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

(Mark One)

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

For the fiscal year ended December 31, 2016

2023

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 No. 001-34600

TENAX THERAPEUTICS, INC.
(Exact name of registrant as specified in its charter)

Delaware26-2593535

TENAX THERAPEUTICS, INC.

(Exact name of registrant as specified in its charter)

Delaware

26-2593535

(State or other jurisdiction of Incorporationincorporation or organization)

(I.R.S. Employer Identification No.)

ONE Copley Parkway,

101 Glen Lennox Drive, Suite 490, Morrisville, NC 27560

(Address300, Chapel Hill, North Carolina 27517

 (Address of Principal Executive Offices) (Zip Code)

Registrant’s Telephone Number, andincluding area code: (919) 855-2100

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, $0.0001 par value per share

TENX

The Nasdaq Stock Market LLC

Securities registered pursuant to Section 12(g) of the 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 Section 15(d) of the 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 of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files). Yes ☒ No ☐

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

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

Large accelerated filer

Accelerated filer

  ☒

Non-accelerated filer

  ☐

Smaller reporting company

  ☐

Emerging growth company

(Do not check if a smaller reporting company)

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☐

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. ☐

Indicate by checkmark 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). ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒

State the

The aggregate market value of the voting and non-voting common equity held by non-affiliates computed by reference to the price at which the common equity was last sold as of June 30, 2016,2023, the last business day of the registrant’s most recently completed second fiscal quarter: $68,589,804.

quarter, was $7,031,280.

The number of shares outstanding of the registrant’s class of $0.0001 par value common stock as of March 9, 201720, 2024 was 28,120,021.

1,958,245.

On January 2, 2024, the registrant effected a 1-for-80 reverse stock split (the “Reverse Stock Split”). The Reverse Stock Split did not change the number of authorized shares of the registrant’s capital stock or cause an adjustment to the par value of the registrant’s capital stock. However, all other share amounts and references to stock prices in this Annual Report on Form 10-K have been retrospectively restated to reflect the reverse split. Pursuant to their terms, a proportionate adjustment also was made to the per share exercise price and number of shares issuable under the registrant’s outstanding stock options and warrants and to the number of shares authorized for issuance pursuant to the registrant’s equity incentive plans to reflect the Reverse Stock Split. The Company also has adjusted the financial statements in this Annual Report on Form 10-K to reflect the Reverse Stock Split.

DOCUMENTS INCORPORATED BY REFERENCE:

Portions of the registrant’s proxy statement to be filed with the Securities and Exchange Commission pursuant to Regulation 14A in connection with the registrant’s 20172024 Annual Meeting of Stockholders, which will be filed subsequent to the date hereof, are incorporated by reference into Part III of this Form 10-K. Such proxy statement will be filed with the Securities and Exchange Commission not later than 120 days following the end of the registrant’s fiscal year ended December 31, 2016.


2023.

TABLE OF CONTENTS

PART I

4

3

ITEM 1—BUSINESS

4

7

ITEM 1A—RISK FACTORS

11

16

ITEM 1B—UNRESOLVED STAFF COMMENTS

23

36

ITEM 1C--CYBERSECURITY

36

ITEM 2—PROPERTIES

23

36

ITEM 3—LEGAL PROCEEDINGS

23

36

ITEM 4— MINE SAFETY DISCLOSURES

23

36

PART II

23

37

ITEM 5—MARKET FOR THE REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES

23

37

ITEM 6—SELECTED FINANCIAL DATARESERVED

25

37

ITEM 7—MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

26

37

ITEM 7A—QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

41

46

ITEM 8—CONSOLIDATED FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA

42

46

ITEM 9—CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE

78

46

ITEM 9A—CONTROLS AND PROCEDURES

78

46

ITEM 9B—OTHER INFORMATION

80

47

PART III

ITEM 9C— DISCLOSURE REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTIONS.

80

47

PART III

48

ITEM 10—DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE

48

ITEM 11—EXECUTIVE COMPENSATION

52

ITEM 12—SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS

58

ITEM 13—CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE

61

ITEM 14—PRINCIPAL ACCOUNTANT FEES AND SERVICES

61

PART IV

81

62

ITEM 15—EXHIBIT AND FINANCIAL STATEMENT SCHEDULES

62

ITEM 16—FORM 10-K SUMMARY

67


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PART I

CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS

All statements contained in this report, other than statements of historical fact, which address activities, actions, goals, prospects, or new developments, that we expect or anticipate will or may occur in the future, including plans for clinical tests and other such matters pertaining to testing and development products, are forward-looking statements. In some cases, you can identify

This Annual Report on Form 10-K contains various forward-looking statements by terminologywithin the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), which represent our expectations or beliefs concerning future events. Forward-looking statements include statements that are predictive in nature, which depend upon or refer to future events or conditions, and/or which include words such as “may”,“believes,” “plans,” “intends,” “anticipates,” “estimates,” “expects,” “may,” “will”, “should”, “expects”, “plans”, “anticipates”, “believes”, “estimates”, “predicts”, “potential” or “continue”similar expressions. In addition, any statements concerning future financial performance, ongoing strategies or the negative of such terms or other comparable terminology.prospects, and possible future actions, including any potential strategic transaction involving us, which may be provided by our management, are also forward-looking statements. These statements are only predictionsnot guarantees of future performance, and involve known and unknown risks, uncertainties and other factors, including, but not limitedwe undertake no obligation to progress in our product development and testing activities, obtaining financing for operations, developmentpublicly update any forward-looking statements, whether as a result of new technologiesinformation, future events, or otherwise, except as required by law.

Forward-looking statements are based on current expectations and other competitive pressures, legalprojections about future events, actual events and regulatory initiatives affecting our products, conditionsresults may differ materially from those expressed or forecasted in forward-looking statements due to a number of factors. You should understand that the capital markets,following important factors, in addition to those discussed in under the risks discussedheading “Risk Factors” included in Item 1A – “Risk Factors,”of Part I of this Annual Report on Form 10-K and in any of our filings with the risks discussed elsewhereU.S. Securities and Exchange Commission (the “SEC”) pursuant to Sections 13(a), 13(c), 14 or 15(d) of the Exchange Act, could affect our stock price or future results and could cause those results to differ materially from those expressed in such forward-looking statements:

·

our ability to raise additional money to fund our operations for at least the next 12 months as a going concern;

·

our ongoing evaluation of strategic alternatives;

·

our ability to develop our current product candidates, and any product candidate which we may develop or in-license in the future;

·

our ability, our partners’ abilities, and third parties’ abilities to protect and assert intellectual property rights;

·

delays in the commencement, enrollment and completion of clinical testing, as well as the analysis and reporting of results from such clinical testing;

·

the success of clinical trials of our product candidates;

·

the need to obtain regulatory approval of our product candidates;

·

potential risks related to any collaborations we may enter into for our product candidates;

·

any delays in regulatory review and approval of product candidates in development;

·

our ability to establish an effective sales and marketing infrastructure;

·

our estimates regarding the potential market opportunity for our product candidates;

·

competition from existing products or new products that may emerge;

·

the ability to receive regulatory approval or commercialize our products;

·

potential side effects of our product candidates that could delay or prevent commercialization;

·

potential product liability claims and adverse events;

·

potential liabilities associated with hazardous materials;

·

our ability to maintain adequate insurance policies;

·

our dependence on third-party manufacturers and clinical research organizations (“CROs”);

·

our ability to establish or maintain collaborations, licensing or other arrangements;

·

costs related to and outcomes of potential litigation;

·

compliance with obligations under intellectual property licenses with third parties;

·

our ability to adequately support future growth;

·

our ability to attract and retain personnel, including our executive team, advisors and members of our Board of Directors; and

·

geopolitical uncertainties, including in the Middle East and the Russian invasion of and war against the country of Ukraine

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The forward-looking statements in this report that may causeAnnual Report on Form 10-K represent our or our industry’s actual results, levelsviews as of activity, performance or achievements to be materially different from any future results, levels of activities, performance or achievements expressed or implied bythe date such forward-looking statements.

Although we believe that the expectations reflected in thestatements are made. These forward-looking statements are reasonable, we cannot guarantee future results, levelsshould not be relied upon as representing our views as of activity, performance or achievements. Moreover, neither we nor any other person assumes responsibility for the accuracy and completeness of such statements. We are under no dutydate subsequent to update any of the forward-looking statements after the date of filing of this report or to conform such statements to actual results, except as may be required by law.
are made.

NOTES

All references in this Annual Report on Form 10-K to “Tenax Therapeutics”the “Company,” “Tenax”, “we”, “our” and “us” means Tenax Therapeutics, Inc.

This Annual Report on Form 10-K contains references to our trademarks and to trademarks belonging to other entities. Solely for convenience, trademarks and trade names referred to in this Annual Report on Form 10-K, including logos, artwork and other visual displays, may appear without the ® or TM symbols, but such references are not intended to indicate, in any way, that we will not assert, to the fullest extent under applicable law, our rights or the rights of the applicable licensor to these trademarks and trade names. We do not intend our use or display of other companies’ trade names or trademarks to imply a relationship with, or endorsement or sponsorship of us by, any other company.

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RISK FACTOR SUMMARY

Our business is subject to significant risks and uncertainties that make an investment in us speculative and risky. Below we summarize what we believe are the principal risk factors, but these are not the only risks we face, and you should carefully review and consider the full discussion of our risk factors in the section titled “Risk Factors”, together with the other information in this Annual Report on Form 10-K. If any of the following risks materializes (or if any of those listed elsewhere in this Annual Report on Form 10-K materialize), our business, reputation, financial condition, results of operations, revenue, and future prospects could be seriously harmed. Additional risks and uncertainties that we are unaware of, or that we currently believe are not material, may also become important factors that adversely affect our business.

Risks Related to Our Financial Position and Need for Additional Capital

Our independent registered public accounting firm’s report includes an explanatory paragraph stating that there is substantial doubt about our ability to continue as a going concern.

We will require substantial additional funding to further develop our product candidates, including to complete the LEVEL trial, which includes an open label extension phase, to complete a subsequent Phase 3 trial of TNX-103, and to initiate or complete the imatinib Phase 3 trial. Failure to obtain this necessary capital when needed on acceptable terms, or at all, or execute on alternative strategic paths, could force us to delay, limit, reduce or terminate our clinical trials, product development efforts and business operations.

Our ongoing exploration of alternative strategic paths may not result in entering into or completing transactions, and the process of reviewing alternative strategic paths or their conclusion could adversely affect our stock price.

If we do not successfully complete strategic transactions, should this be deemed necessary, our Board of Directors may decide to pursue a dissolution and liquidation of our Company.

Our failure to maintain compliance with Nasdaq’s continued listing requirements could result in the delisting of our common stock.

We expect a number of factors to cause our operating results to fluctuate on a quarterly and annual basis, which may make it difficult to predict our future performance.

We have incurred losses since our inception, expect to continue to incur losses in the foreseeable future, and may never become profitable.

Risks Related to Our Business Strategy and Operations

We are limited in the number of products we can simultaneously pursue and therefore our survival depends on our success with a small number of product opportunities.

A pandemic, epidemic, or outbreak of an infectious disease, such as COVID-19, or another coronavirus or similar disrupting illness, may materially and adversely affect our business and our financial results.

If we fail to attract and retain personnel, we may be unable to successfully develop and commercialize our product candidates.

Risks Related to Drug Development and Commercialization

We currently have no approved drug products for sale, and we cannot guarantee that we will ever have marketable drug products.

We are required to conduct additional clinical trials, including the LEVEL trial for oral levosimendan, which are expensive and time consuming, and the outcomes of the clinical trials are uncertain.

The market may not accept our products.

Nonfinal results from our clinical trials announced or published from time to time on an interim, preliminary, or “top-line” basis, may differ from results reported as more patient data become available, and these results are subject to audit and verification procedures that could result in material changes in the final data.

Any collaboration we enter with third parties to develop and commercialize any future product candidates may place the development of our product candidates outside our control, may require us to relinquish important rights or may otherwise be on terms unfavorable to us.

Delays in the enrollment and completion of clinical testing could result in increased costs to us and delay or limit our ability to obtain regulatory approval of our product candidates.

Risks Relating to Our Industry

Intense competition might render our product candidates noncompetitive or obsolete.

Our activities are, and will continue to be, subject to extensive government regulation, which is expensive and time consuming, and we will not be able to sell our products without regulatory approval.

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We may not receive all of the anticipated market exclusivity benefits of imatinib’s orphan drug designation, if we prioritize imatinib’s development in the future.

Even after products are commercialized, we would expect to spend considerable time and money complying with federal and state laws and regulations governing their sale, and, if we are unable to fully comply with such laws and regulations, we could face substantial penalties.

We are subject to uncertainty relating to healthcare reform measures and reimbursement policies that, if not favorable to our products, could hinder or prevent our products’ commercial success, if any of our product candidates are approved.

Governments outside the United States tend to impose strict price controls and reimbursement approval policies, which may adversely affect our prospects for generating revenue outside the United States.

Product liability lawsuits against us could cause us to incur substantial liabilities and limit commercialization of any products that we may develop.

Our business and operations would suffer in the event of computer system failures, cyber-attacks or deficiencies in our cybersecurity.

Risks Related to Our Dependence on Third Parties

We have historically and we will continue to rely significantly on third parties to conduct our nonclinical testing and clinical studies and other aspects of our development programs.

We depend on third parties to formulate and manufacture our products.

We currently have no marketing capabilities and no sales organization.

Risks Related to Intellectual Property

Our success will depend in part on obtaining and maintaining effective patent and other intellectual property protection for our product candidates and proprietary technology.

We rely on confidentiality agreements that, if breached, may be difficult to enforce and could have a material adverse effect on our business and competitive position.

We may incur substantial costs as a result of litigation or other proceedings relating to patent and other intellectual property rights and we may be unable to protect our rights to, or use, our technology.

Under current law, we may not be able to enforce all employees’ covenants not to compete.

We may infringe or be alleged to infringe intellectual property rights of third parties.

Risks Related to Owning Our Common Stock

Our share price has been volatile, and may continue to be volatile, which may subject us to securities class action litigation in the future.

Anti-takeover provisions in our corporate charter documents and under Delaware law could make an acquisition of us more difficult.

Our bylaws contain an exclusive forum provision for certain disputes, which could limit our stockholders’ ability to obtain a favorable judicial forum for disputes with us or our directors, officers, employees, or agents.

We have not paid cash dividends in the past and do not expect to pay dividends in the future. Any return on investment may be limited to the value of our common stock.

Our ability to use our net operating loss carryforwards and certain other tax attributes to offset future taxable income may be subject to certain limitations.

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ITEM 1—BUSINESS

Tenax Therapeutics

Overview

The Company was originally formed as a New Jersey corporation in 1967 under the name Rudmer, David & Associates, Inc., and subsequently changed its name to Synthetic Blood International, Inc. Effective June 30, 2008, we changed the domiciliary state of the corporation to Delaware and changed the companyCompany name to Oxygen Biotherapeutics, Inc. On September 19, 2014, we changed the companyCompany name to Tenax Therapeutics, Inc.

Tenax Therapeutics, Inc. is a specialty pharmaceutical company focused on identifying, developing and commercializing products for the critical care market.

On November 13, 2013, through our wholly owned subsidiary, Life Newco, Inc., or Life Newco, we acquired a license granting Life Newco, our wholly-owned subsidiary, an exclusive, sublicenseablesublicensable right in the United States and Canada to develop and commercialize pharmaceutical products containing levosimendan, 2.5 mg/ml concentrate for solution for infusion / 5ml vial for use in the reductionUnited States and Canada. In October 2020 and January 2022, we entered into an amendment to the license agreement between the Company and Orion to include in the scope of morbiditythe license two new oral product formulations containing levosimendan, in capsule and mortalitysolid dosage form (TNX-103), and a subcutaneously administered dosage form (TNX-102), subject to specified limitations. In February 2024, we entered into an additional amendment to the license, providing global rights to oral and subcutaneous formulations of levosimendan used in cardiac surgery patients at riskthe treatment of PH-HFpEF, revising the royalty structure, lowering the royalty rates, modifying milestones associated with certain regulatory and commercial achievements, and excluding from our right of first negotiation the right to commercialize new applications of levosimendan for developing Low Cardiac Output Syndrome, or LCOS.

We were previously developing Oxycyte®neurological diseases and disorders developed by Orion.

On January 15, 2021, we acquired 100% of the equity of PHPrecisionMed Inc., a systemic perfluorocarbon, or PFC, productDelaware corporation(“PHPM”), with PHPM surviving as our wholly-owned subsidiary. As a result of the merger, pending the outcome of our strategic process, we believedplan to commercialize pharmaceutical products containing imatinib for the treatment of pulmonary arterial hypertension (“PAH”).

Business Strategy

Having carefully considered alternatives within the ongoing strategic process announced in September 2022, and having raised capital expected to fund the Company through 2024, the Company has elected to prioritize its LEVEL trial (Phase 3 testing of oral levosimendan), ahead of imatinib. Activity to initiate the LEVEL trial continued in the fourth quarter of 2023, and site qualification, selection, and initiation processes are ongoing, the Company having received U.S. Food and Drug Administration (“FDA”) input into the oral levosimendan protocol and clinical development program in the third quarter of 2023. The Company began initiating sites in the fourth quarter of 2023 and commenced enrolling patients early in 2024. Additional funding will be needed to complete the LEVEL trial, which includes an open label extension phase following the completion of the randomized phase. The Company will complete efficacy and safety analyses of levosimendan versus placebo at the end of the randomized treatment phase, but many patients will continue to be a safetreated under the protocol on open label levosimendan, beyond the completion of these analyses. Supporting this strategic decision to prioritize levosimendan development and effective oxygen carrier forcommence Phase 3 trial work were two U.S. Patents issued in March and July 2023, covering the use of IV and oral levosimendan in situationspatients with PH-HFpEF. These patents are the second and third levosimendan patents granted to us since the start of acute ischemia. In addition,2022. An additional new patent to be issued in early 2024 provides protections covering all therapeutic doses of all three formulations of the product in patients with PH-HFpEF.  Given our prioritization of the Phase 3 testing of levosimendan, we previously developed a familyhave suspended plans to launch an imatinib Phase 3 trial.

The Company took steps to reduce its monthly operating expenses and conserve cash, as it commenced exploring strategic alternatives in late 2022. The Company at that time cancelled many non-essential operating expenses such as consulting, its office lease, and dues and subscriptions and office supplies associated with that leased office. During the third quarter of perfluorocarbon-based oxygen carriers for use in personal care, topical wound healing,2023, the Company and its contracted CRO increased outreach to North American clinical trial sites, Institutional Review Boards, and other topical indications. During 2014, we suspendedpartners who will support the developmentLEVEL trial, and in the fourth quarter of these PFC products while we evaluate2023 commenced site initiations.

Pending the outcome of our ongoing strategic alternatives for future development and commercialization of these product candidates.

In 2015, our Board of Directors approved a change in our fiscal year to a fiscal year beginning on January 1 and ending on December 31 of each year, such change beginning as of January 1, 2016. Accordingly, this annual report on Form 10-K includes financial statements as of and for (i)process, the calendar year ended December 31, 2016; (ii) the eight months ended December 31, 2015; and (iii) the fiscal years ended April 30, 2015 and 2014.

For comparative purposes, an unaudited consolidated statement of operations and comprehensive loss has been included for the year ended December 31, 2015 and for the eight month period from May 1, 2014 to December 31, 2014. The financial information for the year ended December 31, 2015 and the eight months ended December 31, 2014 has not been audited and is derived from our books and records. In the opinion of management, the financial information for the year ended December 31, 2015 and the eight months ended December 31, 2014 reflects all adjustments necessary to present the financial position and results of operations in accordance with generally accepted accounting principles. Prior to the year-end change, our fiscal year ended on April 30 of each year.
Business Strategy
Our principal business objective is to identify, develop, and commercialize novel therapeutic products for disease indications that represent significant areas of clinical need and commercial opportunity. The key elements of our business strategy are outlined below.

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Efficiently conduct clinical development to establish clinical proof of conceptprinciple in new indications, refine formulation, and commence Phase 3 testing of our current product candidates.

Levosimendan and imatinib have been approved and prescribed in countries around the world for more than 20 years, but we believe their mechanisms of action have not been fully exploited, despite promising evidence they may significantly improve the lives of patients with our lead product candidates. Levosimendan represents novel therapeutic modalities for the treatment of LCOS and other critical care conditions.pulmonary hypertension. We are conducting clinical development with the intent to establish proof of conceptbeneficial activity in several important disease areas wherecardiopulmonary diseases in which these therapeutics would be expected to have benefit.benefit for patients with diseases for which either no pharmaceutical therapies are approved at all, or in the case of pulmonary arterial hypertension (“PAH”), where numerous, expensive therapies generally offer a modest reduction of symptoms. Our focus is primarily on conducting well-designed studiesdesigning and executing formulation improvements, protecting these innovations with patents and other forms of exclusivity, and employing innovative clinical trial science to establish a robust foundation for subsequent development, partnershipproduct approval, and expansioncommercialization. We intend to submit marketing authorization applications following two Phase 3 trials of levosimendan and, when appropriate, a single Phase 3 trial of imatinib. Our trials are designed to incorporate and reflect advanced clinical trial design science and the regulatory and advisory experience of our team. We intend to continue partnering with innovative companies, renowned biostatisticians and trialists, medical leaders, formulation and regulatory experts, and premier clinical testing organizations to help expedite development, and continue expanding into complementary areas.

areas when opportunities arise through our development, research, and discoveries. We also intend to continue outsourcing to CROs, and seeking and acting upon the advice of preeminent scientists focused on cardiovascular and pulmonary drug development, when designing and executing our research.

Efficiently explore new high potentialhigh-potential therapeutic applications, in particular where expedited regulatory pathways are available, leveraging third-party research collaborations and our results from related areas. Our product candidates haveareas.

Levosimendan has shown promise in multiple disease areas.areas in the more than two decades following its approval. Our own Phase 2 study and open-label extension has demonstrated that its property of relaxing the venous circulation, a formerly under-appreciated mechanism of action of levosimendan, , brings durable improvements in exercise capacity and quality of life, as well as other clinical assessments, in patients with PH-HFpEF. We believe this patient population today has no pharmaceutical therapies available and we are committed to exploring potential clinical indications where our therapies may achieve best-in-class profile, and where we can address significant unmet medical needs.

We believe these factors will support approval by the FDA of these product candidates based on positive Phase 3 data. Through our agreement with our licensor, Orion, the originator of levosimendan for acute decompensated heart failure, we have access to a library of ongoing and completed trials and research projects, including certain documentation, which we believe, in combination with positive Phase 3 data we hope to generate in at least one indication, will support FDA approval of levosimendan. Likewise, the regulatory pathway for approval of imatinib for the treatment of PAH, as formulated by us at the dose shown to be effective in a prior Phase 3 trial conducted by Novartis, allows us to build on the dossier of research results already reviewed by the FDA. In order to achieve this goal,our objective of developing these medicines for new groups of patients, we have established collaborative research relationships with [investigatorsinvestigators from leading research and clinical institutions, and]and our strategic partners. These collaborative relationships have enabled us to cost effectively explore where our product candidates may have therapeutic relevance, gain the advice and how it may be utilizedsupport of key opinion leaders in medicine and clinical trial science, and invest in development efforts to exploit opportunities to advance treatment overbeyond current clinical care. Additionally, we believe we will be able to leverage clinical safety data and preclinical results from some programs to support accelerated clinical development efforts in other areas, saving substantial development time and resources compared to traditional drug development.

Continue to expand our intellectual property portfolio.

Our intellectual property and the confidentiality of all our Company information is important to our business and we take significant steps to help protect its value. We have ongoingOur research and development efforts, both through internal activities and through collaborative research activities with others, which aim to develop new intellectual property and enable us to file patent applications that cover new applicationsuses of our existing technologies, alone or in combination with existing therapies, as well as other product candidates.

Notice of Allowance and Patents.

On February 1, 2023, the Company announced it was granted a Notice of Allowance from the United States Patent and Trademark Office (“USPTO”) for its patent application with claims covering the use of IV levosimendan (TNX-101) in the treatment of PH-HFpEF. This patent (U.S. Patent No. 11,607,412) was issued on March 21, 2023. On July 19, 2023, the Company announced USPTO issuance of another patent, this one including claims covering the use of oral levosimendan (TNX-103) in patients with PH-HFpEF. This issued patent (U.S. Patent No. 11,701,355) provides exclusivity through December 2040. On February 6, 2024, the Company announced it was granted a Notice of Allowance from USPTO for its patent application broadening IP protection for oral, I.V., and subcutaneous use of levosimendan and its active metabolites in PH-HFpEF, at all therapeutic doses and in combination with various cardiovascular drugs. At present, the Company has other patent applications pending, with additional decisions expected in the future.  Patents pending in Europe may lead to intellectual property protections on the use of levosimendan in patients with PH-HFpEF in 2024.

Enter into licensing or product co-development arrangements in certain areas, while out-licensing opportunities in non-core areas.

In addition to our internal development efforts, an important part of our product development strategy is to work with collaborators and partners to accelerate product development, reducemaintain our low development and business operations costs, and broaden our commercialization capabilities.capabilities globally. We believe this strategy will help us to develop a portfolio of high qualityhigh-quality product development opportunities, enhance our clinical development and commercialization capabilities, and increase our ability to generate value from our proprietary technologies.

As we focus on our strategic process, we also continue to position ourselves to execute upon licensing and other partnering opportunities. To do so, we need to continue to maintain our strategic direction, manage and deploy our available cash efficiently, and strengthen our collaborative research development and partner relationships.

Historically, we have financed our operations principally through equity and debt offerings, including private placements and loans from our stockholders. Based on our current operating plan, there is substantial doubt about our ability to continue as a going concern. Management has implemented certain cost-cutting measures as described above and is actively exploring a diverse range of strategic options to help drive stockholder value including, among other things, capital raises, a sale of our Company, merger, one or more license agreements, a co-development agreement, a combination of these, or other strategic transactions; however, there is no assurance that these efforts will result in a transaction or other alternative or that any additional funding will be available. Our ability to continue as a going concern depends on our ability to raise additional capital, through the sale of equity or debt securities and through collaboration and licensing agreements, to support our future operations. If we are unable to complete a strategic transaction or secure additional capital, we may be required to curtail our research and development initiatives and take additional measures to reduce costs.

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Our Current Programs

Levosimendan

TNX-101 (IV), TNX-102 (subcutaneous) and TNX-103 (oral) levosimendan Background

Levosimendan was discovered and developed by Orion Pharma, a Finnish company.Orion. Levosimendan, as marketed around the world today, is a calcium sensitizer/K-ATP activator developed for intravenous use in hospitalized patients with acutely decompensated heart failure. It is currently approved in over 6058 countries for this indication andbut is not available in the United States or Canada. It is estimated that to date over 1,000,0001.9 million patients have been treated worldwide with levosimendan.

levosimendan. 

Levosimendan is a novel, first in class calcium sensitizer/K-ATP activator.activator. The therapeutic effects of levosimendan are mediated through:

Increased cardiac contractility by calcium sensitization of troponin C, resulting in a positive inotropic effect which is not associated with substantial increases in oxygen demand.
Opening of potassium channels in the vasculature smooth muscle, resulting in a vasodilatory effect on all vascular beds.
Opening of mitochondrial potassium channels in cardiomyocytes, resulting in a cardioprotective effect.

This triple mechanism of action helps to preserve heart function during cardiac surgery.

·

Opening of potassium channels in the vasculature smooth muscle, resulting in a vasodilatory effect on all vascular beds.

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Increasing cardiac contractility by calcium sensitization of troponin C, resulting in a positive inotropic effect which is not associated with substantial increases in oxygen demand.

·

Opening of mitochondrial potassium channels in cardiomyocytes, resulting in a cardioprotective effect.

Several studies have demonstrated that levosimendan protects the heart and improves tissue perfusion while minimizing tissue damage during cardiac surgery.

In 2013, we acquired certain assets of Phyxius Pharma, Inc. (“Phyxius”), or Phyxius, including its North American rights to a license agreement with Orion to develop and commercialize intravenous levosimendan for any indication in the United States and Canada. On October 9, 2020 and January 25, 2022, we entered into an amendment to the license agreement to include in the scope of the license two new oral product formulations containing levosimendan, in capsule and solid dosage form (TNX-103), and a subcutaneously administered dosage form (TNX-102), subject to specified limitations. In February 2024, we entered into an additional amendment to the license, providing global rights to oral and subcutaneous formulations of levosimendan used in the treatment of PH-HFpEF, revising the royalty structure, lowering the royalty rates, modifying milestones associated with certain regulatory and commercial achievements, and excluding from our right of first negotiation the right to commercialize new applications of levosimendan for neurological diseases and disorders developed by Orion.

In the countries where levosimendanit is marketed, Levosimendanintravenous levosimendan is indicated for the short-term treatment of acutely decompensated severe chronic heart failure in situations where conventional therapy is not sufficient, and in cases where inotropic support is considered appropriate. In acute decompensated heart failure patients, levosimendan has been shown to significantly improve patients’patient symptoms as well as acute hemodynamic measurements such as increased cardiac output, reduced preload and reduced afterload.  Other unique properties of levosimendan include sustained efficacy through the formation of a long acting metabolite, lack of impairment of diastolic function,

TNX-101 (IV), TNX-102 (subcutaneous) and evidence of better compatibility with beta blockers than dobutamine.

The European Society of Cardiology, or the ESC, recommends levosimendan as a preferable agent over dobutamine to reverse the effect of beta blockade if it is thought to be contributing to hypotension. The ESC guidelines also state that levosimendan is not appropriate for patients with systolic blood pressure less than 85mmHg or in patients in cardiogenic shock unless it is used in combination with other inotropes or vasopressors.
LevosimendanTNX-103 (oral) (levosimendan) Development for Cardiac SurgeryPulmonary Hypertension Patients
Levosimendan is under development

In 2020, we completed a Phase 2 clinical trial of intravenous levosimendan in North America for reduction in morbidity and mortality of cardiac surgery patients at risk of LCOS. As noted above, we have the exclusive rights in the United States and Canada to develop and commercialize intravenous levosimendan.

The FDA granted Fast Track status for the development of levosimendan to reduce mortality and morbidity in cardiac surgery patients at risk of LCOS and agreed to an SPA which represents agreement with the Phase III clinical trial’s study protocol. The FDA also provided guidance that a single successful trial will be sufficient to support approval of levosimendan in this indication. Pursuant to our license to levosimendan, we are required to use the “Simdax®” trademark to commercialize this product.
Substantial published scientific research indicates that levosimendan may provide important benefits to cardiac surgery patients, including 35 published prospectively designed clinical trials and multiple published meta-analyses. Many of these publications indicate that levosimendan provides substantial mortality and or morbidity benefits to cardiac surgery patients, particularly those at risk of developing LCOS.
LCOS is generally defined as a patient’s inability to maintain a cardiac index >2.2 L/min/m2 and hence requiring use of inotropic agents and/or mechanical assist devices such as an intra-aortic balloon pump or a left ventricular assistance device. LCOS in the cardiac surgery setting is reported to occur in 5-10%treatment of patients undergoing cardiac surgerywith PH-HFpEF, a disease defined hemodynamically by a mean pulmonary artery pressure (“mPAP”) of ≥25 mmHg, and a pulmonary capillary wedge pressure (“PCWP”) of >15 mmHg. Pulmonary hypertension in these patients is associatedbelieved to arise from a passive backward transmission of elevated filling pressures from left-sided heart failure. These mechanical components of pulmonary venous congestion can trigger pulmonary vasoconstriction, decreased nitric oxide availability, increased endothelin expression, desensitization to natriuretic peptide induced vasodilation, and vascular remodeling. Over time, these changes often lead to advanced pulmonary arterial and venous disease, increased right ventricle afterload, and right ventricle failure.

Per the World Health Organization, PH-HFpEF is the most common of five forms of pulmonary hypertension, with 10-15 fold higher mortality or severe sequelae as a result of poor organ perfusion.

an estimated U.S. prevalence exceeding 1.5 million patients. Currently, no pharmacologic therapies are approved for management or preventiontreatment of post-cardiotomy LCOS. While conventional inotropes are usedPH-HFpEF. Despite the fact that many therapies have been studied in PH-HFpEF patients, including therapies approved to manage cardiac hemodynamics in the peri-operative setting, nonetreat PAH patients, no therapies have been shown to be effective in treating PH-HFpEF patients.

Several published studies provide evidence that levosimendan may improve outcomes.

right ventricular dysfunction which is a common comorbidity in patients with pulmonary hypertension. While none of these studies has focused specifically on PH-HFpEF patients, the general hemodynamic improvements in these published studies of various types of pulmonary hypertension provide a basis for further research into the potential beneficial impact of levosimendan in PH-HFpEF patients. 

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In 2014,March 2018, we met with the FDA to discuss development of levosimendan in these patients. The FDA agreed with our planned Phase 2 design, patient entry criteria, and endpoints. It was agreed the study could be conducted under the existing investigational new drug application with no additional nonclinical studies required to support full development. The FDA recognized there were no approved drug therapies to treat PH-HFpEF patients and acknowledged this provided an opportunity for a limited Phase 3 clinical program. This topic was discussed further at the End-of-Phase 2 Meeting following completion of the Phase 2 study in PH-HFpEF patients, which is known as the HELP Study - Hemodynamic Evaluation of Levosimendan in PH-HFpEF.

We initiated the first of our HELP Study clinical sites in November 2018 and the first of 37 patients was enrolled in the HELP Study in March 2019. Enrollment in the HELP Study was completed in March 2020. The primary endpoint of the HELP Study was based on the change in pulmonary capillary wedge pressure (“PCWP”) during exercise versus baseline compared to placebo. The HELP Study utilized a double-blind randomized design following five weekly outpatient infusions of levosimendan.

On June 2, 2020, we announced preliminary, top-line data from the study. The primary efficacy analysis, PCWP during exercise, did not demonstrate a statistically significant reduction from baseline. Levosimendan did demonstrate a statistically significant reduction in PCWP compared to baseline (p=<0.0017) and placebo (p=<0.0475) when the measurements at rest, with legs up, and on exercise were combined. Levosimendan also demonstrated a statistically significant improvement in 6-minute walk distance as compared to placebo (p=0.0329). These findings from the HELP Study represent important discoveries related to the use of levosimendan in PH-HFpEF patients since this is the first study to evaluate levosimendan in PH-HFpEF patients and this is the first study ever conducted of any therapy in PH-HFpEF patients to show such positive improvements in hemodynamics and 6-minute walk distance.

Hemodynamic Results

Hemodynamic measurements were made at rest (supine), after leg raise on a supine bicycle (a test of rapid increase in ventricular filling) and during exercise (25 watts for three minutes or until the patient tired). In the initial open-label phase, 84% of the patients had a significant reduction in right atrial pressure (“RAP”), pulmonary artery pressure (“PAP”), and PCWP at rest and during exercise. In the randomized double-blinded 6-week trial, levosimendan demonstrated a statistically significant reduction in PCWP compared to baseline (p=<0.0017) and placebo (p=<0.0475) when these three measurements were combined: at rest, with legs up, and during exercise. While there was no significant change in PCWP during exercise, patients receiving levosimendan had reductions from baseline at Week 6 in PCWP and PAP that were statistically significant when patients were “at rest” and/or with their “legs raised” (p<0.05).

Clinical Results (6-Minute Walk Distance)

The clinical efficacy was confirmed by a statistically significant improvement in 6-minute walk distance of 29 meters (p=0.0329). The 6-minute walk distance was a secondary endpoint in the trial and is a validated and accepted endpoint used in many pulmonary hypertension registration trials.

Safety

The incidence of adverse events or serious adverse events between the control and treated groups was similar. In addition, there were no arrhythmias observed, atrial or ventricular, when comparing baseline electrocardiographic monitoring with 72-hour monitoring after five weeks of treatment.

The detailed results from the Phase III trial (LEVO-CTS)2 HELP Study of levosimendan in PH-HFpEF were presented at the Heart Failure Society of America Virtual Annual Scientific Meeting on October 3, 2020 and at the American Heart Association Scientific Sessions 2020 on November 13, 2020. Additionally, the full manuscript was published in the peer-reviewed journal JACC: Heart Failure. Burkhoff D, Borlaug BA, Shah SJ, …Rich S. Levosimendan Improves Hemodynamics and Exercise Tolerance in PH-HFpEF: Results of the Randomized Placebo-Controlled HELP Study. JACC Heart Fail. 2021 May;9(5):360-370.

Next Steps

On October 9, 2020 and January 25, 2022, we entered into amendments to investigatethe license agreement between the Company and Orion to include in the scope of the license two new oral product formulations containing levosimendan, in capsule and solid dosage form (TNX-103), and a subcutaneously administered dosage form (TNX-102), subject to specified limitations. On January 4, 2022, we were issued US Pat. No. 11,213,524, entitled PHARMACEUTICAL COMPOSITIONS FOR SUBCUTANEOUS ADMINISTRATION OF LEVOSIMENDAN. In February 2024, we entered into an additional amendment to the license, providing global rights to oral and subcutaneous formulations of levosimendan used in the treatment of PH-HFpEF, revising the royalty structure, lowering the royalty rates, modifying milestones associated with certain regulatory and commercial achievements, and excluding from our right of first negotiation the right to commercialize new applications of levosimendan for neurological diseases and disorders developed by Orion.

The 2022 and 2024 amendments to the license, which adjusted the timeframe for Phase 3 development and regulatory efforts and broaden the North American rights to be worldwide, as well as the additional patents issued by USPTO, furthered the Company’s justification for continuing and prioritizing the development of levosimendan.

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Following patient completion of the randomized treatment phase of the HELP Study, patients were able to enter a study extension. For over two years, the Company and our HELP investigators continued studying the safety and efficacy of pre-operative administrationTNX-103 in all patients participating in the open-label extension of the HELP Study, all of whom previously received weekly infusions of intravenous levosimendan. These patients were safely transitioned from the intravenous to the oral formulation in late 2021, with positive signs of efficacy observed across all measured parameters during the transition study phase of the open-label extension study (“OLE”). The OLE concluded in the first half of 2023.

In October 2020, we met with the FDA for an End-of-Phase 2 Meeting to discuss the Phase 2 clinical data and further development of levosimendan in PH-HFpEF patients. The FDA agreed that one or two Phase 3 clinical studies (depending on the size) with a primary endpoint of change in 6-minute walk distance over 12 weeks or a single Phase 3 trial with clinical worsening (e.g., death, hospitalization for heart failure, or decline in exercise capacity) over 24 weeks would be sufficient to demonstrate the effectiveness of levosimendan in PH-HFpEF. The FDA also agreed to a plan to replace weekly intravenous levosimendan dosing with daily TNX-103 doses in a Phase 3 clinical study. The FDA expressed that a safety database could be necessary and indicated that the need for a larger safety database could depend on the final design of the Phase 3 study. A proposed Phase 3 study design was provided in late 2021 for FDA review and comment on the safety database requirements at filing. In February 2022, the FDA advised in a written response that the safety database at NDA filing only need meet the minimum International Clinical Harmonization (ICH) standards for a chronic medication.

