UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
WASHINGTON
D.C. 20549
FORM
10-K
☒ ANNUAL
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For
the fiscal year ended December 31 , 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: 001-41507
NEXALIN TECHNOLOGY, INC.
(Exact
name of Registrant as specified in its charter)
Delaware
27-5566468
(State
or other jurisdiction of
incorporation
or organization)
(I.R.S.
Employer
Identification
No.)
1776 Yorktown , Suite 550
Houston ,
TX
77056
(Address
of principal executive offices)
(Zip
Code)
Registrant’s
telephone number, including area code: (832) 260-0222
Securities
registered pursuant to Section 12(b) of the Act:
Title
of each class
Trading
Symbol(s)
Name
of each exchange on which registered
Common
stock, par value $0.001 per share
NXL
The Nasdaq Capital Market
Warrants,
exercisable for one share of Common Stock
NXLIW
The Nasdaq Capital Market
Securities
registered pursuant to Section 12(g) of the Securities Exchange Act: NONE
Indicate
by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No ☒
Indicate
by check mark if the registrant is not required to file reports pursuant to Section 13 or 15 (d) of the Securities Exchange Act. Yes ☐ No ☒
Indicate
by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange
Act 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 every Interactive Data File required to be submitted pursuant to Rule
405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).
Yes ☒ No ☐
Indicate
by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company,
or an emerging growth company. See the definitions of large accelerated filer, accelerated filer, smaller reporting company, and emerging
growth company in Rule 12b-2 of the Exchange Act.
Large
Accelerated Filer
☐
Accelerated
Filer
☐
Non-Accelerated Filer
☒
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 accountant standards provided pursuant to Section 13(a) of the Exchange Act. Yes ☐ No ☒
Indicate
by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness
of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered
public accounting firm that prepared or issued its audit report. Yes ☐ No ☒
If securities are registered pursuant to Section
12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction
of an error to previously issued financial statements. Yes ☐ No ☒
Indicate by check mark whether any of those error
corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant’s
executive officers during the relevant recovery period pursuant to §240.10D-1(b). Yes ☐ No ☒
Indicate
by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
The
registrant completed its initial public offering on September 16, 2022. The registrant’s common stock had an issue price of $4.15
per share. Based upon the initial public offering price of $4.15, the aggregate market value of the voting and non-voting common equity
held by non-affiliates, as of September 16, 2022 was $ 23,476,985 .
As of March 22, 2023, there were 7,286,562 shares
of the Registrant’s common stock outstanding.
DOCUMENTS
INCORPORATED BY REFERENCE
List
hereunder the following documents if incorporated by reference and the Part of the Form 10-K (e.g., Part I, Part II, etc.) into which
the document is incorporated: (1) Any annual report to security holders; (2) Any proxy or information statement; and (3) Any prospectus
filed pursuant to Rule 424(b) or (e) under the Securities Act of 1933.
None
TABLE
OF CONTENTS
Page
PART I
Item 1.
Business
1
Item 1A.
Risk Factors
15
Item 1B.
Unresolved Staff Comments
47
Item 2.
Properties
47
Item 3.
Legal Proceedings
47
Item 4.
Mine Safety Disclosure
47
PART II
Item 5.
Market For the Registrant’s Common Equity, Related Shareholder Matters and Issuer Purchases of Equity Securities
48
Item 6.
[Reserved]
48
Item 7.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
49
Item 7A.
Quantitative and Qualitative Disclosures About Market Risk
59
Item 8.
Financial Statements and Supplemental Data
59
Item 9.
Changes in and Disagreements With Accountants on Accounting and Financial Disclosure
60
Item 9A.
Controls and Procedures
60
Item 9B.
Other Information
61
Item 9C.
Disclosure Regarding Foreign Jurisdictions that Prevent Inspections
61
PART III
Item 10.
Directors, Executive Officers and Corporate Governance
62
Item 11.
Executive Compensation
70
Item 12.
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters
73
Item 13.
Certain Relationships and Related Transactions, and Director Independence
77
Item 14.
Principal Accountant Fees and Services
80
PART IV
Item 15.
Exhibits and Financial Statement Schedules
82
Item 16.
Form 10-K Summary
83
i
SPECIAL
CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS
Certain
information included or incorporated by reference in this document may not address historical facts and, therefore, could be interpreted
to be “forward-looking statements” as that term is defined in the Private Securities Litigation Reform Act of 1995 and other
federal securities laws. All statements other than statements of historical fact are statements that could be deemed forward-looking
statements, including projections of financial performance; statements of plans, strategies and objectives of management for future operations;
any statement concerning developments, performance or industry rankings relating to products or services; any statements regarding future
economic conditions or performance; any statements of assumptions underlying any of the foregoing; and any other statements that address
activities, events or developments that Nexalin technology, Inc. and its subsidiaries (“Nexalin” or the “Company”
and also referred to as “we,” “us” and “our”) intends, expects, projects, believes or anticipates
will or may occur in the future. Forward-looking statements may be characterized by terminology such as “believe,” “anticipate,”
“expect,” “should,” “intend,” “plan,” “will,” “estimates,” “projects,”
“strategy” and similar expressions. These statements are based on assumptions and assessments made by the Company’s
management in light of its experience and its perception of historical trends, current conditions, expected future developments and other
factors it believes to be appropriate. Any such forward-looking statements are not guarantees of future performance (financial or operating),
and actual results, developments and business decisions may differ materially from those envisioned by such forward-looking statements.
These forward-looking statements are subject to a number of risks and uncertainties that include but are not limited to the following:
the outbreak and continued impact of the novel coronavirus (“COVID-19”) and its variants in the United States and China, including the measures to reduce its spread, and its
impact on the economy and demand for our services and products, are uncertain, cannot be predicted, and may precipitate or exacerbate
other risks and uncertainties.
●
our
plans to develop and commercialize our products;
●
our
planned clinical trials for our products;
●
the
timing of the availability of data from our clinical trials;
●
the
timing of our selection of an initial clinical candidate from our program;
●
the
timing of our planned FDA related regulatory filings;
●
the
timing of and our ability to obtain and maintain regulatory approvals for our products;
●
the
clinical utility of our products and their potential advantages compared to other treatments;
●
our
commercialization, marketing and distribution capabilities and strategy;
●
our
ability to establish and maintain arrangements for the manufacture of our products;
●
our
ability to establish and maintain collaborations and to recognize the potential benefits of such collaborations;
●
our
estimates regarding the market opportunities for our products;
●
our
intellectual property position and the duration of our patent rights;
●
our
estimates regarding future expenses, capital requirements and needs for additional financing; and
the
other risk factors set forth under Item 1A, Risk Factors, in this Annual Report on Form 10-K and in our other SEC filings. The forward-looking
statements included herein apply only as of the date of this Annual Report on Form 10-K. The Company disclaims any duty to update such
forward-looking statements, all of which are expressly qualified by the foregoing, except as may be required by law.
ii
PART
I
Item
1. Business
Overview
We
design and develop innovative neurostimulation products to uniquely and effectively help combat the ongoing global mental health epidemic.
We developed an easy-to-administer medical device — referred to as Generation 1 or Gen-1 — that utilizes bioelectronic
medical technology to treat anxiety and insomnia, without the need for drugs or psychotherapy. Our original Gen-1 devices are cranial
electrotherapy stimulation (CES) devices that emit waveform at 4 milliamps during treatment and are presently classified by the
U.S. Food and Drug Administration (“FDA”) as a Class II device.
Medical
professionals in the United States have utilized the Gen-1 device to administer to patients in clinical settings. While the Gen-1 device
had been cleared by the FDA to treat depression, anxiety, and insomnia, three prevalent and serious diseases, because of the FDA’s
December 2019 reclassification of CES devices, the Gen-1 device was reclassified as a Class II device for the treatment of anxiety
and insomnia. We are required to file a new application under Section 510(k) of the Federal Food, Drug and Cosmetic Act (“510(k)
Application”) to be approved by the FDA for the sales and marketing of our devices for the treatment of anxiety and insomnia. In
the FDA’s December 2019 reclassification ruling, the treatment of depression with our device will require a Class III certification
and require a new PMA (premarket approval) application to demonstrate safety and effectiveness.
While we continue providing services to medical professionals to support
patients’ use of the Gen-1 devices which were in operation prior to December 2019, we are not making new sales or new marketing
efforts of Gen-1 devices. We continue to derive revenue from devices which we sold or leased prior to the FDA’s December 2019 reclassification
announcements. This revenue consists of monthly licensing fees and payments for the sale of electrodes. We have suspended marketing efforts
for new sales of devices related to the Gen-1 device for treatment of anxiety and insomnia in the United States until the Nexalin regulatory
team makes a decision on whether to proceed with a new 510(k) application at 4 milliamps, which determination will be based on FDA comments
expected to be received in mid or late spring 2023. Our regulatory team continues to inform the FDA of the suspension of the marketing
and sale of the Gen-1 products to new providers.
Our
Technology
We
have designed and developed a new advanced waveform technology to be emitted at 15 milliamps through new and improved medical devices
referred to as Generation 2 or Gen-2 and Generation 3 or Gen-3. Gen-2 is a clinical use device with a modern enclosure to emit the new
15 milliamp advanced waveform. Gen-3 is a new patient headset that will be prescribed by licensed medical professionals in a virtual
clinic setting similar to existing tele-health platforms. The Nexalin research team believes that the new 15 milliamp Gen-2 and Gen-3
devices can penetrate deeper into the brain and stimulate associated structures of mental illness, which we believe will generate enhanced
patient response without any risk or unpleasant side effects. The Nexalin regulatory team has made a strategic decision to develop strategies
for pilot trials in various mental health disease states. In addition, a new PMA application in the United States is in development for
the treatment of depression utilizing both Gen-2 and Gen-3. The new Gen-3 device is also scheduled for additional pilot trials for anxiety
and insomnia in the United States and China beginning in the late second quarter or early third quarter of 2023. Preliminary data provided by the University of California San Diego
supports the safety of utilizing our 15 milliamp waveform technology. However, the determination of safety and efficacy of medical devices
in the United States is subject to clearance by the FDA.
Additionally,
we are currently designing clinical trial strategies for the use of Gen-3 for the treatment of substance use disorders including opiate,
cocaine, and alcohol abuse. Recently the Gen-2 device was tested in pilot trials in China for the treatment of Alzheimer’s disease,
and dementia. Continued pilot testing for Alzheimer’s and dementia is planned in China in 2023.
In
part due to increased incidence attributed to the devastating impacts of the COVID-19 pandemic, mental health and cognitive disorders
are widespread across the globe and causing substantial health, social and economic losses, and hardships accordingly. Our focus is on
the continued development of our innovative bioelectronic medical technologies and rapid regulatory approval.
1
Our
products are non-invasive, safe, undetectable to the human body and can provide relief to those afflicted with mental health issues without
adverse side effects. We have a proprietary design that eliminates voltage while stabilizing currents, electromagnetic fields, and various
frequencies — referred to collectively as waveform - particularly our proprietary, 15 milliamp patented symmetrical waveform. Our
devices generate a high frequency carrier wave that is charge balanced is applied to the brain with an array of electrodes on the forehead
and behind each ear at the mastoid. The features of this proprietary waveform and the array of electrodes allows the application of the
waveform to the entire brain rather than a small, targeted area of the brain. To ensure deeper penetration in the brain, we have eliminated
the voltage from the waveform which allows the increase of the power from < 4 mAmps to 15 mAmps, more than a 400% increase without
incurring any patient discomfort, risk, or adverse side effects. By increasing the power, our waveform can penetrate deeper into the
brain and stimulate deep mid-brain structures associated with mental illness. Our research and clinical teams believe that a more powerful
waveform will create a stronger response in the brain. A stronger response creates a higher level of efficacy. This entire proprietary
technique allows Nexalin to provide a safe and comfortable treatment that is more powerful than any stimulation device in the market.
Current pilot study protocols and randomized clinical trials have been designed and submitted to the FDA to provide feedback on final
reports and data sets for the purpose of safety and efficacy evaluations in the future. Determinations of the safety and efficacy of
our devices are solely within the authority of the FDA.
Currently,
the waveform that comprises the basis of Gen-2 and new Gen-3 headset devices has been tested in research settings to develop safety data
that has been submitted for review by the FDA for safety evaluation and eventual marketing in the United States. Determinations of the
safety and efficacy of our devices in the United States are solely within the authority of the FDA.
We
recognize that an additional barrier to treatment in today’s mental health treatment landscape — beyond the concerns about
safety, efficacy and side-effects that have been associated with conventional mental health treatments such as ECT (shock therapy), drugs
and psychotherapy is stigma. Industry reports and feedback indicate that many patients that struggle with mood disorders have the stigma
of embarrassment associated with psychiatrists and psychotherapy (e.g., counselling with a therapist). Additional stigmas and other issues
are associated with the side effects of medication prescribed by psychiatrists. When we researched the current pharmaceuticals model,
public information highlighted the many side effects associated with these medications. Frequently, patients would stop taking the medication
because of the uncomfortable side effects. Additional public information mentions dependency and withdrawal issues associated with medication
for psychiatric disorders.
To
address the embarrassment stigma, we are developing a new virtual clinic. After diagnosis, the physician can prescribe the Nexalin Gen-3
headset to the patient for treatment. Next, the Gen-3 device will be shipped to the patient’s home. After patient receives the
device, they will pair the headset device with an app in the patient’s smart phone. The app will communicate with the Nexalin cloud
servers to authorize the device for treatment according to the protocol designed by the physician. The physician will monitor treatment
compliance and other health related issues in a private physician dashboard that connects through the Nexalin app and cloud servers.
We believe that to preserve product safety and integrity for home use, the headset device will require physician oversight that includes
a prescription for use with a monthly authorization provided by the physician after a monthly virtual visit. All appointments will be
in a virtual setting to provide privacy and convenience for the physician and patient. The Nexalin virtual clinic will be provided in
a proprietary virtual platform which is currently in the design stage.
Our
China Gen-2 15 milliamp device was recently approved in China by the NMPA for the treatment of insomnia and depression in China. This
device and all other clinical devices will include a single use electrode for long term revenue streams.
Our
USA Gen-2 device will have a fresh and modern appearance that meets the technology standards of the digital tech world of 2023. Early
adopters of the Gen-1 device will be able to access additional firmware upgrades which are planned to enhance the previously purchased
devices to the new 15-milliamp waveform.
Our
Gen-2 device is expected to be equipped with RFID technology that exchanges electrode usage data with a reader in the main device. The
purpose of RFID is to track and maintain control of the proprietary single use electrode. Our electrode chip will be programmed to exchange
data with the device and allow activation for a single treatment with a new electrode only. We anticipate that this will ensure a recurring
revenue stream on the device and protects against any generic knockoffs designed to avoid treatment costs. This upgrade in technology
also ensures the proprietary nature of the electrodes that support treatment outcomes are sustained.
2
Potential
Joint Venture; China Related Activities
In
September 2018, we entered into an agreement with Wider Come Limited, a company formed under the laws of the People’s Republic
of China (“Wider”), pursuant to which we and Wider have agreed to investigate the formation of a joint venture entity to
be domiciled in Hong Kong (the “potential Joint Venture”) to conduct additional clinical research and implement a business
distribution plan for our devices in China, Macau, Hong Kong, and Taiwan. We do not have any existing operations in
China and will not in the future. We do have current distribution in China through Wider, our potential Joint Venture partner. As of
the date of this Annual Report on Form 10-K, (i) our operations are carried on outside of China; and (ii) the potential Joint
Venture does not maintain any variable interest entity structure or operate any data center in China. However, because of the intended
formation of the potential Joint Venture, we may become subject to laws of The People’s Republic of China (PRC or China) relating
to, among other topics, data security and restrictions over foreign investments. Further, as a result of the complexity and vagaries
of the legal system in the PRC and recent statements and regulatory actions by the PRC government relating to data security, our ability
to operate the potential Joint Venture may be adversely affected or subject to change and adversely impact our ability to offer or continue
to offer securities to investors, with the result that our securities may significantly decline or be worthless. There can be no assurance
that regulators in China will not take a contrary view or will not subsequently require us to undergo the approval procedures and subject
us to penalties for non-compliance.
In
March 2022, we entered into a second supplement to the Joint Venture agreement with Wider whereby the parties confirmed that the potential
Joint Venture had not yet been established and is subject to further review and analysis of regulatory issues in China and the United
States. Pursuant to the second supplement, the parties agreed to use their commercial efforts to complete documentation by September
30, 2022. In light of general economic conditions in China and the United States, the continued impact of regulatory issues within China
and the United States and trade and political issues between the two countries, the parties determined to further extend the time frame
to complete establishment of the joint venture to September 30, 2023 and entered into a Supplement 3 to the potential Joint Venture Agreement
to memorialize such extension. The parties intend to continue to work together to complete the establishment prior to such extended time.
Further, the parties agreed that all references within the Joint Venture agreements to funding and formation were amended from December
21, 2018 to be September 30, 2023. We anticipate that the Joint Venture will be formed by the third quarter of 2023. However, that will
be dependent on the situation at that time.
When
and if the Joint Venture is formed and Wider completes sales of our devices in China on behalf of the potential Joint Venture, we believe
that there are no regulatory or other restrictions that would restrict either (i) the transfer from China of any proceeds resulting
from such sales by Wider to the potential Joint Venture in Hong Kong, other than standard compliance with China’s State Administration
of Foreign Exchange (“SAFE”) policies and approval process, or (ii) our receipt of our share of such proceeds from Hong Kong
to us in the United States, which is not subject to SAFE’s policies and approval process. The Company does not currently believe
any of the Company’s scientific data resulting from activities in China by the potential Joint Venture would fall within the Measures
for the Management of Scientific Data promulgated by the General Office of the PRC State Council. In the event any existing or new laws
or regulations or detailed implementations and interpretations are modified or promulgated, we and the potential Joint Venture will take
all actions to remain in compliance with any such laws or regulations or detailed implementations and interpretations thereof. Neither
we nor our potential Joint Venture Partner can at this point speak to any future changes in rules, regulations or the commercial and
potentials situation that lies ahead which could affect the formation of the Joint Venture.
In
September of 2021, the China National Medical Products Administration (NMPA), the equivalent of the United States Food and Drug Administration
(FDA), approved the Gen-2 device for marketing and sale in China for the treatment of insomnia and depression. These treatment indications
and clearances from the NMPA have allowed Wider to market and sell the Gen-2 device in China for the treatment of insomnia and depression.
3
Regulatory
Background and Matters Related to our Business
United
States
Medical
devices commercially distributed in the United States require either FDA clearance of a 510(k) premarket notification submission, granting
of a de novo request or Premarket Approval (PMA), unless an exemption exists. Under the FFDCA, as administered by the FDA,
medical devices are classified into one of three classes — Class I, Class II or Class III — depending on the degree of risk
associated with each medical device and the extent of manufacturer and regulatory control needed to ensure its safety and effectiveness.
Regulatory control increases from Class I to Class III. Prior to December 20, 2019, in the United States, all cranial electrical stimulation
(CES) technology was classified as a Class III medical device (high-risk).
Class
II devices are moderate risk devices and are subject to the FDA’s general controls, and special controls as deemed necessary by
the FDA to ensure the safety and effectiveness of the device. Such special controls can include performance standards, post-market surveillance,
patient registries and FDA guidance documents. Most manufacturers of Class II devices are required to submit to the FDA a premarket notification
under Section 510(k) of the FFDCA requesting permission to commercially distribute the device.
Class
III devices are deemed the highest risk devices by the FDA and generally include life-sustaining, life-supporting or some implantable
devices or devices that have a new intended use or use advanced technology that is not substantially equivalent to that of a legally
marketed device. Class III devices require a PMA. For a device that is Class III by default (because it is a novel device that was not
previously classified and has no predicate), the manufacturer may request that the FDA reclassify the device into Class II or Class I
via a de novo request.
To
obtain 510(k) clearance, a premarket notification submission must be submitted to the FDA demonstrating that the proposed device is substantially
equivalent to a predicate device. A predicate device is a legally marketed device that is not subject to premarket approval, i.e., a
device that was legally marketed prior to May 28, 1976 (pre-amendments device) and for which a PMA is not required, a device that has
been reclassified from Class III to Class II or I (e.g., via the de novo classification process), or a device that was previously cleared
through the 510(k) process. The FDA’s 510(k) review process usually takes from three to six months but can take longer.
After
a device receives 510(k) marketing clearance, any modification that could significantly affect its safety or effectiveness or that would
constitute a major change or modification in its intended use, will require a new 510(k) marketing clearance or, depending on the modification,
a de novo request or PMA approval. The FDA requires each manufacturer to determine whether the proposed change requires submission of
a 510(k), de novo, or a PMA in the first instance. If the FDA disagrees with a manufacturer’s determination, the FDA can require
the manufacturer to cease marketing and/or request the recall of the modified device until FDA has cleared or approved a 510(k), de novo
or PMA for the modification.
The
PMA process is more demanding than the 510(k) premarket notification process. In a PMA, the manufacturer must demonstrate that the device
is safe and effective, and the PMA must be supported by extensive data, including data from preclinical studies and human clinical trials.
The PMA must also contain, among other things, a full description of the device and its components, a full description of the methods,
facilities and controls used for manufacturing and proposed labelling. Following receipt of a PMA submission, the FDA determines whether
the application is sufficiently complete to permit a substantive review. If the FDA accepts the application for review, it has 180 days
under the FDCA to complete its review of a PMA, although in practice, the FDA’s review often takes significantly longer, and can
take up to several years.
On
December 20, 2019, the FDA issued new rulings related to CES devices for the treatment of anxiety, depression, and insomnia. As a
result of these rulings, depression treatment with CES devices remained a Class III medical device and will require a full PMA that
provides definitive clinical trial evidence of effectiveness and safety. A PMA is the most extensive application and process at the
FDA. All CES manufacturers had one year to prepare and file intentions for the depression treatment with a PMA. CES devices that
treat anxiety and insomnia were reclassified as Class II devices and required a new application in the form of a special control
trial, a summary version of a PMA, requiring safety data and mild efficacy response. All CES manufacturers had one year to complete
special control trials for anxiety and insomnia. We are presently analyzing our previous 510(k) Application for such treatment of
anxiety and insomnia in accordance with the FDA reclassification ruling in December 2019. Our intent is to move forward with
our new 15 milliamp waveform given its success in the China studies. We have also completed 2 prototypes of a Nexalin headset which
can be used at home or in a clinical setting. The new headset will utilize the new 15 milliamp waveform. Final prototypes and design
for manufacturing is expected in the third quarter of 2023.
4
Due
to the COVID-19 pandemic, special control trials according to the December 2019 ruling were delayed. In January 2023, we filed a new
510k pre-sub with the FDA for treatment of anxiety and insomnia with the new 15 milliamp Gen-3. Responses from the FDA are expected in
the second or third quarter of 2023.
After
comments from the FDA on the January 2023 pre-sub, we will begin pilot and pivotal trials for anxiety and insomnia which will take an
estimated 9-18 months to complete patient recruitment and data collection. After data sets are complete and statisticians have reviewed
and created a reporting matrix, members of the executive team will prepare final reports for submission to the FDA.
We
have made a strategic decision to file a new PMA for the treatment of depression with the Gen-2 and Gen-3 devices that administer the
new advanced Nexalin waveform at 15 milliamps. The Gen-1 device was previously cleared by the FDA at 4 milliamps and the re-classification
does not prevent us from servicing previously sold or leased devices. Providers may continue to use these devices for treatment purposes.
Servicing consists of warranty coverage, electrode sales, and patient cable replacement. This servicing is included in the monthly lease
payment. We continue to derive revenue from devices which we sold or leased prior to the FDA’s December 2019 reclassification announcements.
This revenue consists of monthly license fees and payment for the sale of electrodes to clinical providers of our technology. As we are
in the process of evaluating our new Gen-2 15 milliamp waveform for our technology, a strategic decision was made to not pursue a PMA
for the treatment of depression on our existing Gen-1 device. Strategy development has begun for a full PMA for the treatment of depression
for our next generation Gen-2 and Gen-3 devices.
China
The
NMPA is the governmental authority principally responsible for the supervision and administration of medical devices in the PRC. Medical
devices in the PRC (including manufacturing, marketing, and sale) are subject to a mandatory filing/registration regime regulated by
the NMPA. The exact filing pathways are mainly determined by the classification of such devices — like the United States, a three-class
classification system, from Class I (lowest risk) to Class III (highest risk). Local testing and clinical trials are generally required
for Class II and Class III devices. Some imported devices may need to be registered with a higher-level government authority than domestic
devices.
As
determined by the NMPA the three classes for devices are:
Class
I — Medical devices for which routine administration can ensure safety for users and the effectiveness of the device.
Class
II — Medical devices that can only be safe and effective with further control in addition to routine administration.
Class
III — Medical devices that are implanted into the patient’s body, pose a threat to the patient’s health, or provide
sustenance or life support.
All
medical devices must be registered with the NMPA. An overseas device company must submit product samples to test with the NMPA. In addition,
all included product information, packaging, and labels, and related material need to be translated into simplified Chinese. For a Class
I device, simple product filing to NMPA are required. However, for Class II and Class III medical devices, the manufacturing company
must meet all the requirements in the latest regulation, guidelines, and standards.
The
NMPA approved the new Gen-2 15 milliamp device for the treatment of insomnia and depression. These treatment indications and clearances
from the NMPA have allowed us to market and sell the Gen-2 device in China. Wider will be responsible for obtaining future NMPA registrations
and approvals related to the marketing and sales of our devices in China.
Recent
statements and regulatory actions by the Chinese government have targeted those companies whose operations involve cross-border data
security or anti-monopoly concerns. Regarding data security, China has promulgated several important laws recently. Among them, on June
10, 2021, China promulgated the PRC Data Security Law (“DSL”), which became effective on September 1, 2021. The legislative
intent for this law mainly includes regulating data processing activities, ensuring data security, promoting data development and utilization,
protecting the data related legitimate rights and
5
interests of individuals and organizations, and safeguarding national sovereignty,
security and development interests. Article 36 provides that any Chinese entity that provides the data to foreign judicial or law enforcement
agencies (regardless of whether directly or through a foreign entity) without approval from the Chinese authority would likely be deemed
to be in violation of DSL. In addition, pursuant to Article 2 of Measures for Cybersecurity Reviews, the procurement of any network product
or service by an operator of critical information infrastructure that affects or may affect national security shall be subjected to a
cybersecurity review under the Measures. Pursuant to Article 35 of Cybersecurity Law of the People’s Republic of China, where “critical
information infrastructure operators” purchase network products and services, which may influence national security, the operators
are required to be subjected to a cybersecurity review. We do not operate any critical information infrastructure. As a result, we do
not believe that these new legal requirements in China are applicable to us, including sales made to date by Wider as a distributor.
However, the exact scope of the term “critical information infrastructure operator” remains unclear, so there can be no assurance
that the potential Joint Venture when formed will not be subjected to critical information infrastructure operator review in the future.
Furthermore, in the event that the potential Joint Venture becomes an operator of critical information infrastructure in the future it
may be subjected to the above-described regulation.
With
regard to anti-monopoly concerns, Article 3 of Anti-Monopoly Law of the People’s Republic of China prohibits “monopolistic
practices,” which include: a) the conclusion of monopoly agreements between operators; b) the abuse of dominant market position
by operators; c) concentration of undertakings which has or may have the effect of eliminating or restricting market competition. Also,
according to Article 19, the operator(s) will be assumed to have a dominant market position if it has following situation: a) an operator
has 50% or higher market share in a relevant market; b) two operators have 66% or higher market share in a relevant market; c) three
operators have 75% or higher market share in a relevant market. We believe that we have not conducted any monopolistic practices in China,
and that recent statements and regulatory actions by the Chinese government do not impact our ability to conduct business, accept foreign
investments, or list on a U.S. or other foreign stock exchange. However, there can be no assurance that regulators in China will not
promulgate new laws and regulations or adopt new series of interpretations or regulatory actions which may require the potential Joint
Venture to meet new requirements on the issues mentioned above.
Currently,
these statements and regulatory actions of China authorities have had no impact on our daily business operation, including the sales
and marketing efforts made to date of our Gen-2 devices in China through Wider. We do not believe that these statements and regulatory
actions will have any impact on the potential Joint Venture when it is formed. Further, we are a United States’ company with no
physical presence in China, and we do not believe that the formation of the potential Joint Venture in Hong Kong and any resultant exposure
to China regulatory actions will adversely impact our ability to accept foreign investments or list our securities on a United States
or other foreign exchange. However, since these statements and regulatory actions from China authorities are relatively recent, it is
highly uncertain how soon legislative or administrative regulation making bodies will respond and what existing or new laws or regulations
or detailed implementations and interpretations will be modified or promulgated, if any, and the potential impact such modified or new
laws and regulations will have on our daily business operation, the ability to accept foreign investments and list our securities on
a United States or other foreign exchange. In the event any existing or new laws or regulations or detailed implementations and interpretations
are modified or promulgated, we and the potential Joint Venture will take any and all actions to remain in compliance with any such laws
or regulations or detailed implementations and interpretations thereof. See “Risk Factors — Risks Related to Doing Business
in China.”
Following
the formation of the potential Joint Venture, we intend to conduct a portion of our clinical research and implement a business distribution
plan for our devices in China and elsewhere through the potential Joint Venture, which we believe confers clinical, commercial, and regulatory
advantages, but may subject us to significant regulatory, liquidity, and enforcement risks. Although we do not intend to have any physical
presence in China, Hong Kong, Macau and Taiwan, the potential Joint Venture agreements between us and Wider contemplate that the potential
Joint Venture will have a physical presence for the potential Joint Venture in Hong Kong. Wider, as a China formed entity with its physical
presence in China may be subject to regulatory actions and prohibitions from China regulatory entities and required to obtain certain
approvals.
The
PRC legal system is a civil law system based on written statutes. Unlike the common law system, prior court decisions under the civil
law system may be cited for reference but have limited precedential value. Uncertainties in the interpretation and enforcement of Chinese
laws and regulations could limit the legal protections available to us.
6
Market
and Industry Background
General
Historically,
pharmaceutical solutions have been the first line of treatment for those who suffer from anxiety, insomnia, depression, and other mental
health disorders. Beginning in 1950, for patients that were not responding to medication, ECT, also called “shock therapy,”
became available. Over time, researchers began to look at alternative ways to inject electricity into the human brain. One such method
was via implantable neurostimulators that required invasive surgery procedures associated with high cost and high risk. Implantable devices
became the potential solution for those who would not take or could no longer take pharmaceuticals. The interest in electricity continued
with the creation of small handheld devices powered by a direct current (DC) battery that the consumer could buy without any medical
supervision. Clinical versions of DC stimulators, known as transcranial direct current stimulation (tDCS), were developed by researchers;
many of these devices are still in research settings without industry support.
In
1992, a new neurostimulation technique emerged called trans-cranial magnetic stimulation (TMS). This technique evolved into repetitive
trans-cranial magnetic stimulation (rTMS), which utilized repetitive magnetic pulse energy to stimulate the brain of patients struggling
with depression. The American pharmaceutical industry embraced and funded this technology. The FDA cleared rTMS only for patients who
had failed to respond to anti-depressants. Side effects, high cost and moderate efficacy continue to burden this technology sector.
Both
insurance companies and healthcare providers are looking for alternative ways to decrease costs while still providing safe and effective
treatments.
We
believe that our new marketing and growth strategy in combination with our advanced 15 milliamp waveform, technological upgrades and
the development of a modern headset monitored with our IT management platform, will position us for the opportunity to disrupt the traditional
mental health treatment model. Our mission is to remove the stigma of expensive psychotherapy or pharmaceuticals with the attendant side
effects and dependency issues and replace it with clinically proven and cost-effective technology that is easily accessible in the privacy
of the patient’s home and monitored by licensed healthcare providers.
Anxiety
Market
Anxiety
disorders are considered the most prevalent of psychiatric disorders. Anxiety disorders include generalized anxiety disorder, social
anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD) and phobias.
Insomnia
Market
Insomnia
is a common sleep disorder considered to be responsible for at least $63 billion in direct and indirect healthcare costs each year, according
to the Harvard American Insomnia Study. A frightening number of insomnia cases are undiagnosed and untreated, even as the condition becomes
a mounting financial burden on America’s employers and the healthcare system. Data surrounding sleep disorders demonstrate that
insomnia is a growing problem that shows no signs of slowing down. Current market conditions present an opportunity to introduce a technology
that provides a safe, effective and drug-free alternative for those suffering from insomnia. We believe we have the ability to decrease
the number of potentially addictive insomnia prescriptions needed by patients and offer physicians a non-pharmaceutical option to provide
their patients. Additionally, we are developing a solution for home-based treatment for chronic insomnia and to improve sleep hygiene
for its user.
Depression
Market
Depression
continues to be the leading cause of medical disability around the world. Poor efficacy, risk and adverse side effects of current anti-depressants
are driving the preference for non-pharmacological therapies, which will limit growth for the pharmaceutical sector of the depression
treatment market. This limitation will enhance the research and development of novel therapies that treat depression safely and effectively
without adverse side effects. Historically, according to the CDC, only one-third of people with severe depression have taken anti-depressants.
7
Any
decline in the depression medication market should indirectly accelerate the growth of the neurostimulator market. Management believes that, based on the market
data and current trends, the depression market — like the anxiety and insomnia market — creates enormous potential for our products.
Prior
to December 2019, our Gen-1 device was considered a Class III device. Treatment of depression in the United States is limited
to Class III devices only. Prior to 2019, our existing Gen-1 4 milliamp medical device had been used to successfully treat depression
in the U.S. The Gen-2 15 milliamp version of our device when introduced into the United States will be subject to approximately eighteen
months of clinical study before our PMA application for depression will be accepted. Assuming we will be able to obtain successful classification
from the FDA, we expect to market our device in the United States as a treatment for depression.
Substance
Use Disorders (Opioid Addiction) Market
According
to the National Institute on Drug Abuse (NIDA,) substance use, and substance use disorders cost the United States more
than $740 billion a year in healthcare, crime and lost productivity costs; but dollars barely capture the devastating human cost of addiction
to individuals, families and communities. According to the National Survey on Drug Use and Health, 19.7 million adults in the United States
suffered from a substance use disorder in 2017.
The
current success rate of the best drug and alcohol rehabilitation facilities is minimal. We believe that this represents a significant
market opportunity for our company. The disease of addiction is brain-based in its nature. Currently brain-based treatments for the disease
are only available to patients who can afford long-term expensive boutique treatment centers. We intend to demonstrate that a brain-based
approach to addiction treatment will enhance a patient’s success at long-term recovery. Our hypothesis is that the current pilot
study design at the University California San Diego (see below) will provide a source of validation for this treatment modality in addiction
treatment.
Chronic
Pain Market
Originally,
our waveform was designed as an electro-analgesic for pain. This refers to the ability to electrically interrupt the pain signalling
process in the brain. By interrupting the pain signalling process in the brain, our products can reduce symptoms and discomfort associated
with chronic pain. By reducing the symptoms and discomfort associated with chronic pain, physicians can reduce medications and avoid
dependency issues related to opiate-based medications.
According
to Research and Markets, the global chronic pain treatment market is predicted to progress at a CAGR of 6.5% from 2020 to 2030 and generate
revenue of $151.7 billion in 2030.
Currently,
we own an electrostimulation patent for a device that will apply electrodes to the brain, spine, and the place of injury. The placement
of these electrodes in conjunction with our various waveforms creates an opportunity for us to treat chronic pain without medication.
The Nexalin executive team is preparing strategies to develop a prototype of our existing patented design and introduce it into clinical
trials for the treatment of chronic pain. In previous pilot studies, our existing Gen-1 product reduced pain in patients suffering from
injuries originating in industrial accidents. However, we plan to use the new advanced waveform emitted at 15 milliamps into the new
prototype pain device for new clinical trials for the treatment of chronic pain.
Alzheimer’s
Disease and Dementia Market
Alzheimer’s
disease is a degenerative brain disease and the most common form of dementia. Dementia is not a specific disease, but rather an overall
term that describes a group of symptoms. According to the WHO, there are around 50 million people living with Alzheimer’s disease
and other dementias worldwide.
