contained in this Form 10-Q, including statements regarding our future results
of operations and financial position, business strategy and plans and objectives of management for future operations, are forward-looking
statements. The words “may,” “will,” “should,” “expects,” “plans,” “anticipates,”
“could,” “intends,” “target,” “projects,” “contemplates,” “believes,”
“estimates,” “predicts,” “potential” or “continue” or the negative of these terms or
other similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these
identifying words. Forward-looking statements are not guarantees of future performance and the Company’s actual results may differ
significantly from the results discussed in the forward-looking statements. Factors that might cause such differences include, but are
not limited to, those discussed in Item 1A of Part I of the Form 10-K under the heading “Risk Factors.”
Important
factors that may affect our actual results include:
●
our
limited operating history;
●
our
financial performance, including our ability to generate revenue;
●
our
ability to obtain regulatory approval for the commercialization of our products;
●
the
ability of our products to achieve market acceptance;
●
our
success in retaining or recruiting, or changes required in, our officers, key employees or directors;
●
our
potential ability to obtain additional financing when and if needed;
●
our
ability to protect our intellectual property;
●
our
ability to complete strategic acquisitions;
●
our
ability to manage growth and integrate acquired operations;
●
the
potential liquidity and trading of our securities;
●
our
regulatory and operational risks;
●
cybersecurity
risks;
●
risks
related to the COVID-19 pandemic;
●
risks related to our relationship with PAVmed; and
●
our
estimates regarding expenses, future revenue, capital requirements and needs for additional financing.
In
addition, our forward-looking statements do not reflect the potential impact of any future financings, acquisitions, mergers, dispositions,
joint ventures or investments we may make.
We
may not actually achieve the plans, intentions, and/or expectations disclosed in our forward-looking statements, and you should not
place undue reliance on our forward-looking statements. You should read this Form 10-Q and the Form 10-K, and the documents we have filed
as exhibits to this Form 10-Q and the Form 10-K, completely and with the understanding our actual future results may be materially different
from what we expect. We do not assume any obligation to update any forward-looking statements, whether as a result of new information,
future events or otherwise, except as required by applicable law.
18
Overview
We
are a commercial-stage, cancer prevention, medical diagnostics technology company focused on the millions of patients with long-standing
gastroesophageal reflux disease (“GERD”) who are at risk of developing esophageal precancer and cancer, specifically highly
lethal esophageal adenocarcinoma (“EAC”), which is expected to lead to approximately 16,000 U.S. deaths per year.
We
believe that our lead products, the EsoGuard Esophageal DNA Test performed on samples collected with the EsoCheck Esophageal Cell Collection
Device, constitute the first and only commercially available diagnostic test capable of serving as a widespread screening tool to prevent
EAC deaths, through early detection of esophageal precancer in at-risk GERD patients.
●
EsoGuard
is a DNA test performed on surface esophageal cells collected with EsoCheck in a brief noninvasive office procedure which has been
shown to be over 90% sensitive and specific at detecting Barrett’s Esophagus (“BE”), a precancerous condition of
the esophagus and all conditions along the BE-EAC spectrum. (Moinova, et al. Sci Transl Med. 2018 Jan 17;10(424): eaao5848).
●
EsoCheck
is a swallowable balloon capsule catheter capable
of sampling surface esophageal cells in a less-than -five-minute, noninvasive office procedure. We believe EsoCheck’s Collect+Protect™
technology makes it the only noninvasive esophageal cell collection device capable of anatomically targeted and protected sampling
to prevent dilution and contamination during device withdrawal.
We are party to an amended and restated
patent license agreement with CWRU, dated August 23, 2021 (the “Amended CWRU License Agreement”), which provides for the exclusive
worldwide license of the intellectual property rights for the proprietary technologies underlying EsoCheck and EsoGuard.
EsoGuard
is commercialized in the U.S. as a laboratory developed test (“LDT”). It was previously performed by our unrelated
third-party commercial clinical laboratory service partner ResearchDx Inc. (“RDx”), at their Clinical Laboratory
Improvement Amendments (“CLIA”) certified commercial clinical laboratory, located in Irvine, CA. Beginning in March
2022, EsoGuard has been performed at our own CLIA-certified commercial clinical laboratory, located in Lake Forest, CA. RDx also
currently manufactures our EsoGuard specimen kits. EsoCheck is commercialized in the U.S. as a 510(k) cleared esophageal cell
collection device currently manufactured for us by our contract manufacturing partner, Sage Product Development Inc., located in
Foxborough, MA. As discussed below, we are in the process of transferring EsoCheck manufacturing to Coastline International Inc., a
high-volume manufacturer headquartered in San Diego, CA. EsoCheck has completed the CE Mark certification
process. EsoGuard, used with EsoCheck, was granted Food and Drug Administration (“FDA”) Breakthrough Device designation and requires the completion of an
international multicenter pre-market approval (“PMA”) clinical trial to be able to submit EsoGuard to the FDA for
approval as an in vitro diagnostic device (“IVD”).