The HELP Study design was novel in several respects. To date, no other multi-center study has evaluated levosimendan in heart failure patients with preserved ejection fraction (“HFpEF”) patients or PH-HFpEF patients. Instead, all previous levosimendan heart failure studies have enrolled heart failure patients with reduced ejection fraction (“HFrEF”), therefore specifically excluding HFpEF patients. Also, the HELP Study utilized a unique 24-hour weekly infusion regimen of 0.075- 0.1µm/kg/min. Finally, the HELP Study employed a unique home-based intravenous infusion administration via an ambulatory infusion pump. This home-based weekly intravenous administration is unlike all other chronic dosing studies of levosimendan that have typically employed a shorter duration and less frequent infusion regimen administered in a hospital setting. The transition of patients in the OLE from intravenous to oral therapy was encouraging. PH-HFpEF has an approximate 50% rate of survival of five years. The patients who enrolled in the HELP Study had very advanced disease, with 87% Functional Class III at enrollment. At the time of the transition, these patients had already been on levosimendan for two years or longer. The fact that there was an improvement in all measures of efficacy on oral therapy beyond what had been achieved on intravenous therapy speaks to the remarkable durability of the treatment effect.

We believe that the combination of the unique HELP Study patient population, innovative weekly 24-hour dosing, unique home-based site of administration, the transition from intravenous to reduceoral therapy in a subset of these patients who continued in the mortalityOLE until the commencement of this transition sub study, and the novel findings of efficacy and safety in PH-HFpEF patients represent important discoveries and significant intellectual property. We received two U.S. Patents issued in March and July 2023, covering the use of IV and oral levosimendan in patients with PH-HFpEF.

On November 13, 2023, the Company announced that the FDA had reviewed and cleared the Company’s Investigational New Drug (IND) Application for TNX-103 (oral levosimendan) for the treatment of pulmonary hypertension with heart failure with preserved ejection fraction (PH-HFpEF), enabling Tenax to proceed with the first of two Phase 3 studies. The LEVEL Study (LEVosimendan to Improve Exercise Limitation in PH-HFpEF Patients) launched with site initiations in the fourth quarter of 2023.

TNX-201 (imatinib) Background

Imatinib (marketed in the U.S. as Gleevec®) is a tyrosine kinase inhibitor, which changed the treatment of chronic myeloid leukemia (“CML”) following its approval over 20 years ago, as the first curative treatment of chronic leukemia. The first clinical trial of imatinib took place in 1998 and the drug received FDA approval in May 2001. Encouraged by the success of imatinib in treating CML patients, scientists explored its effect in other cancers, and it was found to produce a similar positive effect in malignancies where tyrosine kinases were overexpressed.

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Previous Imatinib Development for Pulmonary Arterial Hypertension Patients

In PAH, a rare disease, patients who remain symptomatic despite available therapies have a high morbidity and mortality. Though several therapies are now available, there is no cure for the disease, and there is no data supporting that the existing approved therapies, all of which are pulmonary vasodilators, halt progression or induce regression of the disease. Imatinib has been shown in cardiac surgeryanimal models of pulmonary hypertension to induce disease reversal by an effect on platelet derived growth factor (“PDGF”), which appears to be causal in the disease. After that discovery was made, several case reports and small case series of patients at riskwith advanced PAH failing combination pulmonary vasodilator therapy were published showing a dramatic effect of imatinib on stabilizing and improving these patients. This led Novartis to develop imatinib as a treatment of PAH.

Novartis sponsored a Phase 2 proof-of-concept trial to evaluate the safety, tolerability, and efficacy of imatinib as an adjunct to PAH-specific therapy in patients with PAH. Novartis then sponsored a Phase 3 trial (IMPRES) which met its primary endpoint of significant increase in 6-minute walk (32 meters, p=0.002), an effect maintained in the extension study in patients remaining on imatinib. However, the data were confounded by a high rate of dropouts in the patients randomized to imatinib attributed largely to gastric intolerance during the first eight weeks. Consequently, Novartis chose to withdraw the Investigational New Drug application as the drug went off patent.

Current TNX-201 Development for developing LCOS. ThePulmonary Arterial Hypertension Patients

On May 30, 2019, PHPrecisionMed Inc., a Delaware corporation (“PHPM”), which we acquired in January 2021, met with the FDA to discuss a proposal for a Phase III3 trial was conductedof imatinib for PAH. At that meeting, PHPM discussed a single Phase 3 trial using change in 6-minute walk distance as the primary endpoint (p<0.05). PHPM received agreement for submission under a United States Foodthe 505(b)(2) regulatory pathway, and Drug Administration, orthereafter received orphan designation. In July 2020, PHPM received agreement from the FDA approved Special Protocol Assessment, or SPA, and with FDA granted Fast Track status for the development of levosimendana modified release formulation that would require only a small comparative PK/bioavailability study. A Phase 3 study of TNX-201, this optimized modified release formulation of imatinib, would be the next clinical trial to commence in cardiac surgery patients at riskour development planning, pending the outcome of LCOS.

The LEVO-CTSour strategic process and funding of the trial design was guided bycosts.

Manufacturing and Supply

We contract with third parties for the published literature, including important dosing refinementsmanufacturing of all of our product candidates and inclusion of patients with low preoperative ejection fraction. In addition,for pre-clinical and clinical studies and intend to continue to do so in the future. We do not own or operate any manufacturing facilities and we relied heavily on the input of European clinicians who have significant personalno plans to build any owned clinical experience withor commercial scale manufacturing capabilities. We believe that the use of levosimendanthird-party manufacturers and contract drug manufacturing organizations (“CMOs”) eliminates the need to directly invest in treating cardiac surgery patients.

Current data in cardiac surgery suggest that levosimendan is superior to traditional inotropes (dobutamine, phosphodiesterase [PDE]-inhibitors) as it achieves:
sustained hemodynamic improvement;
diminished myocardial injury;
improved tissue perfusion;
better outcomesmanufacturing facilities, equipment and fewer hospital days;
effects most favorable in patients with low left ventricular ejection fraction (LVEF) (< 40%); and
opportunity to initiate therapy pre-operatively due to increased cardiac contractility without increasing intracellular calcium, without increasing oxygen consumption, or affecting cardiac rhythm and relaxation.

We selected Duke University’s Duke Clinical Research Institute, or DCRI, to conduct the Phase III trial of levosimendan. DCRI is the world’s largest academic clinical research organization, with substantial experience in conducting cardiac surgery trials. The Phase III trial was conducted in approximately 60-70 major cardiac surgery centers in North America. The trial enrolled patients undergoing coronary artery bypass grafts, or CABG, and/or mitral valve surgery, and CABG with aortic valve surgery who are at risk for developing LCOS. The trial was designed as a double blind, randomized, placebo controlled study seeking to enroll 760 patients. During 2016 we made the decision to increase enrollment in the LEVO-CTS trial to 880 patients. These additional patients were necessary to ensure sufficient powering and were necessary due to:
a small percentage of patients who were randomized but did not receive the study drug;
a small percentage of patients who were missing one or more component measurements of the primary endpoint; and
a slightly lower primary endpoint event rate than we originally projected.
Enrollment began in the third quarter of calendar year 2014, and was completed in December of 2016. On January 31, 2017, we announced top-line results from the Phase III LEVO-CTS trial. Levosimendan, given prophylactically prior to cardiac surgery to patients with reduced left ventricular function, had no effect on the co-primary outcomes. The study did not achieve statistically significant reductions in the dual endpoint of death or use of a mechanical assist device at 30 days, nor in the quad endpoint of death, myocardial infarction, need for dialysis, or use of a mechanical assist device at 30 days.
However, the study results demonstrated statistically significant reductions in two of three secondary endpoints including reduction in LCOS and a reduction in postoperative use of secondary inotropes. Additionally, levosimendan was found to be safe with no clinically significant increases in hypotension or cardiac arrhythmias and the clinical data showed a non-significant numerical reduction in 90-day mortality.
Notwithstanding the fact that the trial’s primary endpoints were not statistically significant, and given the statistically significant reductions in the secondary endpoints, we continue to believe levosimendan is an effective and safe inotrope to increase cardiac output in patients at risk for or with perioperative low cardiac output. Following the announcement of the Phase III LEVO-CTS top-line results, we held a meeting with the FDA to review the preliminary trial data and discuss a path forward to file a NDA for levosimendan. As a follow-up to this meeting, a pre-NDA meeting has been scheduled with the FDA in the second quarter of 2017 to discuss the data that supports the approval of levosimendan for acute decompensated heart failure. The FDA may not approve levosimendan for this or any other indication, and if we are unable to obtain regulatory approval, we will be unable to commercialize levosimendan in the U.S.
Levosimendan Development for Septic Shock Patients
Septic shock is a serious life-threatening condition with high unmet medical need. Small clinical studies suggest that levosimendan may provide important benefits to septic shock patients in the form of improved cardiac function, renal function, organ perfusion, and mitochondrial function. We announced a collaboration with Imperial College London in August of 2014 which provided supplemental funding to support the accelerated enrollment and completion of the ongoing LeoPARDS Trial (Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis). The LeoPARDS trial was designed to determine whether levosimendan reduces the incidence and severity of acute organ dysfunction in adult patients who have septic shock, as well as evaluate its safety profile.

On October 5, 2016, Anthony Gordon, M.D., Chair in Anaesthesia and Critical Care, Imperial College London, presented results from the LeoPARDS trial evaluating levosimendan in septic shock at the 29th Annual Congress of the European Society of Intensive Care Medicine (ESICM), held in Milan, Italy. Results presented by Dr. Gordon show that the levosimendan treatment arm did not achieve the trial’s primary endpoint of reducing the incidence and severity of acute organ dysfunction in adult patients who have septic shock, as well as the pre-specified secondary endpoints. Based upon these results seen, we do not anticipate undertaking further development with levosimendan in the septic shock indication.
Other Products
In addition to levosimendan described above, we have previously developed Oxycyte, a PFC-based oxygen carrier, our Dermacyte® line of topical cosmetic products, which contained our PFC technology and other known cosmetic ingredients to promote the appearance of skin health and other desirable cosmetic benefits, as well as Wundecyte™, a novel gel developed under a contract agreement with a lab in Virginia that was designed to be used as a wound-healing gel.  As we have suspended the development of these PFC products while we evaluate strategic alternatives, we do not expect that Oxycyte, Dermacyte or Wundecyte constitute a material portion of our business going forward.
Suppliers
staff.

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Pursuant to the terms of our license for levosimendan, Orion Corporation is contractually our sole manufacturing source for levosimendan.

TNX-103. We may engage other third-party suppliers and CMOs for the supply and manufacture of TNX-102, or other formulations we may develop.

We have engaged various third-party suppliers and CMOs for the supply and manufacture of imatinib for potential future clinical trials, and relied on such contractors for material contributing to TNX-201, for testing in our two completed Phase 1 trials.

As we further develop our product pipeline, we expect to consider secondary or back-up manufacturers for both active pharmaceutical ingredient and drug product manufacturing. To date, our third-party manufacturers have met the manufacturing requirements for our product candidates. We expect third-party manufacturers to be capable of providing sufficient quantities of our product candidates to meet anticipated full-scale commercial demands, but we have not assessed these capabilities beyond the supply of clinical materials to date.

We believe alternate sources of manufacturing will be available to satisfy our clinical and future commercial requirements; however, we cannot guarantee that identifying and establishing alternative relationships with such sources will be successful, cost effective, or completed on a timely basis without significant delay in the development or commercialization of our product candidates. All of the vendors we use are required to conduct their operations under current Good Manufacturing Practices (“cGMP”), a regulatory standard for the manufacture of pharmaceuticals.

Intellectual Property

We rely on a combination of patent applications, patents, trade secrets, proprietary know-how, trademarks, and contractual provisions to protect our proprietary rights. We believe that to have a competitive advantage, we must develop and maintain the proprietary aspects of our technologies. Currently, we require our officers, employees, consultants, contractors, manufacturers, outside scientific collaborators and sponsored researchers, and other advisors to execute confidentiality agreements in connection with their employment, consulting, or advisory relationships with us, where appropriate. We also require our employees, consultants, and advisors whowhom we expect to work on our products to agree to disclose and assign to us all inventions conceived during the work day,workday, developed using our property, or which relate to our business.

To

As of the date we own or in-licenseof this filing, the rights to seven U.S.Company has been granted three patents and foreign patents. In addition, we have numeroushas one U.S. patent applicationsapplication pending, that are complemented byfor which the appropriate foreign patent applicationsCompany has received a Notice of Allowance, all related to our product candidates and proprietary processes, methodsprocess, method and technologies.technology. Our issued and in-licensed patents, as well as our pendinglevosimendan patents expire between 2017in 2039 and 2030.

We have:
one U.S.late 2040.

On January 4, 2022, we received a patent (6,167,887) and one Australian patent (759,557) pertaining to the use and application of PFCs as gas transport agents in blood substitutes and liquid ventilation with an average remaining life of approximately 2 years;

one U.S. patent (8,404,752) and one European patent (EPO9798325.8) held jointly with Virginia Commonwealth University Intellectual Property Foundation for the treatmentsubcutaneous administration of traumatic brain injury;
 exclusive in-license to one fundamental gas transport patent application that represents the core technology used in our products and product candidates (other than levosimendan) with an average remaining life of approximately 12 years;
one Israel patent (215516) and numerous patent applications forlevosimendan, whether through the formulation of perfluorocarbon emulsionwe have developed in collaboration with an average remaining life of approximately 14 years; and
one U.S.a formulation development partner, or other subcutaneous formulations meeting certain broad characteristics defined in the patent. In addition, we received on March 21, 2023 a patent application for the use of levosimendan to treat left ventricular systolic dysfunction in patients undergoing cardiac surgery requiring cardiopulmonary bypass with an average remaining life of approximately 19 years.

Our patent and patent applications include claims covering:
methods to treat certain diseases and conditions and for biological gas exchange;
therapies for burn and wound victims;
delivery of oxygenated PFC;
various formulations containing PFC; and
use ofIV levosimendan in the treatment of PH-HFpEF patients, undergoing cardiac surgery.
Webased on several discoveries that have receivedemerged from the HELP Study and the OLE.

The U.S. trademark registrationsregistration for Oxycyte®. Simdax® is owned by Orion and is licensed to us for sales and marketing purposes for any intravenous pharmaceutical products containing levosimendan that are commercialized in the United States and Canada.

In addition, we own numerous domain names relevant

Our success will in part depend on the ability to obtain and maintain patent and other proprietary rights in commercially important technology, inventions and know-how related to our business, the validity and enforceability of our patents, the continued confidentiality of our trade secrets and our ability to operate without infringing the valid and enforceable patents and proprietary rights of third parties. We also rely on continuing technological innovation and in-licensing opportunities to develop and maintain our proprietary position.

We cannot be sure that patents will be granted with respect to any of our pending patent applications or with respect to any patent applications we may own or license in the future, nor can we be sure that any of our existing patents or any patents we may own or license in the future will be useful in protecting our technology and products. Comprehensive risks related to our intellectual property are described under the heading “Risk Factors - Risks Related to Our Intellectual Property” included elsewhere in this Annual Report on Form 10-K.

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Simdax License Agreement

On November 13, 2013, we acquired, through our wholly-owned subsidiary, a license agreement between Phyxius and Orion, which was later amended on October 9, 2020, January 25, 2022, and February 19, 2024 (as amended, the “License”). The License grants us an exclusive, sublicenseable right to develop and commercialize pharmaceutical products containing levosimendan worldwide (the “Territory”) and, pursuant to the October 9, 2020 amendment to the License, also includes two product dose forms containing levosimendan, in capsule and solid dosage form, and a subcutaneously administered product containing levosimendan, subject to specified limitations (together, the “Product”). Pursuant to the License, Tenax and Orion will agree to a new trademark when commercializing levosimendan in either of these forms.

Pursuant to the License, we have a right of first negotiation to commercialize new developments of levosimendan, including developments as to the formulation, presentation, means of delivery, route of administration, dosage or indication (i.e., line extension products).  Neurological diseases and disorders are excluded from this right of first negotiation.

Orion’s ongoing role under the License includes sublicense approval, serving as the sole source of manufacture of oral formulations of levosimendan, holding a first right to enforce intellectual property rights in the United States and Canada, and certain regulatory participation rights. Orion must notify the Company before the end of 2024 if it chooses not to exercise its right to supply oral formulations of levosimendan to the Company for commercialization in the Territory. Additionally, the Company must grant back to Orion a broad non-exclusive license to any patents or clinical trial data related to levosimendan developed by the Company under the License. The term of the License extends until 10 years after the launch of a levosimendan product in the United States and Canada, provided that the License will continue after the end of the term in each country in the Territory until the expiration of Orion’s patent rights in levosimendan in such country. In the event that no regulatory approval for levosimendan has been granted in the United States on or before September 20, 2030, however, either party will have the right to terminate the License with immediate effect.

As consideration for the License, we agreed to pay Orion (i) a one-time up-front payment in the amount of $1.0 million, (ii) development milestones consisting of (a) $10.0 million upon the grant of FDA approval and (b) $1.0 million upon the grant of regulatory approval for the Product in Canada, (c) $5.0 million due upon the grant of regulatory approval for a levosimendan-based product in Japan, (iii) commercialization milestones aggregating to up to $45.0 million, upon achievement of certain cumulative net sales amounts in the United States and Canada, and (iv) royalties based on net sales of the Product in the Territory. After the end of the License term, the Company must pay Orion a royalty based on net sales of the Product in the Territory for as www.tenaxthera.com, and others.

long as the Company sells the Product in the Territory.

Competition

The pharmaceutical and biotechnology industries are intensely competitive. Many companies, including biotechnology, chemical, and pharmaceutical companies, are actively engaged in activities similar to ours, including research and development of drugs for the treatment of cardiovascular, pulmonary, and related medical conditions, both rare medical conditions.and common. Many of these companies have substantially greater financial and other resources, larger research and development staffs, and more extensive marketing and manufacturing organizations than we do. In addition, some of them have considerable experience in preclinical testing, clinical trials and other regulatory approval procedures. In addition, thereThere are also academic institutions, governmental agencies and other research organizations that are conducting research in areas in which we are working. We expectOur success will be based in part on our ability to encounter significant competition foridentify, develop and manage a portfolio of product candidates that are safer and more effective than any of the pharmaceutical products we plan to develop.

competing products.

We believe the concept of using a medicationTNX-101/102/103 (levosimendan) to treat low cardiac output syndromepatients with PH-HFpEF is novel.novel, and the patent granted for this use in March 2023 demonstrates USPTO’s concurrence. Because no therapies are currently approved or commonly used to treat LCOS,PH-HFpEF, we believe our ability to succeed in the market is primarily dependent on our ability to change the established practice paradigm, which is never an easy task.could be difficult. Key factors on which we will compete with regards to the development and marketing of levosimendan for the treatment of LCOSpulmonary hypertension in these patients include, among others, the ability to obtain adequate efficacy data, safety data, cost effectiveness data and hospital formulary approval, marketing exclusivity, as well as sufficient distribution and handling. Furthermore, while we believe the mechanism of action of levosimendan is novel, other low pricedlow-priced, generically available products possess some similar qualities, which could present competition in the form of therapeutic substitution.

TNX-201 (imatinib) has the potential to be the first disease-modifying treatment of PAH, a fatal orphan disease. Pulmonary vasodilators, the only approved medications for PAH, do not have disease modifying properties. We do not expect these products, other than one which is not widely used today, to be contraindicated in patients taking TNX-201, and our intended protocol design tests TNX-201 as an additional therapy to one or more of these vasodilators.

Several other companies are developing new therapies to treat PAH, including some that may also be disease-modifying. Novartis developed imatinib for PAH and conducted a Phase 3 trial that in 2013 succeeded in meeting its primary endpoint. However, the high number of dropouts of patients randomized to imatinib led the FDA and the European Medicines Agency (“EMA”) to request another trial before they would approve the product in PAH. To address this, we are developing a modified-release oral formulation designed to reduce the stomach’s exposure to imatinib, thereby lessening the nausea and vomiting commonly observed in patients receiving imatinib. Other companies are developing an inhaled route of administration as their strategy to mitigate gastric intolerance. We believe that our development plan has advantages in that we already know the effective dose of imatinib administered orally, and the systemic exposure from an inhaled route remains uncertain and costly to determine. Since only the first FDA approved formulation of imatinib to treat PAH will qualify for the seven years of Orphan Drug exclusivity in the U.S., these alternative formulations of imatinib represent potential competitive threats.

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In order to compete successfully, in this and other therapeutic areas, we must develop proprietary positions in patented drugs for therapeutic markets that have not been satisfactorily addressed by conventional research strategies. Our product candidates, even if successfully tested and developed, may not be adopted by physicians over other products and may not offer economically feasible alternatives to other therapies.

Government regulation

Regulation

The manufacture and distribution of levosimendan will require the approval of United States government authorities as well as those of foreign countries. In the United States, the FDA regulates medical products. The Federal Food, Drug and Cosmetic Act and the Public Health Service Act govern the testing, manufacture, safety, effectiveness, labeling, storage, record keeping, approval, advertising and promotion of our medical products. In addition to FDA regulations, we are also subject to other federal and state regulations, such as the Occupational Safety and Health Act and the Environmental Protection Act. Product development and approval within this regulatory framework requires a number of years and involves the expenditure of substantial funds.

Preclinical tests include evaluation of product chemistry and studies to assess the safety and effectiveness of the product and its formulation. The results of the preclinical tests are submitted to the FDA as part of the application. The goal of clinical testing is the demonstration in adequate and well-controlled studies of substantial evidence of the safety and effectiveness of the product in the setting of its intended use. The results of preclinical and clinical testing are submitted to the FDA from time to time throughout the trial process. In addition, before approval for the commercial sale of a product can be obtained, results of the preclinical and clinical studies must be submitted to the FDA. The testing and approval process requires substantial time and effort and there can be no assurance that any approval will be granted on a timely basis, if at all. The approval process is affected by a number of factors, including the severity of the condition being treated, the availability of alternative treatments and the risks and benefits demonstrated in clinical trials. Additional preclinical studies or clinical trials may be requested during the FDA review process and may delay product approval. After FDA approval for its initial indications, further clinical trials may be necessary to gain approval for the use of a product for additional indications. The FDA may also require post-marketing testing to monitor for adverse effects, which can involve significant expense,expense.

The effects of government regulations on our business are discussed under the heading “Risk Factors - Risks Relating to monitor for adverse effects.


As noted above, following the announcement of the Phase III LEVO-CTS top-line results, we held a meeting with the FDA to review the preliminary trial dataRegulatory Matters” included elsewhere in this Annual Report on Form 10-K.

Employees and discuss a path forward to file a NDA for levosimendan. As a follow-up to this meeting, a pre-NDA meeting has been scheduled with the FDA in the second quarter of 2017.

Research and Development
Our research and development efforts are focused on the development and commercialization of levosimendan for its use in clinical indications, primarily LCOS. Previously, we were also focused on furthering the development and manufacture of Oxycyte for its use in clinical indications, primarily TBI, spinal cord injury, and decompression sickness. However, we have suspended the development of Oxycyte while we evaluate strategic alternatives.
We spent approximately $13.1 million and $6.5 million on research and development during the fiscal year ended December 31, 2016 and the eight months ended December 31, 2015, respectively. During each of the fiscal years ended April 30, 2015 and 2014 we spent approximately $6.7 million and $3.0 million, respectively, on research and development.
Employees
We believe that our success will be based on, among other things, the quality of our clinical programs, our ability to invent and develop superior and innovative technologies and products, and our ability to attract and retain capable management and other personnel. Human Capital

We have assembled a high qualityhigh-quality team of scientists, clinical development managers and executives with significant experience in the biotechnology and pharmaceutical industries.

As of December 31, 2016,2023, we had tenfive full-time employees and one part-time employee. In addition to our employees, we also userely on the service and support of outside consultants and advisors. None of our employees areis represented by a union, and we believe relationships with our employees are good.

Financial Information by Geographic Area
For the year ended December 31, 2016, the eight months ended December 31, 2015 and the years ended April 30, 2015 and 2014, all revenues from external customers were attributed to United States customers. As of December 31, 2016, December 31, 2015 and April 30, 2015 and 2014, all long-lived assets with a net book value were located in the United States.

Available Information

Our website address is www.tenaxthera.com, and our investor relations website is located at http://investors.tenaxthera.com.investors.tenaxthera.com. Information on our website is not incorporated by reference herein. Copies of our annual reports on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K and our Proxy Statementsproxy statements for our annual meetings of stockholders, and any amendments to those reports, as well as Section 13 and 16 reports filed by our insiders, are available free of charge on our website as soon as reasonably practicable after we file the reports with, or furnish the reports to, the Securities and Exchange Commission, or the SEC. Our SEC filings are also publicly available for reading and copying aton the SEC’s Public Reference Roomwebsite located at 100 F Street, NE, Washington, D.C. 20549. Information on the operation of the Public Reference Room may be obtained by calling the SEC at 1-800-SEC-0330. In addition, the SEC maintains an Internet site (http://www.sec.gov) containingwww.sec.gov, which contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC.


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ITEM 1A—RISK FACTORS

Our business, financial condition and operating results may be affected by a number of factors, including but not limited to those described below. Any one or more of such factors could directly or indirectly cause our actual results of operations and financial condition to vary materially from our past or anticipated future results of operations and financial condition. Any of these factors, in whole or in part, could materially and adversely affect our business, financial condition, results of operations and stock price. The following information should be read in conjunction with Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and the accompanying financial statements and related notes in Part II, Item 8, “Financial Statements and Supplementary Data” of this Annual Report on Form 10-K.

Risks Related to Our Financial Position and Need for Additional Capital

We have a limited operating history, and we expect a number of factors to cause our operating results to fluctuate on a quarterly and annual basis, which may make it difficult to predict our future performance.

Our operations, to date, have been primarily limited to organizing and staffing our company, developing our technology and undertaking preclinical studies and clinical trials of our product candidates. We have not yet obtained regulatory approvals for any of our clinical product candidates. Consequently, any predictions you makeindependent registered public accounting firm’s report includes an explanatory paragraph stating that there is substantial doubt about our future success or viability may not be as accurate as they could be if we had a longer operating history.

Specifically, our financial condition and operating results have varied significantly in the past and will continue to fluctuate from quarter-to-quarter and year-to-year in the future due to a variety of factors, many of which are beyond our control. Factors relating to our business that may contribute to these fluctuations include the following factors, among others:
our ability to continue as a going concern.

As a result of our historical operating losses and expected future negative cash flows from operations, we have concluded that there is substantial doubt about our ability to continue as a going concern. Similarly, the report of our independent registered public accounting firm on our consolidated financial statements, included elsewhere in this Annual Report on Form 10-K, includes an explanatory paragraph indicating that there is substantial doubt about our ability to continue as a going concern. Our ability to continue as a going concern is dependent upon our ability to raise additional capital and to achieve sustainable revenues and profitable operations. Substantial doubt about our ability to continue as a going concern may materially and adversely affect the price per share of our common stock and make it more difficult to obtain financing. Our consolidated financial statements for the fiscal year ended December 31, 2023 have been prepared assuming we will continue as a going concern and do not include any adjustments that might result from uncertainty about our ability to continue as a going concern.

We will require substantial additional funding to further develop our product candidates;

candidates, including to complete the needLEVEL trial, which includes an open label extension phase, to complete a subsequent Phase 3 trial of TNX-103, and to initiate or complete the imatinib Phase 3 trial. Failure to obtain regulatory approval of our most advanced product candidates;
potential risks related to any collaborations we may enter into for our product candidates;
delays in the commencement, enrollment and completion of clinical testing, as well as the analysis and reporting of results from such clinical testing;
the success of clinical trials of our product candidates;
any delays in regulatory review and approval of product candidates in development;
our ability to establish an effective sales and marketing infrastructure;
competition from existing products or new products that may emerge;
the ability to receive regulatory approval or commercialize our products;
potential side effects of our product candidates that could delay or prevent commercialization;
potential product liability claims and adverse events;
potential liabilities associated with hazardous materials;
our ability to maintain adequate insurance policies;
our dependency on third-party manufacturers to supply or manufacture our products;
our ability to establish or maintain collaborations, licensing or other arrangements;
our ability, our partners’ abilities, and third parties’ abilities to protect and assert intellectual property rights;
costs related to and outcomes of potential litigation;
compliance with obligations under intellectual property licenses with third parties;
our ability to adequately support future growth; and
our ability to attract and retain key personnel to manage our business effectively.
Due to the various factors mentioned above, and others, the results of any prior quarterly or annual periods should not be relied upon as indications of our future operating performance.
We may need additional funding and if we are unable to raisethis necessary capital when needed we would be forcedon acceptable terms, or at all, or execute on alternative strategic paths, could force us to delay, limit, reduce or eliminateterminate our clinical trials, product development programs.
efforts and business operations.

Developing biopharmaceutical products, including conducting preclinical studies and clinical trials and establishing manufacturing and sales and marketing capabilities, is expensive. We expect our research and development expenses to continue to increase in connection with our ongoing activities. In addition, our expenses could increase beyond expectations if applicable regulatory authorities, including the FDA, require that we perform studies additional studies to those that we currently anticipate, in which case the timing of any potential product approval may be delayed.

As of December 31, 2016,2023, we had $21.9$9.8 million of cash, including the fair value of our marketable securities on hand. Based on our current operating plans, we believe that our existing cash and cash equivalents will be sufficient to fund our projected operating requirements through the first half of calendar year 2018.on hand. We will need substantial additional capital in the future in order to develop our product candidates, including to complete the LEVEL trial and its associated open label extension, a Phase 3 trial of TNX-103, and to complete the regulatory approval process and commercialization of levosimendan, and, to fund the development and commercialization ofpotentially, imatinib, or any future product candidates. UntilAs a result, we can generate a sufficient amount of product revenue, if ever, we expectcontinue to finance future cash needs throughevaluate strategic alternatives, including pursuing additional public or private equity offerings, debt financings or corporate collaboration and licensing arrangements. Such funding if needed, may not be available on favorable terms, if at all.

In the event we are unableaddition, to obtain additional capital, we may delay or reduce the scope of our current research and development programs and other expenses.


If adequate funds are not available, we may also be required to eliminate one or more of our research or development programs or our commercialization efforts. To the extent that we raise additional funds by issuing equity securities, our stockholders may experience additional significant dilution, anddilution; debt financing, if available, may involve restrictive covenants. To the extent that we raise additional funds through collaboration and licensing arrangements, it may be necessary to relinquish some rights to our technologies or our product candidates or to grant licenses on terms that may not be favorable to us. We may seek to access the public or private capital markets whenever conditions are favorable, even if we do not have an immediate need for additional capital at that time.
Our forecast of the period of time through which our financial resources will be adequate to support our operations is a forward-looking statement and involves risks and uncertainties, and actual results could vary as a result of a number of factors, including the factors discussed elsewhere in this “Risk Factors” section. We have based this estimate on assumptions that may prove to be wrong, and we could utilize our available capital resources sooner than we currently expect.

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Our future funding requirements will depend on many factors, including, but not limited to:

the scope, rate of progress, and cost of our clinical trials and other research and development activities;

the number of investigator sites and patients who participate and the impact that factors such as the rate of patient recruitment, the standard deviation of treatment effect, and the number of patients who have events or withdraw from therapy, have on the expected timelines and the eventual required number of patients enrolled for each of our clinical programs;

the costs and timing of regulatory approval;

the costs of filing, prosecuting, defending and enforcing any patent claims and other intellectual property rights;

the effect of competing technological and market developments;

the terms and timing of any collaboration, licensing or other arrangements that we may establish;

the cost and timing of completion of clinical and commercial-scale manufacturing activities; and

the costs of establishing sales, marketing and distribution capabilities for any product candidates for which we may receive regulatory approval.

We also expect to continue our evaluation of additional strategic alternatives, including a sale of our clinical trialsCompany, merger, other business combination, or recapitalization. In the event we are unable to obtain additional capital as needed or execute on other strategic alternatives, we may further delay, limit, reduce or terminate our current development efforts and business operations.

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Our ongoing exploration of alternative strategic paths may not result in entering into or completing transactions, when necessary, and the process of reviewing alternative strategic paths or their conclusion could adversely affect our stock price.

We continue to evaluate strategic paths to provide the resources necessary to complete our product development and maximize stockholder value. Potential strategic paths may include additional capital raises, a sale of our Company, merger, one or more license agreements, a co-development agreement, a combination of these, or other strategic transactions. There can be no assurance, however, that our evaluation will result in transactions or other alternatives, even when deemed necessary. There is no set timetable for our strategic process and we do not intend to provide updates unless or until the Board of Directors approves a specific action or otherwise determines that disclosure is appropriate or necessary. We have suspended plans to launch the imatinib Phase 3 trial in PAH, and the initiation of that trial and continued development of our product candidates, including completion of the LEVEL Study, our Phase 3 trial of levosimendan in PH-HFpEF, depend on the outcome of our ongoing strategic process.

There can be no assurance any transaction will result from the Company’s ongoing evaluation of strategic paths. Any potential transaction would be dependent on a number of factors that may be beyond our control, including, among other things, market conditions, industry trends, the interest of third parties in a potential transaction with us, obtaining stockholder approval and the availability of financing to third parties in a potential transaction with us on reasonable terms. The process of reviewing alternative strategic paths may be time consuming and may involve the dedication of significant resources and may require us to incur significant costs and expenses. It could negatively impact our ability to attract, retain and motivate employees, and expose us to potential litigation in connection with this process or any resulting transaction. If we are unable to effectively manage the process, our financial condition and results of operations could be adversely affected. In addition, speculation regarding any developments related to the review of strategic alternatives and perceived uncertainties related to the future of our Company could cause our stock price to fluctuate significantly. Further, any alternative strategic paths that may be pursued and completed ultimately may not deliver the anticipated benefits or enhance stockholder value. There can be no guarantee that the process of evaluating alternative strategic paths will result in our Company entering into or completing potential transactions within the anticipated timing or at all.

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In the event we do not successfully complete strategic transactions, should this be deemed necessary, our Board of Directors may decide to pursue a dissolution and liquidation of our Company. In such an event, the amount of cash available for distribution to our stockholders will depend heavily on the timing of such liquidation as well as the amount of cash that will need to be reserved for commitments and contingent liabilities.

There can be no guarantee that the process to identify strategic transactions will result in successfully completed transactions when necessary. If additional transactions are not completed that enable us to continue the development of our product candidates and sustain our business operations, our Board of Directors may decide that it is in the best interest of our stockholders to dissolve our Company and liquidate our assets. In that event, the amount of cash available for distribution to our stockholders will depend heavily on the timing of such decision and, ultimately, such liquidation since the amount of cash available for distribution continues to decrease as we fund our operations and evaluate our strategic alternatives. In addition, if our Board were to approve and recommend, and our stockholders were to approve, a dissolution of our Company, we would be required under Delaware corporate law to pay our outstanding obligations, as well as to make reasonable provision for contingent and unknown obligations, prior to making any distributions in liquidation to our stockholders. As a result of this requirement, a portion of our assets may need to be reserved pending the resolution of such obligations. In addition, we may be subject to litigation or other claims related to a dissolution and liquidation of our Company. If a dissolution and liquidation were pursued, our Board, in consultation with its advisors, would need to evaluate these matters and make a determination about a reasonable amount to reserve. Accordingly, holders of our common stock could lose all or a significant portion of their investment in the event of a dissolution, liquidation or winding up of our Company.

Our failure to maintain compliance with Nasdaq’s continued listing requirements could result in the delisting of our common stock.

Our common stock is currently listed on the Nasdaq Capital Market. In order to maintain this listing, we must satisfy minimum financial and other researchrequirements. On March 29, 2023, we received a notification letter from the Nasdaq Stock Market LLC (“Nasdaq”) indicating that we were not in compliance with Nasdaq Listing Rule 5550(a)(2) (the “Bid Price Rule”) because the minimum bid price of our common stock on the Nasdaq Capital Market closed below $1.00 per share for 30 consecutive business days.  In accordance with Nasdaq Listing Rule 5810(c)(3)(A), the Company had a compliance period of 180 calendar days, or until September 25, 2023, to regain compliance with the Bid Price Rule.  This timeline was extended by Nasdaq until March 25, 2024, and following the Reverse Stock Split, the Company regained compliance. On January 18, 2024, Nasdaq provided the Company with a written confirmation of compliance with the Bid Price Rule.

On January 11, 2024, we received a notification letter from Nasdaq indicating that we were not in compliance with Nasdaq Listing Rule 5550(a)(4) (the “Public Float Rule”), which requires the Company to have a minimum of 500,000 publicly held shares.  On February 22, 2024, Nasdaq provided the Company with a written confirmation of compliance with the Public Float Rule.

While we intend to engage in efforts to maintain compliance, and thus maintain our listing, there can be no assurance that we will be successful or continue to meet all applicable Nasdaq Capital Market requirements in the future. If our common stock were to be removed from listing with the Nasdaq Capital Market, it may be subject to the so-called “penny stock” rules. The SEC has adopted regulations that define a “penny stock” to be any equity security that has a market price per share of less than $5.00, subject to certain exceptions, such as any securities listed on a national securities exchange, which is the exception on which we currently rely. For any transaction involving a “penny stock,” unless exempt, the rules impose additional sales practice requirements on broker-dealers, subject to certain exceptions. If our common stock were delisted and determined to be a “penny stock,” a broker-dealer may find it more difficult to trade our common stock and an investor may find it more difficult to acquire or dispose of our common stock on the secondary market.

If our common stock is delisted and there is no longer an active trading market for our shares, it may, among other things:

cause stockholders difficulty in selling our shares without depressing the market price for the shares or selling our shares at all;

substantially impair our ability to raise additional funds;

result in a loss of institutional investor interest and fewer financing opportunities for us; and/or

result in potential breaches of representations or covenants of agreements pursuant to which we made representations or covenants relating to our compliance with applicable listing requirements. Claims related to any such breaches, with or without merit, could result in costly litigation, significant liabilities and diversion of our management’s time and attention and could have a material adverse effect on our financial condition, business and results of operations.

A delisting would also reduce the value of our equity compensation plans, which could negatively impact our ability to retain employees.

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We expect a number of factors to cause our operating results to fluctuate on a quarterly and annual basis, which may make it difficult to predict our future performance.