According
to Reports and Data, the global Alzheimer’s therapeutics market is projected to reach $13.57 billion by 2027 from $7.42 billion
in 2019 with a substantial compound annual growth rate (CAGR) of 9.2% through the forecast period.
We
believe our products could be leveraged to extend the quality of life for millions of people who are diagnosed with Alzheimer’s
disease.
8
Marketing
and Sales Efforts
We
believe that our marketing and sales plan provides a long-term scalable business model. Our team is preparing the foundation and marketing
assets necessary to launch the new virtual clinic model that will complement the traditional clinic model. Our sales model is to place
more than 1,000 Gen-2 and Gen-3 devices on the global stage. The momentum and branding strategies of Nexalin providers will be leveraged
to enhance the launch of a global sales plan. The Gen-2 device at 15 milliamps supported by the Gen-3 outpatient headset and our virtual
digital management platform is intended to disrupt the current mental healthcare model. The Gen-2 and Gen-3 device at 15 milliamps will
offer patients a cost effective and efficient treatment model for day-to-day mental health challenges. We believe those devices, with
their advanced waveform, can treat existing mental health disorders associated with anxiety and insomnia. Additionally, new strategies
are in research and development for FDA treatment indications of depression, substance use disorder, opioid addiction, alcoholism and
chronic pain. Additional research and treatment efficacy are being investigated for the Alzheimer’s community for patient care
and management.
Our
plan is designed to triangulate and stimulate the physician, consumer, and manufacturer relationship. Trends in healthcare indicate consumers
are involved in treatment decisions that concern their mental health. Because of the advancement in healthcare technologies, home-based
care with medical supervision provides patients with a cost-effective and efficient treatment option. Home-based care also avoids the
stigma associated with treatment for mental health disorders. In our current sales plan, we intend to launch with a physician provider
in each state. These physicians will lead the Nexalin campaign in each state as that states primary provider. These preferred state providers
will begin with the virtual clinic. Our marketing team will drive consumers with quality-of-life struggles related to mental health issues
into the virtual clinic and then to the provider in the consumer’s state of residence. These initial state physicians providing
mental health services in the virtual clinic, will also have ability to offer treatment in their clinic. The in-clinic model will use
the Gen-2 clinical device while the virtual clinic will use the Gen-3 headset. This initial launch plan with state providers will develop
and support multiple marketing verticals to drive the Nexalin brand and treatment as an alternative to medications and psychotherapy.
We will leverage this physician / patient community to establish a national network of physicians that offer mental health evaluations
and the Nexalin treatment in either a clinical setting or in the privacy of the patient home with medical supervision through the future
Nexalin app.
Most,
if not all, patients treated in the Nexalin virtual clinic would be part of a digital community that supports brand awareness and the
sharing of anonymous treatment outcomes in a social media setting. The Patient Activation Program will include a robust data gathering
system on providers and patients (opt-in) that enhances our marketing strategies.
Insurance
Reimbursement for Our Products
In
January 2020, the Centers for Medicare & Medicaid Services (CMS) in conjunction with the Durable Medical Equipment for Medicare
Administrative Contractors issued a code for Cranial Electrotherapy Stimulators (CES). CMS issues codes that are used by medical
practitioners to obtain Medicare, Medicaid and private insurance reimbursement. The issuance of this code is the first time that a reimbursement
code from CMS has been designated specifically for CES. The code does not guarantee reimbursement and is considered at this time, experimental.
The Nexalin consulting team plans to continue preparing clinical data and durability data to pursue long term clinical reimbursement.
Reimbursement
strategies for this type of technology are complex and vary from one diagnosis to another. We utilize an RFID system that will track
doses delivered. This will simplify comparing our devices to pharmaceutical interventions. Beginning in 2023, a complete reimbursement
assessment is being conducted and evaluated to develop a strategy to acquire reimbursement. We will employ a two-prong approach for eventual
reimbursement. The first prong will evaluate the clinic-based product offered by physicians. The second prong will focus on tracking
usage and response from the outpatient headset model that is tracked through the virtual platform. Frequently therapies that are used
in the home are not classified as durable medical equipment and will fall into a reimbursement gap without coverage. We intend to work
to successfully achieve a Level 2 code under the healthcare common procedure coding system. We will work to seek reimbursement for conditions
in sequence with the home based and the clinic-based unit that will maximize value of treatment from a financial standpoint as well as
monitoring the response by the patient community.
9
Research
Research
is the fundamental core of any pharmaceutical or medical device company. Although small trials, with limited patients, can show promise
for a treatment, they are generally not acceptable to the FDA for product approval. To commercialize a product for widespread use, multiple
large-scale trials are required to demonstrate both efficacy and safety. In the past two decades, the cost of conducting such trials
has more than doubled, with many small start-up companies unable to raise the necessary capital to complete these vital projects. The
increase in cost reflects several variables which are required for successful clinical trial completion.
The
various costs can include patient recruitment and retention expenses, physician, and nurse expenses, as well as the expenses of other
healthcare providers. Various regulations, each more complex than the next, also have added significant cost to the process. Data collection,
as well as data analysis, is also a significant portion of the study cost. Additionally, almost all studies are conducted through either
a large university, with its underlying overhead for administrative costs and institutional review board approval, or through a contract
research organization, which also adds significant overhead costs in addition to the hard cost of the study itself. Latest estimates
for the cost per patient for an average trial is approximately $41,000.
In 2019, we began a research partnership with
the University California San Diego (UCSD). Prior to the pandemic, two pilot clinical studies were undertaken with UCSD, however, these
trials were paused due to the shutdown of college campuses in California. In the summer of 2022, new contract negotiations began to explore
strategies for PTSD and mild traumatic brain injury (mTBI). Timelines, contracts, study design and research strategies are in progress
and are waiting for new pilot data sets.
Currently, a pilot trial at UCSD is focused on
veterans suffering from mild traumatic brain injury (mTBI) and is funded by the United States Department of Defense. One of the primary
symptoms associated with mTBI is PTSD (post-traumatic stress disorder). The primary endpoint associated with this study is the assessment
and reduction of post-concussion symptoms associated with PTSD. A secondary endpoint for the study will be improvement in Magnetoencephalography
(MEG) slow-wave abnormalities.
In
addition to UCSD, we are developing strategies to initiate further trials to address new FDA guidelines. These new strategies and pivotal
trials will support new 510(k)s for anxiety and insomnia at 15 milliamps. These trials are in addition to the special control trials
required by the FDA. Final trial designs are due to be executed after recommendations are reviewed from the FDA pre-sub meetings projected
to take place in Q2 2023. Other areas of research that will be designed and funded relate to the treatment of substance use disorders,
Alzheimer’s disease, and dementia.
Additional
research in China is being performed with the goal of publishing the findings in a peer reviewed journal. All research will be controlled
by our team, with all trial designs requiring written final approval by our Chief Medical Officer. Clinical updates will be required
every 30-days. Frequent in-person WeChat meetings will also be performed to ensure the integrity of the research efforts.
In
addition to clinical trial work in China and current studies in the United States required by the FDA, an additional study is planned
with the 15 milliamp Gen-2 and Gen-3 devices to evaluate a large cohort of patients with depression. This trial will include a double-blind
study design with active and sham groups. Patient selection screening will evaluate 200-250 subjects to acquire the number of patients
needed for a successful trial. Each patient, upon enrollment, will be evaluated extensively prior to initiation of therapy. Patients
will be treated a minimum of 20 separate times, with pre- and post-test screening. Moreover, upon completion of therapy, post-test examination
will be performed not only immediately thereafter but also over the course of one to three months to establish not only efficacy but
durability of the treatment. The results of this study will provide the basis of the PMA with the FDA for the treatment of Depression.
10
At
the start of 2021, an Alzheimer’s specific clinical trial was underway in China: “Transcranial alternating current stimulation
for patients with mild Alzheimer’s disease.” Extensive cognitive pre- and post-evaluations are being performed at the beginning
and conclusion of the study, with less rigorous evaluations before and after each therapy session. Because of issues related to Covid-19
in China, this trial was paused. Additionally, results of this trial will dictate additional testing strategies to determine specific
treatment protocols for complex Alzheimer’s and dementia patients.
A
final area of study includes the evaluation of chemical changes within the brain following transcranial stimulation. Chemicals, which
are naturally formed in the brain, control many of our moods and thoughts, modulating feelings of pain, depression and generalized mood.
These substances also drive cravings in substance use disorders. One of the specific areas of research is to validate changes of serotonin
levels in the brain. Serotonin is a “feel good” chemical which has also been associated with learning. Other chemicals, such
as dopamine, act in a reward center mechanism. Additionally, certain other neurons require specific chemicals to either fire or be inhibited
from firing. These areas can be explored with specific radioactive markers in the brain for evaluation with PET MRI scans.
Virtual
Clinic Digital Management Platform
We
expect to capitalize on the post pandemic digital health model. Our team began researching IT digital development firms at the beginning
of the pandemic. We have now completed our research and bidding process and have begun contract negotiations with a leading IT design
team to begin work on an advanced, proprietary IT management platform that will eventually manage all aspects of the Nexalin virtual
clinic model. The vision is to implement a virtual clinic model that will enable providers and clinics to integrate remote outpatients
into an overall treatment process. Our IT platform goes well beyond telehealth and is designed to support all aspects of the treatment
model in conjunction with various data sets to support marketing, data collection and patient monitoring. Our digital management platform
will manage the entire clinical and outpatient headset business model. The proprietary IT platform will manage all aspects of a new virtual
health center related to treatment for mental health. As the development of the new generations of our devices and the outpatient headset
are developed, the digital platform will eventually manage and triangulate the relationship between the medical professional, the patient,
and the manufacturer. The digital platform will handle logistics, data collection and user experience data for clinical evaluation. Additionally,
there will be an app that the patients will install on their phones that will communicate with the outpatient headset. The app will upload
user information that is HIPAA compliant to the IT management platform. Modules will be designed and implemented in the platform to collect
biometric data. The biometric data will be utilized to evaluate patient response. A symptom exam for additional clinical validation will
also be offered in the app. All data and user information will be stored in a secure, HIPAA compliant cloud computing center and access
to the information will be managed through a secure and compliant dashboard management system. The medical professional will have access
to all data to monitor outpatient experience, client response and general health and wellness information.
We
will leverage our IT investment to create a lead management system for mental health physicians connecting prospective patients with
providers. The medical professional will be able to engage in a telehealth virtual appointment with prospective patients to complete
an evaluation and assess whether the patient is a candidate for the outpatient headset program. After the professional approves the device
for the patient, we will automatically prepare shipment of the device directly to the outpatient consumer from the manufacturer. We will
have an internal department to monitor shipment, and to answer questions through a help desk on how to set up and use the device. The
medical professional can be reimbursed for the virtual appointment via the outpatient’s insurance for telehealth care which is
becoming part of the new normal in the post-pandemic, digital-health world.
Additional
design and implementation of modules related to social media marketing, bio-metric data collection and user experience will eventually
complete the design of the IT management platform.
Manufacturing
In
December 2021, we entered into a quality assurance agreement with Apical Instruments, an FDA-registered manufacturer, to ensure quality
assurance of our products. We currently have enough design and manufacturing support to meet all projected company design and sales goals.
Our regulatory team works closely with the Apical quality team to ensure all current compliance and testing standards are adhered to.
All distribution channels will rely on a collaboration between the Apical and Nexalin teams.
11
Intellectual
Property
Our
commercial success depends in part on our ability to: obtain and maintain proprietary or intellectual property protection for our products,
our core technologies and other know-how; operate without infringing on the proprietary rights of others; and prevent others from infringing
on our proprietary or intellectual property rights. Our policy is to seek to protect our proprietary and intellectual property position
by, among other methods, filing United States and foreign patent applications related to our proprietary technology, inventions and improvements
that are important to the development and implementation of our business. We also rely on the skills, knowledge, and experience of our
scientific and technical personnel, as well as that of our advisors, consultants and other contractors. To help protect our proprietary
know-how that is not patentable, we rely on trade secret protection and confidentiality agreements to protect our interests. As part
of our hiring practices and as described in out Code of Ethics which is binding on all employees, our employees, consultants, and advisors
are prohibited from disclosing confidential information and are required to assign to us the ideas, developments, discoveries and inventions
important to our business.
We
file patent applications directed to our key products to establish intellectual property positions. These patent applications are intended
to protect these products as well as their uses in the treatment of diseases. We are the owner and inventor of two existing patent and
five pending patents related to the electro-stimulation techniques related to our products and services. Our current patents cover a
therapeutic electro-stimulation apparatus (the medical device) and the software used to create and administer the stimulation to the
patient. We expect to file additional provisional and non-provisional patent applications and copyright protection pertaining to future
Generation technology, proprietary software, and trademarks. The patent claims associated with the non-provisional patent applications
will be defined and prepared in the filings. The intention is to build an intellectual property portfolio asset. Future research and
development projects related to advancements in neurostimulation and neuromodulation technology will be identified and investigated for
future patent filings.
Our
trademark portfolio currently consists of registered trademark rights for the mark, NEXALIN TECHNOLOGY, in the United States. In connection
with the ongoing development and advancement of our products and services in the United States and various international jurisdictions,
we routinely seek to create protection for our marks and enhance their value by pursuing trademarks and service marks where available
and when appropriate. In addition to patents and trademark protection, we rely upon unpatented trade secrets and know-how and continuing
technological innovation to develop and maintain our competitive position. We seek to protect our proprietary information, in part, by
using confidentiality agreements with our commercial partners, collaborators, employees and consultants, and invention assignment agreements
with our employees. These agreements are designed to protect our proprietary information and, in the case of the invention assignment
agreements, to grant us ownership of technologies that are developed through a relationship with a third party. These agreements may
be breached, and we may not have adequate remedies for any breach. In addition, our trade secrets may otherwise become known or be independently
discovered by competitors. To the extent that our commercial partners, collaborators, employees and consultants use intellectual property
owned by others in their work for us, disputes may arise as to the rights in related or resulting know-how and inventions.
Competition
We
plan to be the leader in brain-based health. We compete with traditional pharmaceutical therapies. All of these have side effects, such
as drug dependency as well as adverse health risks.
We
also compete with several neurostimulators at the high and low end of the market as well as implanted devices. All have either a high-risk
profile or uncomfortable side effects with moderate efficacy. Our products were designed as a cost-effective option to all current reimbursed
treatments available to the patient.
We
believe that existing neurostimulation products are either high risk, high cost and difficult to administer. In addition, they are invasive,
frequently requiring surgery and multiple visits to a physician. Since many of the conditions requiring ongoing treatments, the difficulty
and cost of administering them make them of limited utility for broad application.
Corporate
Information; Recent Initial Public Offering; Employees
We
were originally formed as a Nevada corporation on October 19, 2010 as Nexalin Technology, Inc. On December 1, 2021, we completed the
corporate reorganization described under the sub-section titled “Corporate Reorganization,” pursuant to which Nexalin Nevada
merged with and into a newly incorporated Delaware company of the same name, Nexalin and, as a result, Nexalin succeeded Nexalin Nevada
and our existing shareholders exchanged each of their shares in Nexalin Nevada for one twentieth (1/20 th ) of a common share
of the newly formed Delaware corporation. Nexalin had nominal assets and liabilities and did not conduct any operations prior to the
reorganization other than its incorporation.
12
We
completed the closing of our initial public offering on September 16, 2022. The initial public offering consisted of 2,315,000 units
consisting of 2,315,000 shares of its Common Stock and 2,315,000 accompanying warrants to purchase up to 2,315,000 shares of common stock.
Each share of common stock was sold together with one warrant, each to purchase one share of common stock with an exercise price of $4.15
per share at a combined offering price of $4.15, for gross proceeds of $9,607,250, before deducting underwriting discounts and offering
expenses. In addition, Nexalin granted the underwriters a 45-day option to purchase up to an additional 347,250 shares of common stock
and/or warrants to purchase up to 347,250 shares of common stock to cover over-allotments at the initial public offering price, less
the underwriting discount. The underwriters exercised their option to purchase 347,250 warrants for net proceeds of $3,473.
A
registration statement on Form S-1 (File No. 333-261989) was filed with the Securities and Exchange Commission (“SEC”), which
became effective on September 15, 2022. A final prospectus relating to the offering was filed with the SEC and is available on the SEC’s
website at http://www.sec.gov .
Our
shares and warrants began trading on the Nasdaq Capital Market tier of the Nasdaq Stock Market (“Nasdaq”) on September 16,
2022, under the symbols “NXL” and “NXLIW”, respectively.
Properties
Our
principal executive offices are located at 1776 Yorktown, Suite 550, Houston, Texas 77056. Our phone number is (832) 260-0222. Our website
address is www.nexalin.com . We do not incorporate the information on or accessible through our website into this Report on Form
10-K. We have included our website address in this Annual Report on Form 10-K solely as an inactive textual reference.
Human
Capital Resources
We
currently have 6 full time employees and approximately 7 consultants at different times working on various projects. These consultants,
and our legal and financial advisors assist us in various areas related to regulatory, engineering, research and development, sales and
marketing, legal, financial and other miscellaneous tasks necessary to run our business on day-to-day basis and to facilitate the development
of new products.
None
of our employees are represented by a labor union or covered by a collective bargaining agreement. We consider our relationship with
our employees to be good. We have historically utilized contractors to perform many of our services. Through this process, we believe
that we have attracted highly qualified professionals.
Compensation
and Benefits
We
believe that our future success largely depends upon our continued ability to attract and retain highly skilled employees. Medical device
companies both large and small compete for a limited number of qualified applicants to fill specialized positions. To attract qualified
applicants as we attempt to scale our business, we will need to offer a total rewards package consisting of base salary and cash target
bonus, a comprehensive benefit package and equity compensation to select employees. Bonus opportunity and equity compensation is expected
to increase as a percentage of total compensation based on level of responsibility, and actual bonus pay-out would be based on performance.
Health,
Wellness and Safety
We
believe that the safety and health of our employees and their families is essential to our business. Our culture is driven by a desire
to do what is right, and we strive to support the well-being of our employees. We prioritize the safety and well-being of our employees
even after they have faced both mental and physical challenges related to the COVID-19 pandemic.
13
Implications
of Being an Emerging Growth Company and a Smaller Reporting Company
We
qualify as an “emerging growth company,” as defined in the Jumpstart Our Business Start-ups Act of 2012, as amended, or the
JOBS Act. For so long as we remain an emerging growth company, we are permitted and intend to rely on exemptions from some of the reporting
requirements that are applicable to other public companies that are not emerging growth companies. These exemptions include:
●
being
permitted to present only two years of audited financial statements and only two years of related management’s discussion and
analysis of financial condition and results of operations disclosures;
●
not
being required to comply with the auditor attestation requirements of Section 404 of the Sarbanes-Oxley Act of 2002, as amended,
or the Sarbanes-Oxley Act;
●
not
being required to comply with any requirements that may be adopted by the Public Company Accounting Oversight Board regarding mandatory
audit firm rotation or a supplement to the auditor’s report providing additional information about the audit and the financial
statements;
●
reduced
disclosure obligations regarding executive compensation in our periodic reports, proxy statements and registration statements; and
●
exemptions
from the requirements of holding a nonbinding advisory vote on executive compensation and stockholder approval of any golden parachute
payments not previously approved.
We
may take advantage of these exemptions until the last day of our fiscal year following the fifth anniversary of the completion of our
IPO which was completed on September 16, 2022. However, if any of the following events occur prior to the end of such five-year
period, (i) our annual gross revenue exceeds $1.07 billion, (ii) we issue more than $1.0 billion of non-convertible debt in any
three-year period or (iii) we become a “large accelerated filer,” (as defined in Rule 12b-2 under the Securities
Exchange Act of 1934, as amended (the “Exchange Act”)), we will cease to be an emerging growth company prior to the end of
such five-year period. We will be deemed to be a “large accelerated filer” at such time that we (a) have an aggregate
worldwide market value of common equity securities held by non-affiliates of $700 million or more as of the last business day of our
most recently completed second fiscal quarter, (b) have been required to file annual and quarterly reports under the Exchange Act,
for a period of at least twelve months and (c) have filed at least one annual report pursuant to the Exchange Act. Even after we
no longer qualify as an emerging growth company, we may still qualify as a “smaller reporting company,” which would allow
us to take advantage of many of the same exemptions from disclosure requirements including reduced disclosure obligations regarding executive
compensation in our periodic reports and proxy statements.
The
JOBS Act provides that an emerging growth company can take advantage of an extended transition period for complying with new or revised
accounting standards. We have elected to take advantage of this extended transition period.
We
are also a “smaller reporting company” as defined in the Exchange Act. We may take advantage of certain of the scaled disclosures
available to smaller reporting companies until the fiscal year following the determination that our voting and non-voting common stock
held by non-affiliates is more than $250 million measured on the last business day of our second fiscal quarter, or our annual revenues
are less than $100 million during the most recently completed fiscal year and our voting and non-voting common stock held by non-affiliates
is less than $700 million measured on the last business day of our second fiscal quarter.
14
ITEM
1A RISK FACTORS
Investing
in our common stock and warrants to acquire common stock is speculative and involves a high degree of risk including the risk of a
loss of your entire investment. Before you invest in our common stock or warrants, you should carefully consider the following risk
factors. These risk factors contain, in addition to historical information, forward looking statements that involve risks and
uncertainties. Our actual results could differ significantly from the results discussed in the forward-looking statements. The
occurrence of any of the adverse developments described in the following risk factors and in the documents incorporated herein by
reference could materially and adversely harm our business, financial condition, results of operations or prospects. In such event,
the value of our common stock could decline, and you could lose all or a substantial portion of the money that you pay for our
common stock which may include the exercise price of any warrants. In addition, the risks and uncertainties discussed below are not
the only ones we face. Our business, financial condition, results of operations or prospects could also be harmed by risks and
uncertainties not currently known to us or that we currently do not believe are material, and these risks and uncertainties could
result in a complete loss of your investment. A summary of our risk factors is as follows:
Risks
Related to Our Financial Position and Capital Needs
We
have incurred significant losses since our inception. We expect to incur losses over the next several years and may never achieve or
maintain profitability.
We
are a Delaware corporation with a limited operating history. We have funded our operations to date primarily with proceeds from private
investors and the sale of our stock, including the proceeds from our initial public offering completed in September 2022. We have had
only limited sales of our products and services to date. For the year ended December 31, 2022, we incurred a comprehensive loss
in the amount of $1,661,503. Our accumulated deficit at December 31, 2022 was $72,389,340.
We
have devoted a substantial portion of our financial resources and efforts to research and development, including preclinical studies
and clinical trials. We are still in the early stages of development of our products.
We
expect to continue to incur significant expenses and operating losses over the next several years. Our net losses may fluctuate substantially
from quarter to quarter and year to year. We anticipate that our expenses will increase significantly as we:
●
continue
our ongoing and planned preclinical and clinical development of our existing and next Generation devices;
●
initiate
preclinical studies and clinical trials for any additional products that we may pursue in the future;
●
seek
to discover and develop additional treatment indications;
●
seek
regulatory approvals for any products that successfully complete clinical trials;
●
ultimately
establish sales, marketing and distribution infrastructure and scale up external manufacturing capabilities to commercialize any
product for which we may obtain regulatory approval and intend to commercialize on our own;
●
maintain,
expand and protect our intellectual property portfolio;
●
engage
additional clinical, scientific, manufacturing and controls personnel;
●
add
operational, financial and management information systems and personnel, including personnel to support our product development and
planned future commercialization efforts; and
●
incur
additional legal, accounting and other expenses associated with operating as a public company.
15
To
become and remain profitable, we and our collaborators must succeed in developing and eventually commercializing future and existing
products that generate significant revenue. This will require us to be successful in a range of challenging activities, including completing
preclinical studies and clinical trials of our products and preclinical program, obtaining regulatory approval, manufacturing, marketing
and selling any products for which we may obtain regulatory approval, as well as discovering and developing additional products. Again,
we are only in the preliminary stages of most of these activities. We may never succeed in these activities and, even if we do, may never
generate revenues that are significant enough to achieve profitability.
Because
of the numerous risks and uncertainties associated with product development, we are unable to accurately predict the timing or amount
of expenses or when, or if, we will be able to achieve profitability. If we are required by regulatory authorities to perform studies
in addition to those currently expected, or if there are any delays in the initiation and completion of our clinical trials or the development
of any of our products, our expenses could increase.
Even
if we achieve profitability, we may not be able to sustain or increase profitability on a quarterly or annual basis. Our failure to become
and remain profitable would depress the value of our common stock and could impair our ability to raise capital, expand our business,
maintain our research and development efforts or continue our operations. A decline in the value of our common stock could also cause
you to lose all or part of your investment.
Our
limited operating history may make it difficult for you to evaluate the success of our business to date and to assess our future viability.
We
commenced active operations in 2010, and our operations to date have been largely focused on raising capital, identifying and developing
our products and preclinical program, broadening our expertise in the development of our products and undertaking preclinical studies
and conducting early-stage clinical trials. As a result of the FDA reclassification ruling in December 2019, we had to suspend marketing
of our Gen-1 medical device for the treatment of anxiety and insomnia. We are presently evaluating whether to proceed with amending our
prior application with the FDA for the treatment of insomnia and anxiety or filing new applications 510(k) for our next Generation devices.
Although
we have developed a second-Generation medical device, it has not completed regulatory filings with the FDA for marketing or sales in
the United States. Consequently, any predictions you make about our future success or viability may not be as accurate as they could
be if we had a longer operating history.
We
may encounter unforeseen expenses, difficulties, complications, delays and other known or unknown factors in achieving our business objectives.
We will need to transition at some point from a company with a research and development focus to a company capable of supporting commercial
activities. We may not be successful in such a transition.
We
expect our financial condition and operating results to continue to fluctuate significantly from quarter to quarter and year to year
due to a variety of factors, many of which are beyond our control. Accordingly, you should not rely upon the results of any quarterly
or annual periods as indications of future operating performance.
We
may require substantial additional funding to meet our financial needs and to pursue our business objectives. If we are unable to raise
capital when needed, we could be forced to delay, reduce or altogether cease our product development programs or commercialization efforts.
We
are currently not cash flow positive and are not certain when and if we will be cash flow positive. We incurred a comprehensive loss
in the amount of $1,661,503 for the year ended December 31, 2022. While we believe that the net proceeds from our recently completed
initial public offering will enable us to fund our operating expenses and capital expenditure requirements for the next 12 months, we
may still need to obtain substantial additional funding in connection with our continuing operations and planned activities.
Our future capital requirements will depend on many factors, including:
●
the
timing, progress and results of our ongoing clinical trials of our products;
●
the
scope, progress, results and costs of preclinical development, laboratory testing and clinical trials of other products that we may
pursue;
16
●
the
number and development requirements of other products that we may pursue;
●
our
ability to establish collaborations on favorable terms, if at all;
●
the
costs, timing and outcome of regulatory review of our products;
●
the
costs and timing of future commercialization activities, including product manufacturing, marketing, sales and distribution, for
any of our products for which we receive marketing approval;
●
the
revenue, if any, received from commercial sales of our products for which we receive marketing approval;
●
the
costs and timing of preparing, filing and prosecuting patent applications, maintaining and enforcing our intellectual property rights
and defending any intellectual property-related claims; and
●
the
costs of operating as a public company.
Identifying
potential products and conducting preclinical testing and clinical trials is a time-consuming, expensive and uncertain process that takes
years to complete, and we may never generate the necessary data or results required to continue our regulatory approvals and achieve
product sales. In addition, our products, if approved, may not achieve commercial success. Our commercial revenues, if any, will be derived
from sales of products that are cleared under FDA review. Accordingly, we will need to continue to rely on additional financing to achieve
our business objectives. Adequate additional financing may not be available to us on acceptable terms, or at all. In addition, we may
seek additional capital due to favorable market conditions or strategic considerations even if we believe we have sufficient funds for
our current or future operating plans. If we are unable to raise capital when needed or on attractive terms, we could be forced to delay,
reduce or altogether cease our research and development programs or future commercialization efforts.
Raising
additional capital may cause dilution to our stockholders, restrict our operations or require us to relinquish rights to our technologies
or products.
Until
such time, if ever, as we can generate substantial product revenue, we expect to finance our cash needs through equity offerings. To
the extent that we raise additional capital through the sale of equity or convertible debt securities, your ownership interest will be
diluted, and the terms of these securities may include liquidation or other preferences that adversely affect your rights as a stockholder.
Debt financing and equity financing, if available, may involve agreements that include covenants limiting or restricting our ability
to take specific actions, such as incurring additional debt, making capital expenditures or declaring dividends.
If
we raise additional funds through collaborations, strategic alliances or marketing, distribution or licensing arrangements with third
parties, we may be required to relinquish valuable rights to our technologies, future revenue streams, research programs or products
or to grant licenses on terms that may not be favorable to us. If we are unable to raise additional funds through equity or debt financings
when needed, we may be required to delay, limit, reduce or terminate our product development or future commercialization efforts or grant
rights to a third party to develop and market products that we would otherwise prefer to develop and market ourselves.
Risks
Related to the Development of Our Products and Preclinical Program
We
depend on the success of our future products, some of which are in clinical development but have not completed advanced clinical trials.
If we lose our existing or cannot obtain future regulatory approval for and successfully commercialize one or more of our products or
if we experience significant delays in doing so, we may never become profitable.
The
success of our products and preclinical program will depend on several additional factors, including:
●
successful
completion of preclinical studies and requisite clinical trials;
●
performing
preclinical studies and clinical trials in compliance with the FDA or any comparable regulatory authority requirements;
17
●
receipt
of marketing approvals from applicable regulatory authorities;
●
the
ability of collaborators to manufacture sufficient quantity of product for development, clinical trials or potential commercialization;
●
obtaining
and maintaining patent, trademark and trade secret protection, and regulatory exclusivity for our products and preclinical program;
●
making
arrangements with third parties for manufacturing capabilities;
●
launching
commercial sales of products, if and when approved, whether alone or in collaboration with others;
●
acceptance
of the therapies, if and when approved, by healthcare providers, physicians, clinicians, patients and third-party payors;
●
competing
effectively with other therapies;
●
obtaining
and maintaining healthcare coverage and adequate reimbursement; and
●
protecting
our rights in our intellectual property portfolio.
If
we do not achieve one or more of these factors in a timely manner or at all, we could experience significant delays or an inability to
successfully commercialize our products, which would harm our business.
Our
products and product candidates may be subject to reclassification by the FDA, and a change in the classification may have an adverse
impact on our revenues or our abilities to obtain necessary regulatory approvals.
Originally,
our technology was cleared for the treatment of anxiety, depression and insomnia. Each treatment indication with this technology was
classified as class III from a risk tolerance standpoint at the FDA. In December of 2019, the FDA passed a new ruling that separated
anxiety and insomnia from the treatment of depression. CES devices that treat anxiety and insomnia were reclassified as class II medical
devices and require special control trials to be initiated, as well as the filing of a new 510(k) application for previously approved
devices. The FDA continued to classify the treatment of depression for cranial stimulation as a class III high risk device. In order
to receive approval for treatment for depression, our devices will require a new pre-market application for this indication. We have
decided not to pursue a depression indication for our Gen-1 device at such time.
Any
further such reclassification by the FDA of an indication from a certain class of device to another during our development or post-commercialization
for that indication could have a significant adverse impact due to the more rigorous and lengthy approval process required for a higher
risk class medical device. Such a change in classification can significantly increase development costs and prolong the time for development
and approval, thus delaying revenues. A reclassification of an indication after approval from a certain class of device to another could
result in a change in classification for reimbursement, and there could be a significant negative impact on our revenues relatedly.
Success
in preclinical studies or clinical trials may not be indicative of results in future clinical trials.
Success
in preclinical testing and early clinical trials does not ensure that later clinical trials will generate the same results or otherwise
provide adequate data to demonstrate the efficacy and safety of a product candidate. Our products may fail to show the desired safety
and efficacy in all clinical trials.
If
we experience delays or difficulties in the enrollment of patients in clinical trials, our receipt of necessary regulatory approvals could
be delayed or prevented.
We
may not be able to initiate, continue or complete clinical trials of any product candidate that we develop if we and our collaborators
are unable to locate and enroll a sufficient number of eligible patients to participate in these trials as required by the FDA or other
comparable regulatory authority. We have limited experience enrolling patients in our clinical trials and cannot predict how successful
we will be in enrolling patients in future clinical trials.
18
Public
health threats, including those related to the novel strain of coronavirus, SARS-CoV-2 (which causes the disease now called COVID-19),
have had, and could continue to have an adverse effect on our operations.
Public
health threats have, and could continue to, adversely affect our ongoing or planned research and development activities. In particular,
SARS-CoV-2, which causes the disease now called COVID-19, was first reported to have surfaced in Wuhan, China in December 2019,
and has since spread globally, including to every state in the United States. The outbreak of COVID-19 has severely impacted global
economic activity (including adversely affecting the global supply chain) and caused significant volatility and negative pressure in
financial markets. The global impact of the outbreak has been rapidly evolving and many countries, including the United States and
China, have reacted over time by instituting quarantines, mandating business and school closures and restricting travel. As a result,
the COVID-19 pandemic has negatively impacted almost every industry directly or indirectly.
The
COVID-19 pandemic has delayed our clinical trials and our receipt of marketing approvals from the FDA and also negatively impacted our
ability to complete our proposed joint venture in China and Asia and the ability of our distributor and proposed joint venture partner,
Wider to operate in China. Such pandemic also has reduced, and continues to reduce, participation in our clinical trials, due to
both travel restrictions and a general unwillingness of subjects to travel. The COVID-19 pandemic had severe adverse effects on the economy
in China in 2021 and 2022 and continues to negatively impact the China economy. We cannot presently predict the scope and severity of
any other potential business shutdowns or disruptions, but if we or any of the third parties with whom we engage, including our proposed
joint venture partner, the suppliers, clinical trial sites, regulators and other third parties with whom we conduct business, were to
experience shutdowns or other business disruptions, our ability to conduct our business in the manner and on the timelines presently
planned could be materially and negatively impacted.
Relatedly,
the spread of an infectious disease, including COVID-19, may also result in the inability of our suppliers to deliver components or raw
materials on a timely basis. Such events may result in a period of business and manufacturing disruption, and in reduced operations,
any of which could materially affect our business, financial condition and results of operations. The extent to which the coronavirus
impacts our business will depend on future developments, which are highly uncertain and cannot be predicted, including new information
which may emerge concerning the severity of COVID-19 and the actions to contain the coronavirus or treat its impact, among others.
Risks
Related to Our Dependence on Third Parties
We
rely on third parties to conduct the clinical trials for our products, and those third parties may not perform satisfactorily, including
failing to meet deadlines for the completion of such trials or failing to comply with applicable regulatory requirements.
We
rely on third parties, such as research institutions and Wider, which is based in China, to conduct some of our clinical
trials. Our reliance upon research institutions, including hospitals, clinics and academics, provides us with less control over the timing
and cost of clinical trials and the ability to recruit subjects. If we are unable to reach agreement with suitable research institutions
on acceptable terms, or if any resulting agreement is terminated, we may be unable to quickly replace the research institution with another
qualified institution on acceptable terms. Even if we do replace the institution, we may incur additional costs to conduct the trial
at the new institution. We may not be able to secure and maintain suitable research institutions to conduct our clinical trials.
We
rely on a collaboration with a third party for the quality assurance of our products, and we may seek additional collaborations in the
future. If those collaborations are not successful, we may not be able to capitalize on the market potential of these products.
We
are a party to a quality assurance agreement with a third party for the quality assurance of our products and may enter into additional
collaborations in the future. We are dependent upon the success of our current and any future collaborators in performing their responsibilities
in connection with the relevant collaboration. If we fail to maintain these collaborative relationships for any reason, we would need
to perform the activities that we currently anticipate would be performed by our collaborators on our own at our sole expense. This could
substantially increase our capital needs, and we may not have the capability or financial capacity to undertake these activities on our
own, or we may not be able to find other collaborators on acceptable terms, or at all. This may limit the programs we are able to pursue
and result in significant delays in the development, sale and manufacture of our product candidates and products, and may have a material
adverse effect on our business, financial condition and results of operations.