EsoGuard secured a final Medicare payment determination of $1,938.01, effective January 1, 2021. We are awaiting a Medicare local
coverage determination (“LCD”), as discussed in more detail below. We are also aggressively pursuing U.S.
private payor payment and coverage, as well as payment in Europe.
We
are working to expand EsoGuard commercialization across multiple channels by building a direct sales and marketing team targeting primary
care physicians, specialists, institutions and consumers. To assure sufficient testing capacity and geographic coverage, as part of this
expansion, we are building our own network of Lucid Test Centers, staffed by Lucid-employed clinical personnel, where patients can undergo
the EsoCheck procedure and have the sample sent for EsoGuard testing. We have also established an EsoGuard Telemedicine Program, in partnership
with UpScript, LLC, an independent third-party telemedicine provider, that can accommodate EsoGuard self-referrals from direct-to-consumer
marketing.
Updated Clinical Guidelines and Guidance
In
April 2022, the American College of Gastroenterology (“ACG”) updated its
clinical guideline to support esophageal precancer (including BE) screening to prevent highly lethal EAC utilizing EsoGuard on samples
collected with EsoCheck. The clinical guideline reiterates the ACG’s long-standing recommendation for esophageal precancer screening
in at-risk patients with GERD, commonly known as chronic heartburn, acid reflux or simply reflux. In its Recommendation 5, the ACG suggests
a single screening endoscopy in patients with chronic GERD symptoms and 3 or more additional risk factors for BE, including male sex,
age greater than 50 years, White race, tobacco smoking, obesity, and family history of BE or EAC in a first-degree relative. Furthermore,
and importantly for the first time, the clinical guideline also endorses nonendoscopic biomarker screening as an acceptable alternative
to costly and invasive endoscopy by stating in its Recommendation 6 that the ACG suggests that a swallowable, nonendoscopic capsule device
combined with a biomarker is an acceptable alternative to endoscopy for screening for BE. The clinical guideline specifically mentions
EsoCheck, along with our EsophaCap device, as such swallowable, nonendoscopic esophageal cell collection devices. The clinical guideline
also mentions methylated DNA markers (like those detected by the EsoGuard test) as such a biomarker. The summary of evidence for this
recommendation includes a reference to the seminal NIH-funded multicenter, case-control study published in 2018 in Science Translational
Medicine, which demonstrated that EsoGuard is highly accurate at detecting esophageal precancer and cancer, including on samples collected
with EsoCheck.
19
Overview
- continued
In
July 2022, the American Gastroenterology Association (“AGA”) published updated clinical guidance that mirrors the same
furnished by the ACG as described above , endorsing the use of non-invasive screening
tools like EsoCheck, which is cited in its guideline, as an acceptable alternative to endoscopy to directly address the need for
noninvasive screening tools that are easy to administer, patient friendly, and cost-effective for the detection of BE. The clinical
practice update by the AGA also significantly expands the target population for esophageal precancer screening, including for
EsoGuard and EsoCheck, by recommending, for the first time, screening in at-risk patients without symptoms of reflux. The AGA does
so by adding a history of chronic GERD as merely an additional, seventh risk factor to the six risk factors for BE and EAC that have
traditionally identified at-risk symptomatic patients recommended for screening. As a result, chronic symptomatic GERD is no longer
a mandatory prerequisite and asymptomatic patients with three of the other six risk factors (e.g., male sex, age greater than 50
years, White race, tobacco smoking, obesity, and family history of BE) are now considered at-risk patients
recommended for screening.
Local Coverage Determination
In April 2022, a
proposed LCD DL39256, entitled “Molecular Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and
Neoplasia” was published on the Center for Medicare and Medicaid Services (“CMS”) website by the Medicare Administrative Contractor (“MAC”) Palmetto GBA. The
proposed LCD is a further step in our efforts to secure Medicare coverage and payment for EsoGuard.