Our financial condition and operating results have varied significantly in the past and will continue to fluctuate from quarter-to-quarter and year-to-year in the future due to a variety of factors, many of which are beyond our control. Factors relating to our business that may contribute to these fluctuations include the following factors, among others:

our ability to raise additional money to fund our operations for at least the next 12 months as a going concern;

our ongoing evaluation of strategic alternatives;

our ability to develop our current product candidates, and any product candidate which we may develop or in-license in the future;

delays in the commencement, recruitment and initiation of sites, enrollment of patients, and completion of clinical testing, as well as the analysis and reporting of results from such clinical testing;

the success of clinical trials of our product candidates;

the need to obtain regulatory approval of our product candidates;

potential risks related to any collaborations we may enter into for our product candidates;

any delays in regulatory review and approval of product candidates in development;

our ability to establish an effective sales and marketing infrastructure;

competition from existing products or new products that may emerge;

the ability to receive regulatory approval or commercialize our products;

potential side effects of our product candidates that could delay or prevent commercialization;

potential product liability claims and adverse events;

potential liabilities associated with hazardous materials;

our ability to maintain adequate insurance policies;

our dependency on third-party manufacturers and CROs;

our ability to establish or maintain collaborations, licensing or other arrangements;

our ability, our partners’ abilities, and third parties’ abilities to protect and assert intellectual property rights;

costs related to and outcomes of potential litigation;

compliance with obligations under intellectual property licenses with third parties;

our ability to adequately support future growth;

our ability to attract and retain personnel, including our executive team, advisors and members of our Board of Directors; and

volatility and uncertainty in the global economy and financial markets in light of the possibility of pandemics, global financial and geopolitical uncertainties, including in the Middle East and the Russian invasion of and war against the country of Ukraine.

Due to the various factors mentioned above, and others, the results of any prior quarterly or annual periods should not be relied upon as indications of our future operating performance.

We have incurred losses since our inception, expect to continue to incur losses in the foreseeable future, and may never become profitable.

We have incurred losses since inception. For the years ended December 31, 2023 and 2022, we incurred net operating losses of $8.2 million and $11.0 million, respectively. We have funded our operations since September 1990 principally through the issuance of debt and equity securities and loans from stockholders. We will continue to incur losses until we generate sufficient revenue to offset our expenses, and we anticipate that we will continue to incur net losses for at least the next several years. We expect to incur additional expenses related to our development activities;

the costs and timingpotential commercialization of regulatory approval;
the costs of filing, prosecuting, defending and enforcing any patent claimslevosimendan for pulmonary hypertension and other intellectual property rights;
the effect of competing technologicalpotential indications, imatinib for PAH, as well as identifying and market developments;
the terms and timing of any collaboration, licensing ordeveloping other arrangements that we may establish;
the cost and timing of completion of clinical and commercial-scale manufacturing activities; and
the costs of establishing sales, marketing and distribution capabilities for our cosmetic products and anypotential product candidates, for whichand as a result, we may receive regulatory approval.
will need to generate significant net product sales, royalty and other revenues to achieve profitability.

Risks Related to CommercializationOur Business Strategy and Product Development

Operations

We are limited in the number of products we can simultaneously pursue and therefore our survival depends on our success with a small number of product opportunities.

We have limited financial resources, so at present we are primarily focusing theseour resources on developing levosimendan for the treatment of LCOS. However, on January 31, 2017, we announced top-line results fromPH-HFpEF, while imatinib for the Phase III LEVO-CTS trial. The study did not achieve statistically significant reductions in the dual endpointtreatment of death or usePAH remains part of a mechanical assist device at 30 days, nor in the quad endpoint of death, myocardial infarction, need for dialysis, or use of a mechanical assist device at 30 days. Nevertheless, the study demonstrated statistically significant reductions in two of three secondary endpoints including reduction in LCOS and a reduction in postoperative use of secondary inotropes. Additionally, we observed a non-significant numerical reduction in 90-day mortality. At present, weour portfolio. We intend to commit most of our resources to advancing levosimendan to the point it receives regulatory approval for one or more medical uses. Ifthe treatment of pulmonary hypertension in patients with associated HFpEF. Depending on the funds raised and timing of the funding, as well as on decisions made by USPTO, clinical trial results and other information revealed by competitors, and other factors, we will prioritize our funding and other resources. Pending the outcome of our strategic process, if as a consequence of the results of our planned Phase III LEVO-CTS trial,3 trials, or the results of prior clinical trials performed using levosimendan or imatinib, we are unable to receive regulatory approval of levosimendan,one or both of our existing product candidates, then we may not have resources to pursue development of any other products and our business could terminate.

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A pandemic, epidemic, or outbreak of an infectious disease, such as COVID-19, or another coronavirus or similar disrupting illness, may materially and adversely affect our business and our financial results.

The spread of COVID-19, including variant strains, has affected segments of the global economy and healthcare systems and has previously had an adverse impact on our business operations. COVID-19 or a similar global pandemic could in the future, directly or indirectly, materially and adversely affect our operations, including the potential interruption of our clinical trial activities and our supply chain. There could be continuing or new effects of COVID-19 or similar disrupting illnesses to the processes, timelines, resourcing, and other aspects of operations at FDA or other health authorities, which could result in delays of reviews and approvals, including with respect to our product candidates.

Additionally, the continued spread of COVID-19 or similar disrupting illnesses could adversely affect our future clinical trial operations in the United States, Canada, and elsewhere, including our ability to recruit, retain, and rely on the active participation of patients and principal investigators and site staff who, as healthcare providers, may have heightened exposure to respiratory illnesses if an outbreak occurs in their geography. The spread of COVID-19, or another infectious disease, could also negatively affect the operations at our third-party manufacturers, which could result in delays or disruptions in the supply of our product candidates.

We cannot presently predict the scope and severity of any potential business shutdowns or disruptions. If we or any of the third parties with whom we engage, however, 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 affected, which could have a material adverse impact on our business and our results of operation and financial condition.

If we fail to attract and retain senior management and key scientific personnel, we may be unable to successfully develop and commercialize our product candidates.

We have historically operated with a limited number of employees. As of December 31, 2023, we had five full-time employees and one part-time employee. Therefore, institutional knowledge is concentrated within a small number of employees. Our success depends in part on our continued ability to attract, retain and motivate highly qualified management, clinical and scientific personnel to continue the development, regulatory approval and commercialization of our product candidates. We will need to hire or contract with additional qualified personnel with expertise in preclinical testing, clinical research and testing, government regulation, formulation and manufacturing, and sales and marketing. Additionally, our future success is highly dependent upon the contributions of our senior management team. The loss of services of any of these individuals could delay or prevent the successful development of our product pipeline, completion of our planned clinical trials or the commercialization of our product candidates.

We face competition from other companies and organizations for qualified personnel. Other companies and organizations with which we compete for personnel may have greater financial and other resources and different risk profiles than we do, and a history of successful development and commercialization of their product candidates. Replacing employees and attracting sufficiently skilled new employees may be difficult and costly, and we may not have other personnel with the capacity to assume all the responsibilities of an existing employee upon his or her departure or to take on the duties necessary to continue growing our company and pursuing our business strategy. If we cannot attract and retain skilled personnel, as needed, we may not achieve our development and other goals.

In addition, the success of our business will depend on our ability to develop and maintain relationships with respected service providers and industry-leading consultants and advisors. If we cannot develop and maintain such relationships, as needed, the rate and success at which we can develop and commercialize product candidates may be limited. In addition, our insourcing and outsourcing strategies, which have included engaging consultants to manage core administrative and operational functions, may subject us to scrutiny under labor laws and regulations, which may divert management time and attention and have an adverse effect on our business and financial condition.

Risks Related to Drug Development and Commercialization

We currently have no approved drug products for sale, and we cannot guarantee that we will ever have marketable drug products.

We currently have no approved drug products for sale. The research, testing, manufacturing, labeling, approval, selling, marketing, and distribution of drug products are subject to extensive regulationextensively regulated by the FDA and other regulatory authorities in the United States and other countries, with regulations differing from country to country. We are not permitted to market our product candidates in the United States until we receive approval of a new drug application, or an NDA,New Drug Application (“NDA”) from the FDA for each product candidate. While weWe have not submitted aan NDA or received marketing approval for any of our product candidates, and obtaining approval of an NDA is a lengthy, expensive and uncertain process, we held a meeting with the FDA to review the preliminary trial data for our Phase III LEVO-CTS trial and discuss a path forward to file a NDA for levosimendan. As a follow-up to this meeting, we scheduled a pre-NDA meeting with the FDA to take place in the second quarter of 2017.process. In addition, markets outside of the United States also have requirements for approval of drug candidates which we must comply with prior to marketing. Accordingly, we cannot guarantee that we will ever have marketable drug products.


The development

Prior to obtaining approval to commercialize a product candidate in the United States or abroad, we or our collaborators must demonstrate with substantial evidence from well-controlled clinical trials, and to the satisfaction of levosimendan is subjectthe FDA, that such product candidates are safe and effective for their intended uses. Results from preclinical studies and clinical trials can be interpreted in different ways. Even if we believe the preclinical or clinical data for our product candidates are promising, such data may not be sufficient to a high level of technological risk.

We have devoted a substantial portion of our financialsupport approval by the FDA and managerial resourcesother regulatory authorities. Additionally, the FDA may require us to pursue Phase IIIconduct additional preclinical studies or clinical trials for levosimendan. The biomedical field has undergone rapid and significant technological changes. Technological developmentsour product candidates either prior to or post-approval, or it may result in our products becoming obsolete or non-competitive before we are ableobject to recover any portion of the research and development and other expenses we have incurred to develop and clinically test levosimendan. As our opportunity to generate substantial product revenues within the next three to four years is most likely dependent on successful testing and commercialization of levosimendan for surgical applications, any such occurrence would have a material adverse effect on our operations and could result in the cessationelements of our business.
clinical development program.

We may beare required to conduct additional clinical trials, inincluding the future,LEVEL trial for oral levosimendan, which are expensive and time consuming, and the outcome of the clinical trials is uncertain.

We expect to commit a substantial portion of our financial and business resources overin the next two yearsshort-term to preclinical and clinical testingcompleting the LEVEL trial, a Phase 3 trial of levosimendan, and advancing this product through a subsequent Phase 3 trial and on to regulatory approval for use in one or more medical applications.PH-HFpEF, and potentially other indications. We may in the future commit resources to clinical trials for our other product candidates, including imatinib. All of these clinical trials and testing will be expensive and time consuming and the timing of the regulatory review process is uncertain. The applicable regulatory agencies may suspend clinical trials at any time if they believe that the subjects participating in such trials are being exposed to unacceptable health risks. We cannot ensureassure you that we will be able to complete our clinical trials successfully or obtain FDA or other governmental or regulatory approval of our products,product candidates, or that such approval, if obtained, will not include limitations on the indicated uses for which our productsproduct candidates may be marketed. For example, the top-line results of our Phase III LEVO-CTS trial for levosimendan did not achieve statistically significant reductions in dual or quad primary endpoints but did meet two secondary endpoints with statistically significant reduction in incidence of LCOS and use of postoperative secondary inotropes. Our business, financial condition and results of operations are critically dependent on obtaining capital to advance our testing program and receiving FDA and other governmental and regulatory approvals of our products. A significant delay in or failure of our planned clinical trials or a failure to achieve these approvals would have a material adverse effect on us and could result in major setbacks or jeopardize our ability to continue as a going concern. For instance, based on the results of our LeoPARDS clinical trial, we do not anticipate undertaking further development with levosimendan in the septic shock indication.

business and financial setbacks.

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The market may not accept our products.

Even

If any of our product candidates receive marketing approval, they may nonetheless fail to gain sufficient market acceptance by physicians, patients, third-party payors and others in the medical community. If our product candidates do not achieve an adequate level of acceptance, we may not generate significant revenue and we may not become profitable. The degree of market acceptance of our product candidates, if regulatory approval is obtained, there isapproved for commercial sale, will depend on a number of factors, including:

the efficacy, safety and potential advantages of our product candidates;

our ability to offer our products for sale at competitive prices;

the convenience and ease of administration compared to alternative treatments, if any;

product labeling or product insert requirements of the FDA or foreign regulatory authorities, including any limitations or warnings contained in a product’s approved labeling, including any black box warning;

the willingness of the target patient population to try new treatments and of physicians to prescribe these treatments;

our ability to hire and retain a sales force in the United States;

the strength of manufacturing, marketing and distribution support;

the availability of third-party coverage and adequate reimbursement for of levosimendan, imatinib and any other product candidates, once approved;

the prevalence and severity of any side effects; and

any restrictions on the use of our products together with other medications.

Nonfinal results from our clinical trials announced or published from time to time on an interim, preliminary, or “top-line” basis, and conclusions that may be drawn from such results, may change as more patient data become available, and these results are subject to audit and verification procedures that could result in material changes in the final data.

From time to time, we may publish interim, top-line, or preliminary results from our clinical trials. Interim or top-line results from clinical trials that we may complete are subject to the risk that one or more of the efficacyclinical outcome measurements may materially change as patient enrollment and pricing oftreatment extends and more patient experience is observed. Preliminary or top-line results also remain subject to audit and verification procedures that may result in the final data being materially different from the preliminary data we previously published. As a result, interim and preliminary data should be viewed with caution until the final and complete data are available. Differences between preliminary or interim data and final data could significantly harm our products, considered in relation to our products’ expected benefits, will not be perceived by health care providersbusiness prospects and third-party payers as cost-effective, and thatmay cause the trading price of our products will not be competitive with other new technologies or products. Our results of operations may be adversely affected if the price of our products is not considered cost-effective or if our products do not otherwise achieve market acceptance.


common stock to fluctuate significantly.

Any collaboration we enter with third parties to develop and commercialize ourany future product candidates may place the development of our product candidates outside our control, may require us to relinquish important rights or may otherwise be on terms unfavorable to us.

We may enter into collaborations with third parties to develop and commercialize ourfuture product candidates. Our dependence on future partners for development and commercialization of our product candidates would subject us to a number of risks, including:

we may not be able to controlincluding the amount and timing of resources that our partners may devote to the development or commercialization of our product candidates or to their marketing and distribution;
partners may delay clinical trials, provide insufficient funding for a clinical trial program, stop a clinical trial or abandon a product candidate, repeat or conduct new clinical trials or require a new formulation of a product candidate for clinical testing;
disputes may arise between us and our partners that result in the delay or termination of the research, development or commercialization of our product candidates or that result in costly litigation or arbitration that diverts management’s attention and resources;
partners may experience financial difficulties;
partners may not properly maintain or defend our intellectual property rights, or may use our proprietary information, in such a way as to invite litigation that could jeopardize or invalidate our intellectual property rights or proprietary information or expose us to potential litigation;
business combinations or significant changes in a partner’s business strategy may adversely affect a partner’s willingness or ability to meet its obligations under any arrangement;
a partner could independently move forward with a competing product candidate developed either independently or in collaboration with others, including our competitors; and
the collaborations with our partners may be terminated or allowed to expire, which would delay the development and may increase the cost of developing our product candidates.
following:

we may not be able to control the amount and timing of resources that our partners may devote to the development or commercialization of our product candidates or to their marketing and distribution;

partners may delay clinical trials, provide insufficient funding for a clinical trial program, stop a clinical trial or abandon a product candidate, repeat or conduct new clinical trials or require a new formulation of a product candidate for clinical testing;

disputes may arise between us and our partners that result in the delay or termination of the research, development or commercialization of our product candidates or that result in costly litigation or arbitration that diverts management’s attention and resources;

partners may experience financial difficulties;

partners may not properly maintain or defend our intellectual property rights, or may use our proprietary information, in such a way as to invite litigation that could jeopardize or invalidate our intellectual property rights or proprietary information or expose us to potential litigation;

business combinations or significant changes in a partner’s business strategy may adversely affect a partner’s willingness or ability to meet its obligations under any arrangement;

a partner could independently move forward with a competing product candidate developed either independently or in collaboration with others, including our competitors; and

the collaborations with our partners may be terminated or allowed to expire, which would delay the development and may increase the cost of developing our product candidates.

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Delays in the enrollment and completion of clinical testing could result in increased costs to us and delay or limit our ability to obtain regulatory approval for our product candidates.

Delays in the commencement, enrollment and completion of clinical testing could significantly affect our ability to gain FDA approval of current product candidates, to gain this approval in the timeline planned, and could significantly increase our future product development costs. The completion of clinical trials requires us to identify and maintain a sufficient number of trial sites, many of which maymight already be engaged in other clinical trial programs for the same indication as our product candidates, or maymight be required to withdraw from our clinical trial as a result of changing standards of care, might suffer from staff shortages at the institutional or mayclinic level that impact their ability to enroll and treat patients under our protocols, or might become ineligible to participate in clinical studies. The enrollment and completion of clinical trials can be delayed for a variety of other reasons, including delays related to:

reaching agreements on acceptable terms with prospective trial sites, the terms of which can be subject to extensive negotiation and may vary significantly among trial sites;
obtaining institutional review board, or IRB, approval to conduct a clinical trial at numerous prospective sites;
recruiting and enrolling patients to participate in clinical trials for a variety of reasons, including meeting the enrollment criteria for our study and competition from other clinical trial programs for the same indication as our product candidates;
maintaining and supplying clinical trial material on a timely basis; and
collecting, analyzing and reporting final data from the clinical trials.

reaching agreements on acceptable terms with prospective trial sites, the terms of which can be subject to extensive negotiation and may vary significantly among trial sites;

obtaining institutional review board (“IRB”) approval to conduct a clinical trial at numerous prospective sites;

recruiting and enrolling patients to participate in clinical trials for a variety of reasons, including meeting the enrollment criteria for our study and competition from other clinical trial programs for the same indication as our product candidates;

maintaining and supplying clinical trial material on a timely basis;

collecting, analyzing and reporting final data from the clinical trials; and

an epidemic which might cause site closures because of infected staff or cause patients to avoid or be unable to travel to healthcare facilities and physicians’ offices unless due to a health emergency;

In addition, a clinical trial may be suspended or terminated by us, the FDA or other regulatory authorities due to a number of factors, including:

failure to conduct the clinical trial in accordance with regulatory requirements or our clinical protocols;
inspection of the clinical trial operations or trial sites by the FDA or other regulatory authorities resulting in the imposition of a clinical hold;
unforeseen safety issues or any determination that a trial presents unacceptable health risks; and

lack of adequate funding to continue the clinical trial, including unforeseen costs due to enrollment delays, requirements to conduct additional trials and studies and increased expenses associated with the services of our contract research organizations, or CROs, and other third parties.

failure to conduct the clinical trial in accordance with regulatory requirements or our clinical protocols;

inspection of the clinical trial operations or trial sites by the FDA or other regulatory authorities resulting in the imposition of a clinical hold;

unforeseen safety issues or any determination that a trial presents unacceptable health risks; and

lack of adequate funding to continue the clinical trial, including unforeseen costs due to enrollment delays, requirements to conduct additional trials and studies, and increased expenses associated with the services of our CROs and other third parties.

Changes in regulatory requirements and guidance may occur and we may need to amend clinical trial protocols to reflect these changes with appropriate regulatory authorities. Amendments may require us to resubmit our clinical trial protocols to IRBs for re-examination, which may impact the costs, timing or successful completion of a clinical trial. If we experience delays in the completion of, or if we terminate, our clinical trials, the commercial prospects for our product candidates will be harmed, and our ability to generate product revenues will be delayed. In addition, many of the factors that cause, or lead to, a delay in the commencement or completion of clinical trials may also ultimately lead to the denial of regulatory approval of a product candidate. Even if we are ultimately able to ultimately commercialize our product candidates, other therapies for the same or similar indications may have been introduced to the market and established a competitive advantage.

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Risks Relating to Regulatory Matters

Our Industry

Intense competition might render our cardiovascular and pulmonary product candidates noncompetitive or obsolete.

Competition in the pharmaceutical industry in general and in our therapeutic areas is intense and characterized by extensive research efforts and rapid technological progress. Technological developments by competitors, regulatory approval for marketing competitive products, including potential generic or over-the-counter products, or superior marketing resources possessed by competitors could adversely affect the commercial potential of our cardiovascular and pulmonary disease product candidates and could have a material adverse effect on our future revenue and results of operations. We believe that there are numerous pharmaceutical and biotechnology companies, as well as academic research groups throughout the world, engaged in research and development efforts with respect to pharmaceutical products targeted at cardiovascular and pulmonary diseases and conditions addressed by our product pipeline. Developments by others might render our product pipeline obsolete or noncompetitive. Competitors might be able to complete the development and regulatory approval process sooner and, therefore, market their cardiovascular and pulmonary disease products earlier than we can.

Many of our current competitors have significant financial, marketing and personnel resources and development capabilities. For example, many large, well-capitalized companies already offer cardiovascular and pulmonary products and services in the United States and Europe that target the indications for which our product candidates are being developed, or related indications. Currently, as an example, twelve vasodilators are marketed in the U.S. for use in patients with PAH, and sales teams from Janssen, Pfizer, Bayer, United Therapeutics, and other large companies with marketing and sales capabilities represent these products in the specialized care centers where the disease is treated.  While there are no products currently marketed to treat PH-HFpEF, some products are under development to treat this prevalent disease.

Our activities are and will continue to be subject to extensive government regulation, which is expensive and time consuming,time-consuming, and we will not be able to sell our products without regulatory approval.

Our research, development, testing, manufacturing, marketing, and distribution of levosimendan is,and, potentially in the future, imatinib, are, and will continue to be, subject to extensive regulation, monitoring and approval by the FDA and other regulatory agencies. There are significant risks at each stage of the regulatory scheme.

regulation.

Product approval stage

During the product approval stage, we study and attempt to prove the safety and efficacy of our product candidate for its indicated uses. There are numerous problems that could arise during this stage, including:

the data obtained from laboratory testing and clinical trials are susceptible to varying interpretations, which could delay, limit or prevent FDA and other regulatory approvals;
adverse events could cause the FDA and other regulatory authorities to halt trials;
at any time the FDA and other regulatory agencies could change policies and regulations that could result in delay and perhaps rejection of our products; and
even after extensive testing and clinical trials, there is no assurance that regulatory approval will ever be obtained for any of our products.

the data obtained from laboratory testing and clinical trials are susceptible to varying interpretations, which could delay, limit, or prevent FDA and other regulatory approvals;

adverse events could cause the FDA and other regulatory authorities to halt trials;

at any time, the FDA and other regulatory agencies could change policies and regulations that could result in delay and perhaps rejection of our products;

if a prolonged government shutdown occurs, it could significantly impact the ability of the FDA to timely review and process our regulatory submissions; and

even after extensive testing and clinical trials, and receiving agreements and reassurances from the FDA, EMA, and others, as to their future position on a dataset or result to be generated from a trial the design of which they have weighed in on, there is no assurance that regulatory approval will ever be obtained for any of our products.

Post-commercialization stage

Discovery of previously unknown problems with our products, or unanticipated problems with our manufacturing arrangements, even after FDA and other regulatory approvals of our products for commercial sale, may result in the imposition of significant restrictions, including withdrawal of the product from the market.

Additional laws and regulations may also be enacted that could prevent or delay regulatory approval of our products, including laws or regulations relating to the price or cost-effectiveness of medical products. Any delay or failure to achieve regulatory approval of commercial sales of our products is likely to have a material adverse effect on our financial condition, results of operations and cash flows.

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The FDA and other regulatory agencies continue to review products even after they receive agency approval. If and when the FDA or another regulatory agency outside the United States approves one of our products, its manufacture and marketing will be subject to ongoing regulation, which could include compliance with current good manufacturing practices, adverse event reporting requirements and general prohibitions against promoting products for unapproved or “off-label” uses. We are also subject to inspection and market surveillance by the FDA for compliance with these and other requirements. Any enforcement action resulting from failure, even by inadvertence, to comply with these requirements could affect the manufacture and marketing of levosimendan, imatinib or our other products. In addition, the FDA or other regulatory agencies could withdraw a previously approved product from the market upon receipt of newly discovered information. The FDA or another regulatory agency could also require us to conduct additional, and potentially expensive, studies in areas outside our approved indicated uses.


We must continually monitor the safety of our products once approved and marketed for signs that their use may elicit serious and unexpected side effects and adverse events, which could jeopardize our ability to continue marketing the products.

We may also be requirednot receive all of the anticipated market exclusivity benefits of imatinib’s orphan drug designation, if we prioritize imatinib development in the future.

TNX-201, our proprietary formulation of imatinib mesylate, a kinase inhibitor, received Orphan Drug Designation from the FDA in the second quarter of 2020. Orphan Drug Designation may provide market exclusivity in the United States for seven years if (i) imatinib receives market approval before a competitor using a similar mechanism for the same indication, (ii) we are able to conduct post-approval clinical studies as a conditionproduce sufficient supply to licensing a product.

Asmeet demand in the marketplace, and (iii) another product with all pharmaceutical products, the use of our products could sometimes produce undesirable side effects or adverse reactions or events (referred to cumulatively as adverse events). Forsame active ingredient is not subsequently deemed clinically superior.

Obtaining an Orphan Drug Designation from the most part, we would expect these adverse events to be known and occur at some predicted frequency. When adverse events are reported to us, we will be required to investigate each event and circumstances surrounding it to determine whether it was caused byFDA may not effectively protect our product candidates from competition because different drugs can be approved for the same condition, and whether it implies thatorphan drug exclusivity does not prevent the FDA from approving the same or a previously unrecognized safety issue exists. We will also be required to periodically report summaries of these events to the applicable regulatory authorities.

In addition, the use of our products could be associated with serious and unexpected adverse events, or with less serious reactions at a greater than expected frequency. This may be especially true when our products are useddifferent drug in critically ill or otherwise compromised patient populations. When these unexpected events are reported to us, we will be required to make a thorough investigation to determine causality and implications for product safety. These events must also be specifically reported to the applicable regulatory authorities. If our evaluation concludes, or regulatory authorities perceive, that there isanother indication. Even after an unreasonable risk associated with the product, we would be obligated to withdraw the impacted lot(s) of that product. Furthermore, an unexpected adverse event of a new product could be recognized only after extensive use of the product, which could expose us to product liability risks, enforcement action by regulatory authorities and damage to our reputation and public image.
A serious adverse finding concerning the risk of our products by any regulatory authority could adversely affect our reputation, business and financial results.
When a new productorphan drug is approved, the FDA can subsequently approve a later application for the same drug for the same condition if the FDA concludes that the later drug is clinically superior in that it is shown to be safer in a substantial portion of the target populations, more effective, or other regulatory authoritiesmakes a major contribution to patient care. In addition, a designated orphan drug may require post-approval clinical trials, sometimes called Phase IV clinical trials. Ifnot receive orphan drug exclusivity if it is approved for a use that is broader than the results of such trials are unfavorable, this could resultindication for which it received orphan designation. Moreover, orphan drug exclusive marketing rights in the lossUnited States may be lost if the FDA later determines that the request for designation was materially defective or if we are unable to manufacture sufficient quantities of the licenseproduct to marketmeet the product,needs of patients with the rare disease or condition. Orphan Drug Designation neither shortens the development time or regulatory review time of a resulting loss of sales.
After ourdrug nor gives the drug any advantage in the regulatory review or approval process.

Even after products are commercialized, we would expect to spend considerable time and money complying with federal and state laws and regulations governing their sale, and, if we are unable to fully comply with such laws and regulations, we could face substantial penalties.

Health care providers, physicians and others willwould play a primary role in the recommendation and prescription of our clinical products. Our arrangements with third-party payers and customers may expose us to broadly applicable fraud and abuse and other health care laws and regulations that may constrain the business or financial arrangements and relationships through which we will market, sell and distribute our products. Applicable federal and state health care laws and regulations are expected to include, but not be limited to, the following:

the federal anti-kickback statute is a criminal statute that makes it a felony for individuals or entities knowingly and willfully to offer or pay, or to solicit or receive, direct or indirect remuneration, in order to induce the purchase, order, lease, or recommending of items or services, or the referral of patients for services, that are reimbursed under a federal health care program, including Medicare and Medicaid;
the federal False Claims Act imposes liability on any person who knowingly submits, or causes another person or entity to submit, a false claim for payment of government funds. Penalties include three times the government’s damages plus civil penalties of $5,500 to $11,000 per false claim. In addition, the False Claims Act permits a person with knowledge of fraud, referred to as a qui tam plaintiff, to file a lawsuit on behalf of the government against the person or business that committed the fraud, and, if the action is successful, the qui tam plaintiff is rewarded with a percentage of the recovery;
Health Insurance Portability and Accountability Act imposes obligations, including mandatory contractual terms, with respect to safeguarding the privacy, security and transmission of individually identifiable health information;
the Social Security Act contains numerous provisions allowing the imposition of a civil money penalty, a monetary assessment, exclusion from the Medicare and Medicaid programs, or some combination of these penalties; and
many states have analogous state laws and regulations, such as state anti-kickback and false claims laws. In some cases, these state laws impose more strict requirements than the federal laws. Some state laws also require pharmaceutical companies to comply with certain price reporting and other compliance requirements.

the federal anti-kickback statute is a criminal statute that makes it a felony for individuals or entities knowingly and willfully to offer or pay, or to solicit or receive, direct or indirect remuneration, in order to induce the purchase, order, lease, or recommendation of items or services, or the referral of patients for services, that are reimbursed under a federal health care program, including Medicare and Medicaid;

the federal False Claims Act imposes liability on any person who knowingly submits, or causes another person or entity to submit, a false claim for payment of government funds, with penalties that include three times the government’s damages plus civil penalties for each false claim; in addition, the False Claims Act permits a person with knowledge of fraud, referred to as a qui tam plaintiff, to file a lawsuit on behalf of the government against the person or business that committed the fraud, and, if the action is successful, the qui tam plaintiff is rewarded with a percentage of the recovery;

the Health Insurance Portability and Accountability Act imposes obligations, including mandatory contractual terms, with respect to safeguarding the privacy, security and transmission of individually identifiable health information;

the Social Security Act contains numerous provisions allowing the imposition of a civil monetary penalty, a monetary assessment, exclusion from the Medicare and Medicaid programs, or some combination of these penalties; and

many states have analogous state laws and regulations, such as state anti-kickback and false claims laws, which, in some cases, impose more strict requirements than the federal laws and may require pharmaceutical companies to comply with certain price reporting and other compliance requirements.

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Our failure to comply with any of these federal and state health care laws and regulations, or health care laws in foreign jurisdictions, could have a material adverse effect on our business, financial condition, result of operations and cash flows.

Health care

We are subject to uncertainty relating to healthcare reform measures and controlsreimbursement policies that, if not favorable to our products, could hinder or prevent our products’ commercial success, if any of our product candidates are approved.

Our ability to successfully commercialize our products will depend in part on the extent to which governmental authorities, such as Medicare, private health care spendinginsurers and other organizations establish what we believe to be appropriate coverage and reimbursement for our approved products. The unavailability or inadequacy of third-party payer coverage and reimbursement could negatively affect the market acceptance of our product candidates and the future revenues we may limitexpect to receive from any approved products. The commercial success of our product candidates, if approved, will depend in part on the priceextent to which the costs of such products will be covered by third-party payers, such as government health programs, commercial insurance and other organizations. Third-party payers are increasingly challenging the prices and examining the medical necessity and cost-effectiveness of medical products and services, in addition to their safety and efficacy. If these third-party payers do not consider our products to be cost-effective compared to other therapies, we can chargemay not obtain coverage for our products after approval as a benefit under the third-party payers’ plans or, even if we do, the level of coverage or payment may not be sufficient to allow us to sell our products on a profitable basis.

Significant uncertainty exists as to the reimbursement status for newly approved drug products, including coding, coverage and payment. There is no uniform policy requirement for coverage and reimbursement for drug products among third-party payers in the United States; therefore, coverage and reimbursement for drug products can differ significantly by payer. The coverage determination process is often a time-consuming and costly process that will require us to provide scientific and clinical support for the use of our products to each payer separately, with no assurance that coverage and adequate payment will be applied consistently or obtained. The process for determining whether a payer will cover and how much it will reimburse a product may be separate from the process of seeking approval of the product or for setting the price of the product. Even if reimbursement is provided, market acceptance of our products may be adversely affected if the amount of payment for our products proves to be unprofitable for healthcare providers or less profitable than alternative treatments or if administrative burdens make our products less desirable to use. Third-party payer reimbursement to providers of our products, if approved, may be subject to a bundled payment that also includes the procedure of administering our products or third-party payers may require providers to perform additional patient testing to justify the use of our products. To the extent there is no separate payment for our products, there may be further uncertainty as to the adequacy of reimbursement amounts.

The containment of healthcare costs is a priority of federal, state and foreign governments and the amountprices of drug products have been a focus in this effort. The continuing efforts of government, private insurance companies and other organizations to contain or reduce costs of healthcare may adversely affect our ability to set as high a price for our products as we can sell.

As a result of Patient Protection and Affordable Care Actmight otherwise and the Health Carerate and Education Affordability Reconciliation Actscope of 2010, collectively, the ACA, enacted in March 2010, substantial changes have occurredadoption of our products by healthcare providers. We expect that federal, state and are expected to continue to occur in the system for paying for health carelocal governments in the United States, including changes made in order to extend medical benefits to those who currently lack insurance coverage. This comprehensive health care reform legislation also included provisions to control health care costs and improve health care quality. Together with ongoing statutory and budgetary policy developments at a federal level, this health care reform legislation could include changes in Medicare and Medicaid payment policies and other health care delivery administrative reforms that could potentially negatively impact our business. Because not all the administrative rules implementing health care reform under the legislation have been finalized, and because of ongoing federal fiscal budgetary pressures not yet resolved for federal health programs, the full impact of the ACA and of further statutory actions to reform healthcare payment on our business is unknown, but there can be no assurances that health care reform legislation will not adversely impact either our operational results or the manner in which we operate our business. There have been judicial and Congressional challenges to the ACA and there may be additional challenges and amendments to the ACA in the future, particularly in light of the new presidential administration and U.S. Congress. We expect that the ACA, as well as governments in other countries, will continue to consider legislation directed at lowering the total cost of healthcare. In addition, in certain foreign markets, the pricing of drug products is subject to government control and reimbursement may in some cases be unavailable or insufficient. It is uncertain whether and how future legislation, whether domestic or abroad, could affect prospects for our product candidates or what actions governmental or private payers for healthcare treatment and services may take in response to any such healthcare reform proposals or legislation. Adoption of price controls and cost-containment measures, thatand adoption of more restrictive policies in jurisdictions with existing controls and measures, may be adopted inprevent or limit our ability to generate revenue, attain profitability or commercialize our product candidates.

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These potential courses of action are unpredictable and the future,potential impact of new legislation on our operations and financial position is uncertain, but may result in more rigorous coverage criteria, and lower reimbursement and in additional downward pressure on the price that we may receive for anyan approved product. Cost of care could be reduced by reducing the level of reimbursement for medical services or products (including those biopharmaceuticals that we intend to produce and market), or by restricting coverage (and, thereby, utilization) of medical services or products. In either case, aAny reduction in the utilizationreimbursement from Medicare or other government-funded programs may result in a similar reduction in payments from private payers. The implementation of cost containment measures or reimbursement for,other healthcare reforms may prevent us from being able to generate revenue, attain profitability or commercialize our products, could have a materially adverse impact on our financial performance. Moreover, recently there has been heightened governmental scrutiny over the manner in which manufacturers set prices for their commercial products. We cannot predict what healthcare reform initiatives may be adopted in the future.

Uncertainty of third-party reimbursement could affect our future results of operations.
Sales of medical products largely depend on the reimbursement of patients’ medical expenses by governmental health care programs and private health insurers. We will be required to report detailed pricing information, net of included discounts, rebates and other concessions, to the Centers for Medicare and Medicaid Services, or CMS, for the purpose of calculating national reimbursement levels, certain federal prices, and certain federal rebate obligations. If we report pricing information that is not accurate to the federal government, we could be subject to fines and other sanctions that could adversely affect our business. In addition, the government could change its calculation of reimbursement, federal prices, or federal rebate obligations which could negatively impact us. There is no guarantee that government health care programs or private health insurers will reimburse for the sales of our products, or permit us to sell our products at high enough prices to generate a profit.
if approved.

Governments outside the United States tend to impose strict price controls and reimbursement approval policies, which may adversely affect our prospects for generating revenue outside the United States.

In

We have worldwide distribution rights for levosimendan and our formulation of imatinib, and in some countries, particularly European Union countries and Canada, the pricing of prescription pharmaceuticals is subject to governmental control. In these countries, pricing negotiations with governmental authorities can take considerable time after the receipt of marketing approval for a product. In addition, there can be considerable pressure by governments and other stakeholders on prices and reimbursement levels, including as part of cost containment measures. Political, economic and regulatory developments may further complicate pricing negotiations, and pricing negotiations may continue after reimbursement has been obtained. To obtain or maintain reimbursement or pricing approval in some countries with respect to any product candidate that achieves regulatory approval, we may be required to conduct a clinical trial that compares the cost-effectiveness of our product candidate to other available therapies. If reimbursement of our products upon approval, if at all, is unavailable or limited in scope or amount, or if pricing is set at unsatisfactory levels, our prospects for generating revenue, if any, could be adversely affected, which would have a material adverse effect on our business and results of operations. Further, if we achieve regulatory approval of any product, we must successfully negotiate product pricing for such product in individual countries. As a result, if our products are approved, the pricing of our products if approved, in different countries may vary widely, thus creating the potential for third-party trade in our products in an attempt to exploit price differences between countries. This third-party trade of our products could undermine our sales in markets with higher prices.


Product liability lawsuits against us could cause us to incur substantial liabilities, limit sales of our existing products and limit commercialization of any products that we may develop.

Our business exposes us to the risk of product liability claims that are inherent in the manufacturing, distribution, and sale of biotechnology products. We face an inherent risk of product liability exposure related to the testing of our product candidates in human clinical trials and an even greater risk when we commercially sell any products. If we cannot successfully defend ourselves against claims that our product candidates or products caused injuries, we could incur substantial liabilities. Regardless of merit or eventual outcome, liability claims may result in:

decreased demand for our products and any product candidates that we may develop;

injury to our reputation;

withdrawal of clinical trial participants;

costs to defend the related litigation;

substantial monetary awards to trial participants or patients;

loss of revenue; and

the inability to commercialize any products that we may develop.

We currently maintain limited product liability insurance coverage for our clinical trials in the total amount of $5 million. However, our profitability will be adversely affected by a successful product liability claim in excess of our insurance coverage. There can be no assurance that product liability insurance will be available in the future or be available on reasonable terms.

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Our business and operations would suffer in the event of computer system failures, cyber-attacks or deficiencies in our cybersecurity.

Despite the implementation of security measures, our internal computer systems, and those of third parties on which we rely, are vulnerable to damage from computer viruses, malware, natural disasters, terrorism, war, telecommunication and electrical failures, cyber-attacks or cyber-intrusions over the Internet, attachments to emails, persons inside our organization, or persons with access to systems inside our organization. The risk of a security breach or disruption, particularly through cyber-attacks or cyber intrusion, including by computer hackers, foreign governments, and cyber-terrorists, has generally increased as the number, intensity and sophistication of attempted attacks and intrusions from around the world have increased. If such an event were to occur and cause interruptions in our operations, it could result in a material disruption of our product development programs. For example, the loss of clinical trial data from completed or ongoing or planned clinical trials could result in delays in our regulatory approval efforts and significantly increase our costs to recover or reproduce the data. To the extent that any disruption or security breach was to result in a loss of or damage to our data or applications, or inappropriate disclosure of confidential or proprietary information, we could incur material legal claims and liability, and damage to our reputation, and the further development of our product candidates could be delayed.