19
Our
dependence upon our current and potential future collaborations exposes us to a number of risks, including that our collaborators (i) may
fail to cooperate or perform their contractual obligations, including financial obligations, (ii) may choose to undertake differing
business strategies or pursue alternative technologies or (iii) may take an opposing view regarding ownership of clinical trial
results or intellectual property.
Due
to these factors and other possible events, we could suffer delays in the research, development or commercialization of our product candidates
and future products or we may become involved in litigation or arbitration, which could be time consuming and expensive. We additionally
may be compelled to split revenue with our collaborators, which could have a material adverse effect on our business, financial condition,
and results of operations.
Risks
Related to the Commercialization of Our Products
Even
if any of our products receives marketing approval, it may fail to achieve the degree of market acceptance by healthcare providers, physicians,
clinicians, patients, third-party payors and others in the medical community necessary for commercial success.
The
degree of market acceptance of our products, if approved for commercial sale, will depend on a number of factors, including:
●
the
efficacy and potential advantages compared to alternative treatments;
●
the
potential and perceived advantages and disadvantages of the products, including cost and clinical benefit relative to alternative
treatments;
●
the
convenience and ease of administration compared to alternative treatments;
●
the
willingness of the target patient population to try new therapies and of healthcare providers, physicians, and clinicians to prescribe
these therapies;
●
acceptance
by healthcare providers, physicians, clinicians, patients, operators of hospitals, including in-hospital formularies, and treatment
facilities and parties responsible for coverage and reimbursement of the product;
●
the
availability of coverage and adequate reimbursement by third-party payors and government authorities;
●
the
ability to manufacture our product in sufficient quantities and yields;
●
the
strength and effectiveness of marketing and distribution support;
●
the
prevalence and severity of any side effects;
●
limitations
or warnings, including distribution or use restrictions, contained in the product’s approved labelling;
●
the
approval of other new products for the same indications; and
●
the
timing of market introduction of the approved product as well as competitive products.
Any
failure by any of our existing or future products that obtain regulatory approval to achieve market acceptance or commercial success
would have a material adverse effect on our business prospects.
20
We
may eventually compete for product sales with other companies, many of which will have greater resources or capabilities than we have,
or may succeed in developing better products or in developing products more quickly than we do, and we may not compete successfully with
them.
Our
industry is competitive and has been evolving rapidly with not only existing treatment options, but also the introduction of new technologies
and products as well as the market activities of industry participants. We compete or may eventually compete with other companies and
organizations that are marketing or developing therapies for our targeted disease indications, based on traditional pharmaceutical, medical
device, or other neurostimulation therapy and technologies.
We
also face competition in the neurostimulation field from academic institutions and governmental agencies. Many of our current and potential
competitors have greater financial and human resources than we have, including more experience in research and development and more established
sales, marketing and distribution capabilities.
We
anticipate that competition in our industry will increase. In addition, the health care industry is characterized by rapid technological
change, resulting in new product introductions and other technological advancements. Our competitors may develop and market products
that render product candidates now or under development by us in the future, or any products manufactured or marketed by us, non-competitive
or otherwise obsolete.
Coverage
and adequate reimbursement may not be available for our current or any future products, which could make it difficult for us to sell
profitably, if approved.
Market
acceptance and sales of any products that we commercialize, if approved, will depend in part on the extent to which reimbursement for
these products and related treatments will be available from third-party payors, including government health administration authorities,
managed care organizations and other private health insurers. Third-party payors decide which therapies they will pay for and establish
reimbursement levels. Third-party payors often rely upon Medicare coverage policy and payment limitations in setting their own coverage
and reimbursement policies. However, decisions regarding the extent of coverage and amount of reimbursement to be provided for any products
that we develop will be made on a payor-by-payor basis. One payor’s determination to provide coverage for a product does not assure
that other payors will also provide coverage and adequate reimbursement for the product. Additionally, a third-party payor’s decision
to provide coverage for a therapy does not imply that an adequate reimbursement rate will be approved. Each payor determines whether
it will provide coverage for a therapy, what amount it will pay for the therapy and on what tier of its list of covered products, or
formulary, it will be placed. The position on a payor’s formulary, generally determines the co-payment that a patient will need
to make to obtain the therapy and can strongly influence the adoption of such therapy by patients and physicians. Patients who are prescribed
treatments for their conditions and providers prescribing such services generally rely on third-party payors to reimburse all or part
of the associated healthcare costs. Patients are unlikely to use our products, and providers are unlikely to prescribe our products,
unless coverage is provided, and reimbursement is adequate to cover a significant portion of the cost of our products and their administration.
A
primary trend in the U.S. healthcare industry and elsewhere is cost containment. Third-party payors have attempted to control
costs by limiting coverage and limited reimbursement for medications and certain treatments utilizing digital technologies. We
cannot be sure that coverage and reimbursement will be available for any product that we commercialize and, if reimbursement is
available, what the level of reimbursement will be. Inadequate coverage and reimbursement may impact the demand for, or the price
of, any product for which we obtain marketing approval. If coverage and adequate reimbursement are not available, or are available
only to limited levels, we may not be able to successfully commercialize our current and any future products that we develop.
Product
liability lawsuits against us could cause us to incur substantial liabilities and to limit commercialization of any products that we
may develop.
We
face an inherent risk of product liability exposure related to the testing of our products in human clinical trials and will face an
even greater risk if we commercially sell any products that we may develop. If we cannot successfully defend ourselves against claims
that our products or products caused injuries, we will incur substantial liabilities. Regardless of merit or eventual outcome, liability
claims may result in:
●
reduced
resources of our management to pursue our business strategy;
21
●
decreased
demand for any products or products that we may develop;
●
injury
to our reputation and significant negative media attention;
●
withdrawal
of clinical trial participants;
●
initiation
of investigations by regulators;
●
product
recalls, withdrawals or labelling, marketing or promotional restrictions;
●
significant
costs to defend the resulting litigation;
●
substantial
monetary awards paid to clinical trial participants or patients;
●
loss
of revenue; and
●
the
inability to commercialize any products that we may develop.
We
currently hold $1 million in product liability insurance coverage in the aggregate, with a per incident limit of $1 million, which may
not be adequate to cover all liabilities that we may incur. We may need to increase our insurance coverage as we expand our clinical
trials or if we commence commercialization of our products. Insurance coverage is increasingly expensive. We may not be able to maintain
insurance coverage at a reasonable cost or in an amount adequate to satisfy any liability that may arise.
Risks
Related to Our Business and Managing Our Growth
Our
future success depends on our ability to retain key executives and to attract, retain and motivate qualified personnel.
Recruiting
and retaining qualified scientific and clinical personnel and, if we progress the development of any of our products, commercialization,
manufacturing and sales and marketing personnel, will be critical to our success. The loss of the services of our executive officers
or other key employees could impede the achievement of our research, development and commercialization objectives and seriously harm
our ability to successfully implement our business strategy. Furthermore, replacing executive officers and key employees may be difficult
and may take an extended period because of the limited number of individuals in our industry with the breadth of skills and experience
required to successfully develop, gain regulatory approval of and commercialize our products. Competition to hire from this limited pool
is intense, and we may be unable to hire, train, retain or motivate these key personnel on acceptable terms given the competition among
numerous companies for similar personnel. We also experience competition for the hiring of scientific and clinical personnel from universities
and research institutions. In addition, we rely on consultants and advisors, including scientific and clinical advisors, to assist us
in formulating our research and development and commercialization strategy. Our consultants and advisors may have commitments under consulting
or advisory contracts with other entities that may limit their availability to us. If we are unable to continue to attract and retain
high-quality personnel, our ability to pursue our growth strategy will be limited.
We
expect to expand our development and regulatory capabilities and potentially implement sales, marketing and distribution capabilities,
and as a result, we may encounter difficulties in managing our growth, which could disrupt our operations.
As
of December 31, 2022, we had 6 full-time employees and 7 consultants. As the clinical development
of our products progresses, we also expect to experience significant growth in the number of our employees and the scope of our operations,
particularly in the areas of research, product development and regulatory affairs, including a sales and marketing team for our existing
products. To manage our anticipated future growth, we must continue to implement and improve our managerial, operational and financial
systems, expand our facilities and continue to recruit and train additional qualified personnel. Due to our limited financial resources
and the limited experience of our management team in managing a company with such anticipated growth, we may not be able to effectively
manage the expansion of our operations or recruit and train additional qualified personnel. The expansion of our operations may lead
to significant costs and may divert our management and business development resources. Any inability to manage growth could delay the
execution of our business plans or disrupt our operations.
22
Significant
disruptions of our information technology systems or data security incidents could result in significant financial, legal, regulatory,
business and reputational harm to us.
We
are increasingly dependent on information technology systems and infrastructure, including mobile technologies, to operate our business.
In the ordinary course of our business, we collect, store, process and transmit large amounts of sensitive information, including intellectual
property, proprietary business information, personal information and other confidential information. It is critical that we do so in
a secure manner to maintain the confidentiality, integrity and availability of such sensitive information. We have also outsourced elements
of our operations, including elements of our information technology infrastructure, to third parties and, as a result, we manage a number
of third-party vendors who may or could have access to our computer networks or our confidential information. In addition, many of those
third parties in turn subcontract or outsource some of their responsibilities to other third parties. While all information technology
operations are inherently vulnerable to inadvertent or intentional security breaches, incidents, attacks and exposures, the accessibility
and distributed nature of our information technology systems, and the sensitive information stored on those systems, make such systems
potentially vulnerable to unintentional or malicious, internal and external attacks on our technology environment. Potential vulnerabilities
can be exploited from inadvertent or intentional actions of our employees, third-party vendors, or business partners or by malicious
third parties. Attacks of this nature are increasing in their frequency, levels of persistence, sophistication and intensity, and are
being conducted by sophisticated and organized groups and individuals with a wide range of motives (including industrial espionage) and
expertise, including organized criminal groups, “hacktivists,” nation states and others. In addition to the extraction of
sensitive information, such attacks could include the deployment of harmful malware, ransomware, denial-of-service attacks, social engineering
and other means to affect service reliability and threaten the confidentiality, integrity and availability of information. In addition,
the prevalent use of mobile devices increases the risk of data security incidents.
Significant
disruptions of our third-party vendors’ information technology systems or other similar data security incidents could adversely
affect our business operations and result in the loss, misappropriation and unauthorized access, use or disclosure of, or the prevention
of access to, sensitive information, which could result in financial, legal, regulatory, business and reputational harm to us. In addition,
information technology system disruptions, whether from attacks on our technology environment or from computer viruses, natural disasters,
terrorism, war or telecommunication and electrical failures, could result in a material disruption of our development programs and our
business operations. For example, the loss of clinical trial data from completed or future clinical trials could result in delays in
our regulatory approval efforts and significantly increase our costs to recover or reproduce the data.
There
is no way of knowing with certainty whether we have experienced any data security incidents that have not been discovered. While we have
no reason to believe this to be the case, attackers have become very sophisticated in the way they conceal access to systems, and many
companies that have been attacked are not aware that they have been attacked. Any event that leads to unauthorized access, use or disclosure
of personal information, including personal information regarding our patients or employees, could disrupt our business, harm our reputation,
compel us to comply with applicable federal and state breach notification laws and foreign law equivalents, subject us to time-consuming,
distracting and expensive litigation, regulatory investigation and oversight or mandatory corrective action, require us to verify the
correctness of database contents or otherwise subject us to liability under laws, regulations and contractual obligations, including
those that protect the privacy and security of personal information. This could result in increased costs to us, and result in significant
legal and financial exposure and reputational harm. In addition, any failure or perceived failure by us or our vendors or business partners
to comply with our privacy, confidentiality or data security-related legal or other obligations to third parties, or any further security
incidents or other inappropriate access events that result in the unauthorized access, release or transfer of sensitive information,
which could include personally identifiable information, may result in governmental investigations, enforcement actions, regulatory fines,
litigation or public statements against us by advocacy groups or others, and could cause third parties, including clinical sites, regulators
or current and potential partners, to lose trust in us, or we could be subject to claims by third parties that we have breached our privacy-
or confidentiality-related obligations. Moreover, data security incidents and other inappropriate access can be difficult to detect,
and any delay in identifying them may lead to increased harm of the type described above. While we have implemented security measures
intended to protect our information technology systems and infrastructure, there can be no assurance that such measures will successfully
prevent service interruptions or security incidents.
23
If
we engage in future acquisitions or strategic collaborations, this may increase our capital requirements, dilute our stockholders, cause
us to incur debt or assume contingent liabilities and subject us to other risks.
From
time to time, we may evaluate various acquisitions and strategic collaborations, including licensing or acquiring intellectual property
rights, technologies or businesses, as deemed appropriate to carry out our business plan. Any potential acquisition or strategic collaboration
may entail numerous risks, including:
●
increased
operating expenses and cash requirements;
●
the
assumption of additional indebtedness or contingent liabilities;
●
assimilation
of operations, intellectual property and products of an acquired company, including difficulties associated with integrating new
personnel;
●
the
diversion of our management’s attention from our existing product programs and initiatives in pursuing such a strategic partnership,
merger or acquisition;
●
retention
of key employees, the loss of key personnel and uncertainties in our ability to maintain key business relationships;
●
risks
and uncertainties associated with the other party to such a transaction, including the prospects of that party and their existing
products or products and regulatory approvals; and
●
our
inability to generate revenue from acquired technology and/or products sufficient to meet our objectives in undertaking the acquisition
or even to offset the associated acquisition and maintenance costs.
We
are subject to the risks of conducting business internationally.
On
February 24, 2022, Russia launched an invasion in Ukraine which has increased supply interruptions throughout the world and in the United
States and may hinder our ability to find the materials we need to make our products. Although, to date, there has been minimal effect upon our business, supply disruptions could make it harder for us
to find favorable pricing and reliable sources for the materials we need, putting upward pressure on our costs and increasing the risk
that we may be unable to acquire the materials and services we need to continue to make certain products.
Risks
Related to Doing Business in China
The
medical industry in China is highly regulated and such regulations are subject to change which may affect approval and commercialization
of our products.
A
material portion of our research is expected to be conducted in China through the potential Joint Venture, which we believe confers clinical,
commercial and regulatory advantages, but may subject the potential Joint Venture (and also potentially us) to significant regulatory,
liquidity, and enforcement risks. The medical industry in China is subject to comprehensive government regulation and supervision, encompassing
the approval, registration, manufacturing, packaging, licensing and marketing of new drugs. In recent years, the regulatory framework
in China regarding the medical industry has undergone significant changes, and we expect that it will continue to undergo significant
changes. Any such changes or amendments may result in increased compliance costs on our business or cause delays in or prevent the successful
development or commercialization of our products in China and reduce the current benefits we believe are available to us from researching
our products in China. The People’s Republic of China, or PRC, authorities have become increasingly vigilant in enforcing laws
in the medical industry and any failure by us or our partners to maintain compliance with applicable laws and regulations or obtain and
maintain required licenses and permits may result in the suspension or termination of our business activities in China. We believe our
strategy and approach are aligned with the PRC government’s regulatory policies, but we cannot ensure that our strategy and approach
will continue to be aligned. In the event that there are changes, we and the potential Joint Venture will take any and all actions to
remain in compliance with any such laws or regulations or detailed implementations and interpretations thereof.
24
There
may be difficulties in effecting service of legal process, enforcing foreign judgments or bringing actions in China against us based
on foreign laws.
We
expect to conduct a material portion of our research in China through the potential Joint Venture. Also, the potential Joint Venture
is expected to be formed under the laws of Hong Kong and is expected to be physically located in Hong Kong. Our potential joint venture
partner, Wider, is located in China. As a result, it may be difficult to effect service of process upon the potential Joint Venture
inside China. It may also be difficult to enforce in U.S. courts judgments obtained in U.S. courts based on the civil liability provisions
of the U.S. federal securities laws against the potential Joint Venture. In addition, there is uncertainty as to whether the courts of
the PRC would recognize or enforce judgments of U.S. courts against the potential Joint Venture predicated upon the civil liability provisions
of the securities laws of the United States or any state.
It
may be difficult for us to enforce our rights with respect to the potential Joint Venture. The recognition and enforcement of foreign
judgments are provided for under the PRC Civil Procedures Law. PRC courts may recognize and enforce foreign judgments in accordance with
the requirements of the PRC Civil Procedures Law based either on treaties between China and the country where the judgment is made or
on principles of reciprocity between jurisdictions. China does not have any treaties or other forms of written arrangement with the United States
that provide for the reciprocal recognition and enforcement of foreign judgments. In addition, according to the PRC Civil Procedures
Law, the PRC courts will not enforce a foreign judgment by us against Wider or the potential Joint Venture if they decide that the judgment
violates the basic principles of PRC laws or national sovereignty, security, or the public interest. As a result, it is uncertain whether
and on what basis a PRC court would enforce a judgment rendered by a court in the United States.
It
may be difficult for overseas regulators to conduct investigations or collect evidence within China.
It
may be difficult for you or overseas regulators, such as the Securities and Exchange Commission (SEC), the Department of Justice (DOJ)
and other authorities of the United States, to conduct investigations or collect evidence within China. For example, in China, there
are significant legal and other obstacles to obtaining information, documents and materials needed for regulatory investigations or litigation
outside China or otherwise with respect to foreign entities. Although the authorities in China may establish a regulatory cooperation
mechanism with the securities regulatory authorities of another country or region to implement cross-border supervision and administration,
such regulatory cooperation with the securities regulatory authorities in the United States may not be efficient in the absence of mutual
and practical cooperation mechanism. Furthermore, according to Article 177 of the PRC Securities Law, which became effective in
March 2020, no overseas securities regulator is allowed to directly conduct investigation or evidence collection activities within
the territory of the PRC. Accordingly, without the consent of the competent PRC securities regulators and relevant authorities, no entity
or individual may provide the documents and materials relating to securities business activities to overseas parties. While detailed
interpretation of or implementing rules under Article 177 have yet to be promulgated, the inability for an overseas securities regulator
to directly conduct investigation or evidence collection activities within China may further increase difficulties faced by you in protecting
your interests.
The
PRC’s economic, political and social conditions, as well as governmental policies, could affect the business environment and financial
markets in China, and our ability to operate our business, maintain our liquidity and keep our access to capital.
We
expect that a portion of our operations will be conducted in China through the potential Joint Venture. Accordingly, our business, results
of operations, financial condition and prospects may be influenced to a significant degree by economic, political, legal and social conditions
in China. China’s economy differs from the economies of developed countries in many respects, including with respect to the amount
of government involvement, level of development, growth rate, control of foreign exchange and allocation of resources. While the PRC
economy has experienced significant growth over the past thirty years, growth has been uneven across different regions and among various
economic sectors of China. The PRC government has implemented various measures to encourage economic development and guide the allocation
of resources. Some of these measures may benefit the overall PRC economy but may have a negative effect on us. For example, our financial
condition and results of operations may be adversely affected by government control over capital investments or changes in tax regulations
that are currently applicable to us. In addition, in the past the PRC government implemented certain measures, including interest rate
increases, to control the pace of economic growth. These measures may cause decreased economic activity in China, which may adversely
affect our business and results of operation. More generally, if the business environment in China deteriorates from the perspective
of domestic or international investment, our business in China may also be adversely affected.
25
Uncertainties
with respect to the PRC legal system could adversely affect us.
The
PRC legal system is a civil law system based on written statutes. Unlike the common law system, prior court decisions under the civil
law system may be cited for reference but have limited precedential value.
In
1979, the PRC government began to promulgate a comprehensive system of laws and regulations governing economic matters in general. The
overall effect of legislation over the past four decades has significantly enhanced the protection afforded to various forms of foreign
investments in China. However, China has not developed a fully integrated legal system, and recently enacted laws and regulations may
not sufficiently cover all aspects of economic activities in China. In particular, the interpretation and enforcement of these laws and
regulations involve uncertainties. Since PRC administrative and court authorities have significant discretion in interpreting and implementing
statutory provisions and contractual terms, it may be difficult to evaluate the outcome of administrative and court proceedings and the
level of legal protection we enjoy. These uncertainties may affect our judgment on the relevance of legal requirements and our ability
to enforce our contractual rights or tort claims. In addition, the regulatory uncertainties may be exploited through unmerited or frivolous
legal actions or threats in attempts to extract payments or benefits from us.
In
addition, any administrative and court proceedings in China may be protracted, resulting in substantial costs and diversion of resources
and management attention.
In
May 2019, the Cyberspace Administration of China (“CAC”) issued strict guidelines for the collection and use of data
by operators in China. At this time, Wider does not share any data from any hospital setting or research setting with Nexalin and Nexalin
does not share any data from any hospital setting or research setting with Wider. All clinical data, patient data, provider data associated
with China and the U.S. do not affect the design or statistical interpretation of preclinical or clinical studies in either country.
Uncertainties
in the interpretation and enforcement of Chinese laws and regulations could limit the legal protections available to us.
The
PRC legal system is based on written statutes and prior court decisions have limited value as precedents. Since these laws and regulations
are relatively new and the PRC legal system continues to rapidly evolve, the interpretations of many laws, regulations and rules are
not always uniform and enforcement of these laws, regulations and rules involves uncertainties.
From
time to time, we may have to resort to administrative and court proceedings to enforce our legal rights, most notably our rights with
respect to the potential Joint Venture. However, since PRC administrative and court authorities have significant discretion in interpreting
and implementing statutory and contractual terms, it may be more difficult to evaluate the outcome of administrative and court proceedings
and the level of legal protection we enjoy than in more developed legal systems. Furthermore, the PRC legal system is based in part on
government policies and internal rules. As a result, we may not be able to keep ourselves updated with these policies and rules in time.
Such uncertainties, including uncertainty over the scope and effect of our contractual, property (including intellectual property) and
procedural rights, could materially and adversely affect our business and impede our ability to continue our operations.
Restrictions
on foreign currency may limit our ability to receive and use our revenue effectively.
The
PRC government imposes controls on the conversion of the Renminbi into foreign currencies and, in certain cases, the remittance of foreign
currency out of China. To date, the payments we have received from Wider have been in United States dollars, although in the future,
payments from Wider or from the potential Joint Venture may be in Renminbi. Under existing PRC foreign exchange regulations, payments
of current account items, including profit distributions, interest payments and trade and service-related foreign exchange transactions,
can be made in foreign currencies without prior approval of SAFE, by complying with certain procedural requirements. However, approval
from or registration with appropriate government authorities is required where Renminbi is to be converted into foreign currency and
remitted out of China to pay capital expenses such as the repayment of loans denominated in foreign currencies. As a result, we would
need to obtain approval from SAFE to use cash generated from our operations to pay off any debt in a currency other than Renminbi owed
to entities outside China, or to make other capital expenditure payments outside China in a currency other than Renminbi. The PRC government
may restrict access to foreign currencies for current account transactions in the future. The foreign exchange control system could prevent
us from obtaining sufficient foreign currencies to satisfy our foreign currency demands.
26
Fluctuation
in exchange rates could have a negative effect on our results of operations and the value of your investment.
The
value of the Renminbi against the U.S. dollar and other currencies may fluctuate and is affected by, among other things, changes in political
and economic conditions in China and by China’s foreign exchange policies. Since June 2010, the Renminbi has fluctuated against
the U.S. dollar, at times significantly and unpredictably. On November 30, 2015, the Executive Board of the International Monetary Fund,
or IMF, completed the regular five-year review of the basket of currencies that make up the Special Drawing Right, or the SDR, and decided
that with effect from October 1, 2016, the Renminbi is determined to be a freely usable currency and will be included in the SDR basket
as a fifth currency, along with the U.S. dollar, the euro, the Japanese yen and the British pound. Since the fourth quarter of 2016,
the Renminbi has depreciated significantly in the backdrop of a surging U.S. dollar and persistent capital outflows of China. With the
development of the foreign exchange market and progress toward interest rate liberalization and Renminbi internationalization, the PRC
government may in the future announce further changes to the exchange rate system, and we cannot assure you that the Renminbi will not
appreciate or depreciate significantly in value against the U.S. dollar in the future. It is difficult to predict how market forces or
PRC or U.S. government policy may impact the exchange rate between the Renminbi and the U.S. dollar in the future.
Very
limited hedging options are available in China to reduce our exposure to exchange rate fluctuations. As of the date Form 10-K, we have
not entered into any hedging transactions in an effort to reduce our exposure to foreign currency exchange risk. While we may decide
to enter into hedging transactions in the future, the availability and effectiveness of these hedges may be limited and we may not be
able to adequately hedge our exposure or at all. In addition, our currency exchange losses may be magnified by PRC exchange control regulations
that restrict our ability to convert Renminbi into foreign currency or to convert foreign currency into Renminbi.
The
approval of the CSRC, and other compliance procedures may be required in connection with any offering we may make and, if required, we
cannot predict whether we will be able to obtain such approval.
We
do not have any operations in China and will not have any operations other than the potential Joint Venture following its formation,
of which there can be no assurance. As of the date of this Form 10-K, (i) our business operations are carried on outside of China;
and (ii) we do not maintain any variable interest entity structure or operate any data center in China. We do not believe that sales
of our devices to Wider to date constitute doing business in China. We may still be subject to PRC laws relating to, among others, data
security and restrictions over foreign investments due to the complexity of the regulatory regime in China, and the recent statements
and regulatory actions by the PRC government relating to data security may affect our business operations in China or even our ability
to offer securities in the United States. Our securities are not being offered or sold directly or indirectly in China to or for
the benefit of, legal or natural persons of the PRC. Therefore, we have not obtained the approval from either the China Securities Regulatory
Commission (the “CSRC”) or the Cyberspace Administration of China (the “CAC”) for any offering we may make in
the future, and we do not intend to obtain the approval from either the CSRC or the CAC in connection with any such future offering,
since we do not believe that such approval is required under these circumstances. Under the PRC’s current legal system, Chinese
citizens have the right to purchase securities publicly issued by overseas companies through legal channels and enjoy corresponding benefits
of such ownership. Ownership of such securities does not require approval from the CSRC or the CAC.
On
the website of the CSRC, the CSRC provides that in accordance with current laws and regulations, domestic Chinese residents can invest
in overseas securities markets through legal channels such as purchasing qualified domestic institutional investor (QDII) fund product
shares and participating in Shanghai Hong Kong stock transactions.
There
can be no assurance however, that regulators in China will not take a contrary view or will not subsequently require us to undergo the
approval procedures and subject us to penalties for non-compliance. The approval of the CSRC or the CAC, and other compliance procedures
may be required in connection with any offering we may make and, if required, we cannot predict whether we will be able to obtain such
approval.
27
Recent
regulatory developments in China may subject the potential Joint Venture to additional regulatory review and disclosure requirement,
expose the potential Joint Venture to government interference, or otherwise restrict our ability to offer securities and raise capital
outside China, all of which could materially and adversely affect our business and the value of our securities.
In
light of the recent statements by the Chinese government indicating its intention to exert more oversight and control over overseas offerings
of China-based companies and the proposed CAC review for certain data processing operators in China, we may adjust our business operations
in the future, to comply with PRC laws regulating our industry and our business operations through the potential Joint Venture. However,
such efforts may not be completed in a liability-free manner or at all. We cannot guarantee that we will not be subject to PRC regulatory
inspection and/or review relating to cybersecurity, especially when there remains significant uncertainty as to the scope and manner
of the regulatory enforcement. If the potential Joint Venture is subject to regulatory inspection and/or review by the CAC or other PRC
authorities or are required by them to take any specific actions, it could cause suspension or termination of the future offering of
our securities, disruptions to our operations, result in negative publicity regarding our company, and divert our managerial and financial
resources. The potential Joint Venture may also be subject to fines or other penalties, which could materially and adversely affect our
business, financial condition, and results of operations.
We
may be subject to PRC laws relating to, among others, data security and restrictions over foreign investments in value-added telecommunications
services and other industry sectors set out in the Special Administrative Measures (Negative List) for the Access of Foreign Investment
(2020 Edition). Specifically, we may be subject to PRC laws relating to the collection, use, sharing, retention, security, and transfer
of confidential and private information, such as personal information and other data. These PRC laws apply not only to third-party transactions,
but also to transfers of information between us and our wholly foreign-owned enterprises in China, and other parties with which we have
commercial relations. These PRC laws and their interpretations and enforcement continue to develop and are subject to change, and the
PRC government may adopt other rules and restrictions in the future. The recent regulatory developments in China, in particular with
respect to restrictions on China-based companies raising capital offshore, and the government-led cybersecurity reviews of certain companies
with VIE structure, may lead to additional regulatory review in China over our financing and capital raising activities in the United States.
Pursuant to the PRC Cybersecurity Law, which was promulgated by the Standing Committee of the National People’s Congress on November
7, 2016 and took effect on June 1, 2017, personal information and important data collected and generated by a critical information infrastructure
operator in the course of its operations in China must be stored in China, and if a critical information infrastructure operator purchases
internet products and services that affect or may affect national security, it should be subject to cybersecurity review by the CAC.
The
PRC Cybersecurity Law also establishes more stringent requirements applicable to operators of computer networks, especially to operators
of networks which involve critical information infrastructure. The PRC Cybersecurity Law contains an overarching framework for regulating
Internet security, protection of private and sensitive information, and safeguards for national cyberspace security and provisions for
the continued government regulation of the Internet and content available in China. The PRC Cybersecurity Law emphasizes requirements
for network products, services, operations and information security, as well as monitoring, early detection, emergency response and reporting.
Due to the lack of further interpretations, the exact scope of “critical information infrastructure operator” remains unclear.
On
July 10, 2021, the CAC publicly issued the Cybersecurity Review Measures (the “Draft Measures”) for public comments until
July 25, 2021. According to the Draft Measures, the scope of cybersecurity reviews is extended to data processing operators engaging
in data processing activities that affect or may affect national security. The Draft Measures further requires that any operator applying
for listing on a foreign exchange must go through cybersecurity review if it possesses personal information of more than one million
users. According to the Draft Measures, a cybersecurity review assesses potential national security risk that may be brought about by
any procurement, data processing, or overseas listing. The review focuses on several factors, including, among others, (1) the risk
of theft, leakage, corruption, illegal use or export of any core or important data, or a large amount of personal information, and (2) the
risk of any critical information infrastructure, core or important data, or a large amount of personal information being affected, controlled
or maliciously exploited by a foreign government after a company is listed overseas. While the Draft Measures have been released for
consultation purposes, there is still uncertainty regarding the final content of the Draft Measures, its adoption timeline or effective
date, its final interpretation and implementation, and other aspects. Furthermore, the Standing Committee of the National People’s
Congress passed the Personal Information Protection Law of the PRC (“PIPL”), which became effective November 1, 2021, and
requires general network operators to obtain a personal information protection certification issued by recognized institutions in accordance
with the CAC regulation before such information can be transferred out of China.
28
Additionally,
the Company does not currently believe any of the Company’s scientific data resulting from activities in China to be conducted
by the potential Joint Venture would fall within the Measures for the Management of Scientific Data promulgated by the General Office
of the PRC State Council. Therefore, we do not believe the PRC would prevent us from seeking foreign approval and commercialization of
our product candidates. In the event the potential Joint Venture becomes subject to cybersecurity inspection and/or review by the CAC
or other PRC authorities or are required by them to take any specific actions, we and the potential Joint Venture will take any and all
actions to remain in compliance with any such laws or regulations or detailed implementations and interpretations thereof.
On
July 30, 2021, in response to the recent regulatory developments in China and actions adopted by the PRC government, the Chairman of
the SEC issued a statement requesting additional disclosures from offshore issuers with China-based operating companies before their
registration statements will be declared effective, including detailed disclosure related to VIE structures and whether the VIE and the
issuer, when applicable, received or were denied permission from the PRC authorities to list on U.S. exchanges and the risks that such
approval could be denied or rescinded.
On
August 1, 2021, the CSRC stated that it had taken note of the new disclosure requirements announced by the SEC regarding the listings
of Chinese companies and the recent regulatory development in China, and that the securities regulators in both countries should strengthen
communications on regulating China-related issuers. In light of our business operations, we should not be required to undergo the CAC
review for any offering that we may make. However, if the enacted version of the Draft Measures mandates clearance of cybersecurity review
and other specific actions to be completed by companies aiming to offer securities outside China, we cannot assure you that the PRC regulatory
authorities will not take a contrary view or will not subsequently require us to undergo the approval procedures and subject us to penalties
for non-compliance, or that if we are required to obtain such clearance, such clearance can be timely obtained, or at all. If the potential
Joint Venture becomes subject to cybersecurity inspection and/or review by the CAC or other PRC authorities or are required by them to
take any specific actions, it could cause suspension or termination of the future offering of our securities, disruptions to our operations,
result in negative publicity regarding our company, and divert our managerial and financial resources. We may also be subject to significant
fines or other penalties, which could materially and adversely affect our business, financial condition and results of operations. In
the event the potential Joint Venture becomes subject to cybersecurity inspection and/or review by the CAC or other PRC authorities or
are required by them to take any specific actions, we and the potential Joint Venture will take any and all actions to remain in compliance
with any such laws or regulations or detailed implementations and interpretations thereof.
The
PRC government has significant influence by enforcing existing rules and regulation, adopting new ones, or changing relevant industrial
policies in a manner that may materially increase our compliance cost, change relevant industry landscape or otherwise cause significant
changes to our business operations in China, which could result in material and adverse changes in our operations and cause the value
of our securities to significantly decline or be worthless.
The
PRC government has significant influence by allocating resources, providing preferential treatment to particular industries or companies,
or imposing industry-wide policies on certain industries. The PRC government may also amend or enforce existing rules and regulation,
or adopt ones, which could materially increase our compliance costs of the potential Joint Venture, change the relevant industry landscape,
or cause significant changes to the potential Joint Venture business operations in China. In addition, the PRC regulatory system is based
in part on government policies and internal guidance, some of which are not published on a timely basis, or at all, and some of which
may even have a retroactive effect. We may not be aware of all non-compliance incidents at all times, and we may face regulatory investigation,
fines and other penalties as a consequence. As a result of the changes in the industrial policies of the PRC government, including the
amendment to and/or enforcement of the related laws and regulations, companies with China-based operations, including us, and the industries
in which we operate, face significant compliance and operational risks and uncertainties. For example, on July 24, 2021, Chinese state
media, including Xinhua News Agency and China Central Television, announced a broad set of reforms targeting private education companies
providing after-school tutoring services and prohibiting foreign investments in institutions providing such after-school tutoring services.
As a result, the market value of certain U.S. listed companies with China-based operations in the affected sectors declined substantially.
We are not aware of any similar regulations that may be adopted to significantly curtail our business operations. However, if such other
adverse regulations or policies are adopted in China, the potential Joint Venture may be materially and adversely affected, which may
significantly disrupt our operations and adversely affect our business. In the event any of the foregoing were to occur, we and the potential
Joint Venture will take any and all actions to remain in compliance with any such regulations or policies.
29
We
may be subject to anti-monopoly concerns as a result of our doing business in China.
Article
3 of Anti-Monopoly Law of the People’s Republic of China prohibits “monopolistic practices,” which include: a) the
conclusion of monopoly agreements between operators; b) the abuse of dominant market position by operators; c) concentration of undertakings
which has or may have the effect of eliminating or restricting market competition. Also, according to Article 19, the operator(s) will
be assumed to have a dominant market position if it has following situation: a) an operator has 50% or higher market share in a relevant
market; b) two operators have 66% or higher market share in a relevant market; c) three operators have 75% or higher market share in
a relevant market. We believe we have not conducted any monopolistic practices in China, and that recent statements and regulatory actions
by the Chinese government do not impact our ability to conduct business, accept foreign investments, create the potential Joint Venture
with Wider or list on a U.S. or other foreign stock exchange. However, there can be no assurance that regulators in China will not promulgate
new laws and regulations or adopt new series of regulatory actions which may require us or the potential Joint Venture to meet new requirements
on the issues mentioned above.