The
proposed LCD, which the CMS website explicitly characterizes as a “work in progress” for “public review,” outlines
criteria that MAC Palmetto GBA’s Molecular Diagnostic Services Program (“MolDX”) expects upper gastrointestinal precancer and cancer molecular diagnostic tests to meet. These criteria include active
GERD with at least two risk factors, as well as evidence of analytic validity, clinical validity, and clinical utility. Although it found
that no currently existing test has fulfilled all these criteria, it indicated that it will “monitor the evidence and will provide
coverage based on the pertinent literature and society recommendations.” Notably, the proposed LCD pre-dated, and therefore does
not include consideration of, the most recent ACG clinical guideline update endorsing swallowable, nonendoscopic capsule devices combined
with a biomarker, such as EsoCheck and EsoGuard. The publication of the proposed LCD included a written comment period that extended
through May 14, 2022. MolDX held an open meeting on May 10, 2022, during which stakeholders and other interested parties had the opportunity
to address the proposed LCD.
We
have used the written comment process and the open meeting to bring to MolDX essential information that was not incorporated into the
proposed LCD. These include: the updated ACG clinical guideline; the fact that EsoGuard’s published performance is at or above
accepted performance criteria for detection of lower gastrointestinal cancers in approved and currently effective Medicare coverage determinations;
and data from ongoing clinical utility studies Lucid and clinical investigators are performing. A final LCD will not be issued until
the MAC has had the opportunity to assess and consider the comments and input from the written comment period and the open meeting.
Following
the MAC Palmetto GBA release of a proposed LCD, the MAC Noridian Healthcare Solutions published a proposed LCD entitled Molecular
Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and Neoplasia DL39262. The proposed LCD mirrors the MAC
Palmetto GBA proposed LCD. We have used the MAC Noridian Healthcare Solutions open meeting held on May 26, 2022, and the written
comment period that ended on June 11, 2022 to bring the same essential information that we provided to the MAC Palmetto GBA to
maintain consistency in our approach and advocate appropriately.
Status of Clinical Trials
In
2021, we began conducting two concurrent clinical trials, the “EsoGuard
screening study” (“BE-1”) and the “EsoGuard case-control study” (“BE-2”), to expand the clinical
evidence for the technologies and to support FDA pre-market approval (“PMA”) of the use of EsoGuard and EsoCheck as an in-vitro
diagnostic medical device (“IVD”). However, in light of the MAC Palmetto GBA’s recently published proposed LCD DL39256,
the recently updated AGA guidance, and the ACG update to its clinical guideline that supports screening to prevent highly lethal EAC utilizing
a biomarker test like EsoGuard on samples collected with a swallowable, nonendoscopic capsule device like EsoCheck, we have determined
to prioritize our clinical trial efforts and resources towards supporting studies that will help secure insurance reimbursement adoption
for EsoGuard by government and private insurers. Consequently, we have decided to delay for the time being the BE-1 trial
while continuing to enroll GERD patients with a previous diagnosis of nondysplastic BE, low grade dysplasia, high grade dysplasia, or
EAC in the BE-2 case-control study through Q2 2023.
EsoCure Esophageal Ablation Device
In
connection with our efforts to expand our presence in the diagnostic market, we are also developing a third product, the EsoCure Esophageal
Ablation Device, with the intent to allow a clinician to treat dysplastic BE before it can progress to EAC, a highly lethal esophageal
cancer, and to do so without the need for complex and expensive capital equipment. As described in Note 5, Due To PAVmed Inc. ,
we entered into a license agreement with our parent company, PAVmed, pursuant to which we were granted the rights to commercialize EsoCure.
A successful pre-clinical feasibility animal study of EsoCure has been completed, demonstrating excellent, controlled circumferential
ablation of the esophageal mucosal lining. An acute and survival animal study of EsoCure has also been completed, demonstrating successful
direct thermal balloon catheter ablation of esophageal lining through the working channel of a standard endoscope. We plan to conduct
additional development work and animal testing of EsoCure to support a future FDA 510(k) submission.
20
Recent
Developments
Business
Reimbursement
– Private Payer
As
part of the transition to our own CLIA-certified commercial clinical laboratory, we contracted with a revenue cycle management (“RCM”)
service provider to submit third-party reimbursement claims on our behalf. The RCM service provider has joint oversight of payer claims,
appeals processes, patient billing, online payment collection, and claims tracking. On August 1, 2022, our new RCM company began submitting
claims to third-party payers. At the point when submission by the RCM began, more than 2,000 claims had accumulated since the commencement
of our laboratory operations on February 25, 2022. These claims and other claims that were subsequently generated
are now being processed, including 1,088 tests in the three months ended September 30, 2022.
Refer
to Note 3 of our Condensed Consolidated Financial Statements for more information on Revenue from Contracts with Customers.
EsoCheck
Cell Collection Device Update
In
October 2022, the FDA announced they completed their review of the EsoCheck 510(k) (#K222366) premarket notification of intent to market
the device and granted the use of the EsoCheck Cell Collection Device for the collection and retrieval of surface cells of the esophagus
in the general population of adults and adolescents, 12 years of age and older. This action by the FDA now expands the targeted US patient
population to include adolescents not previously covered by the Company’s initial EsoCheck 510(k) clearance.