Our disclosure controls and procedures address cybersecurity and include elements intended to ensure that there is an analysis of potential disclosure obligations arising from security breaches. We also maintain compliance programs to address the potential applicability of restrictions against trading while in possession of material, nonpublic information generally and in connection with a cybersecurity breach. However, a breakdown in existing controls and procedures around our cybersecurity environment may prevent us from detecting, reporting or responding to cyber-incidents in a timely manner and could have a material adverse effect on our financial position and value of our stock. For more information, see Item 1C. Cybersecurity.

Risks RelatingRelated to Our Dependence on Third Parties

We have historically and we will continue to rely significantly on third parties to conduct our nonclinical testing and clinical studies and other aspects of our development programs. If those third parties do not satisfactorily perform their contractual obligations or meet anticipated deadlines, the development of our product candidates could be adversely affected.

We do not currently employ personnel or possess the facilities necessary to conduct many of the activities associated with our development programs. We have historically and we will continue to engage consultants, advisors, CROs and others to assist in the design and conduct of nonclinical and clinical studies of our product candidates, with interpretation of the results of those studies and with regulatory activities and expect to continue to outsource all or a significant amount of such activities. As a result, many important aspects of our development programs are and will continue to be outside our direct control and our third-party service providers may not perform their activities as required or expected, including the maintenance of Good Laboratory Practices (“GLP”) or Good Clinical Practices (“GCP”) compliance, which are ultimately our responsibility to ensure. Further, such third parties may not be as committed to the success of our programs as our own employees and, therefore, may not devote the same time, thoughtfulness, or creativity to completing projects or problem-solving as our own employees would. To the extent we are unable to successfully manage the performance of third-party service providers, our business may be adversely affected.

The CROs we engage or may engage to execute our clinical studies play a significant role in the conduct of the studies, including the collection and analysis of study data, and we likely will depend on CROs and clinical investigators to conduct future clinical studies and to assist in analyzing data from completed studies and developing regulatory strategies for our product candidates. Individuals working at the CROs with which we contract, as well as investigators at the sites at which our studies are conducted, are not our employees, and we have limited control over the amount or timing of resources that they devote to their programs. If our CROs, study investigators, and/or third-party sponsors fail to devote sufficient time and resources to studies of our product candidates, if we and/or our CROs do not comply with all GLP and GCP regulatory and contractual requirements, or if their performance is substandard, it could adversely affect the development of our product candidates.

In addition, the third parties we engage may have relationships with other commercial entities, some of which may compete with us. Through intentional or unintentional means, our competitors may benefit from lessons learned on the project that could ultimately harm our competitive position. Moreover, if a CRO fails to properly, or at all, perform our activities during a clinical study, we may not be able to enter into arrangements with alternative CROs on acceptable terms or in a timely manner, or at all. Switching CROs may increase costs and divert management time and attention. In addition, there likely would be a transition period before a new CRO commences work. These challenges could result in delays in the commencement or completion of our clinical studies, which could materially impact our ability to meet our desired and/or announced development timelines and have a material adverse impact on our business and financial condition.

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We depend on third parties to formulate and manufacture our products.

We do not own or operate any manufacturing facilities for the clinical- or commercial-scale production of our products. Instead, we rely on third party manufacturers.  For example, pursuant

Pursuant to the terms of our license for levosimendan, Orion Corporation is at present our sole manufacturing source for levosimendan.TNX-103; should they opt not to provide us the product, our license agreement provides for 24 months’ notice to the Company of same, to allow an alternative manufacturer to be brought onboard. We might engage other third-party suppliers and CMOs for the supply and manufacture of TNX-102, or other formulations we might develop. Accordingly, our business is susceptible to disruption, and our results of operations can be adversely affected, by any disruption in supply or other adverse developments in our relationship with Orion Corporation.Orion. If supply from Orion Corporation is delayed or terminated, or if its facilities suffer any damage or disruption, we may need to successfully qualify an alternative supplier in a timely manner in order to not disruptavoid disruption of our business. If we cannot obtain an alternate manufacturer in a timely manner, we would experience a significant interruption in supply of levosimendan, which could negatively affect our financial condition, results of operations and cash flows.

We depend on

To potentially manufacture imatinib in the services of a limited number of key personnel.

Our success isfuture, we have contracted with various third-party suppliers and CMOs making us highly dependent on these CMOs. We do not at present have alternative CMOs planned or contracted to back up our primary vendors of clinical trial material or, if approved, commercial supply material. Identification of and discussions with other CMOs may be protracted and/or unsuccessful, or these new CMOs may be unsuccessful in producing the continued servicessame results as the current primary CMOs producing the material. Therefore, if our primary CMOs become unable or unwilling to perform their required activities, we could experience protracted delays or interruptions in the supply of clinical trial material and, ultimately, product for commercial sale, which would materially and adversely affect our development programs, commercial activities, operating results and financial condition. In addition, the FDA or regulatory authorities outside of the United States may require us to have an alternate manufacturer of a limited numberdrug product before approving any product candidate for marketing and sale in the United States or abroad. Securing such alternate manufacturer, if possible, could result in considerable additional time and cost prior to approval.

We currently have no marketing capabilities and no sales organization. Pending the outcome of scientistsour ongoing strategic process, if we are unable to establish sales and support personnel. The loss of any of these individuals, in particular, John P. Kelley,marketing capabilities on our Chief Executive Officer, could have a material adverse effect on us. In addition, our success will depend, among other factors, on the recruitment and retention of additional highly skilled and experienced management and technical personnel. There is a risk thatown or through third parties, we will be unable to successfully commercialize our products, if approved, or generate product revenue.

Pending the outcome of our strategic process, to commercialize our products, if approved, in the United States and other jurisdictions in which we may seek approvals, we must build our marketing, sales, managerial and other non-technical capabilities or make arrangements with third parties to perform these services, and we may not be able to retain existing employees or to attract and retain additional skilled personnel on acceptable terms given the competition for such personnel among numerous large and well-funded pharmaceutical and health care companies, universities, and non-profit research institutions, which could negatively affect our financial condition, results of operations and cash flows.

successful in doing so. We have limited experiencenot decided upon a commercialization strategy in the sale and marketing of medical products.
these areas. We have limitedno experience in the sale and marketing of approved medical products and marketing the licensing of such products before FDA or other regulatory approval. We have not decided upon a commercialization strategy in these areas. We do not know of any third party that is prepared to distribute our products should they be approved. If we decide to establish our own commercialization capability, we will need to recruit, train and retain a marketing staff and sales force with sufficient technical expertise. We do not know whether we can establish a commercialization program at a cost that is acceptable in relation to revenue or whether we can be successful in commercializing our product. Factors that may inhibit our efforts to commercialize our products directly and without strategic partners include:
our inability to recruit and retain adequate numbers of effective sales and marketing personnel;
the inability of sales personnel to obtain access to or persuade adequate numbers of physicians to prescribe our products;

our inability to recruit and retain adequate numbers of effective sales and marketing personnel;

the inability of sales personnel to obtain access to or persuade adequate numbers of physicians to prescribe our products;

the lack of complementary products to be offered by sales personnel, which may put us at a competitive disadvantage relative to companies with more extensive product lines; and

unforeseen costs and expenses associated with creating and sustaining an independent sales and marketing organization.
Failure to successfully commercialize our products or to do so on a cost effective basis would likely result in failure of our business.
We may enter into distribution arrangements and marketing alliances for certain products and any failure to successfully identify and implement these arrangements on favorable terms, if at all, may impair our ability to commercialize our product candidates.
We do not anticipate having the resources in the foreseeable future to develop global sales and marketing capabilities for all of the products to be offered by sales personnel, which may put us at a competitive disadvantage relative to companies with more extensive product lines; and

unforeseen costs and expenses associated with creating and sustaining an independent sales and marketing organization.

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Further, we develop, if any. We may pursue arrangements regarding the sales and marketing and distribution of one or more of our product candidates and our future revenues may depend, in part, on our ability to enter into and maintain arrangements with other companies having sales, marketing and distribution capabilities and the ability of such companies to successfully market and sell any such products. Any failure to enter into such arrangements and marketing alliances on favorable terms, if at all, could delay or impair our ability to commercialize our product candidates and could increase our costs of commercialization. Any use of distribution arrangements and marketing alliances to commercialize our product candidates will subject us to a number of risks, including the following:


we may be required to relinquish important rights to our products or product candidates;

we may not be able to control the amount and timing of resources that our distributors or collaborators may devote to the commercialization of our product candidates;

our distributors or collaborators may experience financial difficulties;

our distributors or collaborators may not devote sufficient time to the marketing and sales of our products; and

business combinations or significant changes in a collaborator’s business strategy may adversely affect a collaborator’s willingness or ability to complete its obligations under any arrangement.

If we may be requiredare unable to relinquish important rightsimplement our own sales and marketing capability or are unable to our productscontract with one or product candidates;

more third parties for such services on acceptable terms or at all, we may not be able to controlsuccessfully commercialize our products in certain markets. Any failure or delay in the amountdevelopment of our internal or external sales, marketing and timing of resources that our distributors or collaborators may devote todistribution capabilities would adversely impact the commercialization of our product candidates;
products. If we are not successful in commercializing our distributorsproducts, either on our own or collaborators may experience financial difficulties;
our distributorsthrough collaborations with one or collaborators may not devote sufficient time to the marketing and sales of our products; and
business combinations or significant changes in a collaborator’s business strategy may adversely affect a collaborator’s willingness or ability to complete its obligations under any arrangement.
We may need to enter into additional co-promotion arrangements withmore third parties, where our own sales force is neither well situated nor large enough to achieve maximum penetration in the market. We may not be successful in entering into any co-promotion arrangements,future product revenue will suffer and the terms of any co-promotion arrangements we enter into may not be favorable to us.
would incur significant additional losses.

Risks RelatingRelated to Intellectual Property

It is difficult

Our success will depend in part on obtaining and costly to protectmaintaining effective patent and other intellectual property protection for our product candidates and proprietary rights, and we may not be able to ensure their protection.

technology.

Our commercial success will depend in part on obtaining and maintaining effective patent protection and trade secretother intellectual property protection of our product candidates and the methods used to manufacture them, as well as successfully defending these patents against third-party challenges. Our ability to stop third parties from making, using, selling, offering to sell or importing our products, isif any, will be dependent upon the extent to which we have rights under valid and enforceable patents or trade secrets that cover these activities.

We license certain intellectual property from third partiesare pursuing a multi-faceted IP strategy for levosimendan that coversincludes filing patent applications in the U.S. and Canada that, if granted, could protect various uses and formulations of levosimendan In January 2022, the USPTO granted us a patent protecting claims for different uses of various cyclodextrin-based subcutaneous formulations of levosimendan, including a claim for its use in the treatment of PH-HFpEF patients. In addition, we received in March 2023 another patent protecting the use of levosimendan in the treatment of PH-HFpEF.  Two subsequent patents expanded these protections on the use of levosimendan in the treatment of PH-HFpEF.

Our strategy to maximize market exclusivity for imatinib relies on two forms of exclusivity. First, we have been granted Orphan Drug Designation for the treatment of PAH by the FDA which would provide seven years of regulatory exclusivity in the U.S. if our product candidates. We rely on certain of these third partiesimatinib formulation is the first to receive FDA approval for PAH. In addition, we expect to file prosecute and maintainone or more patent applications and otherwise protect the intellectual property to which we havecover patentable subject matter that may result from our imatinib development. If granted, a license, and we have not had and do not have primary control over these activitiespatent would provide protection for certain of these patents or patent applications and other intellectual property rights. We cannot be certain that such activities by third parties have been or will be conducted in compliance with applicable laws and regulations or will result in valid and enforceable patents and other intellectual property rights. Our enforcement of certain of these licensed patents or defense of any claims asserting the invalidity of these patents would also be subject to the cooperation of the third parties.

20 years from its filing date.

The patent positions of pharmaceutical and biopharmaceutical companies can be highly uncertain and involve complex legal and factual questions for which important legal principles remain unresolved. No consistent policy regarding the breadth of claims allowed in biopharmaceutical patents has emerged to date in the United States. The biopharmaceutical patent situation outside the United States is even more uncertain.less certain still. Changes in either the patent laws or in interpretations of patent laws in the United States and other countries may diminish the value of our intellectual property. Accordingly, we cannot predict the breadth of claims that may be allowed or enforced in the patents we own or to which we have a license from a third-party.own. Further, if any of our patents are deemed invalid and unenforceable, it could impact our ability to commercialize or license our technology.

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The degree of future protection for our proprietary rights is uncertain because legal means afford only limited protection and may not adequately protect our rights or permit us to gain or keep our competitive advantage. For example:

others may be able to make compositions or formulations that are similar to our product candidates but that are not covered by the claims of our patents;
we might not have been the first to make the inventions covered by our issued patents or pending patent applications;
we might not have been the first to file patent applications for these inventions;
others may independently develop similar or alternative technologies or duplicate any of our technologies;
it is possible that our pending patent applications will not result in issued patents;
our issued patents may not provide us with any competitive advantages, or may be held invalid or unenforceable as a result of legal challenges by third parties;
we may not develop additional proprietary technologies that are patentable; or
the patents of others may have an adverse effect on our business.

others may be able to make compositions or formulations that are similar to our product candidates but that are not covered by the claims of our patents;

we might not have been the first to make the inventions covered by our issued patents or pending patent applications;

we might not have been the first to file patent applications for these inventions;

others may independently develop similar or alternative technologies or duplicate any of our technologies;

it is possible that our pending patent applications will not result in issued patents;

our issued patents may not provide us with any competitive advantages, or may be held invalid or unenforceable as a result of legal challenges by third parties;

we may not develop additional proprietary technologies that are patentable; or

the patents of others may have an adverse effect on our business.

We also may rely on trade secrets to protect our technology, especially where we do not believe patent protection is appropriate or obtainable. However, trade secrets are difficult to protect. Although we use reasonable efforts to protect our trade secrets, our employees, consultants, contractors, outside scientific collaborators and other advisors may unintentionally or willfully disclose our information to competitors. Enforcing a claim that a third party illegally obtained and is using any of our trade secrets is expensive and time consuming, and the outcome is unpredictable. In addition, courts outside the United States are sometimes less willing to protect trade secrets. Moreover, our competitors may independently develop equivalent knowledge, methods and know-how.

We rely on confidentiality agreements that, if breached, may be difficult to enforce and could have a material adverse effect on our business and competitive position.

Our policy is to enter into agreements relating to the non-disclosure and non-use of confidential information with third parties, including our contractors, consultants, advisors and research collaborators, as well as agreements that purport to require the disclosure and assignment to us of the rights to the ideas, developments, discoveries and inventions of our employees and consultants while we employ them. However, these agreements can be difficult and costly to enforce. Moreover, to the extent that our contractors, consultants, advisors and research collaborators apply or independently develop intellectual property in connection with any of our projects, disputes may arise as to the proprietary rights to the intellectual property. If a dispute arises, a court may determine that the right belongs to a third party, and enforcement of our rights can be costly and unpredictable. In addition, we rely on trade secrets and proprietary know-how that we seek to protect in part by confidentiality agreements with our employees, contractors, consultants, advisors or others. Despite the protective measures we employ, we still face the risk that:

these agreements may be breached;
these agreements may not provide adequate remedies for the applicable type of breach; or
our trade secrets or proprietary know-how will otherwise become known.

these agreements may be breached;

these agreements may not provide adequate remedies for the applicable type of breach; or

our trade secrets or proprietary know-how will otherwise become known.

Any breach of our confidentiality agreements or our failure to effectively enforce such agreements would have a material adverse effect on our business and competitive position.

We may incur substantial costs as a result of litigation or other proceedings relating to patent and other intellectual property rights and we may be unable to protect our rights to, or use, our technology.

If we or our partners choose to go to court to stop someone else from using the inventions claimed in our patents, that individual or company has the right to ask the court to rule that these patents are invalid and/or should not be enforced against that third party. These lawsuits are expensive and would consume time and other resources even if we were successful in stopping the infringement of these patents. In addition, there is a risk that the court will decide that these patents are not valid and that we do not have the right to stop the other party from using the inventions. There is also the risk that, even if the validity of these patents is upheld, the court will refuse to stop the other party on the ground that such other party’s activities do not infringe our rights to these patents.

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Furthermore, a third party may claim that we or our manufacturing or commercialization partners are using inventions covered by the third party’s patent rights and may go to court to stop us from engaging in our normal operations and activities, including making or selling our product candidates. These lawsuits are costly and could affect our results of operations and divert the attention of managerial and technical personnel. There is a risk that a court would decide that we or our commercialization partners are infringing the third party’s patents and would order us or our partners to stop the activities covered by the patents. In addition, there is a risk that a court will order us or our partners to pay the other party damages for having violated the other party’s patents. We have agreed to indemnify certain of our commercial partners against certain patent infringement claims brought by third parties. The biotechnology industry has produced a proliferation of patents, and it is not always clear to industry participants, including us, which patents cover various types of products or methods of use. The coverage of patents is subject to interpretation by the courts, and the interpretation is not always uniform. If we are sued for patent infringement, we would need to demonstrate that our products or methods of use either doesdo not infringe the patent claims of the relevant patent and/or that the patent claims are invalid, and we may not be able to do this. Proving invalidity, in particular, is difficult since it requires a showing of clear and convincing evidence to overcome the presumption of validity enjoyed by issued patents.


Because some patent applications in the United States may be maintained in secrecy until the patents are issued, because patent applications in the United States and many foreign jurisdictions are typically not published until eighteen18 months after filing and because publications in the scientific literature often lag behind actual discoveries, we cannot be certain that others have not filed patent applications for technology covered by our issued patents or our pending applications, or that we were the first to invent the technology. Our competitors may have filed, and may in the future file, patent applications covering technology similar to ours. Any such patent application may have priority over our patent applications or patents, which could further require us to obtain rights to issued patents by others covering such technologies. If another party has filed a U.S. patent application on inventions similar to ours, we may have to participate in an interference proceeding declared by the U.S. Patent and Trademark OfficeUSPTO to determine priority of invention in the United States. The costs of these proceedings could be substantial, and it is possible that such efforts would be unsuccessful if, unbeknownst to us, the other party had independently arrived at the same or similar invention prior to our own invention, resulting in a loss of our U.S. patent position with respect to such inventions.

Some of our competitors may be able to sustain the costs of complex patent litigation more effectively than we can because they have substantially greater resources. In addition, any uncertainties resulting from the initiation and continuation of any litigation could have a material adverse effect on our ability to raise the funds necessary to continue our operations.

Our collaborations with outside scientists and consultants may be subject to restriction and change.
We work with chemists, biologists and other scientists at academic and other institutions, and consultants who assist us in our research, development, regulatory and commercial efforts, including the members of our scientific advisory board. These scientists and consultants have provided, and we expect that they will continue to provide, valuable advice on our programs. These scientists and consultants are not our employees, may have other commitments that would limit their future availability to us and typically will not enter into non-compete agreements with us. If a conflict of interest arises between their work for us and their work for another entity, we may lose their services. In addition, we will be unable to prevent them from establishing competing businesses or developing competing products. For example, if a key scientist acting as a principal investigator in any of our clinical trials identifies a potential product or compound that is more scientifically interesting to his or her professional interests, his or her availability to remain involved in our clinical trials could be restricted or eliminated.

Under current law, we may not be able to enforce all employees’ covenants not to compete and therefore may be unable to prevent our competitors from benefiting from the expertise of some of our former employees.

We have entered into non-competition agreements with certain of our employees. These agreements prohibit our employees, if they cease working for us, from competing directly with us or working for our competitors for a limited period. Under current law, we may be unable to enforce these agreements against certain of our employees and it may be difficult for us to restrict our competitors from gaining the expertise our former employees gained while working for us. If we cannot enforce our employees’ non-compete agreements, we may be unable to prevent our competitors from benefiting from the expertise of our former employees.

We may infringe or be alleged to infringe intellectual property rights of third parties.

Our products or product candidates may infringe on, or be accused of infringing on, one or more claims of an issued patent or may fall within the scope of one or more claims in a published patent application that may be subsequently issued and to which we do not hold a license or other rights. Third parties may own or control these patents or patent applications in the United States and abroad. These third parties could bring claims against us or our collaborators that would cause us to incur substantial expenses and, if successful against us, could cause us to pay substantial damages. Further, if a patent infringement suit were brought against us or our collaborators, we or they could be forced to stop or delay research, development, manufacturing or sales of the product or product candidate that is the subject of the suit.

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If we are found to infringe the patent rights of a third party, or in order to avoid potential claims, we or our collaborators may choose or be required to seek a license from a third party and be required to pay license fees or royalties or both. These licenses may not be available on acceptable terms, or at all. Even if we or our collaborators were able to obtain a license, the rights may be nonexclusive, which could result in our competitors gaining access to the same intellectual property. Ultimately, we could be prevented from commercializing a product, or be forced to cease some aspect of our business operations, if, as a result of actual or threatened patent infringement claims, we or our collaborators are unable to enter into licenses on acceptable terms.


There have been substantial litigation and other proceedings regarding patent and other intellectual property rights in the pharmaceutical and biotechnology industries. In addition to infringement claims against us, we may become a party to other patent litigation and other proceedings, including interference proceedings declared by the United States Patent and Trademark OfficeUSPTO and opposition proceedings in the European Patent Office, regarding intellectual property rights with respect to our products. Our products, after commercial launch, may become subject to Paragraph IV certification under the Hatch-Waxman Act, thus forcing us to initiate infringement proceedings against such third-party filers. The cost to us of any patent litigation or other proceeding, even if resolved in our favor, could be substantial. Some of our competitors may be able to sustain the costs of such litigation or proceedings more effectively than we can because of their substantially greater financial resources. Uncertainties resulting from the initiation and continuation of patent litigation or other proceedings could have a material adverse effect on our ability to compete in the marketplace. Patent litigation and other proceedings may also absorb significant management time.

Many

Some of our employees were previously employed at universities or other biotechnology or pharmaceutical companies, including our competitors or potential competitors. We try to ensure that our employees do not use the proprietary information or know-how of others in their work for us. We may, however, be subject to claims that we or these employees have inadvertently or otherwise used or disclosed intellectual property, trade secrets or other proprietary information of any such employee’s former employer. Litigation may be necessary to defend against these claims and, even if we are successful in defending ourselves, could result in substantial costs to us or be distracting to our management. If we fail to defend any such claims, in addition to paying monetary damages, we may lose valuable intellectual property rights or personnel.

Product liability lawsuits against us could cause us to incur substantial liabilities, limit sales of our existing products and limit commercialization of any products that we may develop.
Our business exposes us to the risk of product liability claims that are inherent in the manufacturing, distribution, and sale of biotechnology products. We face an inherent risk of product liability exposure related to the testing of our product candidates in human clinical trials and an even greater risk when we commercially sell any products. If we cannot successfully defend ourselves against claims that our product candidates or products caused injuries, we could incur substantial liabilities. Regardless of merit or eventual outcome, liability claims may result in:
decreased demand for our products and any product candidates that we may develop;
injury to our reputation;
withdrawal of clinical trial participants;
costs to defend the related litigation;
substantial monetary awards to trial participants or patients;
loss of revenue; and
the inability to commercialize any products that we may develop.
We currently maintain limited product liability insurance coverage for our clinical trials in the total amount of $3 million. However, our profitability will be adversely affected by a successful product liability claim in excess of our insurance coverage. There can be no assurance that product liability insurance will be available in the future or be available on reasonable terms.

Risks Related to Owning Our Common Stock

Our share price has been volatile, and may continue to be volatile, which may subject us to securities class action litigation in the future.

Our stock price has in the past been, and is likely to be in the future, volatile. The stock market in general, and the market for biopharmaceutical companies in particular, has experienced extreme volatility that has often been unrelated to the operating performance of particular companies. During the period from January 20, 2017 to March 9, 2017, the closing sales price of our common stock ranged from a high of $2.50 per share to a low of $0.46 per share. Our stock price experienced significant volatility during that period after we announced the top-line results of our Phase III LEVO-CTS clinical trial. As a result of this volatility, our existing stockholders may not be able to sell their stock at a favorable price. The market price for our common stockCommon Stock may be influenced by many factors, including:

actual or anticipated fluctuations in our financial condition and operating results;
status and/or results of our clinical trials;
status of ongoing litigation;

results of clinical trials of our competitors’ products;
regulatory actions with respect to our products or our competitors’ products;
actions and decisions by our collaborators or partners;
actual or anticipated changes in our growth rate relative to our competitors;

actual or anticipated fluctuations in our financial condition and operating results;

share price and volume fluctuations attributable to inconsistent trading volume levels of our shares;

status and/or results of our clinical trials;

status of ongoing litigation;

results of clinical trials of our competitors’ products;

regulatory actions with respect to our products or our competitors’ products;

actions and decisions by our collaborators or partners;

actual or anticipated changes in our growth rate relative to our competitors;

actual or anticipated fluctuations in our competitors’ operating results or changes in their growth rate;

competition from existing products or new products that may emerge;

issuance of new or updated research or reports by securities analysts;

fluctuations in the valuation of companies perceived by investors to be comparable to us;

share price and volume fluctuations attributable to inconsistent trading volume levels of our shares;

market conditions for biopharmaceutical stocks in general;

status of our search and selection of future management and leadership; and

general economic and market conditions, including as a result of epidemics or other disruptive events broadly affecting society, and as a result of geopolitical uncertainties, including in the Middle East and the Russian invasion of and war against the country of Ukraine.

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Some companies that have had volatile market prices for their growth rate;

competition from existing products or new products that may emerge;
issuance of new or updated research or reports by securities analysts;
fluctuations in the valuation of companies perceived by investors to be comparable to us;
share price and volume fluctuations attributable to inconsistent trading volume levels of our shares;
market conditions for biopharmaceutical stocks in general;
status of our search and selection of future management and leadership; and
general economic and market conditions.
In the past,have had securities class action litigation has often been broughtlawsuits filed against a company following a declinethem. Such lawsuits, should they be filed against us in the market price of its securities. If we face such litigation, itfuture, could result in substantial costs and a diversion of management’s attention and resources.
We are likely to attempt to raise additional capital through issuances of debt or equity securities, which may cause our stock price to decline, dilute the ownership interests of our existing stockholders, and/or limit our financial flexibility.
Historically we This could have financed our operations through the issuance of equity securities and debt financings, and we expect to continue to do so for the foreseeable future. As of December 31, 2016, we had $21.9 million of cash and cash equivalents on hand. Baseda material adverse effect on our current operating plans, we believebusiness, results of operations and financial condition.

Anti-takeover provisions in our existing cashcorporate charter documents and cash equivalents are sufficientunder Delaware law could make an acquisition of us more difficult, which could discourage takeover attempts and lead to continue to fund operations through the first half of calendar year 2018. To the extent that we raise additional funds by issuing equity securities, our stockholders may experience significant dilution of their ownership interests. Debt financing, if available, may involve restrictive covenants that limit our financial flexibility or otherwise restrict our ability to pursue our business strategies. Additionally, if we issue shares of common stock, or securities convertible or exchangeable for common stock,management entrenchment, and the market price of our existing common stock may decline. Therebe lower as a result.

Certain provisions in our Certificate of Incorporation, as amended (the “Charter”), and our Fourth Amended and Restated Bylaws (the “Bylaws”), may make it difficult for a third party to acquire, or attempt to acquire, control of the Company, even if a change in control was considered favorable by the stockholders. For example, our Board of Directors has the authority to issue up to 10,000,000 shares of preferred stock. The Board can fix the price, rights, preferences, privileges and restrictions of the preferred stock without any further vote or action by our stockholders. The issuance of shares of preferred stock may delay or prevent a change in control transaction. As a result, the market price of our common stock and the voting and other rights of our stockholders may be no assuranceadversely affected. An issuance of shares of preferred stock may result in the loss of voting control to other stockholders.

Our organizational documents also contain other provisions that could have an anti-takeover effect, including provisions that:

provide that vacancies on the Board of Directors may be filled only by a majority of directors then in office, even though less than a quorum;

eliminate cumulative voting in the election of directors;

grant the Board of directors the authority to increase or decrease the size of the Board;

prohibit stockholders from calling a special meeting of stockholders;

require that stockholders give advance notice to nominate directors or submit proposals for consideration at stockholder meetings; and

authorize the Board of Directors, by a majority vote, to amend the Bylaws.

In addition, we willare subject to the anti-takeover provisions of Section 203 of the Delaware General Corporation Law, which limit the ability of stockholders owning in excess of 15% of our outstanding voting stock to merge or combine with us. 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 stockholder best interests. These provisions may also prevent changes in our management or limit the price that certain investors are willing to pay for our stock.

Our Bylaws contain an exclusive forum provision, which could limit our stockholders’ ability to obtain a favorable judicial forum for disputes with us or our directors, officers, employees, or agents.

Our Bylaws provide that, unless we consent in writing to the selection of an alternative forum, any North Carolina state court that has jurisdiction, or the Delaware Court of Chancery shall, to the fullest extent permitted by law, be the sole and exclusive forum for any internal corporate claims, including without limitation (i) any derivative action or proceeding brought on behalf of us, (ii) any action asserting a claim of breach of a fiduciary duty owed by any director, officer or other employee of us to us or our stockholders, (iii) any action asserting a claim arising pursuant to any provision of the General Corporation Law of the State of Delaware, and (iv) any action asserting a claim governed by the internal affairs doctrine, in each case subject to said court having personal jurisdiction over the indispensable parties named as defendants in such action. This provision would not apply to suits brought to enforce a duty or liability created by the Securities and Exchange Act of 1934, as amended (the “Exchange Act”) or the Securities Act of 1933, as amended (the “Securities Act”), or any other claim for which federal courts have exclusive jurisdiction.

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This exclusive forum provision may limit a stockholder’s ability to bring a claim in a judicial forum of its choosing for disputes with us or our directors, officers or other employees, which may discourage lawsuits against us and our directors, officers and other employees or could result in increased costs for our stockholders to bring a claim in the chosen forum. If a court were to find the exclusive forum provision in our Bylaws to be inapplicable or unenforceable in an action, we may incur additional costs associated with resolving the dispute in other jurisdictions, which could harm our results of operations. Even if we are successful in obtaining any additional capital resourcesdefending against these claims, litigation could result in substantial costs and be a timely manner, on favorable terms, or at all.

distraction to management and other employees.

We have issuednot paid cash dividends in the past and may issuedo not expect to pay dividends in the future, substantial amountsfuture. Any return on investment may be limited to the value of instruments that are convertible intoour common stock.

We have never declared or exercisable for common stock, and our existing stockholders may face substantial dilution if such instruments are converted or exercised.

As of March 9, 2017, we had outstanding warrants and options, securities purchase agreements, and other instruments that are exercisable into an aggregate of 7,157,921paid any cash dividends on shares of our common stock which, if exercised, would represent approximately 20%and do not intend to pay any cash dividends in the foreseeable future. We anticipate that we will retain all of our current outstanding common stock. These instruments carry a wide varietyfuture earnings for use in the development of different termsour business and prices, and there canfor general corporate purposes. Any determination to pay dividends in the future will be no assurance as to when or whether exercisesat the discretion of these instruments may occur. If all or any substantial portionour Board of these instruments are exercised, our existing stockholders may face substantial dilutionDirectors. Accordingly, investors must rely on sales of their common stock after price appreciation, which may never occur, as the only way to realize any future gains on their investments.

Our ability to use our net operating loss carryforwards and certain other tax attributes to offset future taxable income may be subject to certain limitations.

We have U.S. federal net operating loss carryforwards (“NOLs”), which expire in various years if not utilized. In addition, we have federal research and development credit carryforwards. The federal research and development credit carryforwards expire in various years if not utilized. Under Sections 382 and 383 of Internal Revenue Code of 1986, as amended (the “Code”), if a corporation undergoes an “ownership change,” the corporation’s ability to use its pre-change NOLs and other pre-change tax attributes, such as research tax credits, to offset its future post-change income and taxes may be limited. In general, an “ownership change” occurs if there is a cumulative change in our ownership interests. 

by “5% shareholders” that exceeds 50 percentage points over a rolling three-year period. Similar rules may apply under state tax laws. We have not performed a formal study to determine whether any of our NOLs are subject to these limitations. We have recorded deferred tax assets for our NOLs and research and development credits and have recorded a full valuation allowance against these deferred tax assets. In the event that it is determined that we have in the past experienced additional ownership changes, or if we experience one or more ownership changes as a result of future transactions in our stock, then we may be further limited in our ability to use our NOLs and other tax assets to reduce taxes owed on the net taxable income that we earn in the event that we attain profitability. Any such limitations on the ability to use our NOLs and other tax assets could adversely impact our business, financial condition and operating results in the event that we attain profitability.

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ITEM 1B—UNRESOLVED STAFF COMMENTS

None.

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

ITEM 1C—CYBERSECURITY

The Company has a cybersecurity strategy designed to protect our information systems and data from an evolving cyber-threat landscape.  Our cybersecurity program, administered by the Company’s Senior Network Administrator and overseen by the Audit and Compliance Committee, has the support of executive leadership and the Board of Directors, and the Company continues to invest in cybersecurity to protect the Company’s systems.

Our cybersecurity program focuses on all areas of our business, including cloud-based environments, devices used by employees and contractors, facilities, networks, applications, vendors, disaster recovery, business continuity and controls and safeguards enabled through business processes and tools. We continuously monitor for threats and unauthorized access. We learn of security threats through automated detection solutions as well as reports from users and business partners. We draw on the knowledge and insight of external cybersecurity experts and vendors and employ an array of third-party tools to secure our information infrastructure and protect systems and information from unauthorized access.

As of the date of this Annual Report, we have not encountered any risks from cybersecurity threats that have materially affected or are reasonably likely to materially affect the Company, including its business strategy, results of operations, or financial condition. For more information on our cybersecurity related risks, see “Risk Factors - Risks Related to Our Industry” included elsewhere in this Annual Report on Form 10-K.

ITEM 2—PROPERTIES

We own no real property. We leaseBeginning November 1, 2022, we maintain a membership providing dedicated office space, as well as shared services and shared space for meetings, catering, and other business activities, at our principal executive office at ONE Copley Parkway,relocated to 101 Glen Lennox Drive, Suite 490, Morrisville,300, Chapel Hill, North Carolina 27560.27517. The current rent is approximately $9,179$800 per monthmonth.

On February 7, 2023, we entered into a Lease Termination Agreement with CCP Concourse, LLC, a Virginia limited liability company (the “Landlord”) with respect to the Company’s prior principal executive office lease (the “Prior Lease). The Prior Lease, as amended, was originally entered into on January 27, 2011 and would have terminated on June 30, 2024. As consideration for the facility.

Landlord’s entry into the Lease Termination Agreement, including a release of any claims the Landlord may have had against the Company under the Prior Lease, the Company has paid the Landlord $169,867.41. Pursuant to the Lease Termination Agreement, effective February 8, 2023, the Company has no remaining rent or further obligations to the Landlord pursuant to the Prior Lease.

ITEM 3—LEGAL PROCEEDINGS

The Company is

We are subject to litigation in the normal course of business, none of which management believes will have a material adverse effect on the Company’s Consolidated Financial Statements.


our consolidated financial statements.

ITEM 4— MINE SAFETY DISCLOSURES

Not applicable

applicable.

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PART II

ITEM 5—MARKET FOR THE REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES

Market PriceInformation and Number of Stockholders

Our common stock is listed on the Nasdaq Capital Market under the symbol “TENX.” The following table sets forth, for the periods indicated, the range of high and low sales prices in each fiscal quarter for“TENX”.

Based upon information furnished by our common stock, alltransfer agent, as adjusted for the 1-for-20 reverse split effective May 10, 2013.

Year-Ended April 30, 2015
 
High
 
 
Low
 
First Quarter
 $5.18 
 $3.60 
Second Quarter
 $4.40 
 $3.34 
Third Quarter
 $4.76 
 $3.01 
Fourth Quarter
 $3.54 
 $2.88 
Transition Period Ended December 31, 2015
 
High
 
 
Low
 
First Quarter
 $3.88 
 $3.26 
Second Quarter
 $3.98 
 $2.88 
Two Months Ended December 31, 2015
 $3.40 
 $2.98 
Year-Ended December 31, 2016
 
High
 
 
Low
 
First Quarter
 $3.37 
 $1.94 
Second Quarter
 $2.94 
 $2.00 
Third Quarter
 $2.77 
 $2.16 
Fourth Quarter
 $2.43 
 $1.21 
As of March 9, 2017,22, 2024, there were 1,347approximately 1,337 holders of record of our common stock. In addition, we believe that a significant number of beneficial owners

Dividend Policy

We have never declared dividends on our equity securities, and currently do not plan to declare dividends on shares of our common stock hold their shares in nominee or in “street name” accounts through brokers, and any such beneficial owners are not included in this number of holders of record. On March 9, 2017, the last sale price reported on the Nasdaq Capital Market for our common stock was $0.70 per share.

Performance Graph
The following graph compares the percentage change in cumulative total return from April 30, 2011 through December 31, 2016 for (i) our common stock (ii) the Nasdaq Composite Index (iii) the Nasdaq Biotechnology Index and (iv) the Standard & Poor’s Global Healthcare Index. All values assume the investment on April 30, 2011 of $100 at the closing price on such date and reinvestment of the full amount of all dividends (to date, we have not declared any dividends). The stock price performance of the following graph is not necessarily indicative of future stock price performance.
This stock performance graph and related information shall not be deemed “soliciting material” or “filed” with the SEC, or subject to Section 18 of the Securities Exchange Act of 1934, as amended, nor shall it be deemed incorporated by reference in any of our filings under the Securities Act of 1933, as amended, except to the extent that we specifically incorporate it by reference into such filing.

Comparison of cumulative total return on investment since April 30, 2011:
 
  2011-4-30 
  2012-4-30 
  2013-4-30 
  2014-4-30 
  2015-4-30 
  2015-12-31 
  2016-12-31 
Tenax Therapeutics, Inc.
 $100.00 
 $100.56 
 $14.12 
 $13.79 
 $9.66 
 $9.27 
 $5.51 
Nasdaq Composite
 $100.00 
 $106.01 
 $115.84 
 $143.19 
 $171.96 
 $174.26 
 $187.33 
Nasdaq Biotechnology
 $100.00 
 $116.54 
 $160.98 
 $215.04 
 $313.15 
 $316.91 
 $248.19 
S&P Global Heathcare
 $100.00 
 $103.13 
 $130.72 
 $156.02 
 $184.01 
 $175.33 
 $162.00 
Dividend Policy
Since our inception, we have not paid dividends on our common stock.foreseeable future. We intendexpect to retain our future earnings, if any, earnings for use in the operation and expansion of our business activities, so it is not expected thatbusiness. Subject to the foregoing, the payment of cash dividends in the future, if any, dividends on our common stock will be declaredat the discretion of our Board of Directors and paid in the foreseeable future.
will depend upon such factors as earnings levels, capital requirements, our overall financial condition and any other factors deemed relevant by our Board.