We
may be subject to regulatory and other risks if we were to operate Variable Interest Entities in China
In
July 2021, the Chinese government provided new guidance on China-based companies raising capital outside of China, including through
arrangements called variable interest entities (“VIEs”). In light of such developments, the SEC has imposed enhanced disclosure
requirements on China-based companies seeking to register securities with the SEC. Although we do not have a VIE structure, due to our
potential Joint Venture, any future Chinese, U.S. or other rules and regulations that place restrictions on capital raising or other
activities may adversely affect our business and results of operations. If the business environment in China deteriorates from the perspective
of domestic or international investment, or if relations between China and the United States or other governments deteriorate, the
Chinese government may intervene with our operations and our business in China and United States, as well as the market price of
our securities, may also be adversely affected.
Our
business does not appear to be within the targeted areas of concern by the Chinese government. However, because of our intended potential
Joint Venture, there is a risk that the Chinese government may in the future seek to affect operations of any company with any level
of operations in Hong Kong or China, including its ability to offer securities to investors, list its securities on a U.S. or other
foreign exchange, conduct its business or accept foreign investment. Substantial uncertainties and restrictions with respect to the political
and economic policies of the PRC government and PRC laws and regulations could have a significant impact upon the business that we may
be able to conduct in the PRC and accordingly on the results of our operations and financial condition. If any or all of the foregoing
were to occur, it could, in turn, result in a material change in the Company’s operations and/or the value of its common stock
and/or significantly limit or completely hinder its ability to offer or continue to offer securities to investors and cause the value
of such securities to significantly decline or be worthless. Furthermore, in the event any of the foregoing were to occur or to be interpreted
differently, we and the potential Joint Venture will take any and all actions to remain in compliance with any such laws or regulations
or detailed implementations and interpretations thereof.
Risks
Related to Our Intellectual Property
If
we are unable to obtain and maintain patent protection for our technologies and products, or if the scope of the patent protection obtained
is not sufficiently broad, our competitors could develop and commercialize technologies and products similar or identical to ours, and
our ability to successfully commercialize our technologies and products may be impaired.
Our
success depends in large part on our ability to obtain and maintain patent protection in the United States and other countries with
respect to our products. We seek to protect our proprietary position by filing patent applications in the United States and abroad
related to our technologies and products. If we do not adequately protect our intellectual property, competitors may be able to use our
technologies and erode or negate any competitive advantage that we may have, which could harm our business and ability to achieve profitability.
To protect our proprietary positions, we file patent applications in the United States and abroad related to our novel technologies
and products that are important to our business. The patent application and prosecution processes are expensive and time-consuming. We
and our current licensees, or any future licensors and licensees may not be able to file and prosecute all necessary or desirable patent
applications at a reasonable cost or in a timely manner. We or our current licensees, or any future licensors or licensees may also fail
to identify patentable aspects of our research and development before it is too late to obtain patent protection. Therefore, these and
any of our
30
patents and applications may not be prosecuted and enforced in a manner consistent with the best interests of our business.
It is possible that defects of form in the preparation or filing of our patents or patent applications may exist, or may arise in the
future, such as with respect to proper priority claims, inventorship, claim scope or patent term adjustments. If our current licensees,
or any future licensors or licensees, are not fully cooperative or disagree with us as to the prosecution, maintenance or enforcement
of any patent rights, such patent rights could be compromised and we might not be able to prevent third parties from making, using and
selling competing products. If there are material defects in the form or preparation of our patents or patent applications, such patents
or applications may be invalid and unenforceable. Moreover, our competitors may independently develop equivalent knowledge, methods and
know-how. Any of these outcomes could impair our ability to prevent competition from third parties.
Changes
in either the patent laws or interpretation of the patent laws in the United States and other countries may diminish the value of
our patents or narrow the scope of our patent protection. In addition, the laws of foreign countries may not protect our rights to the
same extent as the laws of the United States. Furthermore, recent changes in patent laws in the United States, including the
America Invents Act of 2011, may affect the scope, strength and enforceability of our patent rights or the nature of proceedings that
may be brought by us related to our patent rights.
We
may not be aware of all third-party intellectual property rights potentially relating to our current and future our products. Publications
of discoveries in the scientific literature often lag behind the actual discoveries, and patent applications in the United States
and other jurisdictions are typically not published until eighteen months after filing, or in some cases not at all. Therefore, we cannot
be certain that we were the first to make the inventions claimed in our patents or pending patent applications, or that we were the first
to file for patent protection of such inventions. Similarly, should we own any patents or patent applications in the future, we may not
be certain that we were the first to file for patent protection for the inventions claimed in such patents or patent applications. As
a result, the issuance, scope, validity and commercial value of our patent rights cannot be predicted with any certainty. Moreover, we
may be subject to a third-party pre-issuance submission of prior art to the U.S. Patent and Trademark Office, or USPTO, or become involved
in opposition, derivation, re-examination, inter partes review or interference proceedings, in the United States or elsewhere,
challenging our patent rights or the patent rights of others. An adverse determination in any such submission, proceeding or litigation
could reduce the scope of, or invalidate, our patent rights, allow third parties to commercialize our technology or products and compete
directly with us, without payment to us, or result in our inability to manufacture or commercialize products without infringing third-party
patent rights.
Our
pending and future patent applications may not result in patents being issued that protect our technology or products, in whole or in
part, or which effectively prevent others from commercializing competitive technologies and products. Even if our patent applications
issue as patents, they may not issue in a form that will provide us with any meaningful protection against competing products or processes
sufficient to achieve our business objectives, prevent competitors from competing with us or otherwise provide us with any competitive
advantage. Our competitors may be able to circumvent our owned or licensed patents by developing similar or alternative technologies
or products in a non-infringing manner. Alternatively, our competitors may seek approval to market their own products similar to or otherwise
competitive with our products. In these circumstances, we may need to defend and/or assert our patents, including by filing lawsuits
alleging patent infringement. In any of these types of proceedings, a court or other agency with jurisdiction may find our patents invalid
and/or unenforceable.
The
issuance of a patent is not conclusive as to its inventorship, scope, validity or enforceability, and our owned and licensed patents
may be challenged in the courts or patent offices in the United States and abroad. Such challenges may result in loss of exclusivity
or freedom to operate or in patent claims being narrowed, invalidated or held unenforceable, in whole or in part, which could limit our
ability to stop others from using or commercializing similar or identical technologies and products, or limit the duration of the patent
protection of our technologies and products. In addition, given the amount of time required for the development, testing and regulatory
review of new products, patents protecting such candidates might expire before or shortly after such candidates are commercialized.
31
We
may become involved in lawsuits to protect or enforce our patents or other intellectual property, which could be expensive, time-consuming
and unsuccessful.
Competitors
may infringe our issued patents, trademarks, copyrights or other intellectual property. To counter infringement or unauthorized use,
we may be required to file infringement claims, which can be expensive and time-consuming and divert the time and attention of our management
and scientific personnel. Any claims we assert against perceived infringers could provoke these parties to assert counterclaims against
us alleging that we infringe their patents, trademarks, copyrights or other intellectual property. In addition, in a patent infringement
proceeding, there is a risk that a court will decide that a patent of ours is invalid or unenforceable, in whole or in part, and that
we do not have the right to stop the other party from using the invention at issue. There is also a risk that, even if the validity of
such patents is upheld, the court will construe the patent’s claims narrowly or decide that we do not have the right to stop the
other party from using the invention at issue on the grounds that our patents do not cover the invention. An adverse outcome in a litigation
or proceeding involving our patents could limit our ability to assert our patents against those parties or other competitors and may
curtail or preclude our ability to exclude third parties from making and selling similar or competitive products. Similarly, if we assert
trademark infringement claims, a court may determine that the marks we have asserted are invalid or unenforceable, or that the party
against whom we have asserted trademark infringement has superior rights to the marks in question. In this case, we could ultimately
be forced to cease use of such trademarks.
In
any infringement litigation, any award of monetary damages we receive may not be commercially valuable. Furthermore, because of the substantial
amount of discovery required in connection with intellectual property litigation, there is a risk that some of our confidential information
could be compromised by disclosure during litigation. In addition, there could be public announcements of the results of hearings, motions
or other interim proceedings or developments and if securities analysts or investors perceive these results to be negative, it could
have a substantial adverse effect on the price of our common stock. Moreover, there can be no assurance that we will have sufficient
financial or other resources to file and pursue such infringement claims, which typically last for years before they are concluded. Some
of our competitors may be able to sustain the costs of such litigation or proceedings more effectively than we can because of their greater
financial resources and more mature and developed intellectual property portfolios. Even if we ultimately prevail in such claims, the
monetary cost of such litigation and the diversion of the attention of our management and scientific personnel could outweigh any benefit
we receive as a result of the proceedings.
Accordingly,
despite our efforts, we may not be able to prevent third parties from infringing, misappropriating or successfully challenging our intellectual
property rights. Uncertainties resulting from the initiation and continuation of patent litigation or other proceedings could have a
negative impact on our ability to compete in the marketplace.
Third
parties may initiate legal proceedings alleging that we are infringing their intellectual property rights, the outcome of which would
be uncertain and could significantly harm our business.
Our
commercial success depends, in part, on our ability to develop, manufacture, market and sell our products and use our proprietary technologies
without infringing the intellectual property and other proprietary rights of third parties.
There
is potential for a substantial amount of intellectual property litigation in our industry, and we may become party to, or threatened
with, litigation or other adversarial proceedings regarding intellectual property rights with respect to our technology or products,
including interference proceedings before the USPTO. Intellectual property disputes arise in a number of areas including with respect
to patents, use of other proprietary rights and the contractual terms of license arrangements. Third parties may assert claims against
us based on existing or future intellectual property rights. The outcome of intellectual property litigation is subject to uncertainties
that cannot be adequately quantified in advance.
If
we are found to infringe a third party’s intellectual property rights, we could be forced, including by court order, to cease developing,
manufacturing or commercializing the infringing product candidate or product. Alternatively, we may be required to obtain a license from
such third party in order to use the infringing technology and continue developing, manufacturing or marketing the infringing product
candidate.
However,
we may not be able to obtain any required license on commercially reasonable terms or at all. Even if we were able to obtain a license,
it could be non-exclusive, thereby giving our competitors access to the same technologies licensed to us. In addition, we could be found
liable for monetary damages, including treble damages and attorneys’ fees if we are found to have willfully infringed a patent.
A finding of infringement could prevent us from commercializing our products or force us to cease some of our business operations. Claims
that we have misappropriated the confidential information or trade secrets of third parties could have a similar negative effect on our
business.
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If
we are unable to protect the confidentiality of our trade secrets, our business and competitive position would be harmed.
In
addition to seeking patent and trademark protection for our products, we also rely on trade secrets, including unpatented know-how, technology
and other proprietary information, to maintain our competitive position. We seek to protect our trade secrets, in part, by entering into
non-disclosure and confidentiality agreements with parties who have access to them, such as our employees, corporate collaborators, outside
scientific collaborators, contract manufacturers, consultants, advisors and other third parties. We also enter into confidentiality and
invention or patent assignment agreements with our employees and consultants. Despite these efforts, any of these parties may breach
the agreements and disclose our proprietary information, including our trade secrets. Monitoring unauthorized uses and disclosures of
our intellectual property is difficult, and we do not know whether the steps we have taken to protect our intellectual property will
be effective. In addition, we may not be able to obtain adequate remedies for any such breaches. Enforcing a claim that a party illegally
disclosed or misappropriated a trade secret is difficult, expensive and time-consuming, and the outcome is unpredictable. In addition,
some courts inside and outside the United States are less willing or unwilling to protect trade secrets.
Moreover,
our competitors may independently develop knowledge, methods and know-how equivalent to our trade secrets. Competitors could purchase
our products and replicate some or all of the competitive advantages we derive from our development efforts for technologies on which
we do not have patent protection. If any of our trade secrets were to be lawfully obtained or independently developed by a competitor,
we would have no right to prevent them, or those to whom they communicate it, from using that technology or information to compete with
us. If any of our trade secrets were to be disclosed to or independently developed by a competitor, our competitive position would be
harmed.
We
may not be able to protect our intellectual property rights throughout the world.
Filing,
prosecuting and defending patents on products in all countries throughout the world would be prohibitively expensive, and our intellectual
property rights in some countries outside the United States could be less extensive than those in the United States. In some
cases, we may not be able to obtain patent protection for certain licensed technology outside the United States. In addition, the
laws of some foreign countries do not protect intellectual property rights to the same extent as federal and state laws in the United States,
even in jurisdictions where we do pursue patent protection. Consequently, we may not be able to prevent third parties from practicing
our inventions in all countries outside the United States, even in jurisdictions where we do pursue patent protection or from selling
or importing products made using our inventions in and into the United States or other jurisdictions.
Competitors
may use our technologies in jurisdictions where we have not pursued and obtained patent protection to develop their own products and,
further, may export otherwise infringing products to territories where we have patent protection, but enforcement is not as strong as
that in the United States. These products may compete with our products and preclinical programs and our patents or other intellectual
property rights may not be effective or sufficient to prevent them from competing.
Many
companies have encountered significant problems in protecting and defending intellectual property rights in foreign jurisdictions. The
legal systems of certain countries, particularly certain developing countries, do not favor the enforcement of patents, trade secrets
and other intellectual property protection, particularly those relating to biotechnology products, which could make it difficult for
us to stop the infringement of our patents, if pursued and obtained, or marketing of competing products in violation of our proprietary
rights generally.
Proceedings
to enforce our patent rights in foreign jurisdictions could result in substantial costs and divert our efforts and attention from other
aspects of our business, could put our patents at risk of being invalidated or interpreted narrowly and our patent applications at risk
of not issuing and could provoke third parties to assert claims against us.
We
may not prevail in any lawsuits that we initiate and the damages or other remedies awarded, if any, may not be commercially meaningful.
Accordingly, our efforts to enforce our intellectual property rights around the world may be inadequate to obtain a significant commercial
advantage from the intellectual property that we develop or license.
33
Risks
Related to Regulatory Approval of Our Products and Other Legal Compliance Matters
Even
if we complete the necessary preclinical studies and clinical trials, the regulatory approval process is expensive, time-consuming and
uncertain and may prevent us or any future collaborators from obtaining approvals for the commercialization of some or all of our products.
As a result, we cannot predict when or if, and in which territories, we, or any future collaborators, will obtain marketing approval
to commercialize a product candidate.
Our
products and the activities associated with their development and commercialization, including their design, research, testing, manufacture,
safety, efficacy, quality control, recordkeeping, labelling, packaging, storage, approval, advertising, promotion, sale, distribution,
import, export and reporting of safety and other post-market information, are subject to comprehensive regulation by the FDA and other
foreign regulatory agencies including the NMPA. Failure to obtain marketing approval for a product candidate will prevent us from commercializing
the product candidate. As a result of the FDA reclassification ruling in December 2019, which impacted the classification of our
devices, we had to suspend marketing of our first-Generation medical device for the treatment of anxiety and insomnia. We are presently
communicating with the FDA with regard to amending our previous 510(k) Application for the treatment of anxiety and insomnia with our
Gen-1 device in accordance with the FDA ruling. Our Gen – 2 medical device has completed development and is in the prototype stage
of manufacturing and testing. Securing marketing approval from the FDA in the United States requires the submission of extensive testing
and clinical data to regulatory authorities for each therapeutic indication to establish the candidate’s safety and efficacy. Securing
marketing approval also requires the submission of information about the product manufacturing process to, and inspection of manufacturing
facilities by, the regulatory authorities. Our products may not be effective, may be only moderately effective or may prove to have undesirable
or unintended side effects, toxicities or other characteristics that may preclude our obtaining marketing approval or prevent or limit
commercial use.
In
addition, changes in marketing approval policies during the development period, changes in or the enactment of additional statutes or
regulations or changes in regulatory review for each submitted product application may cause delays in the approval or rejection of an
application. Regulatory authorities have substantial discretion in the approval process and may refuse to accept any application or may
decide that our data is insufficient for approval and require additional preclinical, clinical, or other studies. In addition, varying
interpretations of the data obtained from preclinical and clinical testing could delay, limit, or prevent marketing approval of a product
candidate. Any marketing approval we ultimately obtain may be limited or subject to restrictions or post-approval commitments that render
the approved product not commercially viable.
If
we experience delays in obtaining approval or if we fail to obtain approval of our products, the commercial prospects for our products
may be harmed and our ability to generate revenues will be impaired.
Failure
to obtain marketing approval in foreign jurisdictions would prevent our products from being marketed in these territories. Any approval
we are granted for our products in the United States would not assure approval of our products in foreign jurisdictions.
To
market and sell our products in China and any other jurisdictions, we must obtain separate marketing approvals and comply with numerous
and varying regulatory requirements. The approval procedure varies among countries and can involve additional testing. The time required
to obtain approval may differ substantially from that required to obtain approval from the FDA in the United States. The regulatory approval
process outside the United States generally includes all the risks associated with obtaining approval from the FDA. In addition,
in many countries outside the United States, it is required that the product be approved for reimbursement before the product can
be approved for sale in that country. We may not obtain approvals from regulatory authorities outside the United States on a timely
basis, if at all. Approval by the FDA does not ensure approval by regulatory authorities in other countries or jurisdictions, and approval
by one regulatory authority outside the United States does not ensure approval by regulatory authorities in other countries or jurisdictions
or by the FDA. However, failure to obtain approval in one jurisdiction may impact our ability to obtain approval elsewhere. We may not
be able to file for marketing approvals and may not receive necessary approvals to commercialize our products in any market.
34
The
U.S. FDA, Chinese National Medical Products Administration and other comparable foreign regulatory authorities may not accept data from
trials conducted in locations outside of their jurisdiction.
We
have chosen, and may continue to choose, to conduct international clinical trials. The acceptance of study data by the U.S. FDA, Chinese
National Medical Products Administration (NMPA) or other comparable foreign regulatory authority from clinical trials conducted outside
of their respective jurisdictions may be subject to certain conditions. In cases where data from foreign clinical trials are intended
to serve as the basis for marketing approval in the United States, the FDA will generally not approve the application on the basis
of foreign data alone unless (1) the data are applicable to the United States population and United States medical practice;
(2) the trials are performed by clinical investigators of recognized competence and pursuant to Current Good Clinical Practice requirements;
and (3) the FDA is able to validate the data through an on-site inspection or other appropriate means. The FDA may accept the use
of some foreign data to support a marketing approval if the clinical trial meets certain requirements. Additionally, the FDA’s
clinical trial requirements, including the adequacy of the subject population studied and statistical powering, must be met. Furthermore,
such foreign trials would be subject to the applicable local laws of the foreign jurisdictions where the trials are conducted. There
can be no assurance that the FDA, NMPA or any applicable foreign regulatory authority will accept data from trials conducted outside
of its respective jurisdiction. If the FDA, NMPA or any applicable foreign regulatory authority does not accept such data, it would result
in the need for additional trials, which would be costly and time-consuming and delay aspects of our business plan, and which may result
in our product candidates not receiving approval for commercialization in the applicable jurisdiction.
Even
if we obtain marketing approvals for our products, the terms of approvals and ongoing regulation of our products may limit how we manufacture
and market our products and compliance with such requirements may involve substantial resources, which could materially impair our ability
to generate revenue.
Even
if marketing approval of a product candidate is granted, an approved product and its manufacturer and marketer are subject to ongoing
review and extensive regulation, including the potential requirements to implement a risk evaluation and mitigation strategy or to conduct
costly post-marketing studies or clinical trials and surveillance to monitor the safety or efficacy of the product. We must also comply
with requirements concerning advertising and promotion for any of our products for which we obtain marketing approval. Promotional communications
are subject to a variety of legal and regulatory restrictions and must be consistent with the information in the product’s approved
labelling. Thus, we will not be able to promote any products we develop for indications or uses for which they are not approved. In addition,
manufacturers of approved products and those manufacturers’ facilities are required to comply with extensive FDA requirements including
ensuring quality control and manufacturing procedures, which include requirements relating to quality control and quality assurance as
well as the corresponding maintenance of records and documentation and reporting requirements. We and our contract manufacturers could
be subject to periodic unannounced inspections by the FDA to monitor and ensure compliance.
Our
employees, independent contractors, principal investigators, consultants, commercial partners and vendors may engage in misconduct or
other improper activities, including non-compliance with regulatory standards and requirements.
We
are exposed to the risk of employee fraud or other misconduct or failure to comply with applicable regulatory requirements. Misconduct
by employees and independent contractors, such as principal investigators, consultants, commercial partners and vendors, could include
failures to comply with regulations of the FDA and other comparable regulatory authorities, to provide accurate information to such regulators,
to comply with manufacturing standards we have established, to comply with healthcare fraud and abuse laws, to report financial information
or data accurately or to disclose unauthorized activities to us. In particular, sales, marketing and other business arrangements in the
healthcare industry are subject to extensive laws intended to prevent fraud, kickbacks, self-dealing and other abusive practices. These
laws may restrict or prohibit a wide range of business activities, including, but not limited to, research, manufacturing, distribution,
pricing, discounting, marketing and promotion, sales commission, customer incentive programs and other business arrangements. Employee
and independent contractor misconduct could also involve the improper use of individually identifiable information, including, without
limitation, information obtained in the course of clinical trials, which could result in regulatory sanctions and serious harm to our
reputation. In addition, federal procurement laws impose substantial penalties for misconduct in connection with government contracts
and require certain contractors to maintain a code of business ethics and conduct. It is not always possible to identify and deter employee
and independent contractor misconduct, and any precautions we take to detect and prevent improper activities may not be effective in
controlling unknown or unmanaged risks or losses or in protecting us from governmental investigations or other actions or lawsuits stemming
from a failure to comply with such laws. If any such actions are instituted against us, those actions could have a significant impact
on our business, including the imposition of civil, criminal and administrative penalties, damages, monetary fines, disgorgement, possible
exclusion from participation in Medicare, Medicaid and other federal healthcare programs, contractual damages, reputational harm, diminished
profits and future earnings, additional reporting or oversight obligations if we become subject to a corporate integrity agreement or
other agreement to resolve allegations of non-compliance with the law and curtailment or restructuring of our operations, any of which
could adversely affect our ability to operate.
35
Our
current and future relationships with healthcare professionals, principal investigators, consultants, customers and third-party payors
in the United States and elsewhere may be subject, directly or indirectly, to applicable anti-kickback, fraud and abuse, false claims,
physician payment transparency, health information privacy and security and other healthcare laws and regulations, which could expose
us to penalties.
Healthcare
providers, physicians, clinicians, and third-party payors in the United States and elsewhere will play a primary role in the recommendation
and prescription of any products for which we obtain marketing approval. Our current and future arrangements with healthcare professionals,
principal investigators, consultants, customers and third-party payors may expose us to broadly applicable fraud and abuse and other
healthcare laws, including, without limitation, the federal Anti-Kickback Statute and the federal False Claims Act, that may constrain
the business or financial arrangements and relationships through which we research, sell, market and distribute any products for which
we obtain marketing approval. In addition, we may be subject to physician payment transparency laws and patient privacy and security
regulation by the federal government and by the states and foreign jurisdictions in which we conduct our business. The applicable federal,
state and foreign healthcare laws that may affect our ability to operate include the following:
●
the
federal Anti-Kickback Statute, which prohibits, among other things, persons from knowingly and willfully soliciting, offering, receiving
or providing remuneration, directly or indirectly, in cash or in kind, to induce or reward, or in return for, either the referral
of an individual for, or the purchase, lease, order or recommendation of, any good, facility, item or service, for which payment
may be made, in whole or in part, under federal and state healthcare programs such as Medicare and Medicaid;
●
federal
civil and criminal false claims laws, including the federal False Claims Act, which impose criminal and civil penalties, including
through civil whistle blower or qui tam actions, against individuals or entities for, among other things, knowingly presenting,
or causing to be presented, to the federal government, including the Medicare and Medicaid programs, claims for payment that are
false or fraudulent or making a false statement to avoid, decrease or conceal an obligation to pay money to the federal government;
●
the
civil monetary penalties statute, which imposes penalties against any person or entity who, among other things, is determined to
have presented or caused to be presented a claim to a federal health program that the person knows or should know is for an item
or service that was not provided as claimed or is false or fraudulent;
●
the
federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, which created additional federal criminal statutes
that prohibit knowingly and willfully executing, or attempting to execute, a scheme to defraud any healthcare benefit program or
obtain, by means of false or fraudulent pretenses, representations or promises, any of the money or property owned by, or under the
custody or control of, any healthcare benefit program, regardless of whether the payor is public or private, knowingly and willfully
embezzling or stealing from a health care benefit program, willfully obstructing a criminal investigation of a health care offense
and knowingly and willfully falsifying, concealing or covering up by any trick or device a material fact or making any materially
false statements in connection with the delivery of, or payment for, healthcare benefits, items or services relating to healthcare
matters;
●
HIPAA,
as amended by the Health Information Technology for Economic and Clinical Health Act of 2009, or HITECH, and their respective implementing
regulations, which impose obligations on “covered entities,”
including certain healthcare providers, health plans, and healthcare clearinghouses, as well as their respective “business associates”
that create, receive, maintain or transmit individually identifiable health information for or on behalf of a covered entity, with respect
to safeguarding the privacy, security and transmission of individually identifiable health information;
●
the
federal Physician Payments Sunshine Act, created under Section 6002 of Patient Protection and Affordable Care Act, as amended
by the Health Care and Education Reconciliation Act, or collectively, the ACA, and its implementing regulations, created annual reporting
requirements for manufacturers of products, devices, biologicals and medical supplies for certain payments and “transfers of
value” provided to physicians and teaching hospitals, as well as ownership and investment interests held by physicians and
their immediate family members; and
36
●
analogous
state and foreign laws, such as state anti-kickback and false claims laws, which may apply to sales or marketing arrangements and
claims involving healthcare items or services reimbursed by non-governmental third-party payors, including private insurers; state
and foreign laws that require companies to comply with voluntary compliance guidelines and the relevant compliance guidance promulgated
by the federal government or to adopt compliance programs as prescribed by state laws and regulations, or that otherwise restrict
payments that may be made to healthcare providers; state and foreign laws that require manufacturers to report information related
to payments and other transfers of value to physicians and other healthcare providers or marketing expenditures; and state and foreign
laws governing the privacy and security of health information in certain circumstances, many of which differ from each other in significant
ways and often are not pre-empted by HIPAA, thus complicating compliance efforts.
Further,
the ACA, among other things, amended the intent requirement of the federal Anti-Kickback Statute and certain criminal statutes governing
healthcare fraud. A person or entity no longer needs to have actual knowledge of the statute or specific intent to violate it. In addition,
the ACA provided that the government may assert that a claim including items or services resulting from a violation of the federal Anti-
Kickback Statute constitutes a false or fraudulent claim for purposes of the False Claims Act.
Efforts
to ensure that our future business arrangements with third parties will comply with applicable healthcare laws and regulations may involve
substantial costs. It is possible that governmental authorities will conclude that our business practices may not comply with current
or future statutes, regulations or case law involving applicable fraud and abuse or other healthcare laws. If our operations are found
to be in violation of any of these laws or any other governmental regulations that may apply to us, we may be subject to significant
civil, criminal and administrative penalties, including, without limitation, damages, monetary fines, disgorgement, possible exclusion
from participation in Medicare, Medicaid and other federal healthcare programs, contractual damages, reputational harm, diminished profits
and future earnings, additional reporting or oversight obligations if we become subject to a corporate integrity agreement or other agreement
to resolve allegations of non-compliance with the law and curtailment or restructuring of our operations, any of which could adversely
affect our ability to operate our business and pursue our strategy. If any of the physicians or other healthcare providers or entities
with whom we expect to do business, including future collaborators, are found not to comply with applicable laws, they may be subject
to criminal, civil or administrative sanctions, including exclusions from participation in government healthcare programs, which could
also affect our business.
Recently
enacted and future legislation may increase the difficulty and cost for us and our collaborators to obtain marketing approval of and
commercialize our products and affect the prices we may obtain.
In
the United States and some foreign jurisdictions, there have been a number of legislative and regulatory changes and proposed changes
regarding the healthcare system that could prevent, alter or delay marketing approval of our existing or future products, restrict or
regulate post-approval activities and affect our ability to profitably sell any products for which we obtain marketing approval.
Among
policy makers and payors in the United States and elsewhere, there is significant interest in promoting changes in healthcare systems
with the stated goals of containing healthcare costs, improving quality and/or expanding access. For example, the ACA, which was enacted
in the United States in March 2010, includes measures to change health care delivery, decrease the number of individuals without
insurance, ensure access to certain basic health care services, and contain the rising cost of care. The healthcare reform movement,
including the enactment of the ACA, has significantly changed health care financing by both governmental and private insurers in the
United States. With respect to pharmaceutical manufacturers, the ACA increased the number of individuals with access to health care
coverage, but it simultaneously imposed, among other things, increased liability for rebates and discounts owed to certain entities and
government health care programs, and new transparency reporting requirements under the Physician Payments Sunshine Act. For a detailed
discussion of the ACA’s provisions of importance to the pharmaceutical industry, as well as a description of reform legislation
passed subsequent to the ACA, see the section titled “Business — Government Regulation — Healthcare Reform Efforts.”
Since
its enactment, there have been judicial and Congressional challenges to certain aspects of the ACA, as well as efforts to repeal or replace
certain aspects of the ACA. We continue to evaluate the effect that the ACA and its possible repeal and replacement has on our business.
It is uncertain the extent to which any such changes may impact our business or financial condition.
37
In
addition to the ACA, other federal health reform measures have been proposed and adopted in the United States. For example, legislation
has been enacted to reduce the level of reimbursement paid to providers under the Medicare program over time, as well as phase in alternative
payment models for provider services under the Medicare program with the goal of incentivizing the attainment of pre-defined quality
measures. As these measures are not fully in effect, and since the U.S. Congress could intervene to prevent their full implementation,
at this time, it is unclear how payment reductions or the introduction of the quality payment program will impact overall physician reimbursement
under the Medicare program. It is also unclear if changes in Medicare payments to providers would impact such providers’ willingness
to prescribe and administer our existing or future products, if approved. Further, there has been heightened governmental scrutiny over
the manner in which companies set prices for their marketed products. For example, there have been several recent Congressional inquiries
and proposed and enacted federal and state legislation designed to, among other things, review the relationship between pricing and patient
programs, and reform government program reimbursement methodologies for products.
We
expect that the ACA, as well as other healthcare reform measures that may be adopted in the future, may result in more rigorous coverage
criteria and in additional downward pressure on the price that we receive for any approved product. Any reduction in reimbursement from
Medicare or other government programs may result in a similar reduction in payments from private payors. The implementation of cost containment
measures or other healthcare reforms may prevent us from being able to generate revenue, attain profitability or commercialize our products.
Legislative
and regulatory proposals have been made to expand post-approval requirements and restrict sales and promotional activities for products.
We cannot be sure whether additional legislative changes will be enacted, or whether the FDA regulations, guidance or interpretations
will be changed, or what the impact of such changes on the marketing approvals of our products, if any, may be. In addition, increased
scrutiny by the U.S. Congress of the FDA’s approval process may significantly delay or prevent marketing approval, as well as subject
us to more stringent product labelling and post-marketing testing and other requirements.
Various
new healthcare reform proposals are emerging at the federal and state level. It is also possible that additional governmental action
will be taken in response to the COVID-19 pandemic. Any new federal and state healthcare initiatives that may be adopted could limit
the amounts that federal and state governments will pay for healthcare products and services, and could harm our business, financial
condition and results of operations.
Our
business activities may be subject to the U.S. Foreign Corrupt Practices Act, or the FCPA, and similar anti-bribery and anti-corruption
laws of other countries in which we operate, as well as U.S. and certain foreign export controls, trade sanctions and import laws and
regulations. Compliance with these legal requirements could limit our ability to compete in foreign markets and subject us to liability
if we violate them.
If
we further expand our operations outside of the United States, we must dedicate additional resources to comply with numerous laws
and regulations in each jurisdiction in which we plan to operate. Our business activities may be subject to the FCPA and similar anti-bribery
or anti-corruption laws, regulations or rules of other countries in which we operate. The FCPA generally prohibits companies and their
employees and third-party intermediaries from offering, promising, giving or authorizing the provision of anything of value, either directly
or indirectly, to a non-U.S. government official in order to influence official action or otherwise obtain or retain business. The FCPA
also requires public companies to make and keep books and records that accurately and fairly reflect the transactions of the corporation
and to devise and maintain an adequate system of internal accounting controls. Our business is heavily regulated and therefore involves
significant interaction with public officials, including officials of non-U.S. governments. Additionally, in many other countries, hospitals
owned and operated by the government and doctors and other hospital employees would be considered foreign officials under the FCPA. Recently
the SEC and DOJ have increased their FCPA enforcement activities with respect to biotechnology and pharmaceutical companies. There is
no certainty that all our employees, agents or contractors, or those of our affiliates, will comply with all applicable laws and regulations,
particularly given the high level of complexity of these laws. Violations of these laws and regulations could result in fines, criminal
sanctions against us, our officers or our employees, disgorgement and other sanctions and remedial measures and prohibitions on the conduct
of our business. Any such violations could include prohibitions on our ability to offer our products in one or more countries and could
materially damage our reputation, our brand, our international activities, our ability to attract and retain employees and our business,
prospects, operating results and financial condition.
38
In
addition, our products and technology may be subject to U.S. and foreign export controls, trade sanctions and import laws and regulations.
Governmental regulation of the import or export of our products and technology, or our failure to obtain any required import or export
authorization for our products, when applicable, could harm our international sales and adversely affect our revenue. Compliance with
applicable regulatory requirements regarding the export of our products may create delays in the introduction of our products in international
markets or, in some cases, prevent the export of our products to some countries altogether. Furthermore, U.S. export control laws and
economic sanctions prohibit the shipment of certain products and services to countries, governments and persons targeted by U.S. sanctions.
If we fail to comply with export and import regulations and such economic sanctions, penalties could be imposed, including fines and/or
denial of certain export privileges. Moreover, any new export or import restrictions, new legislation or shifting approaches in the enforcement
or scope of existing regulations, or in the countries, persons or products targeted by such regulations, could result in decreased use
of our products by, or in our decreased ability to export our products to, existing or potential customers with international operations.
Any decreased use of our products or limitation on our ability to export or sell access to our products would likely adversely affect
our business.
Risks
Related to Ownership of Our Common Stock and Warrants and Our Status as a Public Company
An
active trading market for our common stock and warrants may not develop and you may not be able to resell your shares at or above the
initial offering price, if at all.
We
completed our initial public offering in September 2022. In our initial public offering, we issued shares of common stock and common
stock warrants. These securities are listed for trading on the Nasdaq Stock Market. The timing of our initial public offering and
the subsequent period of time until the filing of this Form 10-K has coincided with a downturn in the U.S. economy and the capital markets.
The downturn has negatively affected trading in securities generally, and our securities in particular. Our securities have not traded
at the same prices as they were issued in our initial public offering. Generally, there is a limited trading market for our shares of
common stock and warrants. there can be no assurance that there will be an increase in the trading our of securities. as a result, investors
may be required to hold our securities for a longer period than originally contemplated.
Warrants
are speculative in nature.
Our
warrants do not confer any rights of common stock ownership on their holders, such as voting rights or the right to receive dividends,
but rather merely represent the right to acquire shares of our common stock at a fixed price for a limited period of time. Specifically,
commencing on the date of issuance, holders of the warrants may exercise their right to acquire the common stock and pay an exercise
price of $4.15 per share prior to three (3) years from the date of issuance, after which date any unexercised warrants will expire and
have no further value.
The
warrants may not have any value.
The
warrants have an exercise term which expires three (3) years from the date of the closing of our IPO (September 16, 2022) at an
initial exercise price equal to $4.15 per share. There can be no assurance that the market price of our shares of common stock will
ever equal or exceed the exercise price of the warrants. In the event that the stock price of our shares of common stock does not
exceed the exercise price of the warrants during the period when the warrants are exercisable, the warrants may not have any
value.
We
may redeem your unexpired warrants prior to their exercise at a time that is disadvantageous to you, thereby making your warrants worthless.