EsoCheck
Manufacturing Update
On
October 4, 2022, we completed our first full day of manufacturing of EsoCheck at Coastline International Inc., a high-volume medical
device manufacturer. By mid-2023, we expect to transition from our current manufacturer, Sage Product Development Inc., to Coastline
International Inc., as the manufacturing process is further optimized.
Financing
In
March 2022, we entered into a committed equity facility with an affiliate of Cantor Fitzgerald (“Cantor”). Under the
terms of the facility, Cantor has committed to purchase up to $50 million of our common stock from time to time upon our request. While there are distinct differences, the facility is structured similarly to a traditional at-the-market
equity facility, insofar as it allows us to raise primary capital on a periodic basis at prices based on the existing market price.
Through September 30, 2022, 680,263 shares of our common stock were issued under this facility for total
proceeds of $1.8 million.
21
Results
of Operations
Overview
Revenue
The
Company recognized revenue resulting from the delivery of patient EsoGuard test results for which cash collections have occurred or payment
was reasonably assured. Additionally, revenue was recognized with respect to the EsoGuard Commercialization Agreement, dated August 1,
2021, between the Company and RDx, a CLIA certified commercial laboratory service provider. On February
25, 2022, the EsoGuard Commercialization Agreement was terminated upon the execution of an Asset Purchase Agreement between the Company’s
wholly-owned subsidiary of LucidDx Labs Inc. and RDx.
Cost
of revenue
Cost
of revenues recognized from the delivery of patient EsoGuard test results includes costs related to EsoCheck device usage, shipment of test collection kits, royalties and the cost of services to
process tests and provide results to physicians. We incur expenses for tests in the period in which the activities occur, therefore,
gross margin as a percentage of revenue may vary from quarter to quarter due to costs being incurred in one period that relate to revenues
recognized in a later period.
We
expect that gross margin for our services will continue to fluctuate and be affected by EsoGuard test volume, our operating efficiencies,
patient compliance rates, payer mix, the levels of reimbursement, and payment patterns of payers and patients.
The
cost of revenue recognized with respect to the revenue recognized under the EsoGuard Commercialization Agreement is inclusive of: a royalty
fee incurred under the Amended CWRU License Agreement; the MSA Fee (as defined and discussed herein below) allocated to cost of revenue,
which is principally employee related costs of PAVmed employees engaged in the administration to patients of the EsoCheck cell sample
collection procedure (principally at the Lucid Test Centers); the EsoCheck devices and EsoGuard mailers (cell sample shipping costs)
distributed to medical practitioners locations and the Lucid Test Centers; and Lucid Test Centers operating expenses, including rent
expense and supplies.
Sales
and marketing expenses
Sales
and marketing expenses consist primarily of salaries and related costs for employees engaged in sales and marketing activities, as well
as the portion of the MSA Fee allocated to sales and marketing expenses, which are principally employee related costs of PAVmed employees.
We anticipate our sales and marketing expenses will increase in the future, as we anticipate an increase in payroll and related expenses
related to the roll-out of our commercial sales and marketing operations as we execute on our business strategy.
General
and administrative expenses
General
and administrative expenses consist primarily of professional fees, accounting and legal services, consultants and expenses associated
with obtaining and maintaining patents within our intellectual property portfolio, along with the portion of the MSA Fee allocated to
general and administrative expenses.
We
anticipate our general and administrative expenses will increase in the future related to continued expansion of our overall business
operations. We also anticipate expenses related to being a public company, including professional services fees for legal, accounting,
tax, audit, employees involved in third-party payor reimbursement contract negotiations and regulatory services associated with maintaining
compliance as a public company, along with insurance premiums, investor relations, and other corporate expenses.
Research
and development expenses
Research
and development expenses are recognized in the period they are incurred and consist principally of internal and external expenses incurred
for the development of our technologies and conducting clinical trials, including:
●
consulting
costs charged to us by various external contract research organizations we contract with to conduct clinical and preclinical studies
and engineering design and development;
●
costs
associated with regulatory filings;
●
patent
license fees;
●
cost
of laboratory supplies and acquiring, developing, and manufacturing preclinical prototypes;
●
product
design engineering studies;
●
fees
associated with conducting clinical trials for our EsoGuard diagnostic assay; and
●
MSA
Fee allocated to research and development, as such MSA Fee are discussed below.
We
plan to incur research and development expenses for the foreseeable future as we continue the development of our existing products as
well as new innovations. Our research and development activities, including our clinical trials, are focused principally on obtaining FDA approvals, facilitating insurer reimbursement, encouraging physician adoption and developing product
improvements or extending the utility of the lead products in our pipeline, including EsoCheck and EsoGuard.