Repurchases of Common Stock

None.

Unregistered Sales of Equity Securities

None.
ITEM 6—SELECTED FINANCIAL DATA
The following consolidated financial and operating data set forth below with respect to our consolidated statements of operations and cash flows for

During the year ended December 31, 2016, the eight months ended December 31, 2015, the fiscal year ended April 30, 2015 and the fiscal year ended April 30, 2014, and the consolidated balance sheets as of December 31, 2016 and December 31, 2015 are derived from the consolidated financial statements included elsewhere2023, we did not issue or sell any unregistered securities not previously disclosed in this report. The consolidated statements of operations and cash flows data for fiscal years ended April 30, 2013 and 2012, and the consolidated balance sheet data as of April 30, 2015, 2014, 2013 and 2012 are derived from previously filed consolidated financial statements. The data set forth below should be reada Quarterly Report on Form 10-Q or in conjunction with our “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and our consolidated financial statements and related notes beginninga Current Report on page 42 and other financial information included in this report. Our historical results are not necessarily indicative of the results we may achieve in any future period.


 
 
Fiscal Year Ended December 31,
 
 
Eight Months Ended December 31,
 
 
Fiscal Year Ended April 30,     
 
 
 
2016
 
 
2015
 
 
2015
 
 
2014
 
 
2013
 
 
2012
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Statements of Operations Data:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total net revenue
 $- 
 $- 
 $49,286 
 $158,926 
 $1,190,928 
 $363,781 
Operating loss
  (52,650,739)
  (10,425,498)
  (14,816,743)
  (16,611,120)
  (5,189,072)
  (8,220,197)
Net loss
  (43,923,904)
  (10,067,964)
  (14,081,812)
  (19,541,839)
  (9,415,800)
  (15,712,410)
Diluted net loss per share (1)
  (1.57)
  (0.36)
  (0.50)
  (2.71)
  (6.68)
  (14.07)
Balance Sheet Data:
    
    
    
    
    
    
Cash, short-term and long-term investments
  21,866,681 
  38,208,001 
  48,101,534 
  58,320,555 
  783,528 
  1,879,872 
Total assets
  23,340,175 
  72,987,078 
  82,908,344 
  93,429,440 
  3,180,643 
  4,141,934 
Long-term liabilities
  - 
  7,962,100 
  7,962,100 
  7,973,032 
  3,049,102 
  1,361,110 
Accumulated deficit
  (204,659,603)
  (160,735,699)
  (150,667,735)
  (136,585,923)
  (117,044,084)
  (107,628,284)
Total stockholders’ equity (deficit)
  17,140,938 
  60,423,348 
  70,429,034 
  82,885,361 
  (1,778,036)
  (346,046)
Statements of Cash Flows Data:
    
    
    
    
    
    
Net cash flows from operating activities
  (15,871,300)
  (8,950,610)
  (9,748,794)
  (9,261,571)
  (4,921,283)
  (8,278,366)
(1)
Computed as described in Note B to our consolidated financial statements included in this report.
Form 8-K.

ITEM 6—RESERVED

ITEM 7—MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

You should read the following discussion and analysis together with the Consolidated Financial Statementsconsolidated financial statements and the related notes to those statements included in “ItemPart II, Item 8 – Consolidated Financial“Financial Statements and Supplementary Data.”Data”. This discussion contains forward-looking statements that involve risks and uncertainties. As a result of many factors, such as those set forth under “Risk Factors” and elsewhere in this Annual Report on Form 10-K, our actual results may differ materially from those anticipated in these forward-looking statements.

Change

Overview

The Company was originally formed as a New Jersey corporation in Fiscal Year

1967 under the name Rudmer, David & Associates, Inc., and subsequently changed its name to Synthetic Blood International, Inc. Effective June 30, 2008, we changed the domiciliary state of the corporation to Delaware and changed the Company name to Oxygen Biotherapeutics, Inc. On September 19, 2014, we changed the Company name to Tenax Therapeutics, Inc.

On November 13, 2013, we acquired a license granting Life Newco, our wholly-owned subsidiary, an exclusive, sublicensable right to develop and commercialize pharmaceutical products containing levosimendan, 2.5 mg/ml concentrate for solution for infusion / 5ml vial in the United States and Canada. On October 9, 2020 and January 25, 2022, we entered into amendments to the license agreement between the Company and Orion to include in the scope of the license two new oral product formulations containing levosimendan, in capsule and solid dosage form (TNX-103), and a subcutaneously administered dosage form (TNX-102), subject to specified limitations.  In 2015,February 2024, we entered into an additional amendment to the license, providing global rights to oral and subcutaneous formulations of levosimendan used in the treatment of PH-HFpEF, revising the royalty structure, lowering the royalty rates, modifying milestones associated with certain regulatory and commercial achievements, and excluding from our Boardright of Directors approved a change infirst negotiation the right to commercialize new applications of levosimendan for neurological diseases and disorders developed by Orion.

On January 15, 2021, we acquired 100% of the equity of PHPM, with PHPM surviving as our fiscal year to a fiscal year beginning on January 1 and ending on December 31 of each year, such change beginning as of January 1, 2016.wholly-owned subsidiary. As a result of the merger, pending the outcome of our strategic process, we plan to develop and commercialize pharmaceutical products containing imatinib for the treatment of PAH.

Reverse Stock Splits

The Company has adjusted all share amounts and references to stock prices in this Annual Report on Form 10-K, as well as our financial statements, to reflect that on January 2, 2024, we effected a 1-for-80 reverse stock split (the “Reverse Stock Split”), and on January 4, 2023, we effected a 1-for-20 reverse stock split (the “Prior Reverse Stock Split”, together with the Reverse Stock Split, the “Reverse Stock Splits”). The Reverse Stock Splits did not change financialthe number of authorized shares of capital stock or cause an adjustment to the par value of our capital stock. Pursuant to their terms, a proportionate adjustment was made to the per share exercise price and number of shares issuable under our outstanding stock options and warrants. The number of shares authorized for issuance pursuant to our equity incentive plans have also been adjusted proportionately to reflect the Reverse Stock Splits.

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Business Strategy

Having carefully considered alternatives within the ongoing strategic process announced in September 2022, and having raised capital expected to fund the Company through 2024, the Company has elected to prioritize its LEVEL trial (Phase 3 testing of oral levosimendan), ahead of imatinib. Activity to initiate the LEVEL trial continued in the fourth quarter of 2023, and site qualification, selection, and initiation processes are ongoing, the Company having received U.S. Food and Drug Administration (“FDA”) input into the oral levosimendan protocol and clinical development program in the third quarter of 2023. The Company began initiating sites in the fourth quarter of 2023, and commenced enrolling patients early in 2024. Additional funding will be needed to complete the LEVEL trial, which includes an open label extension phase following the completion of the randomized phase. The Company will complete efficacy and safety analyses of levosimendan versus placebo at the end of the randomized treatment phase, but many patients will continue to be treated under the protocol on open label levosimendan, beyond the completion of these analyses. Supporting this strategic decision to prioritize levosimendan development and commence Phase 3 trial work were two U.S. Patents issued in March and July 2023, covering the use of IV and oral levosimendan in patients with PH-HFpEF. These patents are the second and third levosimendan patents granted to us since the start of 2022. An additional new patent to be issued in early 2024 provides protections covering all therapeutic doses of all three formulations of the product in patients with PH-HFpEF.  Given our prioritization of the Phase 3 testing of levosimendan, we have suspended plans to launch an imatinib Phase 3 trial.

The Company took steps to reduce its monthly operating expenses and conserve cash, as it commenced exploring strategic alternatives in late 2022. The Company at that time cancelled many non-essential operating expenses such as consulting, its office lease, and dues and subscriptions and office supplies associated with that leased office. During the third quarter of 2023, the Company and its contracted CRO increased outreach to North American clinical trial sites, Institutional Review Boards, and other partners who will support the LEVEL trial, and in the fourth quarter of 2023 commenced site initiations.

Pending the outcome of our ongoing strategic process, the key elements of our business strategy are outlined below.

Efficiently conduct clinical development to establish clinical proof of principle in new indications, refine formulation, and commence Phase 3 testing of our current product candidates.

Levosimendan and imatinib have been approved and prescribed in countries around the world for more than 20 years, but we believe their mechanisms of action have not been fully exploited, despite promising evidence they may significantly improve the lives of patients with pulmonary hypertension. We are conducting clinical development with the intent to establish proof of beneficial activity in cardiopulmonary diseases in which these therapeutics would be expected to have benefit for patients with diseases for which either no pharmaceutical therapies are approved at all, or in the case of PAH, where numerous expensive therapies generally offer a modest reduction of symptoms. Our focus is primarily on designing and executing formulation improvements, protecting these innovations with patents and other forms of exclusivity, and employing innovative clinical trial science to establish a robust foundation for subsequent development, product approval, and commercialization. We intend to submit marketing authorization applications following two Phase 3 trials of levosimendan and, when appropriate, a single Phase 3 trial of imatinib. Our trials are designed to incorporate and reflect advanced clinical trial design science and the regulatory and advisory experience of our team. We intend to continue partnering with innovative companies, renowned biostatisticians and trialists, medical leaders, formulation and regulatory experts, and premier clinical testing organizations to help expedite development, and continue expanding into complementary areas when opportunities arise through our development, research, and discoveries. We also intend to continue outsourcing to CROs, and seeking and acting upon the advice of preeminent scientists focused on cardiovascular and pulmonary drug development, when designing and executing our research.

Efficiently explore new high-potential therapeutic applications, in particular where expedited regulatory pathways are available, leveraging third-party research collaborations and our results from related areas.

Levosimendan has shown promise in multiple disease areas in the more than two decades following its approval. Our own Phase 2 study and open-label extension has demonstrated that a formerly under-appreciated mechanism of action of levosimendan, its property of relaxing the venous circulation, brings about durable improvements in exercise capacity and quality of life, as well as other clinical assessments, in patients with PH-HFpEF. We believe this patient population today has no pharmaceutical therapies available and we are committed to exploring potential clinical indications where our therapies may achieve best-in-class profile, and where we can address significant unmet medical needs.

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We believe these factors will support approval by the FDA of these product candidates based on positive Phase 3 data. Through our agreement with our licensor, Orion, the originator of levosimendan for acute decompensated heart failure, we have access to a library of ongoing and completed trials and research projects, including certain documentation, which we believe, in combination with positive Phase 3 data we hope to generate in at least one indication, will support FDA approval of levosimendan. Likewise, the regulatory pathway for approval of imatinib for the treatment of PAH, as formulated by us at the dose shown to be effective in a prior Phase 3 trial conducted by Novartis, allows us to build on the dossier of research results already reviewed by the FDA. In order to achieve our objective of developing these medicines for new groups of patients, we have established collaborative research relationships with investigators from leading research and clinical institutions, and our strategic partners. These collaborative relationships have enabled us to explore where our product candidates may have therapeutic relevance, gain the advice and support of key opinion leaders in medicine and clinical trial science, and invest in development efforts to exploit opportunities to advance beyond current clinical care.

Continue to expand our intellectual property portfolio.

Our intellectual property and the confidentiality of all our Company information is important to our business and we take significant steps to help protect its value. Our research and development efforts, both through internal activities and through collaborative research activities with others, aim to develop new intellectual property and enable us to file patent applications that cover new uses of our existing technologies, alone or in combination with existing therapies, as well as other product candidates.

Notice of Allowance and Patents

On February 1, 2023, the Company announced it was granted a Notice of Allowance from the USPTO for its patent application with claims covering the use of IV levosimendan (TNX-101) in the treatment of PH-HFpEF. This patent (U.S. Patent No. 11,607,412) was issued on March 21, 2023. On July 19, 2023, the Company announced USPTO issuance of another patent, this one including claims covering the use of oral levosimendan (TNX-103) in patients with PH-HFpEF. This issued patent (U.S. Patent No. 11,701,355) provides exclusivity through December 2040. On February 6, 2024, the Company announced it was granted a Notice of Allowance from USPTO for its patent application broadening IP protection for oral, I.V., and subcutaneous use of levosimendan and its active metabolites in PH-HFpEF, at all therapeutic doses and in combination with various cardiovascular drugs.  At present, we have other patent applications pending, with additional decisions expected in the future.  Patents pending in Europe may lead to intellectual property protections on the use of levosimendan in patients with PH-HFpEF in 2024.

Enter into licensing or product co-development arrangements.

In addition to our internal development efforts, an important part of our product development strategy is to work with collaborators and partners to accelerate product development, maintain our low development and business operations costs, and broaden our commercialization capabilities globally. We believe this strategy will help us develop a portfolio of high-quality product development opportunities, enhance our clinical development and commercialization capabilities, and increase our ability to generate value from our proprietary technologies.

As we focus on our strategic process, we also continue to position ourselves to execute upon licensing and other partnering opportunities. To do so, we need to continue to maintain our strategic direction, manage and deploy our available cash efficiently, and strengthen our collaborative research development and partner relationships.

Historically, we have financed our operations principally through equity and debt offerings, including private placements and loans from our stockholders. Based on our current operating plan, there is substantial doubt about our ability to continue as a going concern. Management has implemented certain cost-cutting measures as described above and is actively exploring a diverse range of strategic options to help drive stockholder value including, among other things, capital raises, a sale of our Company, merger, one or more license agreements, a co-development agreement, a combination of these, or other strategic transactions; however, there is no assurance that these efforts will result in a transaction or other alternative or that any additional funding will be available. Our ability to continue as a going concern depends on our ability to raise additional capital, through the sale of equity or debt securities and through collaboration and licensing agreements, to support our future operations. If we are unable to complete a strategic transaction or secure additional capital, we may be required to curtail our research and development initiatives and take additional measures to reduce costs.

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Comparison of Our Results of Operations for the Years Ended December 31, 2023 and 2022

 

 

The year ended December 31,

 

 

Increase/(Decrease)

 

 

 

2023

 

 

2022

 

 

 

 

 

 

 

 

 

 

 

 

 

Operating expenses

 

 

 

 

 

 

 

 

 

General and administrative

 

$5,005,135

 

 

$5,675,231

 

 

 

(670,096)

Research and development

 

 

3,228,806

 

 

 

5,377,412

 

 

 

(2,148,606)

Total operating expenses

 

 

8,233,941

 

 

 

11,052,643

 

 

 

(2,818,702)

General and Administrative Expenses

General and administrative expenses were $5.0 million for the year ended December 31, 2016 are2023, compared to the unaudited results$5.7 million for the year ended December 31, 2015, and the financial results for the eight months ended December 31, 2015 are compared to the unaudited financial results for the eight months ended December 31, 2014. When financial results for the fiscal year ended April 30, 2015 are compared to the prior year, the results are presented on the basis of our previous fiscal year-end on a twelve month basis.

Results of operations- Comparison of the years ended December 31, 2016 and 2015
General and Administrative Expenses
same period in 2022. General and administrative expenses consist primarily of compensation for executive, finance, legal and administrative personnel, including stock-based compensation. Other general and administrative expenses include facility costs not otherwise included in research and development expenses, legal and accounting services, and other professional services, and consulting fees.services. General and administrative expenses and percentage changes for the years ended December 31, 20162023 and 2015,2022, respectively, are as follows:

 
 
Year ended December 31,
 
 
Increase/ (Decrease)
 
 
% Increase/ (Decrease)
 
 
 
2016
 
 
2015
 
 
 
 
 
 
 
Legal and professional fees
 $1,878,032 
 $2,164,910 
 $(286,878)
  (13)%
Personnel costs
  3,390,457 
  3,269,639 
  120,818 
  4%
Other costs
  824,307 
  1,024,092 
  (199,785)
  (20)%
Facilities
  140,575 
  153,227 
  (12,652)
  (8)%
Depreciation and amortization
  12,587 
  59,700 
  (47,113)
  (79)%

 

 

Year ended December 31,

 

 

Increase/ (Decrease)

 

 

% Increase/ (Decrease)

 

 

 

2023

 

 

2022

 

 

 

 

 

 

 

Personnel costs

 

$2,176,682

 

 

$2,370,362

 

 

$(193,680)

 

 

(8)%

Legal and professional fees

 

 

1,967,276

 

 

 

2,369,126

 

 

 

(401,850)

 

 

(17)%

Other costs

 

 

831,908

 

 

 

782,023

 

 

 

49,885

 

 

 

6%

Facilities

 

 

29,269

 

 

 

153,720

 

 

 

(124,451)

 

 

(81)%

Personnel costs decreased approximately $194,000 for the year ended December 31, 2023, compared to the same period in the prior year. The decrease was due to reductions in head count and stock compensation expenses.

Stock Compensation expense was approximately $191,000 for the year ended December 31, 2023, and decreased approximately $174,000 compared to the same period in the prior year.  The decrease in expense was due to the decrease in head count and option awards during the year.   

Legal and professional fees:

Legal and professionalfees decreased approximately $402,000 for the year ended December 31, 2023, compared to the same period in the prior year. Professional fees consist of the costs incurred for legal fees, accounting fees, recruiting costscapital market expenses, consulting fees and investor relations services, as well as fees paid to the members of our Board of Directors.

Legal and professional fees decreased approximately $287,000$264,000 for the year ended December 31, 2016,2023, as compared to the same period in the prior year. ThisThe decrease was primarily due to a reduction in costs incurred for investor relations services, legallower capital market activities and IP-related costs.

Professional fees and fees paid to our Board of Directors, partially offset by an increase in consulting costs.


Costs associated with investor relations and communication decreased approximately $220,000 in the current year. This decrease was due primarily to fees paid in the prior year to a third-party investor relations firm that is no longer providing marketing and corporate communications services to us in the current year, as well as the costs incurred$138,000 for conferences and presentations during the prior year.

Legal fees decreased in the current year by approximately $127,000. This decrease was due primarily to additional costs incurred in the prior year related to our filing of a Form 10-KT to transition to a calendar year filer and fees associated with our PFC-based intellectual property portfolio which were not incurred in the current year.

Fees paid to our Board of Directors decreased approximately $89,000 in the current year. This decrease was due primarily to the recognized vested value of stock options awarded during the year asended December 31, 2023, compared to the prior year.

Consulting costs increased approximately $151,000same period in the current year. The increase in costs was due primarily to services performed for market research and channel strategy and implementation which were not incurred during the prior year.
Personnel costs:
Personnel costs increased approximately $121,000 for the year ended December 31, 2016 compared to the prior year. The increasedecrease was due primarily attributable to an increase ofdecreased consulting fees and a decrease in accounting, capital markets, and investor relations costs.

Other costs increased approximately $267,000 in the recognized expense$50,000 for the vesting of outstanding stock option awards partially offset by a decrease of approximately $68,000 in salaries and bonuses paid as well as an overall decrease in payroll taxes and benefits paid asyear ended December 31, 2023, compared to the same period in the prior year.

Other costs:
Other costs include costsexpenses incurred for franchise and other taxes, travel, supplies, insurance, depreciation and other miscellaneous charges. The approximately $200,000 decrease in otherincrease was primarily attributable to increased costs for insurance offset by decreases in franchise and other taxes.

Facilities costs decreased approximately $124,000 for the year ended December 31, 2016 was due primarily to an approximately $181,000 decrease in franchise taxes paid, a $29,000 decrease in banking fees, as well as general decreases in costs incurred for travel and supplies; partially offset by an increase of approximately $31,000 in insurance costs, as2023, compared to the same period in the prior year.

Facilities:
Facilities include The decrease was primarily attributable to lower costs paid for rent and utilities at our corporate headquarters in North Carolina. Facilities costs remained relatively consistent

40

Table of Contents

Research and Development Expenses

Research and development expenses were $3.2 million for the years ended December 31, 2016 and 2015.


Depreciation and Amortization:
Depreciation and amortization costs decreased approximately $47,000 for the year ended December 31, 2016,2023 as compared to $5.4 million for the same period in the prior year. The decrease in costs was due primarily to amortization costs incurred in the prior year on our PFC-based intellectual property portfolio that was fully impaired as of April 30, 2015.
Research and Development Expenses 
Research and development expenses include, but are not limited to, (i) expenses incurred under agreements with CROs and investigative sites, which conduct our clinical trials and a substantial portion of our pre-clinical studies; (ii) the cost of manufacturing and supplying clinical trial materials; (iii) payments to contract service organizations, as well as consultants; (iv) employee-related expenses, which include salaries and benefits; and (v) facilities, depreciation and other allocated expenses, which include direct and allocated expenses for rent and maintenance of facilities and equipment, depreciation of leasehold improvements, equipment, laboratory and other supplies. All research and development expenses are expensed as incurred. Research and development expenses and percentage changes for the years ended December 31, 20162023 and 2015,2022, respectively, are as follows:
 
 
Year ended
December 31,  
 
 
Increase/
(Decrease)
 
 % Increase/
(Decrease)
 
 
 
2016
 
 
2015
 
 
 
 
 
 
 
Clinical and preclinical development
 $11,681,352 
 $7,775,366 
 $3,905,986 
  50%
Personnel costs
  785,550 
  594,306 
  191,244 
  32%
Consulting
  640,088 
  490,210 
  149,878 
  31%
Other costs
  26,326 
  25,901 
  425 
  2%
Depreciation
  6,365 
  19,004 
  (12,639)
  (67)%

Clinical and preclinical development:

 

 

Year ended December 31,

 

 

Increase/ (Decrease)

 

 

% Increase/ (Decrease)

 

 

 

2023

 

 

2022

 

 

 

 

 

 

 

Clinical and preclinical development

 

$2,309,652

 

 

$4,657,916

 

 

$(2,348,264)

 

 

(50)%

Personnel costs

 

 

829,588

 

 

 

684,451

 

 

 

145,137

 

 

 

21%

Other costs

 

 

89,566

 

 

 

35,046

 

 

 

54,520

 

 

 

156%

Clinical and preclinical development costs include the costs associated with our Phase III and Phase II clinical trials for levosimendan and Oxycyte. The increase ofdecreased approximately $3.9$2.3 million in clinical and preclinical development costs for the year ended December 31, 2016, compared to the prior year, was primarily due to increased expenditures for CRO costs to manage the Phase III LEVO-CTS clinical trial, partially offset by a reduction in costs incurred in the current period for the development and clinical testing of Oxycyte, which development we decided to suspend in September 2014.

Levosimendan
We incurred approximately $11.7 million in research and development costs for levosimendan during the year ended December 31, 2016, an increase of approximately $4.6 million compared to the prior year. The increase in levosimendan development costs is due primarily to the direct costs of our Phase III LEVO-CTS clinical trial for LCOS. For the year ended December 31, 2016, we recorded CRO costs of approximately $11.7 million for the management of the Phase III trial which includes approximately $4.7 million in pass-through site activation and enrolled patient costs, compared to CRO costs of approximately $7.1 million during the prior year.
Oxycyte
We incurred approximately $12,000 in research and development costs for Oxycyte during the year ended December 31, 2016, a decrease of approximately $576,000 compared to the prior year. The decrease in Oxycyte development costs was due to our decision to suspend development of the Oxycyte product in September 2014 and close out all our sites for the Phase II-B clinical trial for TBI. We do not anticipate any significant additional costs in the future related to this clinical trial or other close-out activities related to the discontinuance of the Oxycyte product development.
Personnel costs:
Personnel costs increased approximately $191,000 for the year ended December 31, 2016 compared to the prior year. This increase was primarily due to severance payments of approximately $156,000 upon resignation of our prior Chief Medical Officer and an increase of approximately $73,000 in overall salaries, including payroll taxes and benefits, paid due to headcount additions during the year to support the clinical development of levosimendan, partially offset by a decrease in bonuses paid of approximately $33,0002023 as compared to the prior year.

Consulting fees:
Consulting fees increased approximately $150,000 for the year ended December 31, 2016 compared to the same period in the prior year, primarily due to an increase in fees paid to a third-party consulting firm for services provided to improve trainingyear. Clinical and communicationpreclinical development costs consist of expenses associated with active sites in supportthe ongoing open label extension phase of our Phase III LEVO-CTS clinical trial as well as fees paid2 HELP Study for pharmacokinetic study analysis, partially offset by a reduction inlevosimendan, costs associated with LCOSour intravenous-to-oral levosimendan transition study, and septic shock costdevelopment costs associated with the formulation for imatinib. The decrease is primarily attributable to lower Phase 1 and incidence studies.
Other costs:
OtherPhase 3 costs remained relatively consistent for imatinib, since the years ended December 31, 2016 and 2015.
Depreciation:
DepreciationCompany suspended clinical development activities for this product candidate in 2022, offset by increased LEVEL trial costs decreasedin 2023.

Personnel costs increased approximately $13,000$145,000 for the year ended December 31, 2016, compared to the prior year. This decrease was due primarily to depreciation of lab equipment that was written off and disposed of in the prior year following our decision to suspend development of our Oxycyte products.

Loss on impairment of long lived assets 
Impairment losses and percentage changes for the years ended December 31, 2016 and 2015, respectively, are as follows:
 
 
Year ended
December 31,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2016
 
 
2015
 
 
 
 
 
 
 
Loss on impairment of long-lived assets
 $33,265,100 
 $1,034,863 
 $32,230,237 
  3114%     
During the year ended December 31, 2016, we recognized an impairment of $33.3 million related to our levosimendan product in Phase III clinical trial, which represents approximately $22 million for in-process research and development, or IPR&D, assets and approximately $11.3 million for Goodwill,2023, as compared to the same period in the prior year. The increase is primarily attributable to increased incentive compensation costs.

Other costs increased approximately $1.0 million during$55,000 for the year ended December 31, 2015.

The LEVO-CTS trial was completed in December of 2016. Based on2023, as compared to the data from the trial, levosimendan, given prophylactically prior to cardiac surgery to patients with reduced left ventricular function, had no effect on the co-primary outcomes. The study did not achieve statistically significant reductionssame period in the dual endpoint of death or use of a mechanical assist device at 30 days, nor inprior year. The increase is primarily attributable to higher regulatory costs over the quad endpoint of death, myocardial infarction, need for dialysis, or use of a mechanical assist device at 30 days. Based on the results of the LEVO-CTS trial, we do not anticipate additional development of levosimendan for the treatment of LCOS in patients undergoing cardiac surgery. As of December 31, 2016, management determined the IPR&D asset,prior year.

Other Income and corresponding Goodwill, was more than temporarily impaired.

Expense, Net

Other income and expense net

Other income and expense includesinclude non-operating income and expense items not otherwise recorded in our consolidated statement of operations.comprehensive loss. These items include, but are not limited to, revenue earned under sublease agreements for our California facility, changes in the fair value of financial assets and liabilities, interest income earned and fixed asset disposals. Other income for the years ended December 31, 2016 and 2015, respectively, is as follows:

 
 
Year ended
December 31,  
 
 (Increase)/
Decrease
 
 
 
2016
 
 
2015
 
 
 
 
Other (income) expense, net
 $(764,735)
 $(633,632)
 $(131,103)
Other income increased approximately $131,000$538,000 for the year ended December 31, 2016 compared to the prior year. This increase is due to primarily to a gain of approximately $74,000 on the disposal of fixed assets previously used in the manufacturing of Oxycyte, partially offset by the change in fair value of our Series C warrant derivative liability and a decrease in interest income earned in the current period as compared to the same period in the prior year.
During the year ended December 31, 2016, we recorded a derivative gain of approximately $298,000 which compared to a derivative gain of approximately $154,000 in the prior year. These charges to income are derived from the free-standing Series C warrants which are measured at their fair market value each period using the Monte Carlo simulation model.
During the year ended December 31, 2016, we recorded interest income of approximately $392,000 from our investments in marketable securities. This income is derived from approximately $992,000 in bond interest paid, partially offset by approximately $603,000 in charges for amortization of premiums paid and fair-value adjustments measured each period, which compares to approximately $1.3 million in bond interest paid, partially offset by approximately $862,000 in charges for amortization of premiums paid and fair-value adjustments during the prior year.
Results of operations- Comparison of the eight months ended December 31, 2015 and 2014
General and Administrative Expenses
General and administrative expenses and percentage changes for the eight months ended December 31, 2015 and 2014, respectively, are as follows:
 
 
Year ended
April 30,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2014
 
 
2013
 
 
 
 
 
 
 
Personnel costs
 $10,593,234 
 $1,490,752 
 $9,102,482 
  611%
Legal and professional fees
  2,556,643 
  2,005,311 
  551,332 
  27%
Other costs
  350,855 
  (206,788)
  557,643 
  270%
Facilities
  157,449 
  167,693 
  (10,244)
  (6)%
Depreciation and amortization
  115,042 
  111,012 
  4,030 
  4%
Personnel costs:
Personnel costs increased approximately $283,000 for the eight months ended December 31, 2015 compared to the same period in the prior year. The increase was due primarily to approximately $400,000 for annual bonuses accrued and the recognition of approximately $98,000 for the vesting of stock options granted during the period, partially offset by a $215,000 accrual for severance payments in the prior year paid to certain employees following the stoppage of the TBI trials.
Legal and professional fees:
Legal and professional fees decreased approximately $853,000 for the eight months ended December 31, 20152023, compared to the same period in the prior year. This decrease was primarily due to a reduction in costs incurred for investor relations services and the vested value of stock option grants to our Board of Directors, partially offset by an increase in legal and consulting fees paid.


Costs associated with investor relations and communications decreased approximately $912,000 in the current period. This decrease was due primarily to the recognition of approximately $475,000 for the fair value of warrants issued to a third party investor relations firm during the same period in the prior year as well as a reduction of approximately $437,000 in fees paid in the prior year to third party investor relations firms for providing marketing and corporate communications services to us in the current period.

Board of Directors fees decreased in the current period by approximately $64,000. This decrease was due primarily to a reduction in the recognized expense for the vesting of stock options awarded in the current period as compared to the recognized expense for stock options awarded in the same period of the prior year.

Consulting costs increased approximately $87,000 due to the costs incurred for market research and commercial development services during the current period that were not incurred during the same period in the prior year.
Other costs:
The approximately $133,000 increase in other costs for the eight months ended December 31, 2015 was due primarily to an approximately $132,000 increase in franchise taxes paid, approximately $20,000 in costs incurred for our sponsorship of the National Sepsis Foundation and approximately $30,000 in legal and proxy-related data services, partially offset by a reductions of approximately $33,000 and $31,000 in travel and employee relocation costs, respectively, as compared to the same period in the prior year.
Facilities:
Facilities costs remained relatively consistent for the eight months ended December 31, 2015 and 2014.
Depreciation and Amortization:
Depreciation and amortization costs decreased approximately $55,000 for the eight months ended December 31, 2015 compared to the same period in the prior year. The decrease in costs was due primarily to amortization costs incurred in the same period of the prior year on our PFC-based intellectual property portfolio that was fully impaired as of April 30, 2015.
Research and Development Expenses 
Research and development expenses and percentage changes for the eight months ended December 31, 2015 and 2014, respectively, are as follows:
 
 
Eight months ended
December 31,  
 
 Increase/
(Decrease)
 
 % Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Clinical and preclinical development
 $5,560,860 
 $3,820,196 
 $1,740,664 
  46%
Consulting
  470,335 
  15,231 
  455,104 
  2988%
Personnel costs
  427,873 
  359,129 
  68,744 
  19%
Other costs
  25,799 
  45,911 
  (20,112)
  (44)%
Clinical and preclinical development:
The increase of approximately $1.7 million in clinical and preclinical development costs for the eight months ended December 31, 2015, compared to the same period in the prior year, was primarily due to increased expenditures for CRO costs to manage the Phase III LEVO-CTS clinical trial, partially offset by a reduction in costs incurred in the current period for the development and clinical testing of Oxycyte, which development we decided to suspend in the prior year.

Levosimendan
We incurred approximately $5.5 million in research and development costs for levosimendan during the eight months ended December 31, 2015, an increase of approximately $3.1 million compared to the same period in the prior year. The increase in levosimendan development costs is due primarily to the direct costs of our Phase III LEVO-CTS clinical trial for LCOS, partially offset by a reduction of approximately $500,000 in costs to support the LeoPARDS trial for septic shock that was conducted during the same period of the prior year. For the eight months ended December 31, 2015, we recorded CRO costs of approximately $5.5 million for the management of the Phase III trial which includes approximately $2.3 million in pass-through site activation and enrolled patient costs, compared to CRO costs of approximately $2.4 million during the same period in the prior year.
Oxycyte
We incurred approximately $25,000 in research and development costs for Oxycyte during the eight months ended December 31, 2015, a decrease of approximately $897,000 compared to the same period in the prior year. The decrease in Oxycyte development costs was due to our decision to suspend development of the Oxycyte product in the prior year and close out all of our sites for the Phase II-B clinical trial for TBI. We do not anticipate any significant additional costs in the future related to this clinical trial or other close-out activities related to the discontinuance of the Oxycyte product development.
Consulting fees:
Consulting fees increased approximately $455,000 for the eight months ended December 31, 2015 compared to the same period in the prior year, primarily due to an increase in fees paid to third party consulting firms for services provided to improve training and communication with active sites in support of our Phase III LEVO-CTS clinical trial and to conduct market research for sepsis and cardiac surgery.
Personnel costs:
Personnel costs increased approximately $69,000 for the eight months ended December 31, 2015 compared to the same period in the prior year, primarily due to approximately $75,000 for annual bonuses accrued, partially offset by reduced costs for benefits and payroll taxes paid due to the headcount reductions in positions responsible for the development of our Oxycyte products as compared to the same period in the prior year.
Other costs:
Other costs decreased approximately $20,000 for the eight months ended December 31, 2015 compared to the same period in the prior year. This decrease was due primarily to depreciation of lab equipment and other lab related costs that were written off and disposed of on April 30, 2015.
Interest expense
Interest expense includes the interest payments due under our long-term debt, amortization of debt issuance costs and accretion of discounts recorded against our outstanding convertible notes and noncash interest charges related to our Series A Stock, when it was outstanding. Interest expense and percentage changes for the eight months ended December 31, 2015 and 2014, respectively, are as follows:
 
 Eight Months ended
December 31,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Interest expense
 $1,507 
 $46,736 
 $(45,229) 
  (97)%
During the eight months ended December 31, 2015, interest expense decreased approximately $45,000 compared to the same period in the prior year. The decrease was due primarily to the maturity and settlement of our outstanding convertible notes in June 2014.
Other income and expense, net
Other income for the eight months ended December 31, 2015 and 2014, respectively, is as follows:
 
 
Eight Months ended
December 31,
 
 
 
(Increase)/
Decrease
 
 
 
2015
 
 
2014
 
 
 
 
Other (income) expense, net
 $(359,041)
 $(509,420)
 $150,379 

Other income decreased approximately $150,000 for the eight months ended December 31, 2015 compared to the same period in the prior year. This decrease was primarily due to changes in the recognized fair value of our derivative warrant liability during the current period, partially offset by an increase of approximately $71,000 in interest income earned net of amortization of premiums and market adjustments.
Results of operations- Comparison of the years ended April 30, 2015 and 2014
Revenue
Product Revenue and Gross Profit
In prior years, we generated revenue from the saleCompany’s money market accounts.

Liquidity, Capital Resources and Plan of Dermacyte® through distribution agreements, on-line retailers and direct sales to physician and medical spa facilities. Product revenue, cost of sales and gross profit, as well as corresponding percentage changes, for the years ended April 30, 2015 and 2014 are as follows:

 
 
Year ended
April 30,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Product revenue
 $- 
 $25,731 
 $(25,731)
  (100)%
Cost of sales
  - 
  129,800 
  (129,800)
  (100)%
Gross profit
 $- 
 $(104,069)
 $104,069 
  (100)%
The decrease in product revenue for the year ended April 30, 2015 was due to our decision to stop producing and selling the Dermacyte product in the year ended April 30, 2014.
Gross profit as a percentage of revenue was (404) % for the year ended April 30, 2014. There was no gross profit during the year ended April 30, 2015 due to the write down of Dermacyte product in the prior year that is no longer being marketed for sale.
Government Grant Revenue
Revenues from a cost-reimbursement grant sponsored by the United States Army, or Grant Revenue, are recognized as milestones under the Grant program are achieved. Grant Revenue is earned through reimbursements for the direct costs of labor, travel, and supplies, as well as the pass-through costs of subcontracts with third-party CROs.
 
 
Year ended
April 30,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Government grant revenue
 $49,286 
 $262,995 
 $(213,709)
  (81)%
For the year ended April 30, 2015, we recorded approximately $49,000 in revenue under the grant program as compared to approximately $263,000 in revenue during the prior year. The decrease in revenue earned under the grant is due primarily to our completion of multiple studies in the prior year.
General and Administrative Expenses
General and administrative expenses and percentage changes for the year ended April 30, 2015 and 2014, respectively, are as follows:
 
 
Year ended
April 30,
 
 Increase/
(Decrease)
 
 % Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Legal and professional fees
 $3,017,584 
 $2,556,643 
 $460,941 
  18%
Personnel costs
  2,986,589 
  10,593,234 
  (7,606,645)
  (72)%
Other costs
  890,940 
  350,855 
  540,085 
  154%
Facilities
  160,818 
  157,449 
  3,369 
  2%
Depreciation and amortization
  114,848 
  115,042 
  (194)
  (0)%

Legal and professional fees:
Legal and professional fees increased approximately $460,000 for the year ended April 30, 2015 compared to the year ended April 30, 2014. This increase was primarily due to costs incurred for investor relations services, consulting fees and Board of Directors fees, partially offset by a decrease in legal fees.

Costs associated with investor relations and communication increased approximately $636,000 in the year ended April 30, 2015. This increase was due primarily to the issuance of 175,000 warrants with a calculated fair value of approximately $475,000 and an increase of approximately $161,000 in fees paid to outsourced corporate communication firms for investor relations services and website development.

Board of Directors fees increased in the year ended April 30, 2015 by approximately $420,000. This increase was due primarily to approximately $280,000 in recognized expense for the vesting of stock options awarded and an increase of approximately $140,000 in fees paid due to the addition of a director and the restructuring of directors’ fees in the year ended April 30, 2015.

Consulting costs increased approximately $132,000 in the year ended April 30, 2015 due primarily to fees paid for recruiting firms for placement services and contract labor in the year ended April 30, 2015.

Legal, accounting and capital market fees decreased in the year ended April 30, 2015 by approximately $600,000. This decrease was due primarily to a reduction of approximately $530,000 in accounting and legal fees incurred in the year ended April 30, 2014 related to the acquisition of the rights to develop levosimendan and the issuance of our Series C and Series D Preferred Stock and a reduction of approximately $70,000 in fees paid for the listing of additional shares with Nasdaq and SEC filings made during the year ended April 30, 2014.
Personnel costs:
Personnel costs decreased approximately $7.6 million for the year ended April 30, 2015 compared to the prior year. The decrease was due primarily to the recognition of approximately $8.3 million of stock based compensation in the year ended April 30, 2014, partially offset by an increase of approximately $633,000 in salaries and benefits paid during the year ended April 30, 2015.