We
have the ability to redeem outstanding warrants at any time after they become exercisable and prior to their expiration, at a price of
$0.01 per warrant, provided that the last reported sales price of our shares equal or exceed $12.45 per share (as adjusted for share
splits, share capitalizations, rights issuances, subdivisions, reorganizations, recapitalizations and the like) for any 20 trading days
within a 30 trading-day period ending on the third trading day prior to the date we send the notice of redemption to the warrant holders.
If and when the warrants become redeemable by us, we may not exercise our redemption right if the issuance of shares upon exercise of
the warrants is not exempt from registration or qualification under applicable state blue sky laws or we are unable to effect such registration
or qualification. We will use our best efforts to register or qualify such shares under the blue sky laws of the state of residence in
those states in which the warrants were offered by us in our recently completed public offering. To date, however, we have not filed
any registration statement to provide for the exercise and free trading of the underlying shares of common stock. Redemption of the outstanding
warrants could force you (i) to exercise your warrants and pay the exercise price therefor at a time when it may be disadvantageous for
you to do so, (ii) to sell your warrants at the then-current market price when you might otherwise wish to hold your warrants or (iii)
to accept the nominal redemption price which, at the time the outstanding warrants are called for redemption, is likely to be substantially
less than the market value of your warrants.
39
Holders
of the Warrants will have no rights as a common stockholder until they acquire our common stock.
Until
holders of the warrants acquire shares of our common stock upon exercise of the warrants, the holders will have no rights with respect
to shares of our common stock issuable upon exercise of the warrants. Upon exercise of the warrants, the holder will be entitled to exercise
the rights of a common stockholder as to the security exercised only as to matters for which the record date occurs after the exercise.
Our
Warrant Agreement designates the courts of the State of New York or the United States District Court for the Southern District of New
York as the sole and exclusive forum for certain types of actions and proceedings that may be initiated by holders of our Warrants, which
could limit the ability of Warrant holders to obtain a favorable judicial forum for disputes with our Company.
Our
Warrant Agreement provides that, subject to applicable law, (i) any action, proceeding or claim against us arising out of or relating
in any way to the Warrant Agreement, including under the Securities Act, will be brought and enforced in the courts of the State of New
York or the United States District Court for the Southern District of New York, and (ii) that we irrevocably submit to such jurisdiction,
which jurisdiction shall be the exclusive forum for any such action, proceeding or claim. We will waive any objection to such exclusive
jurisdiction and that such courts represent an inconvenient forum.
Notwithstanding
the foregoing, these provisions of the Warrant Agreement will not apply to suits brought to enforce any liability or duty created by
the Exchange Act or any other claim for which the federal district courts of the United States of America are the sole and exclusive
forum. Any person or entity purchasing or otherwise acquiring any interest in any of our Warrants shall be deemed to have notice of and
to have consented to the forum provisions in our Warrant Agreement.
If
any action, the subject matter of which is within the scope of the forum provisions of the Warrant Agreement, is filed in a court other
than courts of the State of New York or the United States District Court for the Southern District of New York (a “foreign action”)
in the name of any holder of our Warrants, such holder shall be deemed to have consented to: (x) the personal jurisdiction of the state
and federal courts located in the State of New York in connection with any action brought in any such court to enforce the forum provisions
(an “enforcement action”), and (y) having service of process made upon such Warrant holder in any such enforcement action
by service upon such Warrant holder’s counsel in the foreign action as agent for such Warrant holder.
This
choice-of-forum provision may limit a warrant holder’s ability to bring a claim in a judicial forum that it finds favorable for
disputes with our Company, which may discourage such lawsuits. Alternatively, if a court were to find this provision of our Warrant Agreement
inapplicable or unenforceable with respect to one or more of the specified types of actions or proceedings, we may incur additional costs
associated with resolving such matters in other jurisdictions, which could materially and adversely affect our business, financial condition
and results of operations and result in a diversion of the time and resources of our management and Board of Directors.
The
trading price of our common stock and warrants may be volatile, and you could lose all or part of your investment.
The
trading price of our common stock and warrants is likely to be highly volatile and could be subject to wide fluctuations in response
to various factors, some of which are beyond our control, including limited trading volume. The stock market in general and the market
for companies in our industry in particular have experienced extreme volatility that has often been unrelated to the operating performance
of particular companies. As a result of this volatility, investors may not be able to sell their shares or warrants at or above the price
paid for the units. In addition to the factors discussed in these “Risk Factors” sections, these factors include:
●
the
commencement, enrollment or results of our planned and future clinical trials;
●
the
loss of any of our key scientific or management personnel;
●
regulatory
or legal developments in the United States, China and other countries;
●
the
success of competitive products or technologies;
●
adverse
actions taken by regulatory agencies with respect to our clinical trials or manufacturers;
40
●
changes
or developments in laws or regulations applicable to our products and preclinical program;
●
changes
to our relationships with collaborators, manufacturers or suppliers;
●
the
results of our testing and clinical trials;
●
unanticipated
safety concerns;
●
announcements
concerning our competitors or our industry in general;
●
actual
or anticipated fluctuations in our operating results;
●
changes
in financial estimates or recommendations by securities analysts;
●
potential
acquisitions;
●
the
results of our efforts to discover, develop, acquire or in-license additional products;
●
the
trading volume of our securities on Nasdaq;
●
sales
of our common stock by us, our executive officers and directors or our stockholders or the anticipation that such sales may occur
in the future;
●
general
economic, political and market conditions and overall fluctuations in the financial markets in the United States or China;
●
stock
market price and volume fluctuations of comparable companies and, in particular, those that operate in our industry; and
●
investors’
general perception of us and our business.
These
and other market and industry factors may cause the market price and demand for our common stock and warrants to fluctuate substantially,
regardless of our actual operating performance, which may limit or prevent investors from selling their shares of our common stock and
warrants at or above the price paid for the units or the exercise price of the warrants and may otherwise negatively affect the liquidity
of our common stock. In addition, the stock market in general, and companies in our industry in particular, have experienced extreme
price and volume fluctuations that have often been unrelated or disproportionate to the operating performance of these companies.
Some
companies that have experienced volatility in the trading price of their shares have been the subject of securities class action
litigation. Any lawsuit to which we are a party, with or without merit, may result in an unfavorable judgment. We also may decide to
settle lawsuits on unfavorable terms. Any such negative outcome could result in payments of substantial damages or fines, damage to our
reputation or adverse changes to our business practices. Defending against litigation is costly and time-consuming and could divert our
management’s attention and our resources. Furthermore, during litigation, there could be negative public announcements of the results
of hearings, motions or other interim proceedings or developments, which could have a negative effect on the market price of our common
stock.
If
equity research analysts do not publish research or reports, or publish unfavorable research or reports, about us, our business or our
market, our stock price and trading volume could decline.
The
trading market for our common stock and warrants will be influenced by the research and reports that equity research analysts publish
about us and our business. We do not currently have and may never obtain research coverage by equity research analysts. Equity research
analysts may elect not to provide research coverage of our common stock, and such lack of research coverage may adversely affect the
market price of our common stock and warrants. In the event we do have equity research analyst coverage, we will not have any control
over the analysts, or the content and opinions included in their reports. The price of our shares and warrants could decline if one or
more equity research analysts downgrade our shares or issue other unfavorable commentary or research about us. If one or more equity
research analysts ceases coverage of us or fails to publish reports on us regularly, demand for our shares could decrease, which in turn
could cause the trading price or trading volume of our common stock and warrants to decline.
41
A
significant portion of our total outstanding shares are restricted from immediate resale but may be sold into the market in the near
future. This could cause the market price of our common stock to drop significantly, even if our business is doing well.
Sales
of a substantial number of shares of our common stock in the public market could occur at any time. If our stockholders sell, or the
market perceives that our stockholders intend to sell, substantial amounts of our common stock in the public market, the market price
of our common stock could decline significantly.
Upon completion of our public offering in September 2022, we had outstanding 7,279,961 shares of our common stock. Of these shares, the 2,315,000 shares sold in our public offering are freely tradable and 1,528,271 pre offering shares were eligible for sale in the public market immediately upon the effectiveness of the registration statement for the offering. An additional 3,362,567 shares of our common stock (including an aggregate of 1,704,438 shares held by officers, directors and affiliates) will be available for sale in the public market beginning 180 days after the date of public offering (March 20, 2023) following the expiration of lock-up agreements between our stockholders and the underwriters, subject in certain circumstances to the volume, manner of sale and other limitations under Rule 144 and Rule 701. The representatives of the underwriters may release those stockholders subject to a lock-up agreement from their lock-up agreements with the underwriters at any time, which would allow for earlier sales of shares in the public market.
There
can be no assurances that our shares and warrants will not be subject to potential delisting from the Nasdaq Stock Market if we do not
continue to maintain the listing requirements of Nasdaq, which could negatively impact the price and value of our securities and your
ability to sell them.
Our
shares of our common stock and warrants are listed on the Capital Market tier of the Nasdaq Stock Market, or Nasdaq, under the symbols
“NXL” and “NXLIW”. Nasdaq has rules for continued listing, including, without limitation, minimum market capitalization,
minimum stockholders’ equity and other requirements. Failure to maintain our listing (i.e., being de-listed from Nasdaq) could
result in significant consequences for us and our security holders including:
●
making
it more difficult for holders to sell our common stock or warrants and more difficult to obtain accurate price quotations for such
securities;
●
resulting
in an adverse effect on the price of our common stock and warrants;
●
adversely
our ability to issue additional securities for financing or other purposes, or otherwise to arrange for any financing we may need
in the future;
●
resulting
in determination that our common stock is a “penny stock,” which will require brokers trading in our common stock to
adhere to more stringent rules and possibly result in a reduced level of trading activity in the secondary trading market for our
common stock; and
●
reducing
the amount of news and analyst coverage of our company and our securities.
Concentration
of ownership of our common stock among our existing executive officers, directors and principal stockholders may prevent new investors
from influencing significant corporate decisions and matters submitted to stockholders for approval.
Our
executive officers, directors and current beneficial owners of 5% or more of our common stock and their respective affiliates, in the
aggregate, beneficially own approximately 23.38% of our outstanding common stock, based on the number of shares of our common stock outstanding
as of March 22, 2023. As a result, these persons, acting together, would be able to significantly influence all matters
requiring stockholder approval, including the election and removal of directors, any merger, consolidation or sale of all or substantially
all of our assets or other significant corporate transactions. In addition, these persons, acting together, may have the ability to control
the management and affairs of our company. Accordingly, this concentration of ownership may harm the market price of our common stock
by:
●
delaying,
deferring or preventing a change in control;
42
●
entrenching
our management and/or the board of directors;
●
impeding
a merger, consolidation, takeover or other business combination involving us; or
●
discouraging
a potential acquirer from making a tender offer or otherwise attempting to obtain control of us.
In
addition, some of these persons or entities may have interests different than yours. For example, because many of these stockholders
purchased their shares at prices substantially below the price at which shares were sold in our public offering and have held their shares
for a longer period, they may be more interested in selling our company to an acquirer than other investors, or they may want us to pursue
strategies that deviate from the interests of other stockholders.
Provisions
in our corporate charter documents and under Delaware law could make an acquisition of our company, which may be beneficial to our stockholders,
more difficult and may prevent attempts by our stockholders to replace or remove our current management.
Provisions
in our amended and restated certificate of incorporation and our amended and restated bylaws that became effective on December 1, 2021
(as amended August 11, 2022) may discourage, delay or prevent a merger, acquisition or other change in control of our company that stockholders
may consider favorable, including transactions in which you might otherwise receive a premium for your shares. These provisions also
could limit the price that investors might be willing to pay in the future for shares of our common stock, thereby depressing the market
price of our common stock. In addition, because our board of directors is responsible for appointing the members of our management team,
these provisions may frustrate or prevent any attempts by our stockholders to replace or remove our current management by making it more
difficult for stockholders to replace members of our board of directors. Among other things, these provisions:
●
establish
advance notice requirements for stockholder proposals that can be acted on at stockholder meetings and nominations to our board of
directors;
●
require
that stockholder actions must be effected at a duly called stockholder meeting and prohibit actions by our stockholders by written
consent;
●
limit
who may call stockholder meetings; and
●
require
the approval of the holders of at least 66.66% of the votes that all our stockholders would be entitled to cast to amend or repeal
certain provisions of our charter or bylaws or remove a director.
Moreover,
because we are incorporated in Delaware, we are governed by the provisions of Section 203 of the Delaware General Corporation Law,
which prohibits a person who owns in excess of 15% of our outstanding voting stock from merging or combining with us for a period of
three years after the date of the transaction in which the person acquired more than 15% of our outstanding voting stock, unless the
merger or combination is approved in a prescribed manner. These provisions could discourage potential acquisition proposals and could
delay or prevent a change in control transaction. They could also have the effect of discouraging others from making tender offers for
our common stock, including transactions that may be in your best interests. These provisions may also prevent changes in our management
or limit the price that investors are willing to pay for our stock.
43
Our
amended and restated certificate of incorporation provides that the Court of Chancery of the State of Delaware and the federal district
courts of the United States of America are the exclusive forums for substantially all disputes between us and our stockholders,
including claims under the Securities Act and the Exchange Act, which could limit our stockholders’ ability to obtain a favorable
judicial forum for disputes with us or our directors, officers or employees.
Our
amended and restated certificate of incorporation provides that the Court of Chancery of the State of Delaware is the exclusive forum
for:
●
any
derivative action or proceeding brought on our behalf;
●
any
action asserting a breach of fiduciary duty;
●
any
action asserting a claim against us or any of our directors, officers, employees or agents arising under the DGCL, our amended and
restated certificate of incorporation or our amended and restated bylaws;
●
any
action or proceeding to interpret, apply, enforce or determine the validity of our amended and restated certificate of incorporation
or our amended and restated bylaws; and
●
any
action asserting a claim against us or any of our directors, officers, employees or agents that is governed by the internal-affairs
doctrine.
Our
amended and restated certificate of incorporation further provides that the federal district courts of the United States of America
will be the exclusive forum for resolving any complaint asserting a cause of action arising under the Securities Act and the Exchange
Act.
These
exclusive-forum provisions may limit a stockholder’s ability to bring a claim in a judicial forum that it finds favorable for disputes
with us or our directors, officers or other employees, which may discourage lawsuits against us and our directors, officers and other
employees. If a court were to find either exclusive-forum provision in our amended and restated certificate of incorporation to be inapplicable
or unenforceable in an action, we may incur additional costs associated with resolving the dispute in other jurisdictions. We note that
there is uncertainty as to whether a court would enforce such exclusive-forum provision and that provision may result in increased costs
for investors to bring a claim. We also note that investors cannot waive compliance with the federal securities laws and the rules and
regulations thereunder, and that Section 22 of the Securities Act creates concurrent jurisdiction for federal and state courts over
all suits brought to enforce any duty or liability created by the Securities Act or the rules and regulations thereunder.
We
are an “emerging growth company” and as a result of the reduced disclosure and governance requirements applicable to emerging
growth companies, our common stock and warrants may be less attractive to investors.
We
are an “emerging growth company” as defined in the Jumpstart Our Business Startups Act of 2012, or the JOBS Act, we do not
intend to take advantage of some of the exemptions from reporting requirements that are applicable to other public companies that are
not emerging growth companies, including:
●
not
being required to comply with the auditor attestation requirements of Section 404 of the Sarbanes-Oxley Act of 2002, as amended,
or the Sarbanes-Oxley Act;
●
not
being required to comply with any requirements that may be adopted by the Public Company Accounting Oversight Board regarding mandatory
audit firm rotation or a supplement to the auditor’s report providing additional information about the audit and the consolidated
financial statements;
●
reduced
disclosure obligations regarding executive compensation in our periodic reports, proxy statements and registration statements; and
●
exemptions
from the requirements of holding a nonbinding advisory vote on executive compensation and stockholder approval of any golden parachute
payments not previously approved.
44
We
cannot predict if investors will find our common stock or warrants less attractive because we will rely on these exemptions. If some
investors find our common stock or warrants less attractive as a result, there may be a less active trading market for our common stock
and warrants and the trading prices for our securities may be more volatile. We may take advantage of these exemptions until the last
day of our fiscal year following the fifth anniversary of the completion of our IPO. However, if any of the following events occur prior
to the end of such five-year period, (i) our annual gross revenue exceeds $1.07 billion, (ii) we issue more than $1.0 billion
of non-convertible debt in any three-year period or (iii) we become a “large accelerated filer,” (as defined in Rule 12b-2
under the Exchange Act), we will cease to be an emerging growth company prior to the end of such five-year period. We will be deemed
to be a “large accelerated filer” at such time that we (a) have an aggregate worldwide market value of common equity
securities held by non-affiliates of $700 million or more as of the last business day of our most recently completed second fiscal quarter,
(b) have been required to file annual and quarterly reports under the Exchange Act, for a period of at least twelve months and (c) have
filed at least one annual report pursuant to the Exchange Act. Even after we no longer qualify as an emerging growth company, we may
still qualify as a “smaller reporting company,” which would allow us to take advantage of many of the same exemptions from
disclosure requirements including reduced disclosure obligations regarding executive compensation in this Form 10-K and our other periodic
reports and proxy statements.
Under
the JOBS Act, emerging growth companies can also delay adopting new or revised accounting standards until such time as those standards
apply to private companies. We have irrevocably elected to avail ourselves of this exemption from new or revised accounting standards
and, therefore, will be subject to the same new or revised accounting standards as other public companies that are emerging growth companies.
As a result, changes in rules of U.S. generally accepted accounting principles or their interpretation, the adoption of new guidance
or the application of existing guidance to changes in our business could significantly affect our financial position and results of operations.
If
we fail to maintain proper and effective internal controls, our ability to produce accurate consolidated financial statements on a timely
basis could be impaired.
We
are subject to the reporting requirements of the Securities Exchange Act of 1934, as amended, the Sarbanes-Oxley Act and the rules and
regulations of The Nasdaq Capital Market, or Nasdaq. The Sarbanes-Oxley Act requires, among other things, that we maintain effective
disclosure controls and procedures and internal control over financial reporting. Beginning with our second annual report following our
initial public offering (December 2024), we must perform system and process evaluation and testing of our internal control over financial
reporting to allow management to report on the effectiveness of our internal control over financial reporting in our Form 10-K filing
for that year, as required by Section 404 of the Sarbanes-Oxley Act. This will require that we incur substantial additional professional
fees and internal costs to expand our accounting and finance functions and that we expend significant management efforts. We have never
been required to test our internal controls within a specified period, and, as a result, we may experience difficulty in meeting these
reporting requirements in a timely manner.
We identified control deficiencies in the design
and operation of our internal control over financial reporting that constituted a material weakness, as further described in Item 9A
of this Annual Report (“Controls and Procedures”). A material weakness is a deficiency, or a combination of deficiencies,
in internal control over financial reporting such that there is a reasonable possibility that a material misstatement of our consolidated
financial statements will not be prevented or detected on a timely basis. Our material weakness related to the following control deficiencies:
● Lack of sufficient resources necessary to provide adequate segregation of
duties related to the preparation and review of financial information used in financial reporting and review of controls over the financial
reporting process, including documentation of review/approval of journal entries and reconciliations; and
● Insufficient IT controls which are effectively designed and implemented,
specifically related to user/superuser access to the Company’s financial reporting system.
Our internal control over financial reporting will not prevent or detect all errors and all
fraud. A control system, no matter how well designed and operated, can provide only reasonable, not absolute, assurance that the control
system’s objectives will be met. Because of the inherent limitations in all control systems, no evaluation of controls can provide
absolute assurance that misstatements due to error or fraud will not occur or that all control issues and instances of fraud will be
detected.
If
we are not able to comply with the requirements of Section 404 of the Sarbanes-Oxley Act in a timely manner, or if we are unable
to maintain proper and effective internal controls, we may not be able to produce timely and accurate financial statements. If that were
to happen, the market price of our common stock could decline and we could be subject to sanctions or investigations by Nasdaq, the SEC,
or other regulatory authorities.
Because
we do not anticipate paying any cash dividends on our common stock in the foreseeable future, capital appreciation, if any, will be your
sole source of gains and you may never receive a return on your investment.
You
should not rely on an investment in our common stock to provide dividend income. We have never declared or paid a dividend on our common
stock to date, and we currently intend to retain our future earnings, if any, to fund the development and growth of our business. As
a result, capital appreciation, if any, on our common stock will be your sole source of gains for the foreseeable future. Investors seeking
cash dividends should not purchase our common stock.
45
Tax
authorities may disagree with our positions and conclusions regarding certain tax positions, resulting in unanticipated costs, taxes
or non-realization of expected benefits.
A
tax authority may disagree with tax positions that we have taken, which could result in increased tax liabilities. For example, the Internal
Revenue Service or another tax authority could challenge our allocation of income by tax jurisdiction and the amounts paid between our
affiliated companies pursuant to our intercompany arrangements and transfer pricing policies, including amounts paid with respect to
our intellectual property development. Similarly, a tax authority could assert that we are subject to tax in a jurisdiction where we
believe we have not established a taxable connection, often referred to as a “permanent establishment” under international
tax treaties, and such an assertion, if successful, could increase our expected tax liability in one or more jurisdictions. The foregoing
are only selected examples of potential challenges, and other tax positions we have taken or may take in the future could become the
subject of disputes with one or more tax authorities. A tax authority may take the position that material income tax liabilities, interest
and penalties are payable by us, in which case, we expect that we might contest such assessment. Contesting such an assessment may be
lengthy and costly and if we were unsuccessful in disputing the assessment, the implications could increase our anticipated effective
tax rate, where applicable.
We
will incur significantly increased costs as a result of operating as a company whose common stock is publicly traded in the United States,
and our management will be required to devote substantial time to new compliance initiatives.
As
a public company in the United States, we will continue to incur significant legal, accounting and other expenses that we did not
incur previously. These expenses will likely be even more significant after we no longer qualify as an emerging growth company. The Sarbanes-Oxley
Act, the Dodd-Frank Wall Street Reform and Consumer Protection Act, the listing requirements of Nasdaq and other applicable securities
rules and regulations impose various requirements on public companies in the United States, including the establishment and maintenance
of effective disclosure and financial controls and corporate governance practices. Our senior management and other personnel will need
to devote a substantial amount of time to these compliance initiatives. Moreover, these rules and regulations will increase our legal
and financial compliance costs and will make some activities more time-consuming and costly. For example, we expect that these rules
and regulations may make it more difficult and more expensive for us to obtain director and officer liability insurance, which in turn
could make it more difficult for us to attract and retain qualified senior management personnel or members for our board of directors.
However,
these rules and regulations are often subject to varying interpretations, in many cases due to their lack of specificity, and, as a result,
their application in practice may evolve over time as new guidance is provided by regulatory and governing bodies. This could result
in continuing uncertainty regarding compliance matters and higher costs necessitated by ongoing revisions to disclosure and governance
practices.
Pursuant
to Section 404, we will be required to furnish a report by our senior management on our internal control over financial reporting.
However, while we remain an emerging growth company, we will not be required to include an attestation report on internal control over
financial reporting issued by our independent registered public accounting firm. To prepare for eventual compliance with Section 404,
we will be engaged in a process to document and evaluate our internal control over financial reporting, which is both costly and challenging.
In this regard, we will need to continue to dedicate internal resources, potentially engage outside consultants and adopt a detailed
work plan to assess and document the adequacy of internal control over financial reporting, continue steps to improve control processes
as appropriate, validate through testing that controls are functioning as documented and implement a continuous reporting and improvement
process for internal control over financial reporting. Despite our efforts, there is a risk that we will not be able to conclude, within
the prescribed timeframe or at all, that our internal control over financial reporting is effective as required by Section 404.
If we identify one or more material weaknesses, it could result in an adverse reaction in the financial markets due to a loss of confidence
in the reliability of our consolidated financial statements.
46
ITEM
1B UNRESOLVED STAFF COMMENTS
None
ITEM
2. PROPERTIES
Our
principle executive office is located at 1776 Yorktown, Suite 550, Houston, Texas 77056. Under ASC 842 “ Leases ”, we
have two separate sub-leases totalling approximately 4,000 square feet of office space under operating leases. Our
lease payments totalled approximately $48,000 in 2021. Management and supporting staff are hosted at this location. Our lease payments
for fiscal year 2022 were $54,000. Our lease costs for 2023 will also be $54,000 for the year. The sub-leases are
due to expire in 2024. We sublease our space from an entity controlled by our Chief Executive Officer. We do not have any increase from the primary lease payments for the sub-lease arrangements.
We
do not own or operate manufacturing facilities for the production of any of our products, nor do we have plans to develop our own manufacturing
operations in the foreseeable future. We believe our current premises are sufficient for our needs at this time and for the foreseeable
future.
ITEM
3 LEGAL PROCEEDINGS
There
are no material pending legal proceedings in which the Company or any of its subsidiaries is a party or in which any director, officer
or affiliate of the Company, any owner of record or beneficially of more than 5% of any class of its voting securities, or security holder
is a party adverse to us or has a material interest adverse to the Company other than the following:
Sarah
Veltz v. Nexalin Technology, Inc. et al.
Plaintiff,
Sarah Veltz, filed a lawsuit in this matter on January 20, 2021 in Orange County Superior Court (Case No. 30-2021-01180164-CU-WT-CJC)
(the “Complaint”) naming the Company and others as defendants. In her Complaint, Plaintiff contends that she was employed
by defendants, including Nexalin, and has not been paid all wages, including overtime wages and other benefits allegedly due her. Plaintiff
also contends that, during her employment, she was subjected to sexual harassment by the Company’s then Chief Executive Officer.
Plaintiff seeks both compensatory and punitive damages. On March 12, 2021, the Company filed its answer to the Complaint. Although the
parties are seeking mediation, the court has set a jury trial in this matter for April 24, 2023. Management’s intent is to contest
the allegations vigorously and, as of the date of this report, is unable to provide an evaluation of the potential outcome of the litigation
within the probable or remote range or to provide an estimate of the amount of or a range of potential loss that might be incurred by
the Company.
Employment
Development Department
The
Company is currently engaged in settlement discussions with the Employment Development Department (EDD) of the state of California. This
matter involves issues related to our previous management’s classification of certain work provided to or on behalf of the Company’s
business as contract labor instead of employee labor. The total amount involved is approximately $300,000. Management has petitioned
for reassessment and believe the hired workers at issue were indeed actual contractors and not employees. We have no business in California
other than one part time and one full time worker residing in California. An initial hearing before an EDD magistrate was held on April
15, 2022. A second hearing was held in June of 2022. We are now in negotiations with the EDD for a final settlement. The Company believes
its potential exposure to be approximately $300,000 and, as such, has accrued this amount on the audited consolidated balance sheets
at December 31, 2022 and 2021 and believes it has adequately accrued for this matter.
Demand
Letter from The University of Arizona
On
December 8, 2022, the Company received a demand letter from the University of Arizona seeking payment of $111,094 purportedly due on
an Investigator Initiated Cooperative Study Agreement, dated as of September 25, 2017 (the “2017 Study”) The Company
believes that the 2017 Study was not completed and no payment was due. In fact, for a number of months prior to receipt of the
demand letter, the Company had had discussions with the person at the University of Arizona who were to conduct the 2017 Study
concerning updating the 2017 Study and completing an updated study and related work. After receipt of the demand letter, the Company
has had discussions with the University of Arizona concerning resuming an updated study and receipt of credit for some or all the
monies claimed to be due for the 2017 Study. Such discussions are ongoing, and no resolution has been reached but the Company hopes
to achieve a consensual resolution. We cannot guarantee that a mutually amicable resolution will be reached by the
parties.
ITEM
4 MINE SAFETY
Not
Applicable
47
PART
II
ITEM
5. MARKET FOR THE REGISTRANT’S COMMON EQUITY, RELATED SHAREHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY
SECURITIES
Principal
Market
Our
common stock is currently traded on The Nasdaq Capital Market under the symbol “NXL.” Our common stock warrants are listed
for trading on The Nasdaq Capital Market under the symbol “NXLIW”
Equity
Holders
As of March 22, 2023, the number of shareholders
of our common stock of record was approximately 900 persons and the last reported closing price per share of our common stock on such
date was $1.09. The number of stockholders of record is not representative of the number of beneficial stockholders due to the fact
that many shares are held by depositories, brokers, or nominees.
Dividends
We
have not declared or paid any cash dividends on its common stock since inception. We do not intend to pay any cash dividends at this
time or in the foreseeable future.
Recent
Sales of Unregistered Securities
We
completed our initial public offering on September 16, 2022.
We
issued an aggregate of 6,601 restricted securities to a consultant during the fourth quarter (October 1, 2022 to December 31, 2022).
These shares were issued pursuant to agreements which were in place prior to our initial public offering and represented payment for
services. All of such shares were issued pursuant to an exemption from registration under the Securities Act of 1933 as amended including
Regulation D promulgated thereunder and are restricted securities which may not be sold without registration or only pursuant to an exemption
therefrom such as Rule 144.
Repurchase
of Equity Securities
None.
Securities
Authorized for Issuance under Equity Compensation Plans
We did not have any equity compensation plan in effect during the year
ended December 31, 2022 and we do not have any equity compensation plan as of the date of filing of this Report on Form 10-K. We expect
to seek stockholder approval of a stock based equity plan in calendar year 2023.
See
Item 11. “Executive Compensation” for a discussion of certain stock related compensation agreements with certain of our executive
officers.
ITEM
6 [RESERVED]
48
ITEM
7 MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
Special
Note Regarding Forward-Looking Statements
You
should read the following discussion and analysis of financial condition and operating results together with our financial statements
and the related notes and other financial information included elsewhere in this annual report on Form 10-K. References in this “Management’s
Discussion and Analysis of Financial Condition and Results of Operations” to “us,” “we,” “our,”
and similar terms refer to Nexalin Technology, Inc. This discussion contains forward-looking statements as that term is defined within
the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended
(the “Exchange Act”), which are subject to the “safe harbor” created by those sections. The events described
in forward-looking statements contained in this discussion may not occur. Generally, these statements relate to business plans or strategies,
projected or anticipated benefits or other consequences of our plans or strategies, projected or anticipated benefits from acquisitions
that may be made by us, or projections involving anticipated revenues, earnings or other aspects of our operating results. The words
“may,” “will,” “expect,” “believe,” “anticipate,” “project,”
“plan,” “intend,” “estimate,” and “continue,” and their opposites and similar expressions,
are intended to identify forward-looking statements. We caution you that these statements are not guarantees of future performance or
events and are subject to a number of uncertainties, risks and other influences, many of which are beyond our control, which may influence
the accuracy of the statements and the projections upon which the statements are based. Reference is made to “Risk Factors”
in this annual report on Form 10-K Our actual results may differ materially from those anticipated in these forward-looking statements.
For convenience of presentation some of the numbers have been rounded in the text below.
Overview
We
design and develop innovative neurostimulation products to uniquely and effectively help combat the ongoing global mental health epidemic.
We developed an easy-to-administer medical device — referred to as Generation 1 or Gen-1 — that utilizes bioelectronic
medical technology to treat anxiety and insomnia, without the need for drugs or psychotherapy. Our original Gen-1 devices are cranial
electrotherapy stimulation (CES) devices that emit waveform at 4 milliamps during treatment and are presently classified by the
U.S. Food and Drug Administration (“FDA”) as a Class II device.
Medical
professionals in the United States have utilized the Gen-1 device to administer to patients in clinical settings. While the Gen-1 device
had been cleared by the FDA to treat depression, anxiety, and insomnia, three prevalent and serious diseases, because of the FDA’s
December 2019 reclassification of CES devices, the Gen-1 device was reclassified as a Class II device for the treatment of anxiety
and insomnia. We are required to file a new application under Section 510(k) of the Federal Food, Drug and Cosmetic Act (“510(k)
Application”) to be approved by the FDA for the sales and marketing of our devices for the treatment of anxiety and insomnia. In
the FDA’s December 2019 reclassification ruling, the treatment of depression with our device will require a Class III certification
and require a new PMA (premarket approval) application to demonstrate safety and effectiveness.
While
we continue providing services to medical professionals to support patients’ use of the Gen-1 devices which were in operation prior
to December 2019, we are not making new sales or new marketing efforts of Gen-1 devices in the United States. We continue to
derive revenue from devices which we sold or leased prior to the FDA’s December 2019 reclassification announcements. This revenue
consists of monthly licensing fees and payments for the sale of electrodes and patient cables. We have suspended marketing efforts for
new sales of devices related to the Gen-1 device for treatment of anxiety and insomnia in the United States until the Nexalin regulatory
team makes a decision on a new 510(k) application at 4 milliamps based on FDA comments expected to be received in April 2023. Our regulatory
team continues to inform the FDA of the suspension of the marketing and sale of the Gen-1 products to new providers. We are analyzing
whether to proceed with an amended application with the FDA for Gen-1 devices for the treatment of insomnia and anxiety.
49
We
have designed and developed a new advanced waveform technology to be emitted at 15 milliamps through new and improved medical devices
referred to as Generation 2 or Gen-2 and Generation 3 or Gen-3. Gen-2 is a clinical use device with a modern enclosure to emit the new
15 milliamp advanced waveform. Gen-3 is a new patient headset that will be prescribed by licensed medical professionals in a virtual
clinic setting similar to existing Tele-health platforms. The Nexalin research team believes that the new 15 milliamp Gen-2 and Gen-3
devices can penetrate deeper into the brain and stimulate associated structures of mental illness, which we believe will generate enhanced
patient response without any risk or unpleasant side effects. The Nexalin regulatory team has made a strategic decision to develop strategies
for pilot trials in various mental health disease states. In addition, a new PMA application in the United States is in development for
the treatment of depression utilizing both Gen-2 and Gen-3. The new Gen-3 device is also scheduled for additional pilot trials for anxiety
and insomnia in the United States and China beginning in the third quarter of 2023. Preliminary data provided by the University of California San Diego
supports the safety of utilizing our 15 milliamp waveform technology. However, the determination of safety and efficacy of medical devices
in the United States is subject to clearance by the FDA.
Additionally,
we are currently designing clinical trial strategies for the use of Gen-3 for the treatment of substance use disorders including opiate,
cocaine, and alcohol abuse. Recently the Gen-2 device was tested in pilot trials in China for the treatment of Alzheimer’s disease
and dementia. Continued pilot testing for Alzheimer’s and dementia is planned in China in 2023.
In
part due to increasing incidence attributed to the devastating impacts of the COVID-19 pandemic, mental health and cognitive disorders
are widespread across the globe and cause substantial health, social and economic losses, and hardships accordingly. Our focus is on
the continued development of our innovative bioelectronic medical technologies and rapid regulatory approval. We intend to help reverse
these losses, and hardships of these losses, by safely and effectively treating various mental health disorders associated with post
Covid and long Covid mental disease states.
All
our products are non-invasive, safe, undetectable to the human body and can provide relief to those afflicted with mental health issues
without adverse side effects. We have a proprietary design that eliminates voltage while stabilizing currents, electromagnetic fields,
and various frequencies — referred to collectively as waveform - particularly our proprietary, 15 milliamp patented symmetrical
waveform. Our devices generate a high frequency carrier wave that is charge balanced. It is applied to the brain with an array of electrodes
on the forehead and behind each ear at the mastoid. The features of this proprietary waveform and the array of electrodes allow the application
of the waveform to the entire brain rather than a small, targeted area of the brain. To ensure deeper penetration into the brain, we
have eliminated the voltage from the waveform which allows the increase of the power from < 4 mAmps to 15 mAmps, more than a 400%
increase without incurring any patient discomfort, risk, or adverse side effects. By increasing the power, our waveform can penetrate
deeper into the brain and stimulate deep mid-brain structures associated with mental illness. Our research and clinical teams believe
that a more powerful waveform will create a stronger response in the brain. A stronger response creates a higher level of efficacy. This
entire proprietary technique allows Nexalin to provide a safe and comfortable treatment that is more powerful than any stimulation device
in the market. Current pilot study protocols and randomized clinical trials have been designed and submitted to the FDA to provide feedback
on final reports and data sets for the purpose of safety and efficacy evaluations in the future. Determinations of the safety and efficacy
of our devices are solely within the authority of the FDA.