22
Results
of Operations - continued
Overview
- continued
Presentation
of Dollar Amounts
All
dollar amounts in this Management’s Discussion and Analysis of Financial Condition and Results of Operations are presented as dollars in millions, except for per share amounts.
Three
months ended September 30, 2022 as compared to three months ended September 30, 2021
Revenue
In
the three months ended September 30, 2022, revenue was $0.1 million as compared to $0.2 million in the corresponding period in the prior
year. The $0.1 million decrease principally relates to the termination of the EsoGuard Commercialization Agreement with RDx, as the Company
transitioned to its own laboratory operations effective February 25, 2022. The decrease was offset by revenue for our EsoGuard Esophageal
DNA Test performed in our own CLIA laboratory for the three months ended September 30, 2022.
Cost
of revenue
In
the three months ended September 30, 2022, cost of revenue was approximately $1.6 million as compared to $0.1 million for the corresponding
period in the prior year. The $1.5 million increase principally related to:
●
approximately
$0.2 million increase in compensation related costs as a result of an increase in headcount;
●
approximately
$0.4 million increase in EsoCheck and EsoGuard supplies usage costs; and
●
approximately
$0.9 million increase in laboratory operations costs.
Sales
and marketing expenses
In
the three months ended September 30, 2022, sales and marketing costs were approximately $3.9 million, compared to $0.9 million for the
corresponding period in the prior year. The net increase of $3.0 million was principally related to:
●
approximately
$2.9 million increase in compensation related costs, including stock-based compensation of approximately $0.4 million with respect
to restricted stock awards (“RSA”) grants under the Lucid Diagnostics Inc. 2018 Equity Plan to Lucid Diagnostics and
PAVmed employees and non-employees, and an increase in stock options granted corresponding with the increase in headcount; and
●
approximately
$0.1 million increase in consulting and outside professional services fees.
General
and administrative expenses
In
the three months ended September 30, 2022, general and administrative costs were approximately $5.7 million, compared to $3.5 million
for the corresponding period in the prior year. The net increase of $2.2 million was principally related to:
●
approximately
$0.7 million increase in compensation related costs, including stock-based
compensation of approximately $0.2 million with respect to RSA grants under the Lucid Diagnostics Inc. 2018 Equity Plan to Lucid Diagnostics
and PAVmed employees and non-employees, and an increase in stock options granted corresponding with the increase in headcount;
●
approximately
$0.5 million increase in consulting services related to patents, regulatory compliance, legal processes for contract review, transition
of public relations and investor relations firms, and public company expenses;
●
approximately
$0.6 million increase in the MSA fee allocation from PAVmed related to the growth and expansion of our business and the services
incurred through PAVmed; and
●
approximately
$0.4 million increase in general business expenses.
23
Results
of Operations - continued
Three
months ended September 30, 2022 as compared to three months ended September 30, 2021 - continued
Research
and development expenses
In
the three months ended September 30, 2022, research and development costs were approximately $2.7 million, compared to $2.2 million for
the corresponding period in the prior year. The net increase of $0.5 million was principally related to:
●
approximately
$0.3 million increase in development costs, particularly in clinical trial activities and outside professional and consulting fees
with respect to EsoCheck, EsoCure and EsoGuard; and
●
approximately
$0.2 million increase in the MSA fee allocation from PAVmed related to the growth and expansion of our business and the services
incurred through PAVmed.
See
our accompanying unaudited condensed consolidated financial statements for each of: Note 4 , Related Party Transactions, for a
discussion of the consulting fee expense and stock based compensation expense recognized with respect to the Physician Inventors
consulting agreements and stock options and restricted stock awards and for a discussion of the MSA between Lucid Diagnostics and
PAVmed; and Note 10 , Stock-Based Compensation , for information regarding each of the Lucid Diagnostics 2018 Equity Plan and
the PAVmed Inc. 2014 Equity Plan.
Nine
months ended September 30, 2022 as compared to nine months ended September 30, 2021
Revenue
In
the nine months ended September 30, 2022, revenue was $0.3 million as compared to $0.2 million in the corresponding period in the prior
year. The $0.1 million increase principally relates to revenue for laboratory services rendered for our EsoGuard Esophageal DNA
Test performed in our own CLIA laboratory. The increase was partially offset by the termination of the EsoGuard Commercialization Agreement,
with RDx as the Company transitioned to its own laboratory operations effective February 25, 2022.