Stock based compensation and the vested value of issued stock options decreased approximately $8.3 million in the year ended April 30, 2015 due primarily to the expense recognition of approximately $8.3 million for the granting and vesting of stock options and restricted stock in the year ended April 30, 2014. These option grants were made pursuant to employment agreements, which were negotiated in connection with our acquisition of a license for levosimendan in November 2013.

Salaries and benefits increased approximately $633,000 in the year ended April 30, 2015. This increase was due primarily to full-year salaries paid in the year ended April 30, 2015 to our Chief Executive Officer and the two additional management positions added in connection with our acquisition of certain assets of Phyxius, and approximately $210,000 for severance payments related to the stoppage of Oxycyte development programs.
Other costs:
The approximately $540,000 increase in other costs was due primarily to an increase of approximately $320,000 in franchise tax payments made to North Carolina and Delaware in the year ended April 30, 2015, an increase of approximately $100,000 in banking fees paid to manage our investment portfolio, an increase of approximately $45,000 in travel related costs, an increase of approximately $45,000 in insurance costs related to our Phase III clinical study, and approximately $30,000 in relocation costs paid in the year ended April 30, 2015.
Facilities:
Facilities costs remained relatively consistent for the years ended April 30, 2015 and 2014.
Depreciation and Amortization:
Depreciation and amortization costs remained relatively consistent for the years ended April 30, 2015 and 2014.

Research and Development Expenses 
Research and development expenses and percentage changes for the years ended April 30, 2015 and 2014, respectively, are as follows:
 
 
Year ended
April 30,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Clinical and preclinical development
 $6,034,702 
 $1,947,461 
 $4,087,241 
  210%
Personnel costs
  525,561 
  818,264 
  (292,703)
  (36)%
Consulting
  35,106 
  153,506 
  (118,400)
  (77)%
Depreciation
  33,292 
  35,447 
  (2,155)
  (6)%
Other costs
  27,287 
  31,780 
  (4,493)
  (14)%
Facilities
  4,439 
  10,263 
  (5,824)
  (57)%
Clinical and preclinical development:
The increase of approximately $4.1 million in clinical and preclinical development costs for the year ended April 30, 2015 compared to the year ended April 30, 2014 was primarily due to increased expenditures related to levosimendan and additional costs related to the decision to suspend the development of Oxycyte.
Levosimendan
We incurred approximately $4.5 million in research and development costs for levosimendan in the year ended April 30, 2015, an increase of approximately $4.3 million compared to the year ended April 30, 2014. The increase in levosimendan development costs is due primarily to the direct costs of our Phase III LEVO-CTS clinical trial for LCOS. In the year ended April 30, 2015, we recorded clinical trial costs of approximately $4.0 million for the management of the Phase III trial and pass-through site activation and enrolled patient costs. In addition to the costs associated with the Phase III trial, we incurred expenses of approximately $516,000 to support the development of levosimendan for septic shock by providing financial support for the LeoPaRDS trial, which is currently being conducted through the Imperial College of London.
Oxycyte
We incurred approximately $1.5 million in research and development costs for Oxycyte in the year ended April 30, 2015, a decrease of approximately $248,000 compared to year ended April 30, 2014. The decrease in Oxycyte development costs was due primarily to our decision to suspend development of the Oxycyte product in the year ended April 30, 2015 and close out all of our sites for the Phase II-B clinical trial for TBI. We recorded costs of approximately $837,000 for these close-out activities and we do not anticipate any significant additional costs in the future related to this clinical trial.
We incurred approximately $98,000 in preclinical research and development costs, a decrease of approximately $147,000 compared to the year ended April 30, 2014. The decrease in preclinical development costs was due primarily to the completion and preparation of the final study reports for the Army funded safety studies and we do not anticipate any significant additional costs in the future related to these preclinical studies.
We incurred approximately $550,000 in manufacturing and stability costs for Oxycyte in the year ended April 30, 2015. These costs were due primarily to early termination fees for API and clinical drug manufacturing supply agreements due to our decision to suspend the development of Oxycyte, and we do not anticipate any significant additional costs in the future related to the manufacture and stability of Oxycyte.
Personnel costs:
Personnel costs decreased approximately $293,000 for the year ended April 30, 2015 compared to the year ended April 30, 2014 primarily due to headcount reductions in the year ended April 30, 2015, partially offset by the addition of our Chief Medical Officer in the fourth quarter of the year ended April 30, 2015. The headcount reductions were primarily in positions responsible for managing the manufacturing of Oxycyte clinical drug material, the preclinical safety studies for Oxycyte and the Phase II-B clinical trial for TBI.

Consulting fees:
Consulting fees decreased approximately $118,000 for the year ended April 30, 2015 compared to the year ended April 30, 2014 primarily due to approximately $142,000 of fees incurred to plan and prepare for clinical trial expansions and other clinical support activities for Oxycyte in the year ended April 30, 2014, partially offset by an increase of approximately $24,000 of consulting fees associated with levosimendan development in the year ended April 30, 2015.
Depreciation:
Depreciation expense remained relatively consistent for the years ended April 30, 2015 and 2014.
Other costs:
Other costs remained relatively consistent for the years ended April 30, 2015 and 2014.
Facilities:
Facilities expense remained relatively consistent for the years ended April 30, 2015 and 2014.
Interest expense
Interest expense and percentage changes for the year ended April 30, 2015 and 2014, respectively, are as follows:
 
 
Year ended
April 30,
 
 
Increase/
(Decrease)
 
 
% Increase/
(Decrease)
 
 
 
2015
 
 
2014
 
 
 
 
 
 
 
Interest expense
 $49,081 
 $2,212,283 
 $(2,163,202)
  (98)%
During the year ended April 30, 2015, interest expense decreased approximately $2.2 million compared to the year ended April 30, 2014. The decrease was due primarily to noncash interest charges recorded in the year ended April 30, 2014 related to our convertible notes which matured in the first quarter of the year ended April 30, 2015.
Other income and expense, net
Other expense for the year ended April 30, 2015 and 2014, respectively, is as follows:
 
 
Year ended
April 30,
 
 
(Increase)/
Decrease
 
 
 
2015
 
 
2014
 
 
 
 
Other (income) expense, net
 $(784,012)
 $718,436 
 $(1,502,448)
Other income increased approximately $1.5 million for the year ended April 30, 2015 compared to the year ended April 30, 2014. This increase was primarily due to approximately $393,000 in interest income, net of amortization of premiums and market adjustments, and the reduction of the recognized fair value of our derivative warrant liability during the year ended April 30, 2015.
Liquidity, capital resources and plan of operation
Operation

We have incurred losses since our inception and, as of December 31, 2016,2023, we had an accumulated deficit of approximately $205$297 million. We will continue to incur losses until we generate sufficient revenue to offset our expenses, and we anticipate that we will continue to incur net losses for at least the next several years. We expect to incur additional expenses related to our development and potential commercialization of levosimendan in the LEVEL trial and, pending the outcome of our strategic process, imatinib for heart failurepulmonary hypertension and other potential indications, as well as identifying and developing other potential product candidates, and as a result, we will need to generate significant net product sales, royalty and other revenues to achieve profitability.

The process of conducting preclinical studies and clinical trials necessary to obtain approval from the FDA is costly and time consuming. The probability of success for each product candidate and clinical trial may be affected by a variety of factors, including, among other things, the quality of the product candidate’s early clinical data, investment in the program, competition, manufacturing capabilities and commercial viability. As a result of the uncertainties discussed above, uncertainty associated with clinical trial enrollment and risks inherent in the development process, we are unable to determine the duration and completion costs of current or future clinical stages of our product candidates or when, or to what extent, we will generate revenues from the commercialization and sale of any of our product candidates. Development timelines, probability of success and development costs vary widely. We are currently focused on developing our two product candidates, levosimendan and imatinib, and have prioritized levosimendan in the short-term; however, we will need substantial additional capital in the future in order to complete the development and potential commercialization of levosimendan and imatinib, and to continue with the development of other potential product candidates.

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Liquidity

We have financed our operations since September 1990 through the issuance of debt and equity securities and loans from stockholders. We had total current assets of $13,628,175approximately $11.7 million and $20,560,353$3.2 million and working capital of $7,428,938approximately $8.1 million and $15,958,723$1.4 million as of December 31, 20162023 and December 31, 2015,2022, respectively. Our practice is to invest excess cash, where available, in short-term money market investment instruments and high quality corporate and government bonds.


Clinical and Preclinical Product Development

We are in the clinical trial stage in the development of our product candidates. We recently completedcurrently conducting a Phase III clinical3 trial for levosimendan. We expect our primary focus will be on initiating additional clinicalof oral levosimendan (LEVEL), and preclinical studies for levosimendan for heart failure or other potential indications.intend to recruit patients throughout 2024 and into at least the first half of 2025. Our ability to continue to pursue testing and development of our products, including completing the LEVEL trial, beyond the first half of calendar year 2018 may2024 will depend on obtaining license income or outside financial resources. There is no assurance that we will obtain any license agreement or outside financing or that we will otherwise succeed in obtaining any necessary resources.

Financings

During the years ended April 30, 2015

On February 8, 2024, we sold in a registered public offering (i) an aggregate of 421,260 shares of our common stock and 2014, we received approximately $544,000pre-funded warrants to purchase an aggregate of 1,178,740 shares of our common stock and $7.1 million and issued 209,230 and 3,161,145(ii) accompanying warrants to purchase up to an aggregate of 3,200,000 shares of our common stock at a combined offering price of $5.65 per share of common stock respectively uponand associated warrant, or $5.649 per pre-funded warrant and associated warrant, resulting in gross proceeds to the exerciseCompany of approximately $9.0 million. Net proceeds of the offering were approximately $8.0 million, after deducting the placement agent fees and estimated offering expenses payable by the Company.

As retrospectively adjusted for the Reverse Stock Split, on February 3, 2023, we sold in a registered public offering (i) an aggregate of 86,994 shares of our outstanding warrants. We did not complete any financings duringcommon stock and pre-funded warrants to purchase an aggregate of 21,341 shares of our common stock and (ii) accompanying warrants to purchase up to an aggregate of 216,667 shares of our common stock at a combined offering price of $144.00 per share of common stock and associated warrant, or $143.92 per pre-funded warrant and associated warrant, resulting in gross proceeds to the year ended December 31, 2016 orCompany of approximately $15.6 million. Net proceeds of the eight months ended December 31, 2015.

On March 21, 2014,offering were approximately $14.1 million, after deducting the placement agent fees and offering expenses payable by the Company.

As retrospectively adjusted for the Reverse Stock Splits, on May 17, 2022, we sold 9,285,714 shares6,623 units in a private placement at a purchase price of common stock$1,240.00 per unit for net proceeds of approximately $55$7.9 million.

On July 23, 2013, we sold 5,369 shares Each unit consisted of Series C 8% convertible preferredone unregistered pre-funded warrant to purchase one share of our common stock and warrants for net proceedsone unregistered warrant to purchase one share of approximately $4.9 million. Additionally, on August 22, 2013 we issued 4,600 shares of Series D convertible preferred stock and warrants in exchange for $4.6 million of convertible notes that were scheduled to mature in June 2014.
common stock.

Cash Flows

The following table shows a summary of our cash flows for the periods indicated:

 
 
Year ended December 31,
 
 
 
2016
 
 
2015
 
Net cash used in operating activities
 $(15,871,300)
 $(12,057,891)
Net cash provided by investing activities
  22,206,802 
  4,206,244 
Net cash used in financing activities
  - 
 (164,224)

 

 

Year ended December 31,

 

 

 

2023

 

 

2022

 

Net cash (used in) operating activities

 

$(5,903,532)

 

$(11,388,571)

Net cash (used in) provided by investing activities

 

 

2,843

 

 

 

(2,323)

Net cash provided by financing activities

 

 

13,569,137

 

 

 

7,930,654

 

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Net cash used in(used in) operating activities.activities

Net cash used in operating activities was $15.9approximately $5.9 million for the year ended December 31, 20162023 compared to net cash used in operating activities of $12.1approximately $11.4 million for the year ended December 31, 2015.2022. The increasedecrease in cash used for operating activities of $3.8 million was primarily due primarily to cost incurred forlower expense activity in the Phase III clinic trials for LCOS.

current period as compared to the prior year. 

Net cash (used in)/provided by investing activities

Net cash used in or provided by investing activities was $22.2 millionapproximately $2,843 for the year ended December 31, 20162023, compared to net cash usedapproximately $(2,323) in investing activities of $4.2 million for the year ended December 31, 2015.2022. The increase in cash provided by investing activities was primarily due primarily to the salessale of marketable securities.

Net cash used in financing activities. Net cash used in financing activities was $0 for the year ended December 31, 2016 compared to net cash used in financing activities of $164,224 for the year ended December 31, 2015. The decrease in net cash used in financing activities was due to payments of short term notes in the prior period.
 
 
Eight months ended December 31,
 
 
 
2015
 
 
2014
 
Net cash used in operating activities
 $(8,950,610)
 $(6,632,268)
Net cash provided by (used in) investing activities
  4,784,732 
  (40,356,616)
Net cash (used in) provided by financing activities
  (100,160)
  344,654 
Net cash used in operating activities.  Net cash used in operating activities was $8.95 million for the eight months ended December 31, 2015 compared to net cash used in operating activities of $6.6 million for the eight months ended December 31, 2014. The increase in cash used for operating activities of $3.3 million was due primarily to cost incurred for the Phase III clinic trials for LCOS, partially offset by a decrease in legal and professional fees paid.

Net cash used in investing activities. Net cash provided by investing activities was $4.8 million for the eight months ended December 31, 2015 compared to net cash used in investing activities of $40.4 million for the eight months ended December 31, 2014. The increase in cash provided by investing activities was due primarilyoffice furniture related to the salesrelocation of marketable securities that were purchased during the prior period.
Company’s headquarters.

Net cash provided by financing activities. Net cash used in financing activities was $100,160 for the eight months ended December 31, 2015 compared to net cash provided by financing activities of $344,654 for the eight months ended December 31, 2014. The increase in net cash used in financing activities was due primarily to proceeds received from the exercise of warrants in the prior period.

 
 
Year ended April 30,
 
 
 
2015
 
 
2014
 
Net cash used in operating activities
 $(9,748,794)
 $(9,261,571)
Net cash used in investing activities
  (40,925,860)
  (147,038)
Net cash provided by financing activities
  280,590 
  66,945,636 
Net cash used in operating activities. Net cash used in operating activities was $9.75 million for the year ended April 30, 2015 compared to net cash used in operating activities of $9.26 million for the year ended April 30, 2014. The increase in cash used for operating activities was due primarily to an increase in our costs incurred for the Phase III clinical trials for LCOS and an increase in personnel costs, partially offset by the payment of approximately $1.25 million in assumed liabilities during the prior year.
Net cash used in investing activities. Net cash used in investing activities was $40.93 million for the year ended April 30, 2015 compared to net cash used in investing activities of $147,038 for the year ended April 30, 2014. The increase in cash used for investing activities was due primarily to our investment in marketable securities throughout the year.
Net cash provided by financing activities

Net cash provided by financing activities was $280,590 for the year ended April 30, 2015 compared to net cash provided by financing activities of $66.9approximately $13.6 million for the year ended April 30, 2014.December 31, 2023, compared to approximately $7.9 million in the prior year. The decrease of netincrease in cash provided by financing activities was due primarily to the net proceeds of $55 million received from the issuanceFebruary 3, 2023 sale of common stock $4.9 million received from the issuance of Series C 8% Convertible Preferred Stockand proceeds of $7 million received fromwarrants and the exercise of certain warrants in the prior year.

warrants.

Operating Capital and Capital Expenditure Requirements

Our future capital requirements will depend on many factors that include, but are not limited to the following:

-
the initiation, progress, timing and completion of clinical trials for our product candidates and potential product candidates;
-
the outcome, timing and cost of regulatory approvals and the regulatory approval process;
-
delays that may be caused by changing regulatory requirements;
-
the number of product candidates that we pursue;
-
the costs involved in filing and prosecuting patent applications and enforcing and defending patent claims;
-
the timing and terms of future in-licensing and out-licensing transactions;
-
the cost and timing of establishing sales, marketing, manufacturing and distribution capabilities;
-
the cost of procuring clinical and commercial supplies of our product candidates;
-
the extent to which we acquire or invest in businesses, products or technologies; and
-
the possible costs of litigation.

·

the initiation, progress, timing and completion of clinical trials for our product candidates and potential product candidates;

·

the outcome, timing and cost of regulatory approvals and the regulatory approval process;

·

delays that may be caused by changing regulatory requirements;

·

the number of product candidates we pursue;

·

the costs involved in filing and prosecuting patent applications and enforcing and defending patent claims;

·

the timing and terms of future collaboration, licensing, consulting or other arrangements that we may enter into;

·

the cost and timing of establishing sales, marketing, manufacturing and distribution capabilities;

·

the cost of procuring clinical and commercial supplies of our product candidates;

·

the extent to which we acquire or invest in businesses, products or technologies;

·

delays that may be caused by the global coronavirus pandemic or similar global societal disruptions; and

·

the possible costs of litigation.

Based on our working capital aton December 31, 20162023, and the financing completed on February 8, 2024, we believe we have sufficient capital on hand to continue to fund operations through the first half of calendar year 2018.

2024.

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We will need substantial additional capital beyond 2024, assuming ongoing activities with the LEVEL trial continue at the expected pace. In addition, we will need additional funding in the future in order to complete the regulatory approval and commercialization of levosimendan, as well as to fund the development and commercialization of levosimendan and ourother future product candidates. Until we can generate a sufficient amount of product revenue, if ever, we expect to finance future cash needs through public or private equity offerings, debt financings or corporate collaboration and licensing arrangements. Such funding, if needed, may not be available on favorable terms, if at all. In the event we are unable to obtain additional capital, we may delay or reduce the scope of our current research and development programs and other expenses.

As a result of our historical operating losses and expected future negative cash flows from operations, we have concluded that there is substantial doubt about our ability to continue as a going concern. Similarly, the report of our independent registered public accounting firm on our December 31, 2023 consolidated financial statements include an explanatory paragraph indicating that there is substantial doubt about our ability to continue as a going concern. Substantial doubt about our ability to continue as a going concern may materially and adversely affect the price per share of our common stock and make it more difficult to obtain financing.

If adequate funds are not available, we may also be required to eliminate one or more of our clinical trials, delaying approval of levosimendan or our commercialization efforts. To the extent that we raise additional funds by issuing equity securities, our stockholders may experience additional significant dilution, and debt financing, if available, may involve restrictive covenants. To the extent that we raise additional funds through collaboration and licensing arrangements, it may be necessary to relinquish some rights to our technologies or our product candidates or grant licenses on terms that may not be favorable to us. We may seek to access the public or private capital markets whenever conditions are favorable, even if we do not have an immediate need for additional capital.

Contractual Obligations
Contractual obligations represent future cash commitments and liabilities under agreements with third parties and exclude contingent contractual liabilities for which we cannot reasonably predict future payment,capital at that time. We may also consider strategic alternatives, including contingencies related to potential future development, financing, contingent royalty payments and/a sale of our company, merger, other business combination or scientific, regulatory or commercial milestone payments under development agreements. The following table summarizes our contractual obligations as of December 31, 2016:
 
 
Payments Due by Period
 
 
 
 
 
Total
 
 
Less than
1 Year
 
 
 
 
1-3 Years
 
 
 
 
3-5 Years
 
 
More than
5 Years
 
Operating Lease Obligations
 $528,655 
 $112,431 
 $354,421 
 $61,803 
 $- 
recapitalization.

Off-Balance Sheet Arrangements

Since our inception, we have not engaged in any off-balance sheet arrangements, including the use of structured finance, special purpose entities or variable interest entities.

Summary of Critical Accounting Policies

Use of Estimates—The preparation of the accompanying Consolidated Financial Statementsconsolidated financial statements in conformity with accounting principles generally accepted in the United States of America, or GAAP, requires management to make certain estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the Consolidated Financial Statementsconsolidated financial statements and reported amounts of expenses during the reporting period. Actual results could differ from those estimates.

Preclinical Study and Clinical Accruals—We estimate our preclinical study and clinical trial expenses based on the services received pursuant to contracts with several research institutions and CROs that conduct and manage preclinical and clinical trials on our behalf. The financial terms of the agreements vary from contract to contract and may result in uneven expenses and payment flows. Preclinical study and clinical trial expenses include the following:

-
fees paid to CROs in connection with clinical trials;
-
fees paid to research institutions in conjunction with preclinical research studies; and
-
fees paid to contract manufacturers and service providers in connection with the production and testing of active pharmaceutical ingredients and drug materials for use in preclinical studies and clinical trials.

Revenue Recognition—Revenues from merchandise sales are recognized upon transfer of ownership, including passage of title to the customer and transfer of the risk of loss related to those goods. Revenues are reported on a net sales basis, which is computed by deducting from gross sales the amount of actual product returns received, discounts, incentive arrangements with retailers and an amount established for anticipated product returns.
Grant Revenue is recognized as milestones under the Grant program are achieved. Grant Revenue is earned through reimbursements for the direct costs of labor, travel, and supplies, as well as the pass-through costs of subcontracts with third-party CROs.

·

fees paid to CROs in connection with clinical trials;

·

fees paid to research institutions in conjunction with preclinical research studies; and

·

fees paid to contract manufacturers and service providers in connection with the production and testing of active pharmaceutical ingredients and drug materials for use in preclinical studies and clinical trials.

Stock-Based Compensation—We account for stock-based awards to employees in accordance with Accounting Standards Codification, or ASC 718718: Compensation — Stock Compensation, which provides for the use of the fair value basedvalue-based method to determine compensation for all arrangements where shares of stock or equity instruments are issued for compensation. Fair values of equity securities are determined by management based predominantly on the trading price of our common stock. The values of these awards are based upon their grant-date fair value. That cost is recognized over the period during which the employee is required to provide service in exchange for the reward.

We account for equity instruments issued to non-employees in accordance with ASC 505-50, Accounting for Equity Instruments That Are IssuedEquity-Based Payments to Other Than Employees for Acquiring, or in Conjunction with Selling, Goods or Services. EquityNon-Employees. We record equity instruments issued to non-employees are recordednon- at their fair value on the measurement date and are subject to periodic adjustmentperiodically adjust them as the underlying equity instruments vest.

Impairment TestingIn accordance with GAAP, goodwill impairment testing is performed annually, or more frequently if indicated by events or conditions. In the course of the evaluation of the potential impairment of goodwill, either a qualitative or a quantitative assessment may be performed. If a qualitative evaluation determines that no impairment exists, then no further analysis is performed. If a qualitative evaluation is unable to determine whether impairment has occurred, a quantitative evaluation is performed. The quantitative impairment test first identifies potential impairments by comparing the fair value of the reporting unit with its carrying value. If the fair value exceeds the carrying amount, goodwill is not impaired. If the carrying value exceeds the fair value, the implied fair value of goodwill is calculated and an impairment is recorded if the implied fair value is less than the carrying amount. The determination of goodwill impairment is highly subjective. It considers many factors both internal and external and is subject to significant changes from period to period.
During the year ended December 31, 2016, we recognized an impairment charge of $33.3 million related to our levosimendan product in Phase III clinical trial, which represents approximately $22 million for IPR&D assets and approximately $11.3 million for goodwill.
The LEVO-CTS trial was completed in December of 2016. Based on the data from the trial, levosimendan, given prophylactically prior to cardiac surgery to patients with reduced left ventricular function, had no effect on the co-primary outcomes. The study did not achieve statistically significant reductions in the dual endpoint of death or use of a mechanical assist device at 30 days, nor in the quad endpoint of death, myocardial infarction, need for dialysis, or use of a mechanical assist device at 30 days. Based on the results of the LEVO-CTS trial, we do not anticipate additional development of levosimendan for the treatment of LCOS in patients undergoing cardiac surgery. As of December 31, 2016, management determined the IPR&D asset, and corresponding Goodwill, was more than temporarily impaired.
No goodwill impairment charges have resulted from this analysis for the eight months ended December 31, 2015, or the years ended April 30, 2015 and 2014.
Fair market value accounting (derivative warrant liability)A significant estimate that could have a material effect on net (loss) gain is the fair market value accounting for our derivative liability. Our derivative liability consists of free standing warrants that are recorded as liabilities due to the price protection anti-dilution provisions in the event of a subsequent equity sale. As a result, the warrants must be recorded as a liability at fair value. The changes in fair value are posted in other (income) expense. We utilize the Monte Carlo method to estimate the fair value of our warrants. The three most significant factors in the Monte Carlo method are (i) our stock price, (ii) the volatility of our stock price and (iii) the remaining term of the warrants. During the year ending December 31, 2016, a $1.33 decrease in the value of our stock was the primary cause of the $298,248 derivative gain.

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Recent Accounting Pronouncements

In January 2017,June 2016, the Financial Accounting Standards Board or the FASB,(“FASB”) issued a new accounting standard that provides guidance for evaluating whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The guidance provides a screen to determine when an integrated set of assets and activities, or a set, does not qualify to be a business. The screen requires that when substantially all of the fair value of the gross assets acquired (or disposed of) is concentrated in an identifiable asset or a group of similar identifiable assets, the set is not a business. If the screen is not met, the guidance requires a set to be considered a business to include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create outputs and removes the evaluation as to whether a market participant could replace the missing elements. The new standard will be effective for us on January 1, 2018 and will be adopted on a prospective basis. Early adoption is permitted. We are currently evaluating the effect that the standard will have on our consolidated financial statements and related disclosures.

In August 2016, the FASB issued a new accounting standard that clarifies how companies present and classify certain cash receipts and cash payments in the statement of cash flows where diversity in practice exists. The new standard is effective for us in our first quarter of fiscal 2018 and earlier adoption is permitted. We are currently evaluating the effect that the updated standard will have on our consolidated financial statements and related disclosures.
In June 2016, the FASB, issued a new accounting standard that amends how credit losses are measured and reported for certain financial instruments that are not accounted for at fair value through net income. This new standard will requirerequires that credit losses be presented as an allowance rather than as a write-down for available-for-sale debt securities and will be effective for interim and annual reporting periods beginning January 1, 2020,2023, with early adoption permitted, but not earlier than annual reporting periods beginningpermitted. We adopted this standard on January 1, 2019. A modified retrospective approach is to be used for certain parts of this guidance, while other parts2023. Our adoption of the guidance are to be applied using a prospective approach. We are currently evaluating the impact that this new standard will have on our consolidated financial statements and related disclosures.
In March 2016, the FASB issued a new accounting standard intended to simplify various aspects related to how share-based payments are accounted for and presented in the financial statements. The new guidance includes provisions to reduce the complexity related to income taxes, statement of cash flows, and forfeitures when accounting for share-based payment transactions. The new standard is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. Early adoption is permitted. We dodid not believe the adoption of this standard will have a materialsignificant impact on our consolidated financial statements.
In May 2014, the FASB issued a new accounting standard that supersedes nearly all existing revenue recognition guidance under GAAP. The new standard is principles-based and provides a five-step model to determine when and how revenue is recognized. The core principle of the new standard is that revenue should be recognized when a company transfers promised goods or services to customers in an amount that reflects the consideration to which the Company expects to be entitled in exchange for those goods or services. In March 2016, the FASB issued a new standard to clarify the implementation guidance on principal versus agent considerations, and in April 2016, the FASB issued a new standard to clarify the implementation guidance on identifying performance obligations and licensing. The new standard also requires disclosure of qualitative and quantitative information surrounding the amount, nature, timing and uncertainty of revenues and cash flows arising from contracts with customers. In July 2015, the FASB agreed to defer the effective date of the standard from annual periods beginning after December 15, 2016, to annual periods beginning after December 15, 2017, with an option that permits companies to adopt the standard as early as the original effective date. Early application prior to the original effective date is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. We do not believe the adoption of this standard will have a material impact on our consolidated financial statements.
In February 2016, the FASB issued a new accounting standard intended to improve financial reporting regarding leasing transactions. The new standard will require us to recognize on the balance sheet the assets and liabilities for the rights and obligations created by all leased assets. The new standard will also require us to provide enhanced disclosures designed to enable users of financial statements to understand the amount, timing, and uncertainty of cash flows arising from all leases, operating and capital, with lease terms greater than 12 months. The new standard is effective for financial statements beginning after December 15, 2018, and interim periods within those annual periods. Early adoption is permitted. We are currently evaluating the impact that this new standard will have on our financial statements and related disclosures.

In January 2016, the FASB issued a new accounting standard that will enhance our reporting for financial instruments. The new standard is effective for financial statements issued for annual periods beginning after December 15, 2017, and interim periods within those annual periods. Earlier adoption is permitted for interim and annual reporting periods as of the beginning of the fiscal year of adoption. We do not believe the adoption of this standard will have a material impact on our consolidated financial statements.
In November 2015, the FASB issued a new accounting standard that changes the balance sheet classifications of deferred income taxes. This standard amends existing guidance to require that deferred tax liabilities and assets be classified as noncurrent in a classified statement of financial position. It is effective for annual reporting periods beginning after December 15, 2016, and interim periods within those annual periods. Early adoption is permitted. We do not expect adoption of this standard will have a material impact on our consolidated financial statements.
In August 2014, the FASB issued a new accounting standard that will require management to assess and evaluate whether conditions or events exist, considered in the aggregate, that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the financial statements issue date. It is effective for annual periods ending after December 15, 2016 and for annual and interim periods thereafter; early adoption is permitted. The adoption of this standard did not have a material impact on our consolidated financial statements.

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ITEM 7A—QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Interest Rate Risk
We are subject to interest rate risk on our investment portfolio.
We invest in marketable securities in accordance with our investment policy. The primary objectives of our investment policy are to preserve capital, maintain proper liquidity to meet operating needs and maximize yields. Our investment policy specifies credit quality standards for our investments and limits the amount of credit exposure to any single issue, issuer or type of investment. We place our excess cash with high credit quality financial institutions, commercial

Smaller reporting companies and government agencies in order to limit the amount of credit exposure. Some of the securities we invest in may have market risk. This means that a change in prevailing interest rates may cause the principal amount of the investment to fluctuate.

Our investment exposure to market risk for changes in interest rates relates to the increase or decrease in the amount of interest income we can earn on our portfolio, changes in the market value due to changes in interest rates and other market factors as well as the increase or decrease in any realized gains and losses. Our investment portfolio includes only marketable securities and instruments with active secondary or resale markets to help ensure portfolio liquidity. A hypothetical 100 basis point drop in interest rates along the entire interest rate yield curve would not significantly affect the fair value of our interest sensitive financial instruments. We generally have the ability to hold our fixed-income investments to maturity and therefore do not expect that our operating results, financial position or cash flows will be materially impacted due to a sudden change in interest rates. However, our future investment income may fall short of expectations due to changes in interest rates, or we may suffer losses in principal if forced to sell securities which have declined in market value due to changes in interest rates or other factors, such as changes in credit risk related to the securities’ issuers. To minimize this risk, we schedule our investments to have maturities that coincide with our expected cash flow needs, thus avoiding the need to redeem an investment prior to its maturity date. Accordingly, we do not believe that we have material exposure to interest rate risk arising from our investments. Generally, our investments are not collateralized. We have not realized any significant losses from our investments.
We do not use interest rate derivative instrumentsrequired to manage exposure to interest rate changes. We ensureprovide the safety and preservation of invested principal fundsinformation required by limiting default risk, market risk and reinvestment risk. We reduce default risk by investing in investment grade securities.

this item.

ITEM 8—CONSOLIDATED FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA

See the financial statements included at the end of this report beginning on page F-1.

ITEM 9—CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE

None.

ITEM 9A—CONTROLS AND PROCEDURES

Disclosure Controls and Procedures

As required by paragraph (b) of Rules 13a-15 and 15d-15 promulgated under the Exchange Act, under the supervision and with the participation of our management, including our President and Chief Executive Officer and our Interim Chief Financial Officer, we conducted an evaluation as of the end of the period covered by this Annual Report on Form 10-K, of the effectiveness of our disclosure controls and procedures as defined in Exchange Act Rules 13a-15(e) and 15d-15(e).

In designing and evaluating our disclosure controls and procedures, management recognizes that any disclosure controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives. In addition, the design of disclosure controls and procedures must reflect the fact that there are resource constraints, and that management is required to apply its judgment in evaluating the benefits of possible controls and procedures relative to their costs.

Based on their evaluation, our President and Chief Executive Officer and Interim Chief Financial Officer concluded that our disclosure controls and procedures were effective as of December 31, 2023, the end of the period covered by this Annual Report on Form 10-K, in that they provide reasonable assurance that the information we are required to disclose in the reports we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods required by the SEC and is accumulated and communicated to our management, including our President and Chief Executive Officer and Interim Chief Financial Officer, as appropriate to allow timely decisions regarding required disclosure.

Changes in Internal Controls over Financial Reporting

There were no changes in our internal control over financial reporting during our most recently completed fiscal quarter that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting. We routinely review our internal controls over financial reporting and from time to time make changes intended to enhance the effectiveness of our internal control over financial reporting. We will continue to evaluate the effectiveness of our disclosure controls and procedures and internal controls over financial reporting on an ongoing basis and will take action as appropriate.

During the most recently completed fiscal quarter, management reviewed all work generated in support of the financial statements and corresponding footnotes to determine areas which may be susceptible to human error. The review focused on limiting manual inputs into work papers wherever possible and tying inputs to external source documents. In addition, management also enhanced its work paper review to compare figures to prior year amounts or source documents and increased the number of calculations in the work papers that are reviewed and re-performed.

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Management’s Annual Report on Internal Control over Financial Reporting

Our management is responsible for establishing and maintaining adequate internal control over financial reporting. Internal control over financial reporting, as defined in Rule 13a-15(f) and Rule 15(d)-15(f) under the Exchange Act, is a process designed by, or under the supervision of, our President and Chief Executive Officer and Interim Chief Financial Officer and affected by our Board of Directors, management and other personnel to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with GAAP. Internal control over financial reporting includes those policies and procedures that:

·

Pertain to the maintenance of records that in reasonable detail accurately and fairly reflect the transactions and dispositions of our assets;

·

Provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with GAAP, and that our receipts and expenditures are being made only in accordance with authorizations of our management and our Board of Directors; and

·

Provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of our assets that could have a material effect on our financial statements.

Internal control over financial reporting cannot provide absolute assurance of achieving financial reporting objectives because of its inherent limitations. Internal control over financial reporting is a process that involves human diligence and compliance and is subject to lapses in judgment and breakdowns resulting from human failures. Internal control over financial reporting can also be circumvented by collusion or improper override. Because of such limitations, there is a risk that material misstatements may not be prevented or detected on a timely basis by internal control over financial reporting. However, these inherent limitations are known features of the financial reporting process, and it is possible to design into the process safeguards to reduce, though not eliminate, this risk.

Our management assessed the effectiveness of our internal control over financial reporting as of December 31, 2023. In making its assessment, management used the criteria established by the Committee of Sponsoring Organizations of the Treadway Commission in its 2013 Internal Control — Integrated Framework. Based on its assessment, management has concluded that our internal control over financial reporting was effective as of December 31, 2023.

Attestation Report of Registered Public Accounting Firm

Our independent registered public accounting firm has not assessed the effectiveness of our internal control over financial reporting and, under SEC rules, will not be required to provide an attestation report on the effectiveness of our internal control over financial reporting so long as we qualify as a “non-accelerated filer”.

ITEM 9B—OTHER INFORMATION

None.

ITEM 9C—DISCLOSURE REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTIONS

Not applicable.

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PART III

ITEM 10— DIRECTORS, EXECUTIVE OFFICERS, AND CORPORATE GOVERNANCE

Board of Directors

Information about our directors, their ages as of March 28, 2024, and the expiration dates of their current terms of Board service are provided in the table below. Additional biographical descriptions are set forth in the text below the tables and include the primary individual experience, qualifications, attributes and skills of each director that led to the conclusion that such director should serve as a member of our Board at this time.

Name

Age

Position with Tenax Therapeutics, Inc.

Director Since

June Almenoff, MD, PhD

67

Director

February 2021

Michael Davidson, MD

67

Director

February 2021

Declan Doogan, MD

72

Director

February 2021

Christopher T. Giordano

50

President and Chief Executive Officer and Director

July 2021

Robyn M. Hunter

62

Director

January 2022

Gerald T. Proehl

65

Chair

April 2014

Stuart Rich, MD

74

Chief Medical Officer and Director

February 2021

June Almenoff, MDPhD has served as a director since February 2021. Dr. Almenoff is currently the Chief Medical Officer at RedHill Biopharma Inc. (NASDAQ: RDHL), a specialty biopharmaceutical company, primarily focused on gastrointestinal and infectious diseases, where she serves on the commercial executive team. From March 2010 to October 2014, Dr. Almenoff served as President and Chief Medical Officer and a member of the board of directors of Furiex Pharmaceuticals, Inc. (previously NASDAQ: FURX) (“Furiex”), a drug development collaboration company that was acquired by Actavis plc (now AbbVie, Inc.) for $1.2 billion in July 2014. Prior to joining Furiex, Dr. Almenoff was at GlaxoSmithKline plc (NYSE: GSK) for twelve years, where she held various positions of increasing responsibility, most recently Vice President in the Clinical Safety organization. Dr. Almenoff is on the investment advisory board of the Harrington Discovery Institute, a private venture philanthropy. She serves on the board of directors of Avalo Therapeutics, Inc. (NASDAQ: AVTX) and is a director-advisor of inSoma Bio, Inc. She previously served as a member of the board of directors of Brainstorm Therapeutics, Inc. (NASDAQ: BCLI), Tigenix NV (formerly NASDAQ: TIG), OHR Pharmaceutical Inc. (formerly NASDAQ: OHRP), Kurome Therapeutics, Inc., and as executive chair of the board of directors of RDD Pharma, Ltd. Dr. Almenoff received her B.A. cum laude from Smith College and graduated with AOA honors from the M.D.-Ph.D. program at the Icahn (Mt. Sinai) School of Medicine. She completed post-graduate medical training at Stanford University Medical Center and served on the faculty of Duke University School of Medicine. She is an adjunct Professor at Duke, a Fellow of the American College of Physicians and has authored over 60 publications.

Our Board of Directors believes that Dr. Almenoff’s close to 25 years of leadership experience as a biopharma executive, her expertise in research and development, as well as her experience with public and private biotech boards, venture philanthropy investment, and product commercialization qualify her to serve on our Board.