Currently,
the waveform that comprises the basis of Gen-2 and new Gen-3 headset devices has been tested in research settings to develop safety data
that has been submitted for review by the FDA for safety evaluation and eventual marketing in the United States and around the world.
Determinations of the safety and efficacy of our devices in the United States are solely within the authority of the FDA.
We
recognize that an additional barrier to treatment in today’s mental health treatment landscape -- beyond the concerns about safety,
efficacy and side-effects that have been associated with conventional mental health treatments such as ECT (shock therapy), drugs and
psychotherapy -- is stigma. We have received industry reports and feedback that many patients that struggle with mood disorders have
the stigma of embarrassment associated with psychiatrists and psychotherapy (e.g., counselling with a therapist). Additional stigmas
and other issues are associated with the side effects of medication prescribed by psychiatrists. When we researched the current pharmaceuticals
model, public information highlighted the many side effects associated with these medications. Frequently, patients would stop taking
the medication because of the uncomfortable side effects. Additional public information mentions dependency and withdrawal issues associated
with medication for psychiatric disorders.
50
To
address the embarrassment stigma, we are developing a new virtual clinic that will allow the physician to diagnose a mental health issue
in the privacy of a tele-psychiatry virtual platform. After diagnosis, the physician will prescribe the Nexalin Gen-3 headset to the
patient for treatment. Next, the Gen-3 device will be shipped to the patient’s home. After patient receives the device, they will
pair the headset device with an app in the patient’s smart phone. The app will communicate with the Nexalin cloud servers to authorize
the device for treatment according to the protocol designed by the physician. The physician will monitor treatment compliance and other
health related issues in a private physician dashboard that connects through the Nexalin app and cloud servers. We believe that to preserve
product safety and integrity for home use, the headset device will require physician oversight that will include a prescription for use
with a monthly authorization provided by the physician after a monthly virtual visit. All appointments will be in a virtual setting to
provide privacy and convenience for the physician and patient. The Nexalin virtual clinic will be provided in a proprietary virtual platform
currently in the design stage.
Our
China Gen-2 15 milliamp device was recently approved in China by the NMPA for the treatment of insomnia and depression in China. This
device and all other clinical devices will include a single use electrode for long term revenue streams. The USA Gen-2 device will have
a fresh and modern appearance that meets the technology standards of the digital tech world of 2023. Early adopters of the Gen-1 device
will be able to access additional firmware upgrades which are planned to enhance the previously purchased devices to the new symmetric15-milliamp
waveform. Our Gen-2 device will be equipped with RFID technology that exchanges electrode usage data with a reader in the main device.
The purpose of RFID is to track and maintain control of the proprietary single use electrode. Our electrode chip will be programmed to
exchange data with the device and allow activation for a single treatment with a new electrode only. This ensures a recurring revenue
stream on the device and protects against any generic knockoffs designed to avoid treatment costs. This upgrade in technology also ensures
the proprietary nature of the electrodes that support treatment outcomes are sustained.
Overall,
we believe that our advanced waveform, technological upgrades and the development of a modern headset monitored with our IT management
platform will position us with the opportunity to disrupt the traditional mental health treatment model. Our mission is to remove the
stigma of expensive psychotherapy or pharmaceuticals with the attendant side effects and dependency issues and replace such stigma with
clinically proven and cost-effective technology that is easily accessible in the privacy of the patient’s home and monitored by
licensed healthcare providers.
Since
our inception, we have generated significant losses; we expect to continue to incur significant expenses and increasing operating losses
for at least the next two years. Our net losses may fluctuate significantly from period to period, depending on the timing of our planned
clinical trials and expenditures for other research and development activities. We expect our expenses will increase substantially over
time as we:
●
Continue
the ongoing and planned preclinical and clinical development of our products;
●
review
and analyze the value of amending our previous 510(k) Application for anxiety and insomnia in accordance with the FDA and seek other
regulatory approvals for any future products that successfully complete clinical trials;
●
arrange
for a sales, marketing and distribution infrastructure and scale up external manufacturing capabilities to commercialize any product
candidate for which we may obtain regulatory approval and intend to commercialize on our own;
●
maintain,
expand and protect our intellectual property portfolio;
●
engage
additional clinical, scientific, manufacturing and controls personnel;
●
add
additional operational, financial and management information systems and personnel, including personnel to support our product development
and planned future commercialization efforts;
●
seek
to discover and develop additional products; and
●
initiate
preclinical studies and clinical trials for any additional products that we may pursue in the future.
Furthermore,
we expect to incur additional costs associated with operating as a public company, including significant legal, accounting, investor
relations and other expenses that we did not incur as a private company.
51
Recent
Developments
Completion
of Initial Public Offering
The
Company completed its initial public offering on September 16, 2022. The initial public offering consisted of 2,315,000 units consisting
of 2,315,000 shares of its Common Stock and 2,315,000 accompanying warrants to purchase up to 2,315,000 shares of common stock. Each
share of common stock was sold together with one warrant, each to purchase one share of common stock with an exercise price of $4.15
per share at a combined offering price of $4.15, for gross proceeds of $9,607,250 before deducting underwriting discounts and offering
expenses. In addition, Nexalin granted the underwriters a 45-day option to purchase up to an additional 347,250 shares of common stock
and/or warrants to purchase up to 347,250 shares of common stock to cover over-allotments at the initial public offering price, less
the underwriting discount. The underwriters exercised their option to purchase 347,250 warrants for net proceeds of $3,473.
The
registration statement on Form S-1 (File No. 333-261989) for our initial public offering was filed with the Securities and Exchange Commission
(“SEC”) and became effective on September 15, 2022. A final prospectus relating to the offering was filed with the SEC
and is available on the SEC’s website at http://www.sec.gov . The offering was being made only by means of a prospectus forming
part of the effective registration statement.
The shares and warrants began trading on the Nasdaq Capital Market
tier of the Nasdaq Stock Market (“Nasdaq”) in September 2022, under the symbols “NXL” and “NXLIW”,
respectively.
Impact
of COVID-19 Pandemic
We
continue to monitor how the COVID-19 pandemic is affecting our employees, business and clinical trials. Such pandemic has delayed our
clinical trials and our receipt of marketing approvals from the FDA. Such pandemic also might have reduced, and continue to reduce, participation
in our clinical trials, due to both travel restrictions and a general unwillingness of subjects to travel. We cannot presently predict
the scope and severity of any other potential business shutdowns or disruptions, but if we or any of the third parties with whom we engage,
including the suppliers, clinical trial sites, regulators and other third parties with whom we conduct business, were to experience shutdowns
or other business disruptions, our ability to conduct our business in the manner and on the timelines presently planned could be materially
and negatively impacted.
We
continue to be indirectly impacted because of our current dependence upon our distributor relationship with Wider Come Limited (Wider”.)
Wider acts as a distributor for the Company’s devices in China and Asia. Because of significant restrictions imposed by the Chinese
government during the Covid pandemic, Wider’s ability to market and sell the Company’s devices has been negatively impacted,
resulting in decreased revenue to the Company. Patients and salespeople are restricted in their movements resulting in a significant
slowdown in the medical and other sectors. Fortunately, our Chinese distributor continues our strategy of multiple clinical studies in
the major institution in Beijing in an array of brain related diseases. Very significant efforts and funds expended by our Chinese distributor
has led to regulatory approval in China in both depression and insomnia thus far which has allowed for sales of our devices in China
this year. The extent of future impact will depend on future developments, including future activities by the Chinese government
and other possible events which are highly uncertain and not in the Company’s control, including new information which may emerge
concerning the spread and severity of COVID-19, or any of its variants, and actions taken to address its impact, among others.
In
addition, the spread of an infectious disease, including COVID-19, may also result in the inability of our suppliers to deliver components
or raw materials on a timely basis. Such events may result in a period of business and manufacturing disruption, and in reduced operations,
any of which could materially affect our business, financial condition and results of operations. The extent to which the coronavirus
impacts our business will depend on future developments, which are highly uncertain and cannot be predicted, including new information
which may emerge concerning the severity of COVID-19 and the actions to contain the coronavirus or treat its impact, among other things.
52
Potential
Joint Venture; China Related Activities
In
September 2018, we entered into an agreement with Wider Come Limited, a company formed under the laws of the People’s
Republic of China (“Wider”), pursuant to which we and Wider have agreed to investigate the formation of a joint venture
entity to be domiciled in Hong Kong (the “potential Joint Venture”) to conduct additional clinical research and
implement a business distribution plan for our devices in China, Macau, Hong Kong, and Taiwan. We do not have any existing
operations in China and will not in the future. We do have current distribution in China through Wider, our potential Joint Venture
partner. As of the date of this Annual Report on Form 10-K, (i) our operations are carried on outside of China; and
(ii) the potential Joint Venture does not maintain any variable interest entity structure or operate any data center in China.
However, because of the intended formation of the potential Joint Venture, we may become subject to laws of The People’s
Republic of China (PRC or China) relating to, among other topics, data security and restrictions over foreign investments. Further,
as a result of the complexity and vagaries of the legal system in the PRC and recent statements and regulatory actions by the PRC
government relating to data security, our ability to operate the potential Joint Venture may be adversely affected or subject to
change and adversely impact our ability to offer or continue to offer securities to investors, with the result that our securities
may significantly decline or be worthless. There can be no assurance that regulators in China will not take a contrary view or will
not subsequently require us to undergo the approval procedures and subject us to penalties for non-compliance.
In
March 2022, we entered into a second supplement to the Joint Venture agreement with Wider whereby the parties confirmed that the potential
Joint Venture had not yet been established and is subject to further review and analysis of regulatory issues in China and the United
States. Pursuant to the second supplement, the parties agreed to use their commercial efforts to complete documentation by September
30, 2022. In light of general economic conditions in China and the United States, the continued impact of regulatory issues within China
and the United States and trade and political issues between the two counties, the parties determined to further extend the time frame
to complete establishment of the joint venture to September 30, 2023 and entered into a Supplement 3 to the potential Joint Venture Agreement
to memorialize such extension. The parties intend to continue to work together to complete the establishment prior to such extended time.
Further, the parties agreed that all references within the Joint Venture agreements to funding and formation were amended from December
21, 2018 to be September 30, 2023. We anticipate that the Joint Venture will be formed by the third quarter of 2023. However, that will
be dependent on the situation at that time.
When
and if the Joint Venture is formed and Wider completes sales of our devices in China on behalf of the potential Joint Venture, we believe
that there are no regulatory or other restrictions that would restrict either (i) the transfer from China of any proceeds resulting
from such sales by Wider to the potential Joint Venture in Hong Kong, other than standard compliance with China’s State Administration
of Foreign Exchange (“SAFE”) policies and approval process, or (ii) our receipt of our share of such proceeds from Hong Kong
to us in the United States, which is not subject to SAFE’s policies and approval process. The Company does not currently believe
any of the Company’s scientific data resulting from activities in China by the potential Joint Venture would fall within the Measures
for the Management of Scientific Data promulgated by the General Office of the PRC State Council. In the event any existing or new laws
or regulations or detailed implementations and interpretations are modified or promulgated, we and the potential Joint Venture will take
all actions to remain in compliance with any such laws or regulations or detailed implementations and interpretations thereof. Neither
we nor our potential Joint Venture Partner can at this point speak to any future changes in rules, regulations or the commercial and
potentials situation that lies ahead which could affect the formation of the Joint Venture.
In
September of 2021, the China National Medical Products Administration (NMPA), the equivalent of the United States FDA, approved the Gen-2
device for marketing and sale in China for the treatment of insomnia and depression. These treatment indications and clearances from
the NMPA have allowed Wider to market and sell the Gen-2 device in China for the treatment of insomnia and depression.
53
Results
of Operations
Comparison
of the Years ended December 31, 2022 and 2021
Our
financial results for the years ended December 31, 2022 and 2021 are summarized as follows:
Years Ended
December 31,
2022
December 31,
2021
Change
Change (1)
$
%
Revenues, net
$ 1,321,357
$ 144,065
$ 1,177,292
817 %
Cost of Revenues
363,212
21,442
341,770
1,594 %
Gross profit
958,145
122,623
835,522
681 %
Operating expenses:
Professional fees
605,329
697,063
(91,734 )
(13 )%
Salaries and benefits
694,108
228,738
465,370
203 %
Selling, general and administrative
1,491,739
5,215,423
(3,723,684 )
(71 )%
Total operating expenses
2,791,176
6,141,224
(3,350,048 )
(55 )%
Loss from operations
(1,883,031 )
(6,018,601 )
4,185,570
(70 )%
Other income (expense), net:
Interest expense, net
(59,382 )
(82,319 )
22,937
28 %
Other income
171,681
-
171,681
100 %
PPP loan forgiveness
22,916
22,916
-
-
Total other income (expense), net
135,215
(59,403 )
194,618
328 %
Net loss
(1,697,816 )
(6,078,004 )
4,380,188
72 %
Other comprehensive income:
Unrealized gain on short-term investments
36,313
-
36,313
100 %
Comprehensive loss
$ (1,661,503 )
$ (6,078,004 )
$ 4,416,501
73 %
(1) Percentages
may not foot due to rounding.
Revenues
For
the years ended December 31, 2022 and 2021, we generated $1,321,357 and $144,065, respectively, of revenue primarily from the sale of
devices, supplies and from the reimbursement of costs. In addition, we generated income from licensing and treatment fee agreements with
our customers by charging a monthly licensing fee for the duration of the agreement. We also generated revenue from treatment fee agreements
by collecting fees based on the number of treatments per month the customer performs. In addition, we derive revenue from equipment by
selling electrodes and patient cables to customers for use with our device. The increase in revenue for 2022 compared to 2021 was primarily
due to the sale of 221 devices in 2022. There were no sales of devices in 2021.
Cost
of Revenue s and Gross Profit
For
the years ended December 31, 2022 and 2021, cost of revenues were $363,212 and $21,442, respectively, yielding a gross profit of $958,145
and $122,623, respectively, or 73% and 85%, respectively. Such decrease in gross margin was due to the change in our sources of revenue.
In 2021 our revenue was from licensing fees and the sales of electrodes and patient cables. The licensing fees have no related costs.
Our cost of revenue in 2021 included shipping supplies and the cost of the electrodes and patient cables. In 2022 our revenue was primarily
from sales of equipment. The equipment has higher related costs of revenue and related shipping costs.
54
Operating
Expenses
Total
operating expenses for the years ended December 31, 2022 and 2021 were $2,791,176 and $6,141,224, respectively. The decrease was primarily
due to the decrease of approximately $4,200,000 in stock-based compensation for the issuance of our common stock to various employees
and consultants for services, and a decrease in professional fees for legal and accounting of approximately $100,000 offset by an increase
in salaries and related expenses of approximately $465,000, an increase in research and development costs of approximately $372,000,
an increase in consulting costs of approximately $80,000, and an increase in insurance of approximately $88,000. The decrease in legal
and accounting fees are primarily due to the treatment of costs relating to our initial public offering as a direct cost of the offering.
The increase in salary is primarily due to the hiring of our CFO, our Senior Vice President of Quality, Clinical and Regulatory, and
other staff. The increases in research and development and consulting costs are attributable to the development of our Gen-2 and Gen-3
devices. The increase in insurance is a result of being a public company.
Other
Income (Expense), net
Other
income (expense), net, as of December 31, 2022 and 2021 were $135,215 and ($59,403), respectively, consisting of interest
expense net of the PPP loan forgiveness, settlement income as a result of interest forgiveness, and interest and dividend income.
Liquidity
and Capital Resources
Working
Capital
As of
December 31,
2022
December 31,
2021
Current Assets
$ 7,425,462
$ 752,659
Current Liabilities
1,948,986
2,363,634
Working Capital
$ 5,476,476
$ (1,610,975 )
Current
assets increased for the year ended December 31, 2022 primarily as a result of the proceeds of the Initial Public Offering.
Cash and cash equivalents decreased approximately $500,000, Short-term investments increased approximately $6,800,000, accounts receivable
decreased approximately $10,000, inventory increased approximately $125,000 and prepaid and other current assets increased approximately
$230,000.
Current liabilities decreased for year ended December
31, 2022 primarily as a result of the reduction of accounts payable, settlement of accrued interest and a decrease in deferred revenue.
Accounts payable decreased approximately $185,000, accrued expenses decreased approximately $72,000, lease liability – current portion
increased approximately $10,000, and deferred revenue decreased approximately $130,000.
Cash
Flows
The
following table summarizes our consolidated cash flows for the twelve months ended December 31, 2022 and 2021:
December 31,
2022
December 31,
2021
Net cash used in operating activities
$ 2,215,699
$ 1,076,791
Net cash used in investing activities
$ 6,794,879
$ -
Net cash provided by financing activities
$ 8,511,543
$ 1,660,133
Net
Cash Used In Operating Activities
Net cash used in operating activities was $2,215,699
for the year ended December 31, 2022, as compared to $1,076,791 for the respective period in 2021, primarily due to the net loss of $1,697,816
and $6,078,004, respectively, as well as increases in accounts payable, deferred revenue, prepaid assets and inventory. These amounts
were also offset by $270,670 and $4,478,035 of stock compensation during the periods, respectively.
55
Net
Cash Used In Investing Activities
Net
cash used in investing activities during the year ended December 31, 2022 and 2021 was $6,794,879 and zero, respectively, which was due
to the 2022 purchase of short-term investments.
Net
Cash Provided by Financing Activities
Net
cash provided by financing activities during the year ended December 31, 2022 and 2021 was $8,511,543 and $1,660,133, respectively, which
was primarily due to the sale of common stock at IPO, for cash in 2022 and 2021.
Uses
and Availability of Additional Funds
Our
primary uses of capital are, and we expect will continue to be, compensation and related expenses, third-party clinical research and
development services, manufacturing development costs, legal and other regulatory expenses, and general administrative costs. Although
we have produced Gen-2, which is selling in China where it is approved for certain utilizations by medical practitioners, the successful
development of our future products is highly uncertain. At this time, we cannot reasonably estimate or know the nature, timing and estimated
costs of the efforts that will be necessary to complete the clinical development of Gen-3 and obtain regulatory approvals. We are also
unable to predict when, if ever, net cash inflows from revenues will enable us to be cash flow positive. This is due to the numerous
risks and uncertainties associated with developing products, including, among others, the uncertainty of:
●
successful
enrollment in, and completion of clinical trials;
●
performing
preclinical studies and clinical trials in compliance with the FDA or any comparable regulatory authority requirements;
●
the
ability of collaborators to manufacture sufficient quantity of product for development, clinical trials and/ or potential commercialization;
●
obtaining
and maintaining patent, trademark and trade secret protection for our products;
●
making
arrangements with third parties for manufacturing;
●
scaling
the commercial sales of products, if and when approved, whether alone or in collaboration with others;
●
acceptance
of existing therapies, and future therapies, if and when approved, by healthcare providers, physicians, clinicians, patients and
third-party payors;
●
competing
effectively with other therapies;
●
obtaining
and maintaining healthcare coverage and adequate reimbursement;
●
protecting
our rights in our intellectual property portfolio; and
●
maintaining
a continued acceptable safety profile of our products following approval.
Liquidity
and Capital Resources
At December 31, 2022,
the Company had a significant accumulated deficit of $72.4 million. For the year ended December 31, 2022, the Company had a loss
from operations of $1.8 million and negative cash flows from operations of $2.2 million. The Company’s operating activities
consume the majority of its cash resources. The Company will continue to service existing customers in the United States. The
Company sold devices in China to its acting distributor. The Company anticipates that it will continue to incur operating losses as
it executes its development plans through 2023, as well as other potential strategic and business development initiatives. In
addition, the Company has had and expects to have negative cash flows from operations, at least into the near future. The Company
previously funded these losses primarily through the sale of equity and issuance of convertible notes. The accompanying audited
consolidated financial statements do not include any adjustments that might be necessary should the Company be unable to continue as
a going concern. As of the year ended December 31, 2022, the Company had cash and cash equivalents on hand of $162,743 and
short-term investments of $6,831,192.
56
At
the closing on September 16, 2022, the Company sold 2,315,000 Units and 347,250 of Warrants in an Initial Public Offering (the “Initial
Public Offering”) at a price of $4.15 per Unit and $0.01 per Warrant for a total of $9,610,723. The Company incurred offering costs
of $1,067,078, consisting of $878,858 of underwriting fees and expenses and $188,220 of costs related to the Initial Public Offering.
Although no assurances can be given as to the
Company’s ability to deliver on its revenue plans or that unforeseen expenses may arise, management has evaluated the significance
of the conditions and has concluded that because of the completion of our initial public offering in September 2022, the Company has sufficient
cash and investments on hand to satisfy its anticipated cash requirements for the next twelve months from the issuance date of these financial
statements.
Critical
Accounting Policies and Significant Judgments and Estimates
Our
audited consolidated financial statements are prepared in accordance with generally accepted accounting principles in the United States.
The preparation of our audited consolidated financial statements and related disclosures requires us to make estimates and judgments
that affect the reported amounts of assets, liabilities, costs and expenses, and the disclosure of contingent assets and liabilities
in our audited consolidated financial statements. We base our estimates on historical experience, known trends and events and various
other factors that we believe are reasonable under the circumstances, the results of which form the basis for making judgments about
the carrying values of assets and liabilities that are not readily apparent from other sources. We evaluate our estimates and assumptions
on an ongoing basis. Our actual results may differ from these estimates under different assumptions or conditions.
While
our significant accounting policies are described in more detail in Note 3 to our consolidated financial statements appearing elsewhere
in this Form 10-K, we believe that the following accounting policies are those most critical to the judgments and estimates used in the
preparation of our consolidated financial statements.
Revenue
Recognition
The
Company recognizes revenue when its performance obligations with its customers have been satisfied. At contract inception, the Company
determines if the contract is within the scope of ASC Topic 606 and then evaluates the contract using the following five steps: (1) identify
the contract with the customer; (2) identify the performance obligations; (3) determine the transaction price; (4) allocate the transaction
price to the performance obligations; and (5) recognize revenue when (or as) the entity satisfies a performance obligation. The Company
only recognizes revenue to the extent that it is probable that a significant revenue reversal will not occur in a future period.
The
Company has existing licensing and treatment fee agreements with its customers for the use of the Nexalin Device in their practices.
These agreements generally have terms of one year with automatic renewal if certain requirements are met and amounts due per these agreements
are billed monthly. The Company also sells products related to the provision of services. The Company sells its Devices in China to its
acting distributor and sells products relating to the use of the Devices. The Company has a Royalty Agreement whereby the manufacturer
of the Company’s electrodes will pay a royalty to the Company for a three year period beginning January 1, 2022. The amount of
the Royalty is equal to 20% of the amount that the manufacturer invoices to the acting distributor for the sale of the electrodes.
Revenue
Streams
The
Company derives revenues from its license agreements by charging a monthly licensing fee for the duration of the agreement. The Company
derives revenues from equipment by selling additional individual electrodes and patient cables to customers for use with the Nexalin
Device. The Company receives revenue from the sale in China of its Devices to its acting distributor and from the sale of products relating
to the use of those Devices. The Company derives revenue as a royalty fee from the China-based manufacturer for electrodes ordered in
connection with the Company’s China sales.
Performance
Obligations
Management
identified that subsequent licensing revenue has one performance obligation. That performance obligation is satisfied as long as the
licensing contract remains valid and is not terminated. The licensing revenue is invoiced monthly and is recognized at a point in time
in which the invoice is sent to the customer.
57
Management
identified that our equipment revenue has one performance obligation. That performance obligation is satisfied when the electrodes and
devices are shipped to the customer. We do not offer a warranty on the electrodes or devices.
Management
identified that treatment fee revenue has one performance obligation. The performance obligation is satisfied upon the completion of
individual treatments on patients by customers.
Management
identified that our royalty fee has one performance obligation. The performance obligation is satisfied as long as the royalty agreement
remains valid and is not terminated. The royalty revenue is invoiced when the manufacturer advises the Company that the invoice has been sent to the customer.
Practical
Expedients
As
part of ASC 606, the Company has adopted several practical expedients including:
●
Significant
Financing Component — we do not adjust the promised amount of consideration for the effects of a significant financing
component since we expect, at contract inception, that the period between when we transfer a promised goods or services to the customer
and when the customer pays for that service will be one year or less.
●
Unsatisfied
Performance Obligations —for all performance obligations related to contracts with a duration of less than one year, we
have elected to apply the optional exemption provided in ASC Topic 606 and therefore, are not required to disclose the aggregate
amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of
the reporting period.
●
Shipping
and Handling Activities — we elected to account for shipping and handling activities as a fulfilment cost rather than
as a separate performance obligation.
●
Right
to invoice — we have the right to consideration from a customer in an amount that corresponds directly with the value
to the customer of our performance completed to date we may recognize revenue in the amount to which the entity has a right to invoice.
Recent
Accounting Pronouncements
In
November 2021, the FASB issued ASU 2021-10, Government Assistance (Topic 832). ASU 2021-10 and its amendments will be effective for the
Company for interim and annual periods in fiscal years beginning after December 15, 2021. The Company believes the disclosure requirements
related to governmental assistance have been appropriately made, specifically pertaining to PPP Loans that were forgiven by the government
in 2021. The total impact of the forgiveness on the consolidated financial statements was immaterial.
58
In
February 2020, the FASB issued ASU 2020-02, Financial Instruments-Credit Losses (Topic 326) and Leases (Topic 842) - Amendments
to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 119 and Update to SEC Section on Effective Date Related to Accounting
Standards Update No. 2016-02, Leases (Topic 842), which amends the effective date of the original pronouncement for smaller reporting
companies. ASU 2016-13 and its amendments will be effective for the Company for interim and annual periods in fiscal years beginning
after December 15, 2022. The Company believes the adoption will modify the way the Company analyzes financial instruments, but it does
not anticipate a material impact on results of operations. The Company is in the process of determining the effects adoption will have
on its audited consolidated financial statements.
All
other newly issued but not yet effective accounting pronouncements have been deemed to be not applicable or immaterial to the Company.
Factors
That May Affect Future Results and Financial Condition
The
information contained under the caption “Risk Factors” beginning on page 15 of this Form 10-K provides examples of risks,
uncertainties and events that may cause our actual results to differ materially from the expectations we describe in our forward-looking
statements. Readers should be aware that the occurrence of any of the events described in these risk factors could have a material adverse
effect on our business, results of operations and financial condition. We undertake no obligation to update or revise publicly any forward-looking
statements, whether as a result of new information, future events, or otherwise.
Quantitative
and Qualitative Disclosures about Market Risk
Not
Applicable. As a smaller reporting company, we are not required to provide the information required by this Item.
Use
of proceeds from our Initial Public Offering
The Company completed its initial public offering
on September 16, 2022. A registration statement on Form S-1 (File No. 333-261989) for our initial public offering was filed with the Securities
and Exchange Commission (“SEC”) and became effective on September 15, 2022. The initial public offering consisted of 2,315,000
units consisting of 2,315,000 shares of its Common Stock and 2,315,000 accompanying warrants to purchase up to 2,315,000 shares of common
stock. Each share of common stock was sold together with one warrant, each to purchase one share of common stock with an exercise price
of $4.15 per share at a combined offering price of $4.15, for gross proceeds of $9,607,250, before deducting underwriting discounts and
offering expenses. In addition, we granted the underwriters a 45-day option to purchase up to an additional 347,250 shares of common stock
and/or warrants to purchase up to 347,250 shares of common stock to cover over-allotments at the initial public offering price, less the
underwriting discount. The underwriter partially exercised the overallotment for 347,200 warrants for net proceeds of $3,473. We received net proceeds
of $8,543,645 (after underwriting and offering expenses of $1,067,078) from this initial public offering. As of December 31, 2022, we
utilized the net proceeds to support our daily operations, approximately $406,000 to fund research and development work, approximately
$63,000 for regulatory and certification costs, $237,419 to pay past due service fees to U.S. Asian Consulting Group, LLC and approximately
$285,000 for legal, accounting and administrative expenses.
ITEM
7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
The
Company has not engaged in trading practices in securities or other financial instruments and therefore does not have any material exposure
to interest rate risk, foreign currency exchange rate risk, commodity price risk or other similar risks, which might otherwise result
from such practices. The Company has no foreign operations and therefore is not materially subject to fluctuations in foreign exchange
rates, commodity prices or other market rates or prices from market sensitive instruments.
ITEM
8. CONSOLIDATED FINANCIAL STATEMENTS AND SUPPLEMENTAL DATA
See
attached Consolidated Financial Statements beginning on page F-1 attached to this Report on Form 10-K.
59
ITEM
9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE
As previously reported on Form 8-K filed with
the Securities and Exchange Commission on October 3, 2022, based on information provided by the Company’s independent registered
public accounting firm, Friedman LLP, effective September 1, 2022 Friedman LLP combined with Marcum LLP and continued to operate as an
independent registered public accounting firm. On September 30, 2022, the Audit Committee of the Board of Directors of the Company approved
the dismissal of Friedman LLP and the engagement of Marcum LLP to serve as the independent registered public accounting firm of the Company.
The services previously provided by Friedman LLP are now be provided by Marcum LLP. There are no disagreements with accountants on accounting
and financial disclosure.
ITEM
9A. CONTROLS AND PROCEDURES
Evaluation
of Disclosure Controls and Procedures
Management
of the Company is responsible for establishing and maintaining adequate internal control over financial reporting, as such term is defined
in Exchange Act Rules 13a-15(f) and 15d-15(f). Internal control over financial reporting is a process designed by, or under the supervision
of, our principal executive officer and principal financial officer, or persons performing similar functions, and effected by our board
of directors to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements
in accordance with generally accepted accounting principles. A company’s internal control over financial reporting includes those
policies and procedures that: (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the
transactions and dispositions of the assets of the Company; (ii) provide reasonable assurance that transactions are recorded as necessary
to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures
of the Company are being made only in accordance with authorizations of management and directors of the Company; and (iii) provide reasonable
assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the Company’s assets that
could have a material effect on the financial statements. Our management evaluated, with the participation of our chief executive officer
and chief financial officer (our “Certifying Officers”), the effectiveness of our disclosure controls and procedures as of
December 31, 2022, pursuant to Rule 13a-15(b) under the Exchange Act. Based upon that evaluation, our Certifying Officers concluded that,
as of the evaluation date, our disclosure controls and procedures were not effective due to the following material weaknesses:
● Lack
of sufficient resources necessary to provide adequate segregation of duties related to the preparation and review of financial information
used in financial reporting and review of controls over the financial reporting process, including documentation of review/approval of
journal entries and reconciliations; and
● Insufficient IT controls which are effectively designed and implemented,
specifically related to user/superuser access to the Company’s financial reporting system.
The deficiencies described above
if not remedied, could result in a misstatement of one or more account balances or disclosures in our annual or interim consolidated financial
statements that would not be prevented or detected, and, accordingly, we determined that these control deficiencies constitute a material
weakness.
To address our material weakness, we intend to engage an outside firm
to advise on our financial reporting processes, and intend to implement new financial accounting controls and processes. We intend to
continue to take steps to remediate the material weakness described above through implementing enhancements and controls within our accounting
systems, subject to budget limitations. We will not be able to remediate these control deficiencies until these steps have been completed
and have been operating effectively for a sufficient period of time and Management has concluded, through testing, that the controls are
operating effectively. The redesign and implementation of improvements to our accounting and proprietary systems and controls may be costly
and time consuming and the cost to remediate may impair our results of operations in the future.
Because
of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Therefore, even those
systems determined to be effective can provide only reasonable assurance with respect to financial statement preparation and presentation,
projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because
of changes in conditions or that the degree of compliance with the policies or procedures may deteriorate.
Management’s
Report on Internal Controls over Financial Reporting
This report on Form 10-K does not include a report of management’s assessment regarding internal control over financial reporting due to a transition
period established by the rules of the Commission for newly public companies.
We
are a “smaller reporting company” as defined in Item 10(f)(1) of Regulation S-K under the Securities Act. For as long as
we continue to be a smaller reporting company, we may take advantage of exemptions from various reporting requirements that are applicable
to other public companies that are not smaller reporting companies. Additionally, this Report does not contain an attestation report
of our registered public accounting firm regarding internal control over financial reporting since the Company, as a non-accelerated
filer and “emerging growth company,” is not required to provide such report.
60
Changes
in Internal Control over Financial Reporting
There
were no changes in our internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) of the Exchange
Act) during the most recent fiscal quarter that have materially affected, or are reasonably likely to materially affect, our internal
control over financial reporting.
ITEM
9B. OTHER INFORMATION
None.
ITEM
9C. DISCLOSURE REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTION
Not
Applicable
61
PART
III
ITEM
10. DIRECTORS, EXECUTIVES AND CORPORATE GOVERNANCE
Directors
and Executive Officers
The
following table sets forth the name, age as of December 31, 2022, and position of the individuals who currently serve as our directors
and executive officers. The following also includes certain information regarding the individual experience, qualifications, attributes
and skills of our directors and executive officers as well as brief statements of those aspects of our directors’ backgrounds that
led us to conclude that they are qualified to serve as directors.
Name
Age
Position
Executive
Officers:
Mark
White
62
President,
Chief Executive Officer, Director
David
Owens, M.D.
61
Chief
Medical Officer, Director
Marilyn
Elson
69
Chief
Financial Officer
Michael
Nketiah
47
Senior
Vice President of Quality, Clinical and Regulatory
Non-Employee
Directors:
Rick
Morad
64
Director
Alan
Kazden
62
Director
Ben
Hu, M.D.
65
Director
Executive
Officers and Significant Employees
Mark
White, President and Chief Executive Officer, Board of Directors
Mr.
Mark White has been with Nexalin since 2012, first as an independent consultant from 2012 to 2018, and then as President and Chief Executive
Officer from 2018 to present. Mr. White is a versatile health technology executive with over twenty-five years in leadership roles spanning
medical device development, clinical operations and business development. Prior to joining Nexalin, he owned and operated his own clinics
and addiction centers, where he has saw first-hand the positive results the technology achieves. Early in his career, Mr. White spent
several years building companies and recruiting successful management teams to accelerate growth across several industries. Mr. White
attended the University of Houston.
David
Owens M.D., Chief Medical Officer, Board of Directors
Dr.
David Owens has been with Nexalin since 2017 when he was named Chief Medical Officer of the Company. Dr. Owens has been involved in numerous
medical and software ventures over the past decade. Prior to joining Nexalin, he served with Empiric Systems, LLC, a software company
specializing in radiology information systems and PACS viewing systems. He received a degree in chemistry and physics from Furman University
and later a M.D from the Medical University of South Carolina in Charleston. He completed his residency and fellowship at Emory
University Hospital in Neuroradiology and Interventional Neuroradiology.
Marilyn
Elson, Chief Financial Officer
Ms. Marilyn Elson joined Nexalin as Chief Financial
Officer in January 2022 and has been a Certified Public Accountant for approximately 35 years providing services for a range of clients
including real estate partnerships, corporations and high net worth individuals. Ms. Elson is a shareholder of the Company. She is a member
of U.S. Asian Consulting Group, LLC, which renders advice and consulting services, including services to the Company and which receives
consulting fees from the Company.
Ms.
Elson provides services from time to time to a boutique accounting firm whose predecessor Ms. Elson cofounded and of which she was a
member. Ms. Elson terminated her ownership status with that firm in order to serve as Comptroller for a medical technology company guiding
the company through a public offering and listing on a stock exchange. Ms. Elson received a BA in Accounting from Queens College and
a MS in Taxation from Pace University.
62
Michael
Nketiah, Senior Vice President of Quality, Clinical and Regulatory
Michael Nketiah joined the Company in December,
2022 as its Senior Vice President of Quality, Clinical and Regulatory. He is an expert in regulatory affairs, clinical and quality
assurance specializing in US FDA and international regulatory approvals with over 23 years working directly with the FDA in the medical
device and life sciences industries. His experience includes developing quality systems, authoring various US FDA regulatory submissions,
and assisting with clinical operations. From November 2021 to October 2022 he was Vice President of Quality and Regulatory Affairs at
InterVenn Bioscience. From April 2019 to November 2021 Mr. Nketiah was Vice President of Quality and Regulatory Affairs at Tivie
Health Systems, Inc. He also served as vice President Quality, Regulatory Affairs and Operation at Siris Medical Inc. from November
2015 to April 2019 and held similar positions at various companies such as ClearPath Surgical, Previvo Genetics, Inc. and other companies
over the prior ten years. Michael holds two (2) Bachelor of Science degrees in Chemistry and Mechanical Engineering, and an MBA
degree.