Cost
of revenue
In
the nine months ended September 30, 2022, cost of revenue was approximately $2.0 million as compared to $0.1 million for the corresponding
period in the prior year. The $1.9 million increase principally related to:
●
approximately
$0.4 million increase in compensation related costs as a result of an increase in headcount;
●
approximately
$0.6 million increase in EsoCheck and EsoGuard supplies usage costs; and
●
approximately
$0.9 million increase in laboratory operations costs.
Sales
and marketing expenses
In
the nine months ended September 30, 2022, sales and marketing costs were approximately $11.1 million, compared to $2.6 million for the
corresponding period in the prior year. The net increase of $8.5 million was principally related to:
●
approximately
$7.7 million increase in compensation related costs, including stock-based compensation of approximately $1.2 million with respect
to restricted stock awards (“RSA”) grants under the Lucid Diagnostics Inc. 2018 Equity Plan to Lucid Diagnostics and
PAVmed employees and non-employees, and an increase in stock options granted corresponding with the increase in headcount;
●
approximately
$1.0 million increase in consulting and outside professional services fees and for EsoCheck and EsoGuard; and
●
approximately
$0.2 million decrease in the MSA fee allocation from PAVmed related to the growth and expansion of our business and the services
incurred through PAVmed.
General
and administrative expenses
In
the nine months ended September 30, 2022, general and administrative costs were approximately $18.2 million, compared to $7.8 million
for the corresponding period in the prior year. The net increase of $10.4 million was principally related to:
●
approximately
$2.7 million increase in compensation related costs, including stock-based
compensation of approximately $1.8 million with respect to RSA grants under the Lucid Diagnostics Inc. 2018 Equity Plan to Lucid Diagnostics
and PAVmed employees and non-employees, and an increase in stock options granted corresponding with the increase in headcount;
●
approximately
$4.8 million increase in consulting services related to patents, regulatory compliance, legal processes for contract review, transition
of public relations and investor relations firms, and public company expenses;
●
approximately
$1.3 million increase in the MSA fee allocation from PAVmed related to the growth and expansion of our business and the services
incurred through PAVmed; and
●
approximately
$1.6 million increase general business expenses.
24
Results
of Operations - continued
Nine
months ended September 30, 2022 as compared to nine months ended September 30, 2021 - continued
Research
and development expenses
In
the nine months ended September 30, 2022, research and development costs were approximately $9.0 million, compared to $5.8 million for
the corresponding period in the prior year. The net increase of $3.2 million was principally related to:
●
approximately
$2.5 million increase in development costs, particularly in clinical trial activities and outside professional and consulting fees
with respect to EsoCheck, EsoCure and EsoGuard;
●
approximately
$0.2 million increase in compensation related costs and related to expanded clinical and engineering staff; and
●
approximately
$0.5 million increase in the MSA fee allocation from PAVmed related to the growth and expansion of our business and the services
incurred through PAVmed.
See
our accompanying unaudited condensed consolidated financial statements for each of: Note 4 , Related Party Transactions, for a
discussion of the consulting fee expense and stock based compensation expense recognized with respect to the Physician Inventors
consulting agreements and stock options and restricted stock awards and for a discussion of the MSA between Lucid Diagnostics and
PAVmed; and Note 10 , Stock-Based Compensation , for information regarding each of the Lucid Diagnostics 2018 Equity Plan and
the PAVmed Inc. 2014 Equity Plan.
Liquidity
and Capital Resources
Our
current operational activities are principally focused on the commercialization
of EsoGuard. We are expanding commercialization across multiple sales channels, including: the communication to and education of medical
practitioners and clinicians regarding EsoGuard; and the establishment of Lucid Diagnostics Test Centers for the collection of cell samples
using EsoCheck. Additionally, we are developing expanded clinical evidence to support insurance reimbursement adoption by government and
private insurers. Further, the Company is also pursuing development of other products and services, including EsoCure, an Esophageal Ablation
Device.
Our
ability to generate revenue depends upon our ability to successfully advance
the commercialization of EsoGuard, while also completing the clinical studies, product and service development, and necessary regulatory
approval thereof. There are no assurances, however, we will be able to obtain an adequate level of financial resources required for the
long-term commercialization and development of our products and services.
Prior
to our initial public offering (“IPO”) of our common stock
in October 2021, our operations were funded by PAVmed, inclusive of providing working capital cash advances and the payment of certain
operating expenses on our behalf. Additionally, certain of our operations continue to be managed by PAVmed personnel, for which we incur
expense according to the provisions of a MSA between us and PAVmed. See Note 4 , Related Party Transactions, for a discussion of
the MSA.