Michael Davidson, MD has served as a director since February 2021. Since August 2020, Dr. Davidson has served as the Chief Executive Officer of New Amsterdam Pharma B.V., a clinical stage company focused on the treatment of cardio-metabolic diseases. Since April 2007, Dr. Davidson has also served as Clinical Professor and Director of the Lipid Clinic at the University of Chicago Pritzker School of Medicine. From January 2016 to July 2020, Dr. Davidson was the Founder and Chief Scientific Officer and a director of Corvidia Therapeutics, a company focused on the development of transformational therapies for cardio-renal diseases, which was acquired by Novo-Nordisk for up to $2.1 billion in June 2020. Prior to that, from November 2009 to January 2016, Dr. Davidson was the co-founding Chief Medical Officer of Omthera Pharmaceuticals, Inc., a specialty pharmaceuticals company focusing its efforts on the clinical development of new therapies for dyslipidemia, which was acquired by AstraZeneca plc in 2013 for $443 million. Earlier in his career, he founded the Chicago Center for Clinical Research, which became the largest investigator site in the United States and was acquired by PPD, Inc. in 1996. He currently serves as a member of the board of directors of Caladrius Biosciences, Inc. (NASDAQ: CLBS), Silence Therapeutics PLC (NASDAQ: SLN), Sonogene LLC, Jocasta Neuroscience, Inc. and Trofi Nutritionals, Inc. His research background encompasses both pharmaceutical and nutritional clinical trials including extensive research on statins, novel lipid-lowering drugs, and omega-3 fatty acids. Dr. Davidson is board-certified in internal medicine, cardiology, and clinical lipidology and served as President of the National Lipid Association from 2010 to 2011. He received his B.A./M.S. from Northwestern University and M.D. from The Ohio State University School of Medicine.

Our Board of Directors believes that Dr. Davidson’s medical background and extensive experience in clinical development, as well as his extensive experience as an executive of several biotechnology companies, qualify him to serve on our Board.

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Declan Doogan, MD has served as a director since February 2021. Since November 2019, Dr. Doogan has served as co-founder and Chief Medical Officer of Juvenescence Ltd., a life sciences company developing therapies to modify aging and increase healthy human lifespan. From June 2013 to May 2019, Dr. Doogan served as Chief Executive Officer of Portage Biotech, Inc. (NASDAQ: PRTG), a clinical-stage immuno-oncology company, where he currently remains a director. From 2007 to 2012, Dr. Doogan held various executive roles at Amarin Corporation (NASDAQ: AMRN), a pharmaceutical company focused on cardiovascular disease management, including Head of Research and Development, Interim Chief Executive Officer, and Chief Medical Officer. Prior to that, from 1982 to 2007, he held a number of executive positions in the U.S., the U.K. and Japan at Pfizer, Inc. (NYSE: PFE), a multinational pharmaceutical and biotechnology corporation, and was most recently the Senior Vice President and Head of Worldwide Development. Beyond his executive career, Dr. Doogan is an investor in emerging biotechnology companies, and is a partner at Mediqventures Ltd., a biotech merchant bank and investment firm. In addition to Portage Biotech, Inc., Dr. Doogan currently serves as a member of the board of directors of Apterna Ltd. and Causeway Therapeutics Ltd. Dr. Doogan previously served as chairman of the board of directors of Biohaven Pharmaceuticals (NYSE: BHVN) and a member of the boards of directors of Intensity Therapeutics, Inc. (NASDAQ: INTS), Sosei Group Corporation (TSE: 4565), Kleo Pharmaceuticals, Inc. and Celleron Therapeutics Ltd. Dr. Doogan has also held professorships at Harvard School of Public Health, Glasgow University Medical School and Kitasato University (Tokyo). He received his medical degree from Glasgow University. He is a Fellow of the Royal College of Physicians and the Faculty Pharmaceutical Medicine and holds a Doctorate of Science at the University of Kent in the U.K.

Our Board of Directors believes that Dr. Doogan’s 30 years of experience in the global pharmaceutical industry in both major pharmaceutical and biotechnology companies, in addition to his medical background, experience in clinical development and extensive board experience on both public and privately held life sciences companies, qualify him to serve on our Board.

Christopher T. Giordano joined the Company as our Chief Executive Officer and a member of our Board of Directors in July 2021 and became President and Chief Executive Officer in October 2021. From March 2018 to July 2021, he served as President of IQVIA Biotech LLC and IQVIA MedTech Inc., a provider of integrated clinical and commercial solutions to medical device and small biotech companies, where he led an executive team that managed a clinical trial portfolio that grew from 250 to 400 active projects during his three years of leadership. Prior to that role, from August 2008 to March 2018, Mr. Giordano held roles of increasing responsibility at Quintiles Transnational Holdings Inc., a provider of pharmaceutical outsourcing services (acquired by IMS Health Holdings, Inc. in October 2016 to become IQVIA Holdings Inc.), and was most recently Global Vice President of the cardiovascular, renal, and metabolic group. From January 2001 to July 2008, Mr. Giordano served in various sales and operational roles at PPD, Inc., a global clinical research organization. Mr. Giordano holds a B.A. (summa cum laude) in English from the University of San Diego and a M.A. in English from the University of North Carolina at Chapel Hill.

Our Board of Directors believes that Mr. Giordano’s 20 years of experience in the clinical research industry and extensive experience with bringing pharmaceutical products to market qualify him to serve on our Board.

Robyn M. Hunter has served as a director since January 2022. Since August 2022, she has served as global Chief Financial Officer of Sotio Biotech Inc., a clinical stage immuno-oncology company. Previously, she served as the Chief Financial Officer of Fortress Biotech, Inc. (NASDAQ: FBIO) ("Fortress Biotech") from June 2017 to August 2022, and from August 2011 to June 2017, she served as the Vice President and Corporate Controller of Fortress Biotech. From January 2006 to May 2011, Ms. Hunter served as Senior Vice President and Chief Financial Officer of Schochet Associates, Inc. From August 2004 to January 2006, Ms. Hunter served as the Corporate Controller for Indevus Pharmaceuticals, Inc. From 1990 to 2004, Ms. Hunter held several positions from Accounting Manager to Vice President and Treasurer of The Stackpole Corporation. Ms. Hunter holds a B.A. in Economics from Union College in Schenectady, New York.

Our Board of Directors believes that Ms. Hunter’s general business experience and finance expertise and practice in the pharmaceutical industry, developed through her leadership at other companies, qualifies her to serve on our Board.

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Gerald T. Proehlhas served as a director since April 2014. Since June 2015, Mr. Proehl has served as Founder, President, Chief Executive Officer and Chair of the board of directors of Dermata Therapeutics, Inc., a biotechnology company (NASDAQ: DRMA). In January 1999, Mr. Proehl co-founded Santarus, Inc., a specialty biopharmaceutical company, and through January 2014, until its sale to Salix Pharmaceuticals, Ltd. for $2.6 billion, he held various leadership roles, including as President, Chief Executive Officer and a director. Prior to joining Santarus, Mr. Proehl was with Hoechst Marion Roussel (HMR) for 14 years where he served in various capacities, including Vice President of Global Marketing. During his career at HMR he worked across numerous therapeutic areas, including central nervous system, cardiovascular, and gastrointestinal. In addition to Dermata Therapeutics, Mr. Proehl serves on the board of directors of Kinetek Sports, Inc. Mr. Proehl previously served on the boards of Sophiris Bio Inc. (formerly OTCQB: SPHS), Ritter Pharmaceuticals, Inc. (formerly NASDAQ: RTTR), and Auspex Pharmaceuticals, Inc. (formerly NASDAQ: ASPX). Mr. Proehl holds a B.S. in education from the State University of New York at Cortland, an M.A. in exercise physiology from Wake Forest University and an M.B.A. from Rockhurst University.

Our Board of Directors believes that Mr. Proehl’s general business and commercial experience in the pharmaceutical industry, as well as his strong background in business operations developed through his leadership at other companies, qualify him to serve on our Board.

Stuart Rich, MD has served as our Chief Medical Officer since January 2021 and a director since February 2021. Dr. Rich joined the Company from PHPrecisionMed Inc. (PHPM), where he was a co-founder and held the positions of Chief Executive Officer and Director from October 2018 until PHPM’s merger with the Company in January 2021. Beginning July 2015, Dr. Rich has served as Professor of Medicine (and since 2021, Professor Emeritus) at Northwestern University Feinberg School of Medicine. He was co-founder and a Trustee of the Pulmonary Vascular Research Institute from 2006 until 2023, a U.K. based charity. From July 2015 until January 2021, he also served as the Director of the Pulmonary Vascular Disease Program at the Bluhm Cardiovascular Institute of Northwestern University, and since January 2006 he has served as a Director of the Cardiovascular Medical and Research Foundation, a U.S. based charity. He was a standing member of the Cardiovascular and Renal Advisory Committee of the U.S. Food and Drug Administration from 2002 through 2013. Prior to Northwestern University, Dr. Rich was Professor of Medicine at the Section of Cardiology of the University of Chicago Pritzker School of Medicine from September 2004 to July 2015. Dr. Rich also served as the Chief Medical Officer (part-time) of United Therapeutics from October 2003 until December 2004. He was Professor of Medicine at the Rush Heart Institute of the Rush University School of Medicine from July 1996 to September 2004 and Professor of Medicine and Chief of the Section of Cardiology at the University of Illinois College of Medicine in Chicago from July 1980 to July 1996. Dr. Rich received his B.S. in Biology at the University of Illinois and his M.D. at Loyola University Stritch School of Medicine, and he completed his residency in medicine at the Washington University of St. Louis and his fellowship in cardiology at the University of Chicago.

Our Board of Directors believes that Dr. Rich’s extensive medical background in the field of pulmonary hypertension and experience as a consultant and standing member of the Cardiovascular and Renal Advisory Committee of the U.S. Food and Drug Administration qualify him to serve on our Board.

EXECUTIVE OFFICERS

The following table sets forth information concerning our executive officers as of March 28, 2024:

Name

Age

Position with Tenax Therapeutics, Inc.

Christopher T. Giordano

50

President and Chief Executive Officer and Director

Lawrence R. Hoffman

69

Interim Chief Financial Officer

Stuart Rich, MD

74

Chief Medical Officer and Director

The biographies of Mr. Giordano and Dr. Rich appear above, under the heading “Directors”.

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Lawrence R. Hoffman has served as our Interim Chief Financial Officer since January 2024. Since November 2021, Mr. Hoffman has served as a consultant to several companies through Danforth, including as Interim Chief Financial Officer for SCYNEXIS, Inc. (Nasdaq: SCYX) from November 2021 until October 2022. Prior to joining Danforth, from February 2018 to October 2021, Mr. Hoffman was Chief Financial Officer of Sermonix Pharmaceuticals, Inc. Prior to that, Mr. Hoffman has held executive management positions at multiple public and private companies in the United States. Mr. Hoffman holds a B.S. in Business Administration from La Salle University, a J.D. from Temple University School of Law, an LL.M. (taxation) from Villanova University School of Law, and is a Certified Public Accountant in Pennsylvania.

Director Independence

In accordance with the applicable Nasdaq Listing Rules, our Board of Directors must consist of a majority of “independent directors”, which is defined generally as a person other than an officer or employee of the company or its subsidiaries or any other individual having a relationship, which, in the opinion of our Board would interfere with the director’s exercise of independent judgment in carrying out the responsibilities of a director.

The Board has determined that directors Drs. Almenoff, Davidson, and Doogan, Mr. Proehl and Ms. Hunter are independent directors in accordance with applicable Nasdaq Listing Rules. In making these determinations, the Board reviewed the information provided by the director nominees with regard to each individual’s business and personal activities as they may relate to us and our management.

The Board of Directors has determined that all of the members of each of the Audit and Compliance, Compensation, and Corporate Governance and Nominating Committees are independent as defined under applicable Nasdaq Listing Rules. In addition, the Board has determined that Ms. Hunter, and Drs. Almenoff and Davidson meet the additional test for independence for audit committee members and Ms. Hunter, Mr. Proehl and Dr. Davidson meet the additional test for independence for compensation committee members imposed by SEC regulations and the Nasdaq Listing Rules.

Standing Committees of the Board of Directors

Our Board of Directors has three standing committees: the Audit and Compliance Committee, the Compensation Committee, and the Corporate Governance and Nominating Committee. Copies of the charters of the Audit and Compliance, Compensation, and Corporate Governance and Nominating Committees, as they may be amended from time to time, are available on our website at http://www.tenaxthera.com.

The following table provides membership information of our directors on each committee of our Board of Directors as of January 30, 2024.

Audit and Compliance

Committee

Compensation

Committee

Corporate

Governance and Nominating

Committee

June Almenoff

tenx_10kimg1.jpg

tenx_10kimg2.jpg

Michael Davidson

tenx_10kimg3.jpg

tenx_10kimg4.jpg

Declan Doogan

tenx_10kimg5.jpg

Robyn M. Hunter

tenx_10kimg6.jpg

tenx_10kimg7.jpg

Gerald T. Proehl

tenx_10kimg8.jpg

tenx_10kimg9.jpg

tenx_10kimg10.jpg = Committee Chair

tenx_10kimg11.jpg = Member

Audit and Compliance Committee

The members of the Audit and Compliance Committee are currently Drs. Almenoff and Davidson and Ms. Hunter. Ms. Hunter serves as chair of the Audit and Compliance Committee. The Board of Directors has determined that Ms. Hunter qualifies as an “audit committee financial expert” as defined by applicable SEC rules. The Audit and Compliance Committee met four times during the year ended December 31, 2023.

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Legal Proceedings with Directors or Executive Officers

There are no legal proceedings related to any of our directors or executive officers that require disclosure pursuant to Items 103 or 401(f) of Regulation S-K.

Family Relationships

There is no family relationship between any director, executive officer, or person nominated to become a director or executive officer of our Company.

Code of Ethics

We have adopted a Code of Ethics and Business Conduct (the “Code of Ethics”) applicable to all of our officers, directors and employees, including our principal executive officer, principal financial officer, principal accounting officer, controller, or persons performing similar functions. A copy of this Code of Ethics is available free of charge and is posted on our website at http://investors.tenaxthera.com/corporate-governance. In the event the Code of Ethics is revised, or any waiver is granted under the Code of Ethics with respect to our principal executive officer, principal financial officer, principal accounting officer, controller, or persons performing similar functions, notice of such revision or waiver will be posted on our website or disclosed on a current report on Form 8-K as required.

Compliance with Section 16(a) Reports

The information required by this Item, if any, concerning compliance with Section 16(a) of the Exchange Act will be incorporated by reference from the section of the proxy statement captioned “Delinquent Section 16(a) Reports”.

ITEM 11— EXECUTIVE COMPENSATION

The following tables and narrative discussion describe the material elements of our executive compensation program during 2023. We also provide an overview of our executive compensation philosophy, including our principal compensation policies and practices.

Our “named executive officers” for fiscal year 2023 includes the individual who served as our principal executive officer during 2023, the only other person serving as an executive officer as of December 31, 2023, and the individual who formerly served as our principal financial officer during 2023 (who died in December 2023). Our named executive officers (“NEOs”) for 2023 were:

·

Christopher T. Giordano, our President and Chief Executive Officer (our “CEO”);

·

Stuart Rich, our Chief Medical Officer (our “CMO”); and

·

Eliot M. Lurier, our Former Interim Chief Financial Officer (our “Former Interim CFO”).

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2023 Summary Compensation Table

 

 

 

 

Salary

 

 

Option

Awards

 

 

 

 

Non-Equity

Incentive Plan Compensation

 

 

 

 

All Other

Compensation

 

 

 

 

Total

 

Name and Principal Position

 

Year

 

($)(1)

 

 

($)(2)

 

 

 

 

($)

 

 

 

 

($)

 

 

 

 

($)

 

Christopher T. Giordano

 

2023

 

 

405,300

 

 

 

--

 

 

 

 

 

 

202,650

 

 

 

(3)

 

 

36,820

 

 

 

(4)

 

 

644,770

 

President and Chief Executive Officer

 

2022

 

 

386,000

 

 

 

104,296

 

 

 

(5)

 

 

144,750

 

 

 

(6)

 

 

32,286

 

 

 

(7)

 

 

667,332

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stuart Rich

 

2023

 

 

318,000

 

 

 

--

 

 

 

 

 

 

 

127,200

 

 

 

(8)

 

 

36,023

 

 

 

(9)

 

 

481,223

 

Chief Medical Officer

 

2022

 

 

309,000

 

 

 

52,148

 

 

 

(10)

 

 

92,700

 

 

 

(11)

 

 

14,296

 

 

 

(12)

 

 

468,144

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eliot M. Lurier (13)

 

2023

 

 

--

 

 

 

--

 

 

 

 

 

 

 

--

 

 

 

 

 

 

 

166,288

 

 

 

(14)

 

 

166,288

 

Former Interim Chief Financial Officer

 

2022

 

 

--

 

 

 

--

 

 

 

 

 

 

 

--

 

 

 

 

 

 

 

221,700

 

 

 

(14)

 

 

221,700

 

(1)

Reflects base salary earned during the fiscal year covered.

(2)

The amounts in these columns reflect the aggregate grant date fair value of awards granted during the year computed in accordance with FASB ASC Topic 718, Compensation - Stock Compensation. The assumptions made in determining the fair values of our stock and option awards are set forth in Note F to our Financial Statements for the year ended December 31, 2022, included in our Form 10-K for the fiscal year ended December 31, 2022, filed with the SEC on March 31, 2023.

(3)

In March 2024, the Compensation Committee calculated the predetermined operational goals for 2023 had been achieved at 100%, resulting in a cash bonus of $202,650 paid to Mr. Giordano.

(4)

Consists of $23,620 of health and benefit premiums for coverage of Mr. Giordano and his eligible dependents and $13,200 of Company contributions to Mr. Giordano’s 401(k) plan.

(5)

During 2022, we granted an option to purchase 125 shares of Common Stock at an exercise price of $992 per share to Mr. Giordano, as retrospectively adjusted for the Reverse Stock Splits. The option is exercisable as to one-fourth of the shares underlying the option on each of June 9, 2023, June 9, 2024, June 9, 2025 and June 9, 2026, subject to Mr. Giordano’s continued employment.

(6)

Mr. Giordano was eligible to receive a target cash bonus of $193,000, if the Compensation Committee calculated that the predetermined operational goals had been achieved at 100%. In March 2023, the Compensation Committee calculated the predetermined operational goals for 2022 had been achieved at 75% resulting in a cash bonus of $144,750 paid to Mr. Giordano.

(7)

Consists of $20,086 of health and benefit premiums for coverage of Mr. Giordano and his eligible dependents and $12,200 of Company contributions to Mr. Giordano’s 401(k) plan.

(8)

In March 2024, the Compensation Committee calculated the predetermined operational goals for 2023 had been achieved at 100%, resulting in a cash bonus of $127,200 paid to Dr. Rich.

(9)

Consists of $22,823 of benefit premiums for Dr. Rich and $13,200 of Company contributions to Dr. Rich’s 401(k) plan.

(10)

During 2022, we granted an option to purchase 63 shares of Common Stock at an exercise price of $992 per share to Dr. Rich, as retrospectively adjusted for the Reverse Stock Splits. The option is exercisable as to one-fourth of the shares underlying the option on each of June 9, 2023, June 9, 2024, June 9, 2025 and June 9, 2026, subject to Dr. Rich’s continued employment.

(11)

Dr. Rich was eligible to receive a target cash bonus of $123,600, if the Compensation Committee calculated that the predetermined operational goals had been achieved at 100%. In March 2023, the Compensation Committee calculated the predetermined operational goals for 2022 had been achieved at 75% resulting in a cash bonus of $92,700 paid to Dr. Rich.

(12)

Consists of $2,096 of benefit premiums for Dr. Rich and $12,200 of Company contributions to Dr. Rich’s 401(k) plan.

(13)

Mr. Lurier died in December 2023.

(14)

Mr. Lurier was a consulting Interim Chief Financial Officer employed by Danforth and was contracted on a part time basis beginning in October 2021. We paid $166,288 in consulting fees to Danforth for Mr. Lurier’s services in fiscal year 2023 and $221,700 in 2022.

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Narrative to Summary Compensation Table

Elements of Compensation

During the year ended December 31, 2023, we compensated our Named Executive Officers generally through a mix of (i) base salary and (ii) annual cash bonus based on achievement of predetermined operational goals. We did not issue long-term equity compensation because the Board determined there were insufficient shares reserved under our 2022 Stock Incentive Plan.

Mr. Lurier was our Interim Chief Financial Officer employed by Danforth and was compensated on an hourly basis in accordance with his consulting agreement (the “Danforth Consulting Agreement”). See “Employment and Other Contracts - Eliot M. Lurier” for further discussion of Mr. Lurier's consulting agreement.

Annual Base Salaries

Mr. Giordano and Dr. Rich received a base salary to compensate them for services rendered to us during the year ended December 31, 2023. The base salary is intended to provide a fixed component of compensation reflecting the executive’s skill set, experience, role and responsibilities. In the year ended December 31, 2023, we paid an annual base salary of $405,300 to Mr. Giordano and $318,000 to Dr. Rich.

Cash Bonuses

Under each of their employment agreements, Mr. Giordano and Dr. Rich are eligible to receive annual cash bonuses based on the achievement of annual goals. During the year ended December 31, 2023, Mr. Giordano and Dr. Rich were eligible to receive a target cash bonus consisting of 50% and 40%, respectively, of their base salaries, based on 100% achievement of the predetermined operational goals. There is no cap on the bonuses for greater than 100% achievement of goals, and there is no pre-identified threshold amount that must be achieved to receive any cash bonus payment. Our Compensation Committee evaluated performance for the year ended December 31, 2023, and consistent with the determinations made in prior years, did so in March 2024.

Long-Term Equity Compensation

Provided we have sufficient shares reserved under our 2022 Stock Incentive Plan, we typically award stock options to our key employees, including to our non-executive employees, on an annual basis and subject to approval by (i) the Board of Directors upon the Compensation Committee’s recommendation with respect to executive officers and (ii) the Compensation Committee with respect to all other employees.

Other Elements of Compensation

Employee Benefits and Perquisites

We maintain broad based benefits that are provided to all employees, including health and dental insurance. Our executive officers are eligible to participate in all of our employee benefit plans, in each case, on the same basis as other employees.

No Tax Gross-Ups

We do not make gross-up payments to cover our NEOs’ personal income taxes that may pertain to any of the compensation or perquisites paid or provided by us.

Severance and Change-of-Control Benefits

Pursuant to employment agreements we have entered into with certain NEOs, each such officer is entitled to specified benefits in the event of the termination of his employment under specified circumstances, including termination following a change in control of the Company. We have provided more detailed information about these benefits under the caption “-Employment and Other Contracts” below.

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Employment and Other Contracts

Christopher T. Giordano

We entered into an executive employment agreement with Mr. Giordano, effective July 6, 2021 (the “Giordano Employment Agreement”). Under the Giordano Employment Agreement, Mr. Giordano initially received an annual base salary of $375,000, which has been subsequently increased to $469,000, effective January 1, 2024. Mr. Giordano also will receive participation in medical insurance, dental insurance, and other benefit plans on the same basis as our other officers. Under the Giordano Employment Agreement, Mr. Giordano will receive an annual cash bonus consisting of 50% of his base salary, based on 100% achievement of annual goals (with no cap on the bonus for greater than 100% achievement of goals). The Giordano Employment Agreement also provides for the grant of the following employment inducement stock options (as retrospectively adjusted for the Reverse Stock Splits): (i) a one-time stock option grant of 160 shares of Common Stock with four-year straight-line vesting; and (ii) a one-time stock option grant of 63 shares of Common Stock with 50% vesting upon the achievement of certain performance metrics related to our clinical trials. As of December 31, 2023, none of the vesting milestones had been achieved and the options were subsequently cancelled. We also reimbursed Mr. Giordano for up to $10,000 of legal expenses related to the Giordano Employment Agreement.

The Giordano Employment Agreement is effective for a one-year term, and automatically renews for additional one-year terms, unless the Giordano Employment Agreement is terminated in advance of renewal or either party gives notice at least 90 days prior to the end of the then-current term of an intention not to renew. If Mr. Giordano is terminated without “cause”, if he terminates his employment for “good reason”, or if the Company elects not to renew the Giordano Employment Agreement, Mr. Giordano would be entitled to receive (i) one-year of base salary, (ii) a pro-rated amount of the annual bonus that he would have received had 100% of goals been achieved, and (iii) one-year of COBRA reimbursements or benefits payments, as applicable. Mr. Giordano’s entitlement to these payments is conditioned upon execution of a release of claims.

For purposes of the Giordano Employment Agreement: (i) “cause” includes (1) a willful material breach of the Giordano Employment Agreement by Mr. Giordano, (2) material misappropriation of Company property, (3) material failure to comply with our policies, (4) abuse of illegal drugs or abuse of alcohol in a manner that interferes with the performance of his duties, (5) dishonest or illegal action that is materially detrimental to the Company, (6) failure to cooperate with internal investigations or law enforcement and regulatory investigations, and (7) failure to disclose material conflicts of interest and (ii) “good reason” includes (1) a material reduction in base salary, (2) a material reduction of Mr. Giordano’s authority, duties or responsibility, (3) certain changes in geographic location of Mr. Giordano’s employment, or (4) a material breach of the Giordano Employment Agreement or other written agreement with Mr. Giordano by the Company.

Stuart Rich

We entered into an employment agreement with Dr. Rich, effective January 15, 2021 (the “Rich Employment Agreement”). Under the Rich Employment Agreement, Dr. Rich initially received an annual base salary of $300,000, which has been subsequently increased to $318,000. Dr. Rich will also receive participation in medical insurance, dental insurance, and other benefit plans on the same basis as our other officers. Under the Rich Employment Agreement, Dr. Rich is eligible for an annual target cash bonus of 40% of his base salary, based on 100% achievement of annual goals (with no cap on the bonus for greater than 100% achievement of goals). Pursuant to the Rich Employment Agreement, Dr. Rich received as an inducement award a one-time non-statutory stock option grant of 160 shares of Common Stock (as retrospectively adjusted for the Reverse Stock Splits). The option award will vest as follows: 25% upon initiation of a Phase 3 trial (the “Trial”); 25% upon database lock of the Trial; 25% upon acceptance for review of an Investigational New Drug Application; and 25% upon approval from the FDA. The option grant has a 10-year term and an exercise price of $2,848 per share.

The Rich Employment Agreement is effective for a one-year term, and automatically renews for additional one-year terms, unless terminated in advance of renewal or either party gives notice at least 90 days prior to the end of the then-current term of an intention not to renew. If Dr. Rich is terminated without “cause”, if he terminates his employment for “good reason, or if we elect not to renew the Rich Employment Agreement, Dr. Rich would be entitled to receive (i) one-year of his then current base salary, (ii) a pro-rated amount of the annual bonus that he would have received had 100% of goals been achieved, (iii) acceleration of vesting of all outstanding equity-based compensation awards held by Dr. Rich, and (iv) one-year of COBRA reimbursements or benefits payments, as applicable. Dr. Rich’s entitlement to these payments is conditioned upon execution of a release of claims.

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For purposes of the Rich Employment Agreement: (i) “cause” includes (1) a willful material breach of the Rich Employment Agreement by Dr. Rich, (2) material misappropriation of Company property, (3) material failure to comply with our policies, (4) abuse of illegal drugs or abuse of alcohol in a manner that materially interferes with the performance of his duties, (5) dishonest or illegal action that is materially detrimental to the Company, and (6) failure to disclose material conflicts of interest; and (ii) “good reason” includes (1) a material reduction in base salary, (2) a material reduction of his authority, duties or responsibility, or (3) a material breach of the Rich Employment Agreement by the Company.

Eliot M. Lurier

We entered into a consulting agreement with Danforth, dated October 14, 2021, providing for the engagement of Mr. Lurier, a consultant with Danforth, as Interim Chief Financial Officer of the Company (the “Danforth Consulting Agreement”). Pursuant to the Danforth Consulting Agreement, Mr. Lurier was responsible for the Company’s accounting and finance functions and served as our principal financial officer and principal accounting officer. Mr. Lurier provided services to the Company under the Danforth Consulting Agreement as an independent contractor. The Danforth Consulting Agreement may be terminated by us or Danforth (i) with “Cause”, immediately upon written notice to the other party or (ii) without Cause upon 30 days prior written notice to the other party. Pursuant to the Danforth Consulting Agreement, Danforth received cash compensation at a rate of $416 per hour for Mr. Lurier’s services.

As of January 2024, our new Interim Chief Financial Officer, Mr. Hoffman will provide services to the Company as an independent contractor pursuant to the Company’s existing Danforth Consulting Agreement. Pursuant to the Danforth Consulting Agreement, Danforth will receive cash compensation at a rate of $416 per hour for Mr. Hoffman’s services, which rate may be increased by up to 4% annually.

For purposes of the Danforth Consulting Agreement, “Cause” is a material breach of the terms of the Danforth Consulting Agreement which, if curable, is not cured within 10 days of written notice of such default, or the commission of any act of fraud, embezzlement or deliberate disregard of a rule or policy of the Company.

Outstanding Equity Awards

The following table provides information about outstanding equity awards held by the NEOs as of December 31, 2023, as retrospectively adjusted for the Reverse Stock Splits.

Outstanding Equity Awards as of December 31, 2023

 

 

Option Awards

 

Name and Principal Position

 

Number of securities underlying unexercised options (Exercisable)

 

 

Number of securities underlying unexercised options (Unexercisable)

 

 

Option exercise price

 

 

Option expiration date

 

 

 

(#)

 

 

(#)

 

 

($/Sh)

 

 

 

Christopher T. Giordano

 

 

31

 

 

 

94

(1)

 

 

992

 

 

6/9/2032

 

President and Chief Executive Officer

 

 

80

(2)

 

 

80

 

 

 

3,152

 

 

7/6/2031

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stuart Rich

 

 

16

 

 

 

47

(3)

 

 

992

 

 

6/9/2032

 

Chief Medical Officer

 

 

40

(4)

 

 

120

 

 

 

2,848

 

 

1/15/2031

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eliot M. Lurier

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

Former Interim Chief Financial Officer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

The option is exercisable as to one-fourth of the shares of Common Stock underlying the option on each of June 9, 2023, June 9, 2024, June 9, 2025 and June 9, 2026, subject to Mr. Giordano’s continued employment.

(2)

The option is exercisable as to one-fourth of the shares of Common Stock underlying the option on each of July 6, 2022, July 6, 2023, July 6, 2024 and July 6, 2025, subject to Mr. Giordano’s continued employment.

(3)

The option is exercisable as to one-fourth of the shares of Common Stock underlying the option on each of June 9, 2023, June 9, 2024, June 9, 2025 and June 9, 2026, subject to Dr. Rich’s continued employment.

(4)

This option award is exercisable in four equal installments, with 25% vesting after the start of the Trial, 25% vesting after the database lock with respect to the Trial, 25% vesting after the opening of an Investigational New Drug Application with the FDA, and 25% vesting after the approval from the FDA, subject to Dr. Rich’s continued employment.

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DIRECTOR COMPENSATION

During the fiscal year ended December 31, 2023, our non-employee directors were paid the following compensation for service on the Board of Directors and committees according to the policies established for director compensation by the Corporate Governance and Nominating Committee:

·

An annual director fee in each fiscal year of $45,000 ($75,000 for our Chairman of the Board of Directors), which is paid in equal quarterly installments on the first day of each fiscal quarter;

·

An annual Audit and Compliance Committee member fee in each fiscal year of $7,500 ($15,000 for our Audit and Compliance Committee Chair), which is paid in equal quarterly installments on the first day of each fiscal quarter;

·

An annual Compensation Committee member fee in each fiscal year of $5,000 ($10,000 for our Compensation Committee Chair), which is paid in equal quarterly installments on the first day of each fiscal quarter;

·

An annual Corporate Governance and Nominating Committee member fee in each fiscal year of $3,500 ($7,000 for our Corporate Governance and Nominating Committee Chair), which is paid in equal quarterly installments on the first day of each fiscal quarter;

·

If sufficient shares are available under our 2022 Stock Incentive Plan, an annual grant of 63 stock options (79 stock options in the initial year), which vest one-year after the grant date and are exercisable for a period of ten years, issued at the date of the annual meeting of stockholders each year (beginning in fiscal year 2024, the initial equity grant to new directors will vest over three years); and

·

Reimbursement of travel and related expenses for attending Board of Directors and committee meetings, as incurred.

The following table summarizes the compensation paid to non-employee directors for fiscal year ended December 31, 2023:

Director

 

Fees Earned or Paid in Cash

 

 

Option Awards (1)

 

 

Stock Awards

 

 

All Other Compensation

 

 

Total

 

 

 

($)

 

 

($)

 

 

($)

 

 

($)

 

 

($)

 

Gerald T. Proehl (Chairman)

 

 

88,500

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

88,500

 

June Almenoff, MD, PhD

 

 

59,500

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

59,500

 

Michael Davidson, MD

 

 

57,500

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

57,500

 

Declan Doogan, MD

 

 

48,500

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

48,500

 

Robyn M. Hunter

 

 

65,000

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

65,000

 

(1)

Due to insufficient shares reserved under the 2022 Stock Incentive Plan, the Board determined not to issue an annual option grant to the directors. As of December 31, 2022, as retrospectively adjusted for the Reverse Stock Splits, our non-employee directors then serving on the Board of Directors held the following stock options: Mr. Proehl, 9; Dr. Almenoff, 8; Dr. Davidson, 8; Dr. Doogan, 8; and Ms. Hunter 4.

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ITEM 12— SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS

Equity Compensation Plan Information

The following table provides information about the securities authorized for issuance under our equity compensation plans as of December 31, 2023.

 

 

Number of securities to be issued upon exercise of outstanding options, warrants and rights

 

 

Weighted-average exercise price of outstanding options, warrants and rights

 

 

Number of securities remaining available for future issuances under equity compensation plans (excluding securities reflected in column (a))

 

Plan category

 

 

 

 

 

 

 

 

 

Equity compensation plans approved by security holders:

 

 

 

 

 

 

 

 

 

2022 Stock Incentive Plan

 

 

331

 

 

$992.00

 

 

 

1,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2016 Stock Incentive Plan, as amended

 

 

284

 

 

$3,251.77

 

 

 

--

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amended and Restated 1999 Amended Stock Plan, as amended

 

 

9

 

 

$86,108.74

 

 

 

--

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equity compensation plans not approved by security holders:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plan for Employee Inducement Stock Option Grants

 

 

312

 

 

$3,008.00

 

 

 

--

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

936

 

 

$3,140.29

 

 

 

1,000

 

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Security Ownership of Certain Beneficial Owners and Management

The following table sets forth, as of March 20, 2024, the number and percentage of the outstanding shares of common stock that, according to the information supplied to us, were beneficially owned by (i) each person who is currently a director or a director nominee, (ii) our Named Executive Officers, (iii) all current directors and executive officers as a group and (iv) each person who, to our knowledge, is the beneficial owner of more than five percent of the outstanding common stock. Except as otherwise indicated, the persons named in the table have sole voting and dispositive power with respect to all shares beneficially owned, subject to community property laws where applicable.

Beneficial Owner Name and Address (1)

 

Amount and Nature

of Beneficial

Ownership(2)

 

 

Percent of Class

 

Principal Stockholders

 

 

 

 

 

 

CVI Investments, Inc. (3)

P.O. Box 309GT

Ugland House

South Church Street

George Town, Grand Caman, KY1-1104

Cayman Islands

 

 

195,629

 

 

 

9.99%

Lind Global Fund II LP (4)

44 Madison Ave., Floor 41

New York, NY 10022

 

 

195,629

 

 

 

9.99%

S.H.N. Financial Investments Ltd.(5)

     Herzliya Hills

     Arik Einstein 3, Israel, 4610601

 

 

205,465

 

 

 

9.99%

Officers and Directors

 

 

 

 

 

 

 

 

June Almenoff, MD(6)

 

 

8

 

 

*

 

Michael Davidson, MD (7)

 

 

388

 

 

*

 

Declan Doogan, MD (8)

 

 

2,282

 

 

*

 

Christopher T. Giordano (9)

 

 

110

 

 

*

 

Lawrence R. Hoffman

 

 

--

 

 

*

 

Robyn M. Hunter(10)

 

 

4

 

 

*

 

Gerald T. Proehl (11)

 

 

10

 

 

*

 

Stuart Rich, MD (12)

 

 

2,711

 

 

*

 

All current officers and directors as a group (8 persons) (13)

 

 

5,513

 

 

*

 

* Less than 1%

(1)

Unless otherwise noted, all addresses are in care of Tenax Therapeutics, Inc. at 101 Glen Lennox Drive, Suite 300, Chapel Hill, North Carolina 27517.

(2)

Based upon 1,958,245 shares of common stock outstanding on March 20, 2024. The number and percentage of shares beneficially owned is determined in accordance with Rule 13d-3 of the Exchange Act and the information is not necessarily indicative of beneficial ownership for any other purpose. Under such rule, beneficial ownership includes any shares as to which the person has sole or shared voting power or investment power and also any shares that the person has the right to acquire within 60 days of March 20, 2024 through the exercise of any stock options, warrants or other rights or the conversion of preferred stock. Any shares that a person has the right to acquire within 60 days are deemed to be outstanding for the purpose of computing the percentage ownership of such person but are not deemed outstanding for the purpose of computing the percentage ownership of any other person.

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(3)

Based in part on a Schedule 13G filed with the SEC on February 16, 2024. CVI Investments, Inc. and Heights Capital Management, Inc. (with CVI Investments, Inc., collectively “CVI”) have voting and dispositive power over 60,000 shares and up to 531,000 shares issuable upon the exercise of common warrants and 205,500 shares issuable upon the exercise of pre-funded warrants. Based upon Company records, CVI has exercised all of the pre-funded warrants. All of the pre-funded warrants held by CVI were subject to beneficial ownership limitations of 9.99%, which prohibited CVI from exercising any portion of any pre-funded warrant to the extent that, following such exercise, CVI’s ownership of the common stock would exceed the 9.99% beneficial ownership limitation. All of the common warrants held by CVI are subject to beneficial ownership limitations of 4.99%, which prohibit CVI from exercising any portion of any common warrant to the extent that, following such exercise, CVI’s ownership of the common stock would exceed the 4.99% beneficial ownership limitation. The beneficial ownership limitations, taken as a whole, cap CVI’s ownership in the common stock at 9.99% of the Company’s outstanding shares, other than to the extent CVI were to acquire additional shares on the open market. Consequently, CVI is not able to exercise all of its common warrants due to the aforementioned beneficial ownership limitations, which is reflected in the table above.