John
Patrick Claude
Mr.
John Claude, in conjunction with Dr. Yakov Katsnelson, designed and developed the original tACS waveform that is marketed as Nexalin
Technology. Mr. Claude now leads all engineering, research and development at Nexalin Technology. Additionally, Mr. Claude has an extensive
background in regulatory, compliance and quality management. Mr. Claude graduated from the University of Notre Dame with a BS in Physiology.
He subsequently received an ME in Biomedical Engineering from the University of Virginia. Mr. Claude has designed and built advanced
technologies for NASA, NIH, Stanford Medical Center and the Palo Alto Veterans Administration.
Non-Employee
Directors
Rick
Morad, Chairman of the Board
Mr.
Rick Morad is a founding investor and shareholder in Nexalin. He has served on our board of directors since 2018. Mr. Morad has been
a successful business operator since 1987. Mr. Morad is also a licensed attorney. Mr. Morad received a B.S./B.A. in business administration,
with a major in Finance and a minor in Accounting, from John Carroll University. He also received a J.D., and graduated with high honors,
from John Marshall Law School.
Alan
Kazden
Mr.
Alan Kazden was an original investor in Nexalin and has served as a Director since 2019. Mr. Kazden has over 30 years of diverse experience
consulting with emerging growth companies in strategic business planning, partnering, raising capital, and acting as a virtual CFO. Prior
to joining Nexalin, Mr. Kazden worked in various industries such as technology, manufacturing & distribution, real estate, health
care, entertainment, and emerging growth companies. He also previously served as a consultant to the Mayor’s Office and Los Angeles
City Council on local tax issues.
Ben
V. Hu M.D.
Dr.
Ben V. Hu is a founding investor and shareholder in Nexalin. Dr. Hu is currently in private practice in Ohio, focusing on Ophthalmology.
Since 2018, he has advised the Nexalin executive team on market development strategies and clinical trial structures to support marketing
and distribution at a global level. Dr. Hu is also an advisor and member of the Board of Directors to Med-logics Inc. a company developing
a surgical technology for cataract surgery utilizing a new patented technology. Dr Hu was awarded his Doctor of Medicine in 1983 from
Case Western University and his Chemical Engineering degree from MIT School of Chemical Engineering.
Medical
Board Advisors
Our
Medical Board advises our management team in planning, development and execution of scientific, clinical and research and development
initiatives and strategies. Our Medical Board consists of experts across a range of key disciplines relevant to our initiatives.
63
Our
current Medical Board advisors are:
Abe
Scheer, M.D.
Dr.
Abraham Scheer specializes in both neurology and psychiatry. Dr. Scheer has over forty years of experience in the field of neurosciences.
Dr. Scheer has lectured extensively throughout the United States on neuromodulation devices. Dr. Scheer was part of the Speakers’
Bureau for both Medtronic’s and Cyberonic’s Neuromodulating Divisions. His clinical expertise includes Adult and Child Neurology,
Brain Injury Medicine and Adult and Child Psychiatry. Dr. Scheer has trained and worked at the finest medical institutions in the United
States, which include Columbia University College of Physicians and Surgeons, Cornell Medical College, George Washington University,
Georgetown University, University of Connecticut and the University of Pittsburgh. Dr. Scheer served as Director of Neurology and Stroke
Services for Beebe Healthcare in Delaware. He is currently a neurohospitalist/neurointensivist for Bay Health in Delaware. Dr. Scheer
is the cousin of our Chief Financial Officer, Marilyn Elson.
Dr. Scheer and the Company entered into consulting agreements whereby
Dr. Scheer agreed to provide consulting services to the Company during the years ended December, 2021 and December 2022. For his services
he was compensated with 10,000 shares of common stock of the Company for each year of service. Dr. Scheer’s current agreement with
the Company has expired. The Company and Dr. Scheer are discussing terms of a new consulting arrangement.
Irene
Cergnul, M.D.
Dr.
Irene Cergnul completed her postgraduate training at Bronx Lebanon Hospital Center in New York and after her final year as Chief Resident
was recruited as Assistant Professor/Faculty in the Depart of Family Medicine. She worked as the Medical Director in the in-patient service
and taught residents in training for the next four years. She was a Research Coordinator involving multiple studies on HIV, depression,
as well as neuropathy, and is a co-author on several publications.
Dr.
Cergnul has been involved in the field of addiction medicine, HIV care and mental health for the last seventeen years. She is committed
to developing and integrating current and new modalities in the treatment of addictive disorders and has dedicated her working career
to treating the underserved population in NY and NJ. Her private practice focuses on novel modalities used in treating addiction and
dual diagnosis patients and has successfully incorporated Nexalin as an integral part of her treatment armamentarium.
Nancy
White, Ph.D.
Dr.
Nancy White is the Clinical Director of Unique Mind Care in Houston, Texas. She is recognized as an industry leader in the development
of a brain-based approach to support neurobehavioral wellness. Dr. White has specialized in the diagnosis and treatment of functional
brain disorders for more than twenty years. She is a Fellow, past President and Board member of the International Society for Neurofeedback
and Research (ISNR), a Certified EEG Fellow of the Biofeedback Certification International Alliance (BCN) and a QEEG Diplomate and member
of the Quantitative EEG Certification Board. Dr. White is a licensed Clinical Psychologist in the State of Texas as well as an Advanced
Addictions Counselor.
Dr.
White is a pioneer in the practical application of neuroscientific research to clinical practice, including the extension of advanced
brain-based therapies to all psychiatric mood disorders including Post-Traumatic Stress, Autism and Addictions. She is a frequent presenter
of her work at conferences, including the American Academy of Anti-Aging Medicine, the International Society for Neurofeedback and Research,
the Association for Applied Psychophysiology and Biofeedback, Future Health and the National Academy of Neuropsychology. She also serves
as a consulting editor of the Journal of Neurotherapy (Taylor and Francis).
Dr.
White has dedicated seven years to the development of the clinical application of the Nexalin therapy. Her research and clinical data
on the use of Nexalin therapy has been presented at international conferences. Dr. White is the mother of our Chief Executive Officer,
Mark White.
64
Non-Medical
Board of Advisors
Nexalin
has also established a non-medical Board of Advisors. The members of the Board of Advisors serve at the request of the Board and advise
and make recommendations with respect to the strategic direction of the company and similar matters. The members of the Board of Advisors
do not have, or shall be deemed to have, a fiduciary relationship in respect of the company. The members of the Board of Advisors are
set forth below. We have entered into agreements with each member of the Board of Advisors, which set forth the terms and conditions
relating to the individual’s service on the Board of Advisors. The agreements provide for an initial one-year term, which can be
extended for an additional year. The agreements commenced December 24, 2021 and include confidentiality and protection of Company’s
intellectual property, and indemnification protection. Under the agreements, each advisor is entitled to receive $80,000 worth of our
Common Stock. The value of the shares issuable is $5.00 per share, which was the price of our Common Stock based upon transactions with
unaffiliated third parties at such time. All the members of our Board of Advisors have waived compensation for fiscal 2022.
Tucker
Anderson
Tucker
Andersen spent twenty-seven years with the private investment partnership Cumberland Associates, including fifteen years as a co-managing
partner of the firm. Subsequent to his retirement from that position, he founded Above All Advisors, a consulting and investment firm.
He is on several advisory and private company boards, including, Questech Corporation, Value Insight Partners, and Artificial Cell Technologies.
He received his B.A. in Quantitative Studies from Wesleyan University in 1963. Tucker is the recipient of both the Wesleyan Distinguished
Alumnus Award and the Exeter Founder’s Day Award. He is both a Chartered Financial Analyst and an Associate Member of the Society
of Actuaries.
Leonard
Osser
Leonard
Osser has been a Director of Milestone Scientific, Inc. since he founded that company in 1989. He served as Chief Executive Officer of
Milestone Scientific from the time of its founding until 2021, other than twice during the last 20 years when he intended to retire from
that position. He served as Chairman of Milestone Scientific from 1991 until September 2009 at which time he resigned as Chairman of
Milestone Scientific, but remained a director. Mr. Osser serves as Managing Member of U.S. Asian Consulting Group LLC, which provides
various consulting services to the Company. Mr. Osser is a shareholder of the Company. He is a member of our non-medical Board of Advisors
and serves as Director of China operations. Mr. Osser is the spouse of Marilyn Elson, our Chief Financial Officer.
Gian
Domenico Trombetta
Gian
Domenico Trombetta has been the President and CEO of Innovest S.p.A. an Italian corporation specializing in private equity and distressed
assets since 1992. He was previously with Booz Allen & Hamilton Inc. focusing on strategy and acquisition services. Mr. Trombetta
received B.A, from Luiss University in Rome in 1984. Mr. Trombetta is also an independent director of Milestone Scientific Inc.
Family
Relationships
Ms.
Marilyn Elson, our Chief Financial Officer, is the spouse of Leonard Osser, a member of our non-medical Board of Advisors and director
of China Operations. Ms. Elson is the cousin of Abraham Scheer, one of the members of our Medical Board of Advisors. Dr. Nancy White,
a member of our Medical Board of Advisors is the mother of Mr. Mark White, our Chief Executive Officer. Other than as stated in the preceding
two sentences, there are no family relationships between any of our directors or executive officers.
65
Board
Composition
Our
board of directors currently consists of five members. There are no contractual obligations regarding the election of our directors.
Our nominating and corporate governance committee and our board of directors may therefore consider a broad range of factors relating
to the qualifications and background of nominees. Our nominating and corporate governance committee’s and our board of directors’
priority in selecting board members is identification of persons who will further the interests of our stockholders through their established
record of professional accomplishment, the ability to contribute positively to the collaborative culture among board members, knowledge
of our business, understanding of the competitive landscape, professional and personal experiences and expertise relevant to our growth
strategy. Our directors hold office until their successors have been elected and qualified or until the earlier of their resignation
or removal. Our amended and restated certificate of incorporation and amended and restated bylaws provide that our directors may be removed
only for cause by the affirmative vote of the holders of at least two-thirds of the votes that all our stockholders would be entitled
to cast in an annual election of directors, and that any vacancy on our board of directors, including a vacancy resulting from an enlargement
of our board of directors, may be filled only by vote of a majority of our directors then in office.
Under
our agreements with U.S. Asian Consulting Group LLC, U.S. Asian was granted a right to appoint one director to our Board of Directors.
To date, U.S. Asian has not exercised this right.
Director
Independence
Our
board of directors has undertaken a review of its composition, the composition of its committees and the independence of each director.
Based upon information requested from and provided by each director concerning his or her background, employment and affiliations, including
family relationships, our board of directors has determined that all of our directors (Rick Morad, Alan Kazden and Ben Hu M.D.) other
than Mark White and Dr. Owens have no relationships that would interfere with the exercise of independent judgment in carrying out the
responsibilities of a director and that each of these directors is “independent” as that term is defined under the applicable
rules and regulations of the SEC and Nasdaq. In making this determination, our board of directors considered the current and prior relationships
that each non-employee director has with our company and all other facts and circumstances our board of directors deemed relevant in
determining his or her independence, including the beneficial ownership of our share capital held by each non-employee director.
Committees
of the Board of Directors
Our board of directors has established an audit
committee, a compensation committee and a nominating and corporate governance committee, each of which will have the composition and responsibilities
described below. From time to time, the board may establish other committees to facilitate the oversight of our business. The charters
for each of our committees is available on our website (https://nexalin.com/).
Audit
Committee
Our
audit committee is composed of our three independent directors, Messrs. Alan Kazden, Rick Morad and Ben Hu M.D. Our board of directors
has determined that each of these persons are independent within the meaning of applicable Nasdaq listing requirements and the independence
requirements contemplated by Rule 10A-3 under the Securities Exchange Act of 1934, as amended. Alan Kazden is the chairman of the audit
committee and our board of directors has determined that he is an “audit committee financial expert” as defined by SEC rules
and regulations. Our board of directors has determined that the composition of our audit committee meets the criteria for independence
under, and the functioning of our audit committee complies with, the applicable requirements of the Sarbanes-Oxley Act, applicable Nasdaq
listing requirements and SEC rules and regulations. We intend to continue to evaluate the requirements applicable to us and we intend
to comply with the future requirements to the extent that they become applicable to our audit committee. The principal duties and responsibilities
of our audit committee include:
●
appointing
and retaining an independent registered public accounting firm to serve as independent auditor to audit our financial statements,
overseeing the independent auditor’s work and determining the independent auditor’s compensation;
●
approving
in advance all audit services and non-audit services to be provided to us by our independent auditor;
66
●
establishing
procedures for the receipt, retention and treatment of complaints received by us regarding accounting, internal accounting controls,
auditing or compliance matters, as well as for the confidential, anonymous submission by our employees of concerns regarding questionable
accounting or auditing matters;
●
reviewing
and discussing with management and our independent auditor the results of the annual audit and the independent auditor’s review
of our quarterly financial statements;
●
conferring
with management and our independent auditor about the scope, adequacy and effectiveness of our internal accounting controls, the
objectivity of our financial reporting and our accounting policies and practices; and
●
reviewing
and approving any related party transaction required to be disclosed pursuant to Item 404 of Regulation S-K promulgated by the SEC
prior to us entering into such transactions.
Compensation
Committee
Our
compensation committee is composed of two directors, Alan Kazden and Ben Hu, M.D., each of whom is a non-employee member of our
board of directors as defined in Rule 16b-3 under the Exchange Act. Alan Kazden is the chairman of the compensation committee. Our board
of directors has determined that the composition of our compensation committee satisfies the applicable independence requirements under,
and the functioning of our compensation committee complies with the applicable requirements of, Nasdaq listing rules and SEC rules and
regulations. We intend to continue to evaluate and intend to comply with all future requirements applicable to our compensation committee.
The principal duties and responsibilities of our compensation committee include:
●
establishing
and approving, and making recommendations to the board of directors regarding, performance goals and objectives relevant to the compensation
of our chief executive officer, evaluating the performance of our chief executive officer in light of those goals and objectives
and setting, or recommending to the full board of directors for approval, the chief executive officer’s compensation, including
incentive-based and equity-based compensation, based on that evaluation;
●
setting
the compensation of our other executive officers, based in part on recommendations of the chief executive officer;
●
exercising
administrative authority under our stock plans and employee benefit plans;
●
establishing
policies and making recommendations to our board of directors regarding director compensation;
●
reviewing
and discussing with management the compensation discussion and analysis that we may be required from time to time to include in SEC
filings; and
●
preparing
a compensation committee report on executive compensation as may be required from time to time to be included in our annual proxy
statements or annual reports on Form 10-K filed with the SEC.
Nominating
and Corporate Governance Committee
The
nominating and corporate governance committee is composed of three directors, Alan Kazden, Rick Morad, and Ben Hu, M.D. Alan Kazden is
the chairman of the nominating and corporate governance committee. Our board of directors has determined that the composition of our
nominating and corporate governance committee satisfies the applicable independence requirements under, and the functioning of our nominating
and corporate governance committee complies with the applicable requirements of, Nasdaq listing standards and SEC rules and regulations.
We will continue to evaluate and will comply with all future requirements applicable to our nominating and corporate governance committee.
The nominating and corporate governance committee’s responsibilities include:
●
assessing
the need for new directors and identifying individuals qualified to become directors;
●
recommending
to the board of directors the persons to be nominated for election as directors and to each of the board’s committees;
67
●
assessing
individual director performance, participation and qualifications;
●
developing
and recommending to the board corporate governance principles;
●
monitoring
the effectiveness of the board and the quality of the relationship between management and the board; and
●
overseeing
an annual evaluation of the board’s performance.
Board
Leadership Structure
Our corporate governance guidelines provide that, if the chairman of
the board is a member of management or does not otherwise qualify as independent, the independent directors of the board may elect a lead
director. The lead director’s responsibilities will include, but not be limited to: presiding over all meetings of the board of
directors at which the chairman is not present, including any executive sessions of the independent directors; approving board meeting
schedules and agendas; and acting as the liaison between the independent directors and the chief executive officer and chairman of the
board. Our corporate governance guidelines will further provide the flexibility for our board of directors to modify our leadership structure
in the future as it deems appropriate. Mr. Rick Morad is the chairman of the board, and we have determined that he qualifies as an independent
director.
Role
of the Board in Risk Oversight
One of the key functions of our board of directors is informed oversight
of our risk management process. Our board of directors will not have a standing risk management committee but will rather administer this
oversight function directly through our board of directors as a whole, as well as through various standing committees of our board of
directors that address risks inherent in their respective areas of oversight. In particular, our board of directors is responsible for
monitoring and assessing strategic risk exposure and our audit committee has the responsibility to consider and discuss our major financial
risk exposures and the steps our management has taken to monitor and control these exposures, including guidelines and policies to govern
the process by which risk assessment and management is undertaken. Our audit committee also monitors compliance with legal and regulatory
requirements. Our nominating and corporate governance committee will monitor the effectiveness of our corporate governance practices,
including whether they are successful in preventing illegal or improper liability-creating conduct. Our compensation committee assesses
and monitors whether any of our compensation policies and programs has the potential to encourage excessive risk-taking. While each committee
will be responsible for evaluating certain risks and overseeing the management of such risks, our entire board of directors will be regularly
informed through committee reports about such risks.
Code
of Business Conduct and Ethics for Employees, Executive Officers and Directors
We
have adopted a Code of Business Conduct and Ethics, or the code of conduct, applicable to all our employees, executive officers and directors.
The code of conduct is available on our website at www.nexalin.com . The nominating and corporate governance committee of our board
of directors will be responsible for overseeing the code of conduct and must approve any waivers of the code of conduct for employees,
executive officers and directors. We expect that any amendments to the code of conduct, or any waivers of its requirements for any executive
officer or director, will be disclosed on our website.
Compensation
Committee Interlocks and Insider Participation
None
of our directors who currently serve as members of our compensation committee is or has at any time during the past year been, one of
our officers or employees. None of our executive officers currently serves, or in the past year has served, as a member of the board
of directors or compensation committee of any other entity that has one or more of its executive officers serving on our board of directors
or compensation committee.
68
Limitation
on Liability and Indemnification Matters
Our
amended and restated certificate of incorporation, and our amended and restated bylaws, limit our directors’ liability, and may
indemnify our directors and officers to the fullest extent permitted under Delaware General Corporation Law, or the DGCL. The DGCL provides
that directors of a corporation will not be personally liable for monetary damages for breach of their fiduciary duties as directors,
except for liability for any:
●
transaction
from which the director derives an improper personal benefit;
●
act
or omission not in good faith or that involves intentional misconduct or a knowing violation of law;
●
unlawful
payment of dividends or redemption of shares; or
●
breach
of a director’s duty of loyalty to the corporation or its stockholders.
These
limitations of liability do not apply to liabilities arising under federal securities laws and do not affect the availability of equitable
remedies such as injunctive relief or recession.
The
DGCL and our amended and restated bylaws provide that we will, in certain situations, indemnify our directors and officers and may indemnify
other employees and other agents, to the fullest extent permitted by law. Any indemnified person is also entitled, subject to certain
limitations, to advancement, direct payment or reimbursement of reasonable expenses (including attorneys’ fees and disbursements)
in advance of the final disposition of the proceeding.
In
addition, we have entered or will enter into indemnification agreements with our directors and officers. These indemnification agreements,
among other things, require us to indemnify our directors and officers for certain expenses, including attorneys’ fees, judgments,
fines and settlement amounts incurred by a director or officer in any action or proceeding arising out of their services as a director
or officer, or any other company or enterprise to which the person provides services at our request.
We
also maintain a directors’ and officers’ insurance policy pursuant to which our directors and officers are insured against
liability for actions taken in their capacities as directors and officers.
We
believe that these provisions in our amended and restated certificate of incorporation and amended and restated bylaws, these indemnification
agreements and this insurance are necessary to attract and retain qualified persons as directors and officers.
Insofar
as indemnification of liabilities arising under the Securities Act of 1933, as amended, or the Securities Act, may be permitted to our
board of directors, executive officers or persons controlling us pursuant to the foregoing provisions, we have been informed that, in
the opinion of the SEC, such indemnification is against public policy as expressed in the Securities Act and is therefore unenforceable.
69
ITEM
11 EXECUTIVE AND DIRECTOR COMPENSATION
Our
named executive officers for the year ended December 31, 2022, which consist of our principal executive officer and our other most highly
compensated executive officers, were:
Mark
White, our President and Chief Executive Officer
Marilyn
Elson, our Chief Financial Officer
David
Owens, M.D., our Chief Medical Officer
Michael
Nketiah, our Senior Vice President of Quality, Clinical and Regulatory
Summary
Compensation Table
The
following table presents the compensation awarded to, earned by, or paid to our named executive officers, during the two (2) years ended
December 31, 2022 and 2021.
Name and Principal Position
Year
Salary
$
Bonus
$
Stock
Awards
$
Total
$
Mark White
2021
175,000
5,000
404,132
584,132
Chief Executive Officer
2022
191,292
-
-
191,292
Marilyn Elson (1)
2021
-
-
-
-
Chief Financial Officer
2022
345,000
-
-
345,000
David Owens, M.D. (2)
2021
-
-
293,750
293,750
Chief Medical Officer
2022
-
-
-
-
Michael Nketiah (3)
2021
-
-
-
-
Senior Vice-President of Quality, Clinical and Regulator
2022
32,080
-
-
32,080
(1) Marilyn
Elson was appointed as our Chief Financial Officer on January 11, 2022. Ms. Elson has entered into an employment agreement with the Company.
The agreement provides for a term of three years commencing as of January 1, 2022 at an annual salary of $360,000 per annum. The compensation
table does not include payments due to U.S. Asian, an entity which provides consulting services to the Company and of which Ms. Elson
is a member.
(2) David
Owens, M.D., Chief Medical Officer, has no 2022 compensation due to waiver of his 2022 compensation.
(3) Michael
Nketiah was retained by the Company effective November 15, 2022 to serve as its Senior Vice President of Quality, Clinical
and Regulatory. His compensation agreement with the Company provides for a base salary of $250,000 per annum. The amount shown reflects
his compensation received during the year ended December 31, 2022.
The
Compensation Committee of the Board of Directors is discussing with the Company’s Chief Executive Officer, Chief Medical Officer
and Senior Vice President changes or additions to their compensation arrangements. It is expected that the base salary of our Chief Executive
Officer will be increased. The compensation packages may include new bonus compensation arrangements which may include new stock-based
compensation. The Compensation Committee is also considering making modifications to the compensation arrangements with its non-employee
directors and members of the Board of Advisors. In order to make any definitive agreements with its officers or directors or employees
generally, the Company will need to implement a stock-based plan in accordance with Nasdaq Stock markets rules, which include among other
things, approval of any such plan by stockholders.
70
Narrative
to Summary Compensation Table
We
review compensation annually for all employees, including our executives. In setting executive base salaries and bonuses and granting
equity incentive awards, we consider compensation for comparable positions in the market, the historical compensation levels of our executives,
individual performance as compared to our expectations and objectives, our desire to motivate our employees to achieve short- and long-term
results that are in the best interests of our stockholders and a long-term commitment to our company. In addition, we have also engaged
compensation consultants and take into consideration their assessments of our compensation.
The
compensation committee of our board of directors has historically reviewed and made recommendations to our board of directors regarding
our executives’ compensation. Our compensation committee typically reviews and discusses management’s proposed compensation
with the chief executive officer for all executives other than the chief executive officer. Based on those discussions and its discretion,
the compensation committee then recommends the compensation for each executive officer for approval by our board of directors. To date,
our compensation committee has not adopted a peer group of companies for purposes of determining executive compensation.
On
February 15, 2021, the Company entered into an employment agreement with Mark White to serve as Chief Executive Officer of the Company
for a three-year term. Pursuant to the agreement, Mr. White is entitled to receive $200,000 in annual compensation and is eligible to
receive up to $200,000 in additional cash and stock-based compensation upon achieving certain performance metrics. During the 2021 and
2022 years, Mr. White received cash compensation of $180,000 and $191,292 respectively. Additionally, on February 15, 2021, pursuant
to the agreement, the Company issued shares of the Company’s common stock in an amount representing two (2%) percent of the Company’s
issued and outstanding shares as of the effective date of the agreement, or 80,827 shares of the Company’s common stock. Mr. White
has waived the deficit amounts otherwise payable under his employment arrangements.
On
February 15, 2021, the Company entered into an employment agreement with David Owens, M.D. to serve as Chief Medical Officer of the Company
for a three-year term. Dr. Owens has provided services to the Company prior to the date of his employment agreement. For the 2021 year,
Dr Owens received compensation paid in shares of common stock in the amount of $293,750. Pursuant to the agreement, Dr. Owens is entitled
to receive $150,000 in annual compensation payable by the issuance of Company common stock. He is also eligible to receive bonus compensation
based upon achieving certain performance metrics. In March 2022, the Company entered into an amendment to the agreement with Dr. Owens
to clarify certain matters related to his compensation. Dr. Owens has agreed that all shares issuable to him as compensation through
December 31, 2021 (shares of common stock with a compensation value of $293,750) have been issued and he has been paid in full all amounts
due to him for his prior service through December 31, 2021. For determining the number of shares issuable to him for his 2022 services,
the number of shares would be based upon offering price of the Company’s Common Stock in our IPO. For the number of shares issuable
during 2022 and 2023, the value shall equal, the average closing price of the Company’s Common Stock for the 30 trading days prior
to December 23, 2022. Dr. Owens has waived his 2022 compensation.
On
November 15, 2022 the Company retained Michael Nketiah to serve as its Senior Vice President of Quality, Clinical and Regulatory. His
compensation agreement with the Company provides for a base salary of $250,000 per annum. For the year ended December 31, 2022, Mr. Nketiah
received total compensation of $32,080.
On
January 11, 2022, the Company entered into an employment agreement with Marilyn Elson to serve as Chief Financial Officer of the Company
for a three-year term. Pursuant to the agreement, Ms. Elson is entitled to receive $360,000 in annual compensation that is payable to
her in cash. For the year ended December 31, 2022, Ms. Elson received total compensation of $345,000.
The
Company (through its Board Compensation Committee) is in discussions with its Chief Executive Officer and Chief Medical Officer regarding
potential changes to their compensation arrangements. These discussions may include modifications to the base salary and bonus arrangements
which may include stock-based compensation. The Company expects to submit for shareholder approval, in accordance with NASDAQ Stock Market
requirements, a stock-based compensation plan so that it can enter into new individual agreements with its executive officers and allow
for stock based grants to employees, advisors and directors.
71
Annual
Base Salary
Base
salaries for our executives are initially established through arm’s length negotiation at the time the executive is hired, taking
into account such executive’s qualifications, experience, prior salary, the scope of his or her responsibilities and competitive
market compensation paid by other companies for similar positions within the industry. Base salaries are to be reviewed annually in January
by our compensation committee and approved by our board of directors in connection with our annual performance review process. Salaries
may be adjusted from time to time to realign salaries with market levels after taking into account individual responsibilities, performance
and experience. In making decisions regarding salary increases, we may also confer with a compensation consultant or draw upon the experience
of members of our board of directors with other companies. The 2022 and 2021 base salaries of our named executive officers are as follows:
December 31,
Name
2022
$
2021
$
Mark White (1)
200,000
200,000
David Owens, M.D (2)
150,000
150,000
Marilyn Elson (3)
360,000
-
Michael Nketiah (4)
250,000
-
(1)
During
the 2022 year, Mr. White received cash compensation of $191,292. During the 2021 year, he received cash compensation of $180,000. Both
amounts were less than the agreed upon cash compensation level in the agreement. Mr. White has agreed to waive any amounts which were
not paid under his employment agreement for 2022 and 2021.
(2)
On
February 15, 2021, the Company entered into an employment agreement with David Owens, M.D. to serve as Chief Medical Officer of the
Company for a three-year term. Dr. Owens was providing services to the Company prior to the date of his employment agreement. For
the 2022 year, Dr. Owens received no compensation. For the 2021 year he received compensation paid in shares of common stock in the
amount of $293,750. In March 2022, we entered into an amendment of the agreement with Dr. Owens to clarify certain matters related
to his compensation. Dr. Owens has agreed that all shares issuable to him as compensation or for any other amounts he may have been
due or owed through December 31, 2021 (shares of common stock with a compensation value of $293,750) have been issued and no further
amounts are due. The stated amounts in the table above reflects the employment agreement amount. Amounts payable to Dr. Owens are
paid in shares of common stock. Dr. Owens waived his compensation for fiscal 2022.
(3)
Ms.
Elson is entitled to a base salary of $360,000 per annum. For the year ended December 31, 2022, based on less than a full
year of employment, she received total compensation of $345,000.
(4)
Mr.
Nketiah is entitled to a base salary of $250,000 per annum. For the year ended December 31, 2022, based on less than a
full year of employment, he received total compensation of $32,080.
Health
and Welfare Benefits
We
adopted a company medical benefit plan in fiscal year 2023 and all employees are eligible to participate. The Company believes that the
plan is usual and customary in nature to provide for health coverage for all employees.
Non-Employee
Director Compensation
Each
non-employee director elected to our board of directors receives shares of our common stock equal to $35,000 per annum. Mr. Morad has
received an aggregate of 21,000 shares of common stock for his services during 2019, 2020 and 2021. Dr Hu and Mr. Kazden have each received
an aggregate of 14,000 shares of common stock for their two years of service during 2020 and 2021. In August 2022, Mr. Morad, Dr. Hu
and Mr. Kazden were each issued 5,833 shares of the Company’s stock for their 2022 services.
Our
policy of compensating our non-employee directors is intended to provide a total compensation package that enables us to attract and
retain qualified and experienced individuals to serve as directors and to align our directors’ interests with those of our stockholders.
The Board of Directors is considering new arrangements for compensation of directors and advisors. No definitive plans have been determined,
but it is expected that compensation will include a stock-based provision. The Company expects to request stockholder approval for a
broad-based equity plan at its annual meeting to be held in the second or third quarter of 2023.
72
Item
12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWENRS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS
The
following table sets forth the beneficial ownership of our 7,286,562 shares of our common stock outstanding as of March 22, 2023 for:
●
each
person, or group of affiliated persons, who is known by us to beneficially own more than 5% of our common stock;
●
each
of our named executive officers;
●
each
of our directors; and
●
all
of our current executive officers and directors as a group.
We
have determined beneficial ownership in accordance with the rules of the SEC. These rules generally attribute beneficial ownership of
securities to persons who possess sole or shared voting power or investment power with respect to those securities. For purposes of this
table, we have not included or given effect to any warrants, including warrants to be sold in this offering, or any underlying shares
of common stock.
The
address for persons listed in the table is c/o Nexalin Technology, Inc., 1776 Yorktown, Suite 550, Houston, TX 77056.
Directors,
Executive Officers and 5% Shareholders
Name of Beneficial Owner
Number of
Shares
Beneficially
Owned
Percentage of
Shares
Beneficially
Owned
Marilyn Elson and Leonard Osser
835,244 (2)
11.46 %
Mark White
309,127 (1)(3)
4.24 %
Rick Morad
170,126 (3)(4)
2.33 %
Benjamin Hu
165,636 (3)(5)
2.27 %
David Owens, MD
141,174 (3)(6)
1.94 %
Alan Kazden
83,131 (3)(7)
1.14 %
Michael Nketiah
-
-
All Directors, Executive Officer and Affiliates as a Group (7 People)
1,704,438
23.38 %
(1) Mark
White is Chief Executive Officer and a director of the Company. Includes shares owned by Mr. White in his individual name and IICOM Strategic
LLC, an entity controlled by Mr. White. Mr. White has voting and dispositive power over the shares held by IICOM Strategic LLC.
(2) Leonard
Osser and Marilyn Elson, Chief Financial Officer of the Company, are husband and wife and deemed to have beneficial ownership of each
other’s holdings. Each has joint voting and dispositive control in the securities owned by each other. The calculation of the number
of shares issued to U.S. Asian Consulting, Group LLC that sustains their equity at 15% of issued and outstanding shares included 300,000
shares held in escrow for the benefit of Wider, which are to be released upon the completion of Wider’s clinical trials. Under
the consulting agreement with U.S. Asian Consulting Group LLC, the parties agreed that in consideration for deferring payments and for
terminating previously agreed upon ant-dilution rights, U.S Asian would be entitled to 15% of the issued and outstanding shares of the
Company until our public offering completed in September 2022.
(3) Director
of the Company.
(4) Includes
shares owned by Mr. Morad individually and through the Rick Morad Family Trust, and his individual retirement account
(5) Includes
shares owned by Mr. Hu individually and through the Benjamin V. Hu American Estate and Equity Trust Custodian FBO Benjamin V Hu, over
which shares Mr., Hu has voting and dispositive power. Also includes shares owned by Mr. Hu’s spouse through the Amy N. Hu American
Estate and Equity Trust Company Custodian FBO Amy N. Lun Hu IRA, over which shares Mr. Hu’s spouse has voting and dispositive power.
73
(6) Dr.
Owens is the Chief Medical Officer and a Director of the Company. Includes shares owned by Dr. Owens individually and through LTB Investment
Holdings, LLC, an entity controlled by Dr. Owens. Dr. Owens has voting and dispositive control over all of such shares.
(7) Mr.
Kazden is a director of the Company. Includes shares owned by the Alan and Natalie Kazden Family Trust. Mr. Kazden has voting and dispositive
control over all of such shares.
Description
Of Capital Stock
The
following description of our capital stock and certain provisions of our amended and restated certificate of incorporation and amended
and restated bylaws are summaries. You should also refer to the amended and restated certificate of incorporation and bylaws, which are
filed as exhibits to the registration statement for our IPO.
General
Our
authorized capital consists of shares of common stock, par value $0.001 per share. Under our Certificate of Incorporation, as amended
to date, we are authorized to issue 100,000,000 shares of common stock, $0.001 par value per share.
Common
Stock
As of March 22, 2023, we had 7,286,562 shares
of common stock outstanding, held of record by approximately 900 stockholders.
Voting
Rights
Each
holder of common stock is entitled to one vote for each share on all matters submitted to a vote of the stockholders. The affirmative
vote of holders of at least 66% of the voting power of all of the then-outstanding shares of capital stock, voting as a single class,
will be required to amend certain provisions of our amended and restated certificate of incorporation, including provisions relating
to amending our amended and restated bylaws, the classified board, the size of our board, removal of directors, director liability, vacancies
on our board, special meetings, stockholder notices, actions by written consent and exclusive forum.
Dividends
Holders
of our common stock are entitled to receive ratably any dividends that our board of directors may declare out of funds legally available
for that purpose.
Liquidation
In
the event of our liquidation, dissolution or winding up, holders of our common stock are entitled to share ratably in all assets remaining
after payment of liabilities.
Rights
and Preferences
Holders
of our common stock have no pre-emptive, conversion, subscription or other rights, and there are no redemption or sinking fund provisions
applicable to our common stock. The rights, preferences and privileges of the holders of our common stock are subject to and may be adversely
affected by the rights of the holders of shares of any series of preferred stock that we may designate in the future.
Fully
Paid and Nonassessable
All
outstanding shares of our common stock are fully paid and non-assessable.
74
Warrants
Issued in Our Initial Public Offering
The
following summary of certain terms and provisions of the warrants included in our initial public offering competed in September, 2022.
and is subject to and qualified in its entirety by the provisions of the form of the warrants agent agreement filed as an exhibit to
our registration statement filed in connection with our initial public offering.
Exercisability
The
warrants are exercisable at any time after their original issuance and at any time up to the date that is three (3) years after their
original issuance (September 20, 2025). The warrants are exercisable, at the option of each holder, in whole or in part by delivering
to us a duly executed exercise notice accompanied by payment in full for the number of shares purchased upon such exercise (except in
the case of a cashless exercise as discussed below).