We
are subject to all of the risks and uncertainties typically faced by medical
device and diagnostic companies that devote substantially all of their efforts to the commercialization of their initial product and services
and ongoing research and development activities and conducting clinical trials. We expect to continue to experience recurring losses from
operations and will continue to fund our operations with debt and equity financing transactions. Notwithstanding, however, with our cash
on-hand as of the date hereof and committed equity sources of financing, the Company expects to be able to fund its operations and meet
its financial obligations as they become due for the one year period from the date of the issue of the Company’s unaudited condensed
consolidated financial statements, as included herein in this Form 10-Q.
Committed
Equity Facility - March 28, 2022
On March 28, 2022, we entered into a committed equity facility with Cantor.
Under the terms of the committed equity facility, Cantor has committed to purchase up to $50 million of our common stock from time to
time at our request. While there are distinct differences, the committed equity facility is structured similarly to a traditional at-the-market
equity facility, insofar as it allows us to raise primary equity capital on a periodic basis at prices based on the existing market price.
As of September 30, 2022, under the committed equity facility, a total of 680,263 shares of common stock of the Company were issued
for proceeds of approximately $1.8 million.
Due
To: PAVmed Inc.
Since our inception in May 2018
through our IPO in October 2021, our operations were funded by PAVmed providing working capital cash advances and the payment by PAVmed
of certain operating expenses on our behalf. Additionally, our daily operations have been and continue to be principally managed by personnel
employed by PAVmed, for which we incur a MSA Fee expense. The MSA Fee is charged on a monthly basis and is subject-to periodic adjustment
corresponding with changes in the services provided by PAVmed Inc. personnel to the Company, with any such change in the MSA Fee being
subject to approval of the Lucid Diagnostics Inc. and PAVmed Inc. boards of directors. In this regard, in August 2022, the boards of directors
of Lucid Diagnostics Inc. and PAVmed Inc. approved a sixth amendment to the MSA to increase the MSA Fee to $550 per month from $390 per
month, with such increase effective on a prospective basis commencing July 1, 2022. Pursuant to the sixth amendment, the parties agreed
PAVmed Inc. may elect to receive payment of the monthly MSA Fee in cash or in shares of our common stock, with such shares valued at the
volume weighted average price (“VWAP”) during the final ten trading days of the applicable month (subject to a floor price
of $0.70 per share). However, in no event will PAVmed Inc. be entitled to receive under the MSA, as amended, more than 7,709,836 shares
of our common stock (representing 19.99% of our outstanding shares of common stock as of immediately prior to the execution of the sixth
amendment). The shares that may be issued under the MSA, as amended, are being offered and sold in transactions exempt from registration
under the Securities Act of 1933, as amended, in reliance on the exemption afforded under Section 4(a)(2) thereof.
As of September 30, 2022,
we had a Due To: PAVmed Inc. payment obligation liability of an aggregate of approximately $6.6 million payable for the transfer of CapNostics,
LLC, and for reimbursement of employee related costs and certain operating expenses paid by PAVmed on our behalf. See our accompanying
unaudited condensed consolidated financial statements Note 5 , Due To PAVmed Inc.
Critical
Accounting Policies and Significant Judgments and Estimates
The
discussion and analysis of our (unaudited) financial condition and consolidated results of operations is based on our unaudited condensed
consolidated financial statements, which have been prepared in accordance with generally accepted accounting principles in the United
States of America (“U.S. GAAP”). The preparation of these unaudited condensed consolidated financial statements requires
us to make estimates and assumptions affecting the reported amounts of assets, liabilities, and equity, along with the disclosure of
contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported amounts of
expenses during the corresponding periods. In accordance with U.S. GAAP, we base our estimates on historical experience and on various
other assumptions we believe are reasonable under the circumstances. Actual results may differ from these estimates under different assumptions
or conditions. Our critical accounting policies are as disclosed in the Company’s annual report on Form 10-K for the year ended
December 31, 2021 as filed with the SEC on April 6, 2022, except as otherwise noted in Note 2, Summary of Significant Accounting Policies
and Recent Accounting Standards Updates , of our unaudited condensed consolidated financial statements included herein in this Form
10-Q.
25
Item
4. Controls and Procedures
Evaluation
of Disclosure Controls and Procedures
Our
management, with the participation of our principal executive officer and our principal financial officer, evaluated the
effectiveness of our disclosure controls and procedures as of September 30, 2022. Based on such evaluation, our principal executive
officer and principal financial officer concluded our disclosure controls and procedures (as defined in Rules 13a-15(f) and
15d-15(f) under the Exchange Act) were effective as of such date to provide reasonable assurance the information required to be
disclosed by us in the reports we file or submit under the Exchange Act is (i) recorded, processed, summarized and reported within the time periods specified in
the SEC’s rules and forms and (ii) accumulated and communicated to our management, including our principal executive officer and
principal financial officer, as appropriate to allow timely decisions regarding required disclosure.