Exercise
Limitation
A
holder will not have the right to exercise any portion of the warrant if the holder (together with its affiliates) would beneficially
own in excess of 4.99% of the number of shares of our common stock outstanding immediately after giving effect to the exercise, as such
percentage ownership is determined in accordance with the terms of the warrants. However, any holder may increase or decrease such percentage
to any other percentage not in excess of 9.99%, provided that any increase in such percentage shall not be effective until 61 days following
notice from the holder to us.
Exercise
Price
The
exercise price per share of common stock purchasable upon exercise of the warrants is $4.15 per share, The exercise price is subject
to appropriate adjustment in the event of certain stock dividends and distributions, stock splits, stock combinations, reclassifications
or similar events affecting our common stock and also upon any distributions of assets, including cash, stock or other property to our
stockholders.
Cashless
Exercise
If,
at any time during the term of the warrants, the issuance of shares of common stock upon exercise of the warrants is not covered by an
effective registration statement, the holder is permitted to effect a cashless exercise of the warrants (in whole or in part) by having
the holder deliver to us a duly executed exercise notice, cancelling a portion of the warrant in payment of the purchase price payable
in respect of the number of shares of common stock purchased upon such exercise.
Failure
to Timely Deliver Shares
If
we fail for any reason to deliver to the holder the shares subject to an exercise by the date that is the earlier of (i) two (2)
trading days and (ii) the number of trading days that is the standard settlement period on our primary trading market as in effect on
the date of delivery of the exercise notice, we must pay to the holder, in cash, as liquidated damages and not as a penalty, for each
$1,000 of shares subject to such exercise (based on the daily volume weighted average price of our shares of common stock on the date
of the applicable exercise notice), $10 per trading day (increasing to $20 per trading day on the fifth (5 th ) trading
day after such liquidated damages begin to accrue) for each trading day after such date until such shares are delivered or the holder
rescinds such exercise. In addition, if after such date the holder is required by its broker to purchase (in an open market transaction
or otherwise) or the holder’s brokerage firm otherwise purchases, shares of common stock to deliver in satisfaction of a sale by
the holder of the shares which the holder anticipated receiving upon such exercise, then we shall (A) pay in cash to the holder
the amount, if any, by which (x) the holder’s total purchase price (including brokerage commissions, if any) for the shares of
common stock so purchased exceeds (y) the amount obtained by multiplying (1) the number of shares that we were required to deliver to
the holder in connection with the exercise at issue times (2) the price at which the sell order giving rise to such purchase obligation
was executed, and (B) at the option of the holder, either reinstate the portion of the warrant and equivalent number of shares for which
such exercise was not honored (in which case such exercise shall be deemed rescinded) or deliver to the holder the number of shares of
common stock that would have been issued had we timely complied with our exercise and delivery obligations.
75
Exchange
Listing
Our
warrants are listed on Nasdaq under the symbol “NXLIW.”
Redemption
We
may redeem the outstanding warrants, in whole and not in part, at a price of $0.01 per warrant:
●
at
any time while the warrants are exercisable,
●
upon
a minimum of 30 days’ prior written notice of redemption,
●
if,
and only if, the last sales price of our common stock equals or exceeds $12.45 per share for any 20 trading days within a 30 trading
day period ending three (3) business days before we send the notice of redemption, and
●
if,
and only if, there is a current registration statement in effect with respect to the shares of common stock underlying such warrants
at the time of redemption and for the entire 30-day trading period referred to above and continuing each day thereafter until the
date of redemption.
If
the foregoing conditions are satisfied and we issue a notice of redemption, each warrant holder can exercise his, her or its warrant
prior to the scheduled redemption date. However, the price of our common stock may fall below the $12.45 redemption trigger price, as
well as the $4.15 warrant exercise price, after the redemption notice is issued.
The
redemption criteria for our warrants have been established at a price which is intended to provide warrant holders a reasonable premium
to the initial exercise price and provide a sufficient differential between the then-prevailing share price and the warrant exercise
price so that if the share price declines as a result of our redemption call, the redemption will not cause the share price to drop below
the exercise price of the warrants.
Rights
as a Stockholder
Except
as otherwise provided in the warrants or by virtue of such holder’s ownership of shares of our common stock, the holder of a warrant
does not have the rights or privileges of a holder of our common stock, including any voting rights, until the holder exercises the warrant.
Governing
Law
The
Warrants and the Warrant Agency Agreement are governed by New York law. Our warrant agreement with our transfer agent, which govern the
terms of the warrants, will provide that, subject to applicable law, (i) any action, proceeding or claim against us or the warrant agent
arising out of or relating in any way to the warrant agreement shall be brought and enforced in the courts of the State of New York or
the United States District Court for the Southern District of New York, and (ii) that we and the warrant agent irrevocably submit to
such jurisdiction, which jurisdiction shall be the exclusive forum for any such action, proceeding or claim. We and the warrant agent
will waive any objection to such exclusive jurisdiction and that such courts represent an inconvenient forum.
Notwithstanding
the foregoing, this exclusive forum provision shall not apply to suits brought to enforce a duty or liability created by the Exchange
Act, any other claim for which the federal courts have exclusive jurisdiction or any complaint asserting a cause of action arising under
the Securities Act against us or any of our directors, officers, other employees or agents. Section 27 of the Exchange Act creates exclusive
federal jurisdiction over all suits brought to enforce any duty or liability created by the Exchange Act or the rules and regulations
thereunder. In addition, shareholders cannot waive compliance with the federal securities laws and the rules and regulations thereunder.
Transfer
Agent and Registrar
Our
transfer agent and registrar for our common stock and warrants is Continental Stock Transfer & Trust Company.
76
Item
13 CERTAIN RELATIONSHIPS AND RELATED PARTY TRANSACTIONS AND DIRECTOR INDEPENDENCE
The following is a description of transactions since our inception
to which we have been a participant in which the amount involved exceeded or will exceed $120,000, and in which any of our directors,
executive officers or holders of more than 5% of our share capital, or any members of their immediate family, had or will have a direct
or indirect material interest, other than compensation arrangements which are described under the section titled “Executive and
Director Compensation.”
Joint
Venture
In
September 2018, we entered into an agreement with Wider, pursuant to which we and Wider shall form the Joint Venture. Wider has an experienced
medical technology team in China and when formed, the Joint Venture will design and implement a comprehensive business model and distribution
plan for our devices in China, Hong Kong, Macau and Taiwan. In May 2019 we entered into a separate agreement with Wider authorizing it
to act as a distributor of our devices pending completion of the potential Joint Venture. We do not pay Wider any commissions or distributor
related fees; it derives profit from its markup of devices it sells.
In
March 2022, we entered into a second supplement to the Joint Venture agreement with Wider, whereby the parties confirmed that the Joint
Venture had not yet been established and is subject to further review and analysis of regulatory issues in China and the United States,
trade and political issues between the two countries and potential changes in the use and market for the Company’s products and
technology. Pursuant to the second supplement, the parties agreed to use their commercial efforts to complete documentation by September
30, 2022. In light of general economic conditions in China and the United States and the continued impact of regulatory issues in China
and the United States and trade and political issues between the two counties, the parties determined to further extend the time frame
to complete establishment of the joint venture to September 30, 2023 and entered into a supplement 3 to the Joint Venture Agreement to
memorialize such extension. The parties intend to continue to work together to complete the establishment prior to such extended time.
During
2022, we sold Gen-2 devices in China through Wider which agreed to act as a distributor on a limited basis pursuant to a separate agreement
entered into in May 2019, pending formation of the Joint Venture. We do not pay Wider any commissions or distributor related fees; it
derives profit from its markup of devices it sells.
We
will own 50% of the Joint Venture when and if it is established. Additionally, under the terms of the Joint Venture agreements, Wider
will receive a one-eighth equity position in our company at a valuation of $40 million, one-third of which has been issued (which equalled
an aggregate of 150,000 shares of Common Stock) and the balance of which is to be issued upon completion of the four clinical trials
and at the time the potential Joint Venture is established and is fully funded by Wider.
U.S.
Asian Consulting Group, LLC
On
May 9, 2018, the Company entered into a five-year consulting agreement with U.S. Asian Consulting Group, LLC (“U.S. Asian”).
In March 2021 the Company agreed to extend the consulting agreement for an additional period of eight years upon the closing of our initial
public offering. The two members of U.S. Asian are shareholders in the Company, with Marilyn Elson having been appointed Chief Financial
Officer of the Company on January 11, 2022. Pursuant to the consulting agreement, U.S. Asian provides consulting services to the Company
with regards to, among other things, corporate development and financing arrangements. The Company is to pay U.S. Asian $10,000 per month
for services rendered and, on October 24, 2018, the Company issued 249,750 shares of the Company’s common stock to U.S. Asian.
The Company recorded consulting expenses related to the consulting agreement of $120,000 and $120,000 for the years ended December 31,
2022 and 2021, respectively, on the Company’s statements of operations. For the years ended December 31, 2022 and 2021, U.S. Asian
was owed $260,000 and $299,320, respectively, for accrued and unpaid services and expenses. We utilized $237,419 of the proceeds of our
IPO to repay a portion the outstanding amount due to U.S. Asian.
77
Pursuant
to the consulting agreement, U.S Asian was originally entitled to anti-dilution protection with respect to its share percentage ownership
in the Company whereas U.S. Asian’s security holdings, during the term of the consulting agreement, would remain at 10% of the
Company’s total number of issued and outstanding shares of the Company’s common stock, on a fully diluted basis. In March
2021, the Company entered into an agreement with U.S. Asian pursuant to which U.S. Asian waived and relinquished any rights of protection
against dilution afforded to it, provided such dilution results from a transaction that (i) imputes a pre-money valuation to the Company
of not less than $7 million, (ii) raises not less than $7 million, and (iii) imputes a post-money valuation to the Company of not less
than $25 million. In exchange for the waiver and relinquishment of such rights, the Company issued shares of the Company’s common
stock in an amount sufficient for U.S. Asian (together with its owners) to own an aggregate amount of fifteen (15%) percent of the Company’s
issued and outstanding shares of common stock as of the date of issuance. On June 22, 2021, the Company issued 304,570 shares of common
stock in satisfaction of the waiver. On November 29, 2021 and in August of 2022, the Company issued an additional 217,500 and 17,699
respectively shares of common stock to U.S. Asian in satisfaction of the waiver.
Under
our agreements with U.S. Asian Consulting Group LLC, U.S. Asian was granted a right to appoint one director to our Board of Directors.
To date, U.S. Asian has not exercised this right.
Our principle executive office is located at 1776
Yorktown, Suite 550, Houston, Texas 77056. Under ASC 842 “ Leases ”, we have two separate sub-leases (through IIcom Strategic
Inc. controlled and owned by our Chief Executive Officer) totaling approximately 4,000 square feet of office space under operating leases.
Our lease payments totaled approximately $48,000 in 2021. Management and supporting staff are hosted at this location. Our lease payments
for fiscal year 2022 were $54,000. Our lease costs for 2023 will also be $54,000 for the year. The sub-leases are due to expire in 2024.
Pursuant to the sublease, we pay the third-party landlord (not the sub landlord) all direct and indirect rent costs under the primary
lease directly for the leased premises. No additional payments are made to the Chief Executive Officer or the entity controlled by him.
Loans
and Notes Payable
On
October 19, 2018, the Company issued an on demand promissory note payable with the Company’s Chairman of the Board for $10,000
with interest to begin accruing on January 1, 2020 at 5% per annum. On September 28, 2022, the Company’s Chairman of the Board
waived the accrued interest of $2,718 which is reflected as Additional Paid in Capital. Total interest expense on this note was $369
and $1,448 for the years ended December 31, 2022 and 2021, respectively. The loan was paid in full in 2022.
On November 1, 2021, the Company received $200,000
from the Company’s Chief Executive Officer. The loan has a principal of $200,000, an interest rate of 9%, and a maturity date of
the earlier of (i) October 31, 2022 or (ii) the date of the consummation of our IPO. Total interest expense on this note was $18,000 and
$3,000 for years December 31, 2022 and 2021. There was $200,000 outstanding at both December 31, 2022 and 2021. The loan principal was
paid in full on March 17, 2023.
Related
Person Transaction Policy
Prior
to our IPO, we did not have a formal policy regarding approval of transactions with related parties. We created and adopted a Code of
Ethics which includes a written related person transaction policy that sets forth our procedures for the identification, review, consideration
and approval or ratification of related person transactions. The related person transaction policy is part of our Code of Ethics, a copy
of which was filed as an exhibit to the registration statement for our IPO and is available on our website.
For
purposes of this policy, a related person transaction is a transaction, arrangement or relationship or any series of similar transactions,
arrangements or relationships, in which we and any related person are, were or will be participants in which the amount involved exceeds
$120,000. Transactions involving compensation for services provided to us as an employee or director are not covered by this policy.
A related person is any executive officer, director or beneficial owner of more than 5% of any class of our voting securities, including
any of their immediate family members and any entity owned or controlled by such persons.
Under
the policy, if a transaction has been identified as a related person transaction, including any transaction that was not a related person
transaction when originally consummated or any transaction that was not initially identified as a related person transaction prior to
consummation, our management must present information regarding the related person transaction to our audit committee, or, if audit committee
approval would be inappropriate, to another independent body of our board of directors, for review, consideration and approval or ratification.
78
The
presentation must include a description of, among other things, the material facts, the interests, direct and indirect, of the related
persons, the benefits to us of the transaction and whether the transaction is on terms that are comparable to the terms available to
or from, as the case may be, an unrelated third party or to or from employees generally. Under the policy, we will collect information
that we deem reasonably necessary from each director, executive officer and, to the extent feasible, significant stockholder to enable
us to identify any existing or potential related-person transactions and to effectuate the terms of the policy. In addition, under our
code of business conduct (Code of Ethics), our employees and directors have an affirmative responsibility to disclose any transaction
or relationship that reasonably could be expected to give rise to a conflict of interest. In considering related person transactions,
our audit committee, or another independent body of our board of directors, will take into account the relevant available facts and circumstances
including, but not limited to:
●
the
risks, costs and benefits to us;
●
the
impact on a director’s independence in the event that the related person is a director, immediate family member of a director
or an entity with which a director is affiliated;
●
the
availability of other sources for comparable services or products; and
●
the
terms available to or from, as the case may be, unrelated third parties or to or from employees generally.
The
policy requires that, in determining whether to approve, ratify or reject a related person transaction, our audit committee, or other
independent body of our board of directors, must consider, in light of known circumstances, whether the transaction is in, or is not
inconsistent with, our best interests and those of our shareholders, as our audit committee, or other independent body of our board of
directors, determines in the good faith exercise of its discretion.
79
ITEM
14. PRINCIPAL ACCOUNTANT FEES AND SERVICES
Our consolidated financial statements as of December
31, 2022 and for the year then ended, have been included herein in reliance upon the report of Marcum LLP, independent registered public
accounting firm, appearing elsewhere herein.
Our consolidated financial statements as of December
31, 2021 and for the years then ended, have been included herein in reliance upon the report of Friedman, LLP, independent registered
public accounting firm, appearing elsewhere herein.
Principal
Accountant Fees and Services
The Audit Committee of the Board of Directors
of our Company selected Marcum LLP as its independent registered public accounting firm for the fiscal year ended December 31, 2022. During
fiscal 2022, the audit services that Marcum provided consisted of examination of financial statements, services relative to filings with
the SEC. The following table presents the total fees for professional audit and non-audit services rendered by our independent registered
public accounting firms for the fiscal years ended December 31, 2022 and 2021, and fees for other services rendered by our independent
registered public accounting firm during those periods. The fees to Friedman LLP in 2022 and 2021 were $76,250 and $110,000, respectively.
The fees to Marcum LLP were $70,000 in 2022.
Year Ended
December 31,
2022
2021
Audit Fees (1)
$ 146,250
$ 110,000
Audit-Related Fees (2)
$
$
Tax Fees (3)
$
$
All Other Fees (4)
$
$
Total
$ 146,250
$ 110,000
(1) “Audit
Fees” consist of fees for professional services rendered for the audit of the Company’s annual financial statements, review
of the interim financial statements included in quarterly reports, and services that are normally provided by the Company’s independent
registered public accounting firm in connection with statutory and regulatory filings, including registration statements filed with the
Securities and Exchange Commission. All audit fees for 2021 related to Friedman LLP services, while audit fees for 2022 relate to services provided by both Friedman LLP and Marcum LLP.
(2) “Audit-Related
Fees” consist of fees for services that are traditionally performed by the independent registered public accounting firm, including
fees billed or accrued primarily for employee benefit plan audits and other attestation services.
(3) “Tax
Fees” consist of fees for professional services rendered for tax compliance, tax advice and tax planning.
(4) “All
Other Fees” consist of fees for those services not captured in the audit, audit-related and tax categories. The Company generally
does not request such services from the independent auditors.
Our
Audit Committee has determined that the services provided by our independent registered public accounting firm and the fees paid to them
for such services has not compromised the independence of our independent registered public accounting firm.
80
Policy
on Audit Committee Pre-Approval of Audit and Permissible Non-Audit Services
Consistent
with SEC policies regarding auditor independence, the Audit Committee has responsibility for appointing, setting compensation and overseeing
the work of the independent registered public accounting firm. In recognition of this responsibility, the Audit Committee has established
a policy to pre-approve all audit and permissible non-audit services provided by the independent registered public accounting firm. Prior
to engagement of the independent registered public accounting firm for the next year’s audit, management will submit a detailed
description of the audit and permissible non-audit services expected to be rendered during that year for each of four categories of services
provided by the independent registered public accounting firm to the Audit Committee for approval. The four categories of services provided
by the independent registered public accounting firm are as defined in the footnotes to the fee table set forth above. In addition, management
will also provide to the Audit Committee for its approval a fee proposal for the services proposed to be rendered by the independent
registered public accounting firm. Prior to the engagement of the independent registered public accounting firm, the Audit Committee
will approve both the description of audit and permissible non-audit services proposed to be rendered by the independent registered public
accounting firm and the budget for all such services. The fees are budgeted, and the Audit Committee requires the independent registered
public accounting firm and management to report actual fees versus the budget periodically throughout the year by category of service.
During the year, circumstances may arise when it may become necessary to engage the independent registered public accounting firm for
additional services not contemplated in the original pre-approval. In those instances, the Audit Committee requires separate pre-approval
before engaging the independent registered public accounting firm. To ensure prompt handling of unexpected matters, the Audit Committee
may delegate pre-approval authority to one or more of its members. The member to whom such authority is delegated must report any pre-approval
decisions to the Audit Committee at its next scheduled meeting.
81
PART
IV
Item
15. Exhibits and Financial Statement Schedules.
(a) Exhibits.
Exhibit
Number
Description
of Document
1.1**
Underwriting
Agreement dated as of September 15, 2022 between the Registrant and Maxim Group LLC
3.1*
Certificate
of Incorporation, as amended and as currently in effect.
3.2*
Amended
and Restated Bylaws.
4.1*
Form
of Specimen stock certificate evidencing shares of common stock.
4.2*
Warrant
Agreement between the Company and Continental Stock Transfer and Trust company as warrant agent dated as of September 16, 2022
4.3*
Form
of Warrant Certificate (filed as part of Exhibit 4.2)
10.1*
Potential
Joint Venture Agreement between the Company and Wider Come Limited, and Supplement thereto, dated as of September 21, 2018, as supplemented
by Supplement Number 1.
10.2*
Employment
Agreement between the Company and Mark White dated as of February 15, 2021.
10.3*
Agreement
between the Company and David Owens, M.D. dated as of February 15, 2021
10.4*
Quality
Assurance Agreement between the Company and Apical Instruments dated December 31, 2020.
10.5*
Advisor
Agreement with Leonard Osser dated as of December 22,2021.
10.6*
Advisor
Agreement with Tucker Anderson dated as of December 24, 2021.
10.7*
Advisor
Agreement with Gian Domenico Trombetta dated December 24, 2021.
10.8*
Employment
Agreement between the Company and Marilyn Elson dated as of January 11, 2022
10.9*
Amendment
and Deferral Agreement dated as of March 30, 2022 to Consulting Agreement between the Company and US Asian Consulting Group LLC
10.10*
Supplement
Number 2 to potential Joint Venture Agreement dated as of March 1, 2022 between the Company and Wider Come Limited.
10.11*
Amendment
to Employment Agreement with David Owens, M.D.
10.12*
Form
of Lock-Up Agreement.
10.13*
Consulting
Agreement dated as of May 9, 2018 as amended between the Company and US Asian Consulting Group, LLC, as amended on January 2, 2019
and March 4, 2021
10.14*
Promissory
Note in favor Mark White dated as of November 1, 2021, as amended
10.15*
Distribution
Authorization Agreement dated as of May 1, 2019 with Wider Come Limited.
23.1*
Consent
of Friedman LLP, independent registered public accounting firm.
31.1****
Certification of the Chief Executive Officer pursuant to Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as amended.
31.2****
Certification of the Chief Financial Officer pursuant to Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as amended
32.1****
Certification of the Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2****
Certification of the Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
99.1*
Code
of Ethics
99.2*
Audit
Committee Charter
99.3*
Compensation
Committee Charter
99.4*
Nominating
and Corporate Governance Committee Charter
*
Previously
filed as an exhibit to Form S-1 as declared effective by the SEC on September 15, 2022 (SEC File Number 333-261989).
**
Previously
filed as an exhibit to Form 8-K as filed with the SEC on September 20, 2022
***
Previously
filed as an exhibit to Form 8-K/A as filed with the SEC on September 20, 2022.
****
Filed
as an exhibit to this Form 10-K.
82
ITEM
16. FORM 10-K SUMMARY
None.
83
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.
NEXALIN
TECHNOLOGY, INC.
By:
/s/
Mark White
Mark
White
Chief
Executive Officer
(Principal
Executive Officer)
Date:
March 24, 2023
By:
/s/
Marilyn Elson
Marilyn
Elson
Chief
Financial Officer
(Principal
Financial and Accounting Officer)
Date:
March 24, 2023
Pursuant
to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the
registrant and in the capacities and on the dates indicated.
By:
/s/
Mark White
Mark
White
Chief
Executive Officer
(Principal
Executive Officer)
Date:
March 24, 2023
By:
/s/
Marilyn Elson
Marilyn
Elson
Chief
Financial Officer
(Principal
Financial and Accounting Officer)
Date:
March 24, 2023
By:
/s/
Rick Morad
Rick
Morad
Director
Date:
March 24, 2023
By:
/s/
Alan Kazden
Alan
Kazden
Director
Date:
March 24, 2023
By:
/s/
Ben Hu, M.D.
Ben
Hu, M.D.
Director
Date:
March 24, 2023
By:
/s/ David Owens
David Owens
Director
Date:
March 24, 2023
84
ITEM
8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
NEXALIN
TECHNOLOGY, INC.
CONSOLIDATED
FINANCIAL STATEMENTS AS OF DECEMBER 31, 2022 AND 2021
TABLE
OF CONTENTS
Page
REPORTS OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRMS (MARCUM LLP PCAOB FIRM ID 688 and FRIEDMAN LLP PCAOB FIRM ID 711)
F-2
CONSOLIDATED
FINANCIAL STATEMENTS:
Consolidated Balance Sheets as of December 31, 2022 and 2021
F-4
Consolidated Statements of Operations and Comprehensive Loss for the Years Ended December 31, 2022 and 2021
F-5
Consolidated Statements of Changes Stockholders’ Equity (Deficit) as of December 31, 2022 and 2021
F-6
Consolidated Statements of Cash Flows for the Years Ended December 31, 2022 and 2021
F-7
Notes to Consolidated Financial Statements
F-8
F- 1
REPORT
OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To
the Stockholders and Board of Directors of
Nexalin
Technology, Inc. and Subsidiary
Opinion
on the Consolidated Financial Statements
We
have audited the accompanying consolidated balance sheet of Nexalin Technology, Inc. and Subsidiary (the “Company”) as of
December 31, 2021, and the related consolidated statements of operations, stockholders’ deficit, and cash flows for the year ended
December 31, 2021, and the related notes (collectively referred to as the “consolidated financial statements”). In our opinion,
the consolidated financial statements present fairly, in all material respects, the financial position of the Company as of December
31, 2021, and the results of its operations and its cash flows for the year ended December 31, 2021, in conformity with accounting principles
generally accepted in the United States of America.
Basis
for Opinion
These
consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on
the Company’s consolidated financial statements based on our audit. We are a public accounting firm registered with the Public Company
Accounting Oversight Board (United States) (“PCAOB”) and are required to be independent with respect to the Company in accordance
with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We
conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud.
The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. As part
of our audit we are required to obtain an understanding of internal control over financial reporting but not for the purpose of expressing
an opinion on the effectiveness of the Company’s internal control over financial reporting. Accordingly, we express no such opinion.
Our
audit included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due
to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence
regarding the amounts and disclosures in the consolidated financial statements. Our audit also included evaluating the accounting principles
used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.
We believe that our audit provide a reasonable basis for our opinion.
/s/
Friedman llp
Friedman
llp
We
served as the Company’s auditor from 2020-2022.
Marlton,
New Jersey
April
7, 2022
F- 2
To
the Stockholders and Board of Directors of
Nexalin
Technology, Inc. and Subsidiary
Opinion
on the Consolidated Financial Statements
We
have audited the accompanying consolidated balance sheet of Nexalin Technology, Inc. and Subsidiary (the “Company”) as of
December 31, 2022, the related consolidated statements of operations and comprehensive loss, stockholders’ equity (deficit)
and cash flows for the year ended December 31, 2022, and the related notes (collectively referred to as the “consolidated financial
statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position
of the Company as of December 31, 2022, and the results of its operations and its cash flows for the year ended December 31, 2022, in
conformity with accounting principles generally accepted in the United States of America.
Basis
for Opinion
These
consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on
the Company’s consolidated financial statements based on our audit. We are a public accounting firm registered with the Public Company
Accounting Oversight Board (United States) (“PCAOB”) and are required to be independent with respect to the Company in accordance
with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We
conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the
consolidated financial statements are free of material misstatement, whether due to error or fraud. The Company is not required to have,
nor were we engaged to perform, an audit of its internal control over financial reporting. As part of our audit, we are required to obtain
an understanding of internal control over financial reporting but not for the purpose of expressing an opinion on the effectiveness of
the Company’s internal control over financial reporting. Accordingly, we express no such opinion.
Our
audit included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due
to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence
regarding the amounts and disclosures in the consolidated financial statements. Our audit also included evaluating the accounting principles
used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.
We believe that our audit provides a reasonable basis for our opinion.
/s/
Marcum llp
Marcum
LLP
We
have served as the Company’s auditor since 2020 (such date takes into account the acquisition of certain assets of Friedman LLP
by Marcum LLP effective September 1, 2022.)
Marlton,
New Jersey
March 24, 2023
F- 3
NEXALIN
TECHNOLOGY, INC. AND SUBSIDIARY
CONSOLIDATED
BALANCE SHEETS
December 31,
2022
2021
ASSETS
Current Assets:
Cash and cash equivalents
$ 162,743
$ 661,778
Short-term investments
6,831,192
-
Accounts receivable
4,875
16,303
Inventory
154,370
31,410
Prepaid expenses and other current assets
272,282
43,168
Total Current Assets
7,425,462
752,659
ROU Asset
6,171
-
Equipment, net of accumulated depreciation of $ 2,181 and $ 29,862 , respectively
503
1,039
Total Assets
$ 7,432,136
$ 753,698
LIABILITIES AND STOCKHOLDERS’ EQUITY (DEFICIT)
Current Liabilities:
Accounts payable (Includes related party of $ 260,000 and $ 399,320 , respectively)
$ 658,367
$ 843,794
Accrued expenses
539,822
611,795
Lease liability, current portion
50,797
40,845
Loan payable - shareholder
-
37,200
Loan payable - officer
200,000
200,000
Note payable
500,000
500,000
Deferred revenue
-
130,000
Total Current Liabilities
1,948,986
2,363,634
Long-term Liabilities:
Lease liability, net of current portion
4,463
49,089
PPP Loan payable
-
22,916
Total Liabilities
1,953,449
2,435,639
Commitments and Contingencies (Note 8)
Stockholders’ Equity (Deficit):
Common stock, $ 0.001 par value; 100,000,000 shares authorized; 7,286,562 and 4,879,923 shares issued and outstanding at December 31, 2022 and December 31, 2021, respectively
7,287
4,880
Accumulated other comprehensive income
36,313
-
Additional paid in capital
77,824,427
69,004,703
Accumulated deficit
( 72,389,340 )
( 70,691,524 )
Total Stockholders’ Equity (Deficit)
5,478,687
( 1,681,941 )
Total Liabilities and Stockholders’ Equity (Deficit)
$ 7,432,136
$ 753,698
The
accompanying notes are an integral part of these consolidated financial statements.
F- 4
NEXALIN
TECHNOLOGY, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS
Year Ended
December 31,
2022
2021
Revenues, net (Includes related party of $ 1,183,367 and $ 26,132 for the year ended December 31, 2022 and December 31, 2021, respectively)
$ 1,321,357
$ 144,065
Cost of revenues
363,212
21,442
Gross profit
958,145
122,623
Operating expenses
Professional fees
605,329
697,063
Salaries and benefits
694,108
228,738
Selling, general and administrative
1,491,739
5,215,423
Total operating expenses
2,791,176
6,141,224
Loss from operations
( 1,833,031 )
( 6,018,601 )
Other income (expense), net:
Interest expense, net
( 59,382 )
( 82,319 )
Other income
171,681
-
Forgiveness of PPP Loan
22,916
22,916
Total other income (expense), net
135,215
( 59,403 )
Net loss
( 1,697,816 )
( 6,078,004 )
Other comprehensive income:
Unrealized gain from short-term investments
36,313
-
Comprehensive loss
$ ( 1,661,503 )
$ ( 6,078,004 )
Net loss per share attributable to common stockholders - Basic and Diluted
$ ( 0.30 )
$ ( 1.43 )
Weighted Average Shares Outstanding - Basic and Diluted
5,572,402
4,256,360
The
accompanying notes are an integral part of these consolidated financial statements.
F- 5
NEXALIN
TECHNOLOGY, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF CHANGES IN STOCKHOLDERS’ EQUITY (DEFICIT)
Accumulated Other Comprehensive Gain (Loss)
Additional
Total
Stockholders’
Common Stock
on ST
Paid-in
Accumulated
Equity
Shares
Amount
Investments
Capital
Deficit
(Deficit)
Balance at January 1, 2021
3,695,464
$ 3,695
$ -
$ 63,019,495
$ ( 64,613,520 )
$ ( 1,590,330 )
Stock issued for cash
297,099
297
-
1,433,470
-
1,433,767
Stock compensation
865,861
865
-
4,464,670
-
4,465,535
Shares issued for conversion of debt
10,507
11
-
38,614
-
38,625
Shares issued for exercise of warrants
8,492
9
-
35,957
-
35,966
Shares issued for inducement
2,500
3
-
12,497
-
12,500
Net loss
-
-
-
-
( 6,078,004 )
( 6,078,004 )
Balance as of December 31, 2021
4,879,923
$ 4,880
$ -
$ 69,004,703
$ ( 70,691,524 )
$ ( 1,681,941 )
Stock issued for cash
2,315,850
2,316
-
8,542,954
-
8,545,270
Stock compensation
90,789
91
-
270,579
-
270,670
Related party foregone interest
-
-
-
2,718
-
2,718
Warrants issued for cash
-
-
-
3,473
-
3,473
Other comprehensive gain
-
-
36,313
-
-
36,313
Net loss
-
-
-
-
( 1,697,816 )
( 1,697,816 )
Balance as of December 31, 2022
7,286,562
$ 7,287
$ 36,313
$ 77,824,427
$ ( 72,389,340 )
$ 5,478,687
The
accompanying notes are an integral part of these consolidated financial statements.
F- 6
NEXALIN
TECHNOLOGY, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF CASH FLOWS
Years Ended
December 31,
2022
2021
Cash flows from operating activities:
Net Loss
( 1,697,816 )
( 6,078,004 )
Adjustments to reconcile net loss to net cash used in operating activities:
Bad debt expense
11,175
-
Stock compensation
270,670
4,478,035
Forgiveness of interest expense
( 168,361 )
-
Forgiveness of PPP loan
( 22,916 )
-
Depreciation
535
537
Non-cash lease expense
5,188
-
Write off of inventory
19,892
-
Changes in operating assets and liabilities:
Accounts receivable
253
( 9,704 )
Prepaid assets
( 229,114 )
( 33,974 )
Inventory
( 142,852 )
( 8,754 )
Accounts payable - related party
( 139,320 )
-
Accounts payable
( 46,107 )
382,633
Accrued expenses
99,107
99,413
Deferred revenue
( 130,000 )
130,000
Lease liability
( 46,033 )
( 36,973 )
Net cash used in operating activities
( 2,215,699 )
( 1,076,791 )
Cash flows from investing activities:
Purchase of short-term investments
( 6,794,879 )
-
Net cash used in investing activities
( 6,794,879 )
-
Cash flows from financing activities:
Sale of common stock for cash, net of financing fees
8,545,270
1,433,767
Proceeds from exercise of warrants
3,473
35,966
Payments on loan payable - shareholder
( 37,200 )
( 9,600 )
Proceeds from notes payable – officer
-
200,000
Net cash provided by financing activities
8,511,543
1,660,133
Net decrease in cash and cash equivalents
( 499,035 )
583,342
Cash and cash equivalents - beginning of year
661,778
78,436
Cash and cash equivalents - end of year
162,743
661,778
Non-cash investing and financing activities:
Unrealized gain on short-term investments
36,313
-
Conversion of debt and accrued interest into common stock
-
38,625
ROU asset and lease liability recorded
11,359
-
Forgiveness of interest expense
168,361
-
Forgiveness of PPP loan
22,916
-
The
accompanying notes are an integral part of these consolidated financial statements.
F- 7
NEXALIN
TECHNOLOGY, INC. AND SUBSIDIARY
NOTES
TO CONSOLIDATED FINANCIAL STATEMENTS
NOTE
1 — NATURE OF THE ORGANIZATION AND BUSINESS
Corporate
History
Nexalin
Technology, Inc. (“NV Nexalin”) was formed on October 19, 2010 as a Nevada corporation. The Company’s principal offices
are located at 1776 Yorktown, Suite 550, Houston, Texas 77056.
On
September 6, 2019, Neuro-Health International, Inc. (“Neuro-Health”), a Nevada corporation, a wholly owned subsidiary of
NV Nexalin, was formed. Neuro-Health had no activity from December 6, 2019 (Inception) through December 31, 2022.
On
November 22, 2021, NV Nexalin entered into an Agreement and Plan of Merger (the “Merger Agreement”) with Nexalin Technology,
Inc., a Delaware corporation (“Nexalin”, or the “Company”). Pursuant to the Merger Agreement, NV Nexalin merged
with and into Nexalin with all shareholders of NV Nexalin receiving one common share of Nexalin in exchange for twenty shares of NV Nexalin
held at the time of the Merger Agreement. NV Nexalin treated the transaction as a corporate reorganization with the historical consolidated
financial statements of NV Nexalin becoming the historical consolidated financial statements of Nexalin. Nexalin had nominal assets and
liabilities and did not conduct any operations prior to the reorganization other than its incorporation. NV Nexalin has retroactively
applied the 20-for-1 exchange, effective on November 22, 2021, to share and per share amounts on the audited consolidated financial statements
for the years ended December 31, 2022 and 2021. NV Nexalin’s authorized shares of common stock were not affected as a result of
the Merger Agreement. As a result of the Merger Agreement, NV Nexalin was dissolved, and Neuro-Health became a subsidiary of Nexalin.
The Company completed its initial public offering on September 16, 2022.
The initial public offering consisted of 2,315,000
units consisting of 2,315,000 shares of its Common Stock and 2,315,000 accompanying warrants to purchase up to 2,315,000 shares of common
stock. Each share of common stock is being sold together with one Warrant, each to purchase one share of common stock with an exercise
price of $ 4.15 per share at a combined offering price of $4.15, for gross proceeds of $ 9,607,250 , before deducting underwriting discounts
and offering expenses. In
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.