Changes
to Internal Controls Over Financial Reporting
There
has been no change in internal controls over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act)
that occurred during our fiscal quarter ended September 30, 2022 that has materially affected, or is reasonably likely to materially
affect, our internals control over financial reporting.
Part
II - Other Information
Item
1. Legal Proceedings
In
the ordinary course of our business, particularly as it begins commercialization of its products, the Company may be subject to certain
other legal actions and claims, including product liability, consumer, commercial, tax and governmental matters, which may arise from
time to time. Except as otherwise noted herein, the Company does not believe it is currently a party to any other pending legal proceedings.
Notwithstanding, legal proceedings are subject-to inherent uncertainties, and an unfavorable outcome could include monetary damages,
and excessive verdicts can result from litigation, and as such, could result in a material adverse impact on the Company’s business,
financial position, results of operations, and /or cash flows. Additionally, although the Company has specific insurance for certain
potential risks, the Company may in the future incur judgments or enter into settlements of claims which may have a material adverse
impact on the Company’s business, financial position, results of operations, and /or cash flows.
Item
2. Unregistered Sales of Equity Securities and Use of Proceeds
See the disclosure in “Liquidity and Capital Resources - Committed Equity Facility - March 28, 2022” under Item
2 above and in the Current Report on Form 8-K filed by us with the SEC on April 1, 2022, each of which is incorporated herein by reference,
for a description of the committed equity facility with Cantor and the shares issuable to Cantor thereunder.
In
addition, effective as of August 25, 2022, we issued 82,618 shares of our common stock to an entity designated by RDx, in satisfaction
of a $250,000 installment payment due under the asset purchase agreement dated February 25, 2022, between LucidDx Labs (our wholly-owned
subsidiary) and RDx, and unrelated third-party. See the Current Report on Form 8-K filed by us with the SEC on March 3, 2022, which is
incorporated herein by reference, for a fuller description of the asset purchase agreement with RDx and the installment payments thereunder.
On
October 14, 2021, we completed our initial public offering (“IPO”) of our common stock under an effective registration statement
on Form S-1 (SEC File No. 333-259721). As of September 30, 2022, of the net proceeds of $64.4 million, approximately $39.3 million has
been used, in a manner consistent with the use of proceeds set forth in the prospectus for our IPO, as follows: approximately $5.3 million
of net repayments due to PAVmed; approximately $4.7 million for the purchase of our laboratory equipment, software, and its operating
expenses; and $29.3 million of working capital expenditures. None of the proceeds have been paid to any of our directors, officers, 10%
stockholders, or affiliates, other than as described above.
Item
5. Other Information
None.
Item
6. Exhibits
The
exhibits filed as part of this Quarterly Report on Form 10-Q are set forth in the “ Exhibit Index ” below.
26
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.
Lucid
Diagnostics Inc.
November 14, 2022
By:
/s/
Dennis M McGrath
Dennis
M McGrath
Chief
Financial Officer
(Principal
Financial and Accounting Officer)
27
EXHIBIT
INDEX
Incorporation
by Reference
Exhibit
No.
Description
Form
Exhibit
No.
Date
2.1‡
Asset
Purchase Agreement, dated as of February 25, 2022, by and among LucidDx Labs Inc., Lucid Diagnostics Inc. and ResearchDx, Inc. ‡
8-K
2.1
3/3/2022
10.1
Amended
and Restated 2018 Long-Term Incentive Equity Plan.
DEF
14A
Annex
A
5/2/2022
10.2
Employee
Stock Purchase Plan
DEF
14A
Annex
B
5/2/2022
31.1
Certification
of Principal Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
*
31.2
Certification
of Principal Financial and Accounting Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
*
32.1
Certification
of Principal Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of
2002
*
32.2
Certification
of Principal Financial and Accounting Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley
Act of 2002.
*
101.INS
Inline
XBRL Instance Document
*
101.CAL
Inline
XBRL Taxonomy Extension Schema
*
101.DEF
Inline
XBRL Taxonomy Extension Calculation Linkbase
*
101.LAB
Inline
XBRL Taxonomy Extension Label Linkbase
*
101.PRE
Inline
XBRL Taxonomy Extension Presentation Linkbase
*
104
Cover
Page Interactive Data File (embedded within the Inline XBRL document)
*
*
Filed herewith.
‡
Certain exhibits and schedules have been omitted pursuant to Item 601(b)(10) of Regulation S-K. The registrant hereby undertakes to furnish
supplementally a copy of any omitted exhibit or schedule upon request by the Securities and Exchange Commission.
28
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.