(4)

Based in part on a Schedule 13G filed with the SEC on February 15, 2024. Lind Global Fund II LP and Lind Global Partners II LLC (with Lind Global Fund II LP, collectively “Lind”) have voting and dispositive power over 70,000 shares and up to 442,480 shares issuable upon the exercise of common warrants and 151,240 shares issuable upon the exercise of pre-funded warrants. Based upon Company records, Lind has exercised all of the pre-funded warrants. All of the common warrants and pre-funded warrants held by Lind were or are subject to beneficial ownership limitations of 9.99%, which prohibit Lind from exercising any portion of any warrant to the extent that, following such exercise, Lind’s ownership of the common stock would exceed the beneficial ownership limitation. The beneficial ownership limitations, taken as a whole, cap Lind’s ownership in the common stock at 9.99% of the Company’s outstanding shares, other than to the extent Lind were to acquire additional shares on the open market. Consequently, Lind is not able to exercise all of its common warrants due to the aforementioned beneficial ownership limitations, which is reflected in the table above.

(5)

Based in part on a Schedule 13G filed with the SEC on February 20, 2024. S.H.N Financial Investments Ltd. (“S.H.N.”) has voting and dispositive power over 70,000 shares and up to 354,000 shares issuable upon the exercise of common warrants and 107,000 shares issuable upon the exercise of pre-funded warrants. S.H.N. has exercised all of the pre-funded warrants. All of the warrants held S.H.N. were or are subject to beneficial ownership limitations of 9.99%, which prohibit S.H.N. from exercising any portion of any warrant to the extent that, following such exercise, S.H.N.’s ownership of the common stock would exceed the beneficial ownership limitation. The beneficial ownership limitations, taken as a whole, cap S.H.N.’s ownership in the common stock at 9.99% of the Company’s outstanding shares, other than to the extent S.H.N. were to acquire additional shares on the open market. Consequently, S.H.N. is not able to exercise all of its common warrants due to the aforementioned beneficial ownership limitations, which is reflected in the table above.

(6)

With respect to Dr. Almenoff, includes 8 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

(7)

With respect to Dr. Davidson, includes 8 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

(8)

With respect to Dr. Doogan, includes 8 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

(9)

With respect to Mr. Giordano, consists of 110 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

(10)

With respect to Ms. Hunter, consists of 4 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

(11)

With respect to Mr. Proehl, includes 9 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

(12)

With respect to Dr. Rich, includes (i) 56 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024, (ii) 1,194 shares of common stock held by the Andrea Rich 2021 Irrevocable Trust of which Dr. Rich is a co-trustee and (iii) 1,194 shares of common stock held by the Stuart Rich 2022 Irrevocable Trust of which Dr. Rich is special asset advisor.

(13)

With respect to all current officers and directors as a group, includes 203 shares of common stock subject to options that are vested or vesting within 60 days of March 20, 2024.

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ITEM 13— CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS AND DIRECTOR INDEPENDENCE

Related Party Transactions Policy and Procedures

The Board of Directors has adopted a written related person transaction policy setting forth the policies and procedures for the review and approval or ratification of related person transactions. This policy covers, with certain exceptions set forth in Item 404 of Regulation S-K, any transaction, arrangement or relationship, or any series of similar transactions, arrangements or relationships, in which we were or are to be a participant, in which the amount involved exceeds $120,000 in any fiscal year and a related person had, has or will have a direct or indirect material interest, including without limitation, purchases of goods or services by or from the related person or entities in which the related person has a material interest, indebtedness, guarantees of indebtedness and employment by us of a related person. In reviewing and approving any such transactions, our Audit and Compliance Committee is tasked to consider all relevant facts and circumstances, including, but not limited to, whether the transaction is on terms comparable to those that could be obtained in an arm’s length transaction and the extent of the related person’s interest in the transaction. Notwithstanding anything therein to the contrary, the policy is to be interpreted only in such a manner as to comply with Item 404 of Regulation S-K.

Certain Related Person Transactions

Described below is each transaction occurring since January 1, 2022, and any currently proposed transaction to which we were or are to be a participant, respectively, and in which:

·

The amounts involved exceeded or will exceed the lesser of $120,000 or 1% of the average of our total assets at year-end for the last two completed fiscal years; and

·

Any person (i) who since January 1, 2022 served as a director or executive officer of the Company or any member of such person’s immediate family that had or will have a direct or indirect material interest, other than compensation, termination and change of control arrangements that are described under the section titled “Executive Compensation” or (ii) who, at the time when a transaction in which such person had a direct or indirect material interest occurred or existed, was a beneficial owner of more than 5% of our outstanding Common Stock or any member of such person’s immediate family.

Each such transaction is approved pursuant to our related transaction policy.

May 2022 Private Placement (the “May 2022 Offering”)

On May 17, 2022, we entered into a securities purchase agreement with then-affiliate Armistice Capital, LLC, pursuant to which we agreed to sell and issue to the investor 6,623 units in a private placement at a purchase price of $1,240 per unit. Each unit consisted of (i) one unregistered pre-funded warrant to purchase one share of our Common Stock and (ii) one unregistered warrant to purchase one share of Common Stock, at an exercise price of $1,008 per share with a term of five and a half years, (together with the pre-funded warrants, the “2022 Warrants”). The net proceeds from the May 2022 Offering, after direct offering expenses, were approximately $7.9 million.

Additionally, in connection with the May 2022 Offering, we entered into a warrant amendment agreement with Armistice, in consideration for Armistice’s purchase of units in the May 2022 Offering, pursuant to which we agreed to amend certain previously issued warrants held by Armistice.

Also, on May 17, 2022, and in connection with the May 2022 Offering, the Company entered into a registration rights agreement with Armistice, pursuant to which the Company agreed to register for resale the shares of Common Stock issuable upon exercise of the 2022 Warrants within 120 days following the effective date of the May 2022 registration rights agreement. Pursuant to the May 2022 registration rights agreement, on May 25, 2022, the Company filed a resale registration statement on Form S-3, which went effective on June 3, 2022.

This description of the May 2022 Offering has been retrospectively adjusted for the Reverse Stock Splits.

ITEM 14— PRINCIPAL ACCOUNTANT FEES AND SERVICES

The information required by this Item is incorporated by reference to the information under the section captioned “Audit and Compliance Committee Report” in our proxy statement.

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PART IV

ITEM 15—EXHIBITS AND FINANCIAL STATEMENT SCHEDULES

(a) List of documents filed as part of this report:

i.

Financial Statements:

The financial statements of the Company and the related reports of the Company’s independent registered public accounting firm thereon have been filed under Item 8 hereof.

ii.

Financial Statement Schedules:

None.

iii.

Exhibit Index

The following exhibits have been or are being filed herewith and are numbered in accordance with Item 601 of Regulation S-K:

Incorporated by Reference

(Unless Otherwise Indicated)

Exhibit Number

Exhibit Title

Form

File

Exhibit

Filing Date

2.1

Agreement and Plan of Merger between Synthetic Blood International, Inc. and Oxygen Biotherapeutics, Inc. dated April 28, 2008.

8-K

002-31909

2.01

June 30, 2008

 

 

 

 

2.2

 

Asset Purchase Agreement by and between Oxygen Biotherapeutics, Inc., Life Newco, Inc., Phyxius Pharma, Inc., and the stockholders of Phyxius Pharma, Inc. dated October 21, 2013.

 

 

8-K

 

001-34600

 

2.1

 

October 25, 2013

 

 

 

 

2.3

Agreement and Plan of Merger among PHPrecisionMed Inc., Tenax Therapeutics, Inc., Life Newco II, Inc., and Dr. Stuart Rich dated January 15, 2021.

8-K

001-34600

2.1

January 19, 2021

 

 

 

 

3.1.1

Certificate of Incorporation of Oxygen Biotherapeutics, Inc., dated April 17, 2008.

8-K

002-31909

3.01

June 30, 2008

 

 

 

 

3.1.2

Certificate of Amendment of the Certificate of Incorporation, effective November 9, 2009.

8-K

002-31909

3.1

November 13, 2009

 

 

 

 

3.1.3

Certificate of Amendment of the Certificate of Incorporation, effective May 10, 2013.

8-K

001-34600

3.1

May 15, 2013

62

Table of Contents

3.1.4

Certificate of Amendment of the Certificate of Incorporation, effective September 19, 2014.

10-Q

001-34600

3.4

December 15, 2014

 

 

 

 

3.1.5

Certificate of Amendment of the Certificate of Incorporation, effective February 23, 2018.

8-K

001-34600

3.1

February 23, 2018

 

 

 

 

3.2

Certificate of Designation of Series A Convertible Preferred Stock, dated December 10, 2018.

8-K

001-34600

4.1

December 11, 2018

 

 

 

 

 

 

 

 

 

 

 

3.3

Certificate of Designation of Series B Convertible Preferred Stock, dated January 15, 2021.

8-K

001-34600

4.1

January 19, 2021

 

 

 

 

3.4

Fourth Amended and Restated Bylaws.

10-Q

001-34600

3.1

August 15, 2023

 

 

 

 

4.1

Specimen Stock Certificate.

10-K

001-34600

4.1

July 23, 2010

 

 

 

 

4.2

Representative’s Warrant to Purchase Shares of Common Stock, dated December 11, 2018.

8-K

001-34600

4.2

December 11, 2018

 

 

 

 

4.3

Form of Warrant to Purchase Shares of Common Stock, dated December 11, 2018.

8-K

001-34600

4.3

December 11, 2018

 

 

 

 

4.4

Warrant Agency Agreement, dated December 11, 2018

8-K

001-34600

4.4

December 11, 2018

 

 

 

 

4.5

 

Form of Pre-Funded Warrant, dated March 13, 2020.

 

8-K

001-34600

4.1

March 13, 2020

 

 

 

 

4.6

 

Form of Unregistered Warrant, dated March 13, 2020.

 

8-K

001-34600

4.2

March 13, 2020

 

 

 

 

4.7

Form of Placement Agent Warrant, dated March 13, 2020.

8-K

001-34600

4.3

March 13, 2020

 

 

 

 

4.8

 

Form of Pre-Funded Warrant, dated July 6, 2020.

 

8-K

001-34600

4.1

July 8, 2020

 

 

 

 

4.9

 

Form of Unregistered Warrant, dated July 6, 2020.

 

8-K

001-34600

4.2

July 8, 2020

 

 

 

 

4.10

 

Form of Placement Agent Warrant, dated July 8, 2020.

 

8-K

001-34600

4.3

July 8, 2020

 

 

 

 

4.11

 

Form of Unregistered Pre-Funded Warrant, dated July 6, 2021.

 

8-K

001-34600

4.1

July 8, 2021

 

 

 

 

4.12

 

Form of Unregistered Warrant, dated July 6, 2021.

 

8-K

001-34600

4.2

July 8, 2021

 

 

 

 

4.13

 

Form of HCW Warrant, dated July 6, 2021.

 

8-K

001-34600

4.3

July 8, 2021

63

Table of Contents

4.14

 

Form of Pre-Funded Warrant (2022)

 

8-K

 

001-34600

 

4.1

 

May 20, 2022

 

 

 

 

 

 

 

 

 

 

 

4.15

 

Form of Series E Common Stock Warrant (2022)

 

8-K

 

001-34600

 

4.2

 

May 20, 2022

 

 

 

 

 

 

 

 

 

 

 

4.16

 

Warrant Amendment Agreement, dated as of May 17, 2022, by and between the Company and the Investor

 

8-K

 

001-34600

 

4.3

 

May 20, 2022

 

 

 

 

4.17

 

Warrant Agency Agreement, dated February 3, 2023, by and between Tenax Therapeutics, Inc. and Direct Transfer LLC.

 

8-K

 

001-34600

 

4.1

 

February 7, 2023

 

 

 

 

 

 

 

 

 

 

 

4.18

 

Form of Pre-Funded Common Stock Purchase Warrant, dated February 3, 2023.

 

8-K

 

001-34600

 

4.2

 

February 7, 2023

 

 

 

 

 

 

 

 

 

 

 

4.19

 

Form of Common Stock Purchase Warrant, dated February 3, 2023.

 

8-K

 

001-34600

 

4.3

 

February 7, 2023

 

 

 

 

 

 

 

 

 

 

 

4.20

Description of Common Stock.

-

-

-

Filed herewith

 

 

 

 

10.1.1+

1999 Amended Stock Plan, as amended and restated June 17, 2008.

10-K

002-31909

10.15

August 13, 2008

 

 

 

 

10.1.2+

Amendment No. 1 to Oxygen Biotherapeutics, Inc. 1999 Amended Stock Plan.

10-K

001-34600

10.19

July 29, 2014

 

 

 

 

 

 

 

 

 

 

 

 10.1.3+

Amendment No. 2 to Oxygen Biotherapeutics, Inc. 1999 Amended Stock Plan.

10-K

001-34600

10.20

July 29, 2014

 

 

 

 

10.1.4+

Form of Option issued to Executive Officers and Directors.

10-K

002-31909

10.5

August 13, 2004

 

 

 

 

10.1.5+

Form of Option issued to Employees.

10-K

002-31909

10.6

August 13, 2004

 

 

 

 

10.1.6+

Form of Option Agreement with Form of Notice of Grant.

10-K

001-34600

10.9

March 16, 2017

 

 

 

 

10.2.1

 

Lease Agreement for North Carolina Corporate Office.

 

10-Q

001-34600

10.6

March 21, 2011

 

 

 

 

10.2.2

 

First Amendment to Lease Agreement for North Carolina Corporate Office.

 

10-K

001-34600

10.74

March 14, 2016

 

 

 

 

 

 

 

 

 

 

 

10.2.3

 

Lease Termination Agreement for North Carolina Corporate Office.

 

8-K

 

001-34600

 

10.1

 

February 10, 2023

 

 

 

 

 

 

 

 

 

 

 

10.3+

 

Form of Indemnification Agreement.

 

10-K

001-34600

10.36

July 15, 2011

 

 

 

 

10.4.1*

 

License Agreement dated September 20, 2013 by and between Phyxius Pharma, Inc. and Orion Corporation.

 

10-Q

001-34600

10.3

March 17, 2014

64

Table of Contents

10.4.2*

 

Amendment to License Agreement, dated as of October 9, 2020, by and between Tenax Therapeutics, Inc. and Orion Corporation.

 

8-K

 

001-34600

 

10.1

 

October 15, 2020

 

 

 

 

10.4.3*

 

Amendment to the License Agreement of September 20, 2013, by and between Tenax Therapeutics, Inc. and Orion Corporation, dated as of January 25, 2022.

 

8-K

 

001-34600

 

10.1

 

January 28, 2022

 

 

 

 

10.5+

 

Description of Non-Employee Director Compensation, effective June 15, 2015.

 

10-Q

001-34600

10.1

September 9, 2015

 

 

 

 

10.6.1+

2016 Stock Incentive Plan.

10-Q

001-34600

10.1

August 9, 2016

 

 

 

 

10.6.2+

Amendment No. 1 to 2016 Stock Incentive Plan.

10-Q

001-34600

10.1

August 14, 2019

 

 

 

 

10.6.3+

 

Amendment No. 2 to 2016 Stock Incentive Plan.

 

10-Q

001-34600

10.1

August 16, 2021

 

 

 

 

10.6.4+

Form of Option issued to Non-Employee Directors under 2016 Stock Incentive Plan.

10-Q

001-34600

10.2

August 14, 2018

 

 

 

 

10.6.5+

Form of Option issued to Employees and Contractors under 2016 Stock Incentive Plan.

10-Q

001-34600

10.3

August 14, 2018

 

 

 

 

10.6.6+

Form of Incentive Stock Option Agreement under 2016 Stock Incentive Plan.

10-Q

001-34600

10.4

August 14, 2018

 

 

 

 

10.7

 

 

Form of Securities Purchase Agreement, dated as of March 11, 2020, by and between Tenax Therapeutics, Inc. and the investor identified on the signature page thereto.

 

 

8-K

 

001-34600

 

10.1

 

March 13, 2020

 

 

 

 

10.8

 

 

Form of Securities Purchase Agreement for Class C Units and Class D Units, dated as of July 6, 2020, by and between Tenax Therapeutics, Inc. and the Investor.

 

8-K

 

001-34600

 

10.1

 

July 8, 2020

 

 

 

 

10.9

 

 

Form of Securities Purchase Agreement for Class E Units and Class F Units, dated as of July 6, 2020, by and between Tenax Therapeutics, Inc. and the Investor.

 

8-K

 

001-34600

 

10.2

 

July 8, 2020

65

Table of Contents

10.10

 

Form of Registration Rights Agreement, dated as of July 6, 2020, by and between Tenax Therapeutics, Inc. and the Investor.

 

8-K

 

001-34600

 

10.3

 

July 8, 2020

 

 

 

 

10.11+

 

Executive Employment Agreement with Dr. Stuart Rich dated January 15, 2021.

 

8-K

001-34600

10.1

January 19, 2021

 

 

 

 

10.12

 

Securities Purchase Agreement for Unregistered Pre-Funded Warrant, dated as of July 6, 2021 by and between Tenax Therapeutics, Inc. and the Investor.

 

8-K

 

001-34600

 

10.1

 

July 8, 2021

 

 

 

 

10.13

 

Registration Rights Agreement, dated July 6, 2021, by and between Tenax Therapeutics, Inc. and the Investor.

 

8-K

001-34600

10.2

July 8, 2021

 

 

 

 

10.14+

 

Executive Employment Agreement dated July 6, 2021, by and between Tenax Therapeutics, Inc. and Christopher T. Giordano.

 

8-K

 

001-34600

 

10.4

 

July 8, 2021

 

 

 

 

10.15+

 

Plan for Employee Inducement Stock Options adopted July 6, 2021 with Form of Stock Option Agreement.

 

8-K

001-34600

10.5

July 8, 2021

 

 

 

 

10.16 +* 

 

Consulting Agreement dated October 14, 2021, by and between Tenax Therapeutics, Inc. and Danforth Advisors, LLC.

 

10-K

 

001-34600

 

10.20

 

March 29, 2022

 

 

 

 

10.17

 

Securities Purchase Agreement for Units, dated as of May 17, 2022, by and between the Company and the Investor.

 

8-K

 

001-34600

 

10.1

 

May 20, 2022

 

 

 

 

 

 

 

 

 

 

 

10.18

 

Registration Rights Agreement, dated as of May 17, 2022, by and between the Company and the Investor.

 

8-K

 

001-34600

 

10.2

 

May 20, 2022

 

 

 

 

 

 

 

 

 

 

 

10.19+

 

Tenax Therapeutics, Inc. 2022 Stock Incentive Plan.

 

8-K

 

001-34600

 

10.1

 

June 10, 2022

66

Table of Contents

10.20+

 

Form of Tenax Therapeutics, Inc. Notice of Stock Option Grant and Award Agreement.

 

8-K

 

001-34600

 

10.2

 

June 10, 2022

 

 

 

 

 

 

 

 

 

 

 

10.21

 

Waiver dated June 13, 2022.

 

8-K

 

001-34600

 

10.1

 

June 16, 2022

 

 

 

 

 

 

 

 

 

 

 

10.22

 

Placement Agency Agreement, dated as of February 3, 2023, by and between Tenax Therapeutics, Inc. and Roth Capital Partners, LLC.

 

8-K

 

001-34600

 

10.1

 

February 7, 2023

 

 

 

 

 

 

 

 

 

 

 

10.23

 

Form of Securities Purchase Agreement by and between Tenax Therapeutics, Inc. and the purchasers named therein.

 

8-K

 

001-34600

 

10.2

 

February 7, 2023

 

 

 

 

 

 

 

 

 

 

 

10.24

 

Form of Leak-Out Agreement by and between Tenax Therapeutics, Inc. and the purchasers named therein.

 

8-K

 

001-34600

 

10.3

 

February 7, 2023

 

 

 

 

 

 

 

 

 

 

21.1

List of Subsidiaries of Registrant.

10-K

001-34600

21.1

March 31, 2023

 

 

 

 

 

 

 

 

 

 

23.1

Consent of Independent Registered Public Accounting Firm.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

31.1

Certification of President and Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

31.2

Certification of Interim Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

32.1

Certification of the President and Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

-

 

 

-

 

 

-

 

Furnished herewith

 

 

 

 

 

 

 

 

 

 

32.2

 

Certification of the Interim Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

 

-

 

 

-

 

 

-

 

 

Furnished herewith

 

 

 

 

 

 

 

 

 

 

 

 

97.1

 

Tenax Therapeutics, Inc. Compensation Recovery Policy, adopted September 20, 2023

 

-

 

-

 

-

 

Filed herewith

 

 

 

 

 

 

 

 

 

 

 

101.INS

XBRL Instance Document.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

101.SCH

XBRL Taxonomy Extension Schema Document.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

101.CAL

XBRL Taxonomy Extension Calculation Linkbase Document.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

101.DEF

 

Inline XBRL Taxonomy Extension Definition Linkbase Document.

 

-

 

-

 

-

 

Filed herewith

 

 

 

 

 

 

 

 

 

 

101.LAB

XBRL Taxonomy Extension Label Linkbase Document.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

101.PRE

XBRL Taxonomy Extension Presentation Linkbase Document.

-

 

-

 

-

Filed herewith

 

 

 

 

 

 

 

 

 

 

 

104

 

Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101).

 

 

 

 

 

 

 

Filed herewith

__

+ Management contract or compensatory plan.

* Certain confidential portions and/or the schedules and attachments to this exhibit have been omitted from this filing pursuant to a confidential treatment request filed with the SEC, or Item 601(a)(5) or 601(b)(10)of Regulation S-K, as applicable. The Company agrees to furnish supplementally an unredacted copy of the exhibit to the SEC upon request.

ITEM 16—FORM 10-K SUMMARY

None.

67

Table of Contents

SIGNATURES

Pursuant to the requirements of Section 13 or 15(d) of the Securities and Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.

Date: March 28, 2024

TENAX THERAPEUTICS, INC.

By:

/s/ Lawrence R. Hoffman

Lawrence R. Hoffman

Interim Chief Financial Officer

(On behalf of the Registrant and as Principal Financial and Accounting Officer)

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

Name

Title

Date

/s/ Christopher T. Giordano

President and Chief Executive Officer and Director

March 28, 2024

Christopher T. Giordano

(Principal Executive Officer)

/s/ Lawrence R. Hoffman

Interim Chief Financial Officer

March 28, 2024

Lawrence R. Hoffman

(Principal Financial Officer and Principal Accounting Officer)

/s/ Gerald Proehl

Chairman of the Board and Director

March 28, 2024

Gerald Proehl

/s/ June Almenoff, MD

Director

March 28, 2024

June Almenoff, MD

/s/ Michael Davidson, MD

Director

March 28, 2024

Michael Davidson, MD

/s/ Declan Doogan, MD

Director

March 28, 2024

Declan Doogan, MD

/s/ Robyn M. Hunter

Director

March 28, 2024

Robyn M. Hunter

/s/ Stuart Rich, MD

Director

March 28, 2024

Stuart Rich, MD

68

Table of Contents

TENAX THERAPEUTICS, INC.

INDEX TO CONSOLIDATED FINANCIAL STATEMENTS

42
TENAX THERAPEUTICS, INC.
Report of Independent Registered Public Accounting Firm

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

To the Board of Directors and Stockholders

Tenax Therapeutics, Inc.

Morrisville,Inc

Chapel Hill, North Carolina

Opinion on the Financial Statements

We have audited the accompanying consolidated balance sheets of Tenax Therapeutics, Inc.Inc and SubsidiarySubsidiaries (the “Company”) as of December 31, 20162023 and 2015,2022, and the related consolidated statements of operations and comprehensive loss, stockholders’ equity, and cash flows for each of the yearyears in the two-year period ended December 31, 2016, eight months ended December 31, 20152023, and the years ended April 30, 2015 and 2014. We also have auditedrelated notes (collectively referred to as the Company’s internal control over“consolidated financial reporting as of December 31, 2016, based on criteria established inInternal Control - Integrated Frameworkissued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”statements”). The Company’s management is responsible for these consolidated financial statements, for maintaining effective internal control over financial reporting, and for its assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management’s Annual Report on Internal Control over Financial Reporting included in Item 9A - Controls and Procedures in the Company’s December 31, 2016 Annual Report on Form 10-K. Our responsibility is to express an opinion on these consolidated financial statements and an opinion on the Company’s internal control over financial reporting based on our audits.

We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement and whether effective internal control over financial reporting was maintained in all material respects. Our audits of the consolidated financial statements included examining, on a test basis, evidence supporting the amounts and disclosures in the consolidated financial statements, assessing the accounting principles used and significant estimates made by management, and evaluating the overall financial statement presentation. Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk. Our audits also included performing such other procedures as we considered necessary in the circumstances. We believe that our audits provide a reasonable basis for our opinions.
A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of consolidated financial statements for external purposes in accordance with generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of consolidated 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 (3) 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 consolidated financial statements.
Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, 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.

In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of the Company as of December 31, 20162023 and 2015,2022, and the results of its operations and its cash flows for each of the yearyears in the two-year period ended December 31, 2016, the eight months ended December 31, 2015 and the years ended April 30, 2015 and 2014,2023, in conformity with accounting principles generally accepted in the United States of America. Also in our opinion,

Going Concern Uncertainty

The accompanying consolidated financial statements have been prepared assuming that the Company maintained,will continue as a going concern. As discussed in allNote A and Note B to the consolidated financial statements, the Company has suffered recurring losses from operations and negative cash flows from operations. These conditions raise substantial doubt about the Company’s ability to continue as a going concern. Management’s plans concerning these matters are described in Note A and Note B to the consolidated financial statements. The consolidated financial statements do not include any adjustments that might result from the outcome of this uncertainty.

Basis for Opinion

These financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on the Company’s financial statements based on our audits. We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) (“PCAOB”) and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material respects, effectivemisstatement, whether due to error or fraud. The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. As part of our audits, we are required to obtain an understanding of internal control over financial reporting, but not for the purpose of expressing an opinion on the effectiveness of the Company’s internal control over financial reporting. Accordingly, we express no such opinion.

Our audits included performing procedures to assess the risks of material misstatement of the 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 financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of December 31, 2016,the financial statements. We believe that our audits provide a reasonable basis for our opinion.

F-2

Table of Contents

Critical Audit Matters

The critical audit matters communicated below are matters arising from the current period audit of the financial statements that were communicated or required to be communicated to the audit committee and that: (1) relate to accounts or disclosures that are material to the financial statements and (2) involved our especially challenging, subjective, or complex judgments. The communication of critical audit matters does not alter in any way our opinion on the financial statements, taken as a whole, and we are not, by communicating the critical audit matters below, providing separate opinions on the critical audit matters or on the accounts or disclosures to which they relate.

Capital Raise Transaction Involving Equity Instruments

Description of Matter – As disclosed in Note E to the consolidated financial statements, the Company participated in a significant capital raise transaction during the year which involved the issuance of shares of the Company’s common stock, unregistered pre-funded warrants, and unregistered common stock warrants to purchase shares of the Company’s common stock. The accounting for the transaction was complex and a valuation of the freestanding warrants was required, which involved estimation of the fair value, and evaluation of the appropriate classification of both the pre-funded warrants and common stock warrants in the consolidated financial statements.

How We Addressed the Matter in Our Audit – Our audit procedures included the following:

·

We obtained an understanding of the internal controls and processes in place over management’s process for recording transactions involving equity instruments.

·

We obtained and read the underlying agreements.

·

We confirmed shares outstanding with the stock transfer agent as of December 31, 2023.

·

We verified proper approval of equity transactions by the Board of Directors.

·

We evaluated the Company’s selection of the valuation methodology and significant assumptions used by the Company and evaluated the completeness and accuracy of the underlying data supporting the significant assumptions.

·

Specifically, when assessing the key assumptions, we evaluated the appropriateness of the Company’s estimates of its credit risk, volatility, dividend yield, and the market risk free rate.

·

We tested management’s application of the relevant accounting guidance.

Prepaid or Accrued Clinical Trial Expenses

Description of Matter – TheCompany’s total prepaid expenses and other current assets totaled $1.9 million, which included amounts in advance of services incurred pursuant to clinical trials in the amount of approximately $1.1 million.

As discussed in Note B to the consolidated financial statements, when the third party contract research organization and other vendor billing terms do not coincide with the Company’s period-end, the Company is required to make estimates of its obligations to those vendors, including personnel costs, allocated facility costs, lab supplies, outside services, contract laboratory costs related to manufacturing drug product, clinical trials, and preclinical studies costs incurred in a given accounting period and record accruals at the end of the period. The Company bases its estimates on its knowledge of the research and development programs, services performed for the period, past history for related activities, and the expected duration of the vendor service contract, where applicable. Payments for these activities are based on criteria establishedthe terms of the individual arrangements and may result inInternal Control - Integrated Frameworkissued by payment terms that differ from the COSO.

Forpattern of costs incurred. There may be instances in which payments made to vendors will exceed the period ended December 31, 2016,level of services provided and result in a prepayment of the clinical expense.

F-3

Table of Contents

Auditing the Company’s prepaid or accrued clinical trial expenses is especially challenging due to the large volume of information received from multiple vendors that perform services on the Company’s behalf. While the Company’s estimates of prepaid or accrued clinical trial expenses are primarily based on information received related to each study from its vendors, the Company recognized a net lossmay need to make an estimate for additional costs incurred. Additionally, due to the long duration of approximately $43.9 millionclinical trials and asthe timing of December 31, 2016,invoicing received from vendors, the Company hadactual amounts incurred cumulative net losses of approximately $204.7 million. Management’s plans with regard to liquidity and capital resources are describednot typically known at the time the financial statements are issued.

How We Addressed the Matter in Note B.

/s/ CHERRY BEKAERT LLP
Our Audit Our audit procedures included, among others, the following:

·

Obtained an understanding of the internal controls and processes in place over the Company’s process used in determining the existence and completeness of prepaid or accrued clinical trial expenses.

·

Tested the accuracy and completeness of the underlying data used in determining the prepaid or accrued clinical trial expenses and evaluating the assumptions and estimates used by management to adjust the actual information received. We corroborated the schedules of the underlying data used in the accrual calculation with the Company’s third party contract research organization who oversees the clinical trials. To evaluate the completeness any required accrual, we also tested subsequent invoices received to assess the impact to the accrual.

/s/ Cherry Bekaert LLP

We have served as the Company’s auditor since 2009.

Raleigh, North Carolina

March 16, 201728, 2024

 
F-4

Table of Contents
43

TENAX THERAPEUTICS, INC.

CONSOLIDATED BALANCE SHEETS

 
 
December 31, 2016
 
 
December 31, 2015
 
 
 
 
 
 
 
 
ASSETS
 
 
 
 
 
 
Current assets
 
 
 
 
 
 
Cash and cash equivalents
 $9,995,955 
 $3,660,453 
Marketable securities
  3,284,616 
  16,528,494 
Accounts receivable
  72,599 
  49,448 
Prepaid expenses
  275,005 
  321,958 
Total current assets
  13,628,175 
  20,560,353 
Marketable securities
  8,586,110 
  18,019,054 
Property and equipment, net
  19,105 
  35,786 
Intangible assets, net
  - 
  22,000,000 
Goodwill
  - 
  11,265,100 
Other assets
  1,106,785 
  1,106,785 
Total assets
 $23,340,175 
 $72,987,078 
 
    
    
LIABILITIES AND STOCKHOLDERS’ EQUITY
    
    
Current liabilities
    
    
Accounts payable
 $727,599 
 $972,483 
Accrued liabilities
  5,245,546 
  3,104,807 
Warrant liabilities
  226,092 
  524,340 
Total current liabilities
  6,199,237 
  4,601,630 
Deferred tax liability
  - 
  7,962,100 
Total liabilities
  6,199,237 
  12,563,730 
 
    
    
 
    
    
Commitments and contingencies; see Note H
    
    
Stockholders' equity
    
    
Common stock, par value $.0001 per share; authorized 400,000,000 shares; issued and outstanding 28,120,021 and 28,119,694, respectively
  2,812 
  2,812 
Additional paid-in capital
  221,816,447 
  221,285,677 
Accumulated other comprehensive loss
  (18,718)
  (129,442)
Accumulated deficit
  (204,659,603)
  (160,735,699)
Total stockholders’ equity
  17,140,938 
  60,423,348 
Total liabilities and stockholders' equity
 $23,340,175 
 $72,987,078 

 

 

December 31,

2023

 

 

December 31,

2022

 

 

 

 

 

 

 

 

ASSETS

 

 

 

 

 

 

Current assets

 

 

 

 

 

 

Cash and cash equivalents

 

$9,792,130

 

 

$2,123,682

 

Prepaid expenses

 

 

1,639,797

 

 

 

738,927

 

Other current assets

 

 

251,583

 

 

 

345,856

 

Total current assets

 

 

11,683,510

 

 

 

3,208,465

 

Right of use asset

 

 

-

 

 

 

179,503

 

Property and equipment, net

 

 

-

 

 

 

7,189

 

Other assets

 

 

1,117

 

 

 

9,552

 

Total assets

 

$11,684,627

 

 

$3,404,709

 

 

 

 

 

 

 

 

 

 

LIABILITIES AND STOCKHOLDERS’ EQUITY

 

 

 

 

 

 

 

 

Current liabilities

 

 

 

 

 

 

 

 

Accounts payable

 

$2,073,149

 

 

$448,425

 

Accrued liabilities

 

 

1,012,468

 

 

 

775,045

 

Note Payable

 

 

500,903

 

 

 

624,302

 

Total current liabilities

 

 

3,586,520

 

 

 

1,847,772

 

Long term liabilities

 

 

 

 

 

 

 

 

Lease liability

 

 

-

 

 

 

64,196

 

Total long term liabilities

 

 

-

 

 

 

64,196

 

Total liabilities

 

 

3,586,520

 

 

 

1,911,968

 

 

 

 

 

 

 

 

 

 

Commitments and contingencies; See Note F

 

 

 

 

 

 

 

 

Stockholders' equity

 

 

 

 

 

 

 

 

Preferred stock, undesignated, authorized 4,818,654 shares; See Note E

 

 

 

 

 

 

 

 

Series A Preferred stock, par value $0.0001, issued 5,181,346 shares; outstanding 210, as of December 31, 2023 and December 31, 2022, respectively

 

 

-

 

 

 

-

 

Common stock, par value $0.0001 per share; authorized 400,000,000 shares; issued and outstanding 298,281 as of December 31, 2023 and 28,648 as of December 31, 2022

 

 

30

 

 

 

3

 

Additional paid-in capital

 

 

305,350,830

 

 

 

291,034,818

 

Accumulated deficit

 

 

(297,252,753)

 

 

(289,542,080)

Total stockholders’ equity

 

 

8,098,107

 

 

 

1,492,741

 

Total liabilities and stockholders' equity

 

$11,684,627

 

 

$3,404,709

 

The accompanying notes are an integral part of these Consolidated Financial Statements.

44
Statements

F-5

Table of Contents

TENAX THERAPEUTICS, INC.

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS


 
 
Year ended
December 31,
 
 Eight months ended December 31, 
 Year ended April 30, 
 
 
2016
 
 
2015
 
 
2015
 
 
2014
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Product revenue
 $- 
 $- 
 $- 
 $25,731 
Cost of sales
  - 
  - 
  - 
  129,800 
Net product revenue
  - 
  - 
  - 
  (104,069)
Government grant revenue
  - 
  - 
  49,286 
  262,995 
Total net revenue
  - 
  - 
  49,286 
  158,926 
 
    
    
    
    
Operating expenses
    
    
    
    
General and administrative
  6,245,958 
  3,940,631 
  7,170,779 
  13,773,325 
Research and development
  13,139,681 
  6,484,867 
  6,660,387 
  2,996,721 
Loss on impairment of long-lived assets
  33,265,100 
  - 
  1,034,863 
  - 
Total operating expenses
  52,650,739 
  10,425,498 
  14,866,029 
  16,770,046 
 
    
    
    
    
Net operating loss
  52,650,739 
  10,425,498 
  14,816,743 
  16,611,120 
 
    
    
    
    
Interest expense
  - 
  1,507 
  49,081 
  2,212,283 
Other (income) expense
  (764,735)
  (359,041)
  (784,012)
  718,436 
Income tax benefit
  (7,962,100)
  - 
  - 
  - 
Net loss
 $43,923,904 
 $10,067,964 
 $14,081,812 
 $19,541,839 
 
    
    
    
    
Unrealized (gain) loss on marketable securities
  (110,724)
  156,160 
  (26,718)
  - 
Total comprehensive loss
 $43,813,180 
 $10,224,124 
 $14,055,094 
 $19,541,839 
 
    
    
    
    
Reconciliation of net loss to net loss attributable to common stockholders
    
    
    
    
Net loss
 $43,923,904 
 $10,067,964 
 $14,081,812 
 $19,541,839 
Preferred stock dividend
  - 
  - 
  - 
  5,803,362 
Net loss attributable to common stockholders
 $43,923,904 
 $10,067,964 
 $14,081,812 
 $25,345,201 
 
    
    
    
    
 
    
    
    
    
Net loss per share, basic and diluted
 $(1.56)
 $(0.36)
 $(0.50)
 $(2.71)
Weighted average number of common shares outstanding, basic and diluted
  28,119,835 
  28,119,597 
  28,077,963 
  9,362,031 

 

 

The year ended December 31,

 

 

 

2023

 

 

2022

 

 

 

 

 

 

 

 

Operating expenses

 

 

 

 

 

 

General and administrative

 

$5,005,135

 

 

$5,675,231

 

Research and development

 

 

3,228,806

 

 

 

5,377,412

 

Total operating expenses

 

 

8,233,941

 

 

 

11,052,643

 

 

 

 

 

 

 

 

 

 

Net operating loss

 

 

8,233,941

 

 

 

11,052,643

 

 

 

 

 

 

 

 

 

 

Interest expense

 

 

23,967

 

 

 

4,443

 

Other income, net

 

 

(547,235)

 

 

(9,191)

Net loss

 

$7,710,673

 

 

$11,047,895

 

 

 

 

 

 

 

 

 

 

Total comprehensive loss

 

$7,710,673

 

 

$11,047,895

 

 

 

 

 

 

 

 

 

 

Net loss per share, basic and diluted

 

$(31.04)

 

$(600.71)

Weighted average number of common shares outstanding, basic and diluted

 

 

248,447

 

 

 

18,391

 

The accompanying notes are an integral part of these Consolidated Financial Statements.

45
Statements

F-6

Table of Contents

TENAX THERAPEUTICS, INC.

CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY


 
 Preferred Stock 
 
Common Stock   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Number of
Shares
 
 Amount 
 Number of
Shares
 
 Amount 
 
Additional paid-in capital
 
 Accumulated other comprehensive gain (loss)
 
 Accumulated
deficit
 
 Total stockholders' equity 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Balance at April 30, 2013
  987 
 $1 
  1,930,078 
 $193 
 $115,265,854 
 $- 
 $(117,044,084)
 $(1,778,036)
Preferred stock sold, net of offering costs
  5,369 
  1 
    
    
  4,895,187 
    
    
  4,895,188 
Preferred stock issued for convertible debt
  4,600 
  3 
    
    
  4,599,997 
    
    
  4,600,000 
Common and preferred stock issued for asset purchase
  32,992 
  3 
  1,366,844 
  137 
  24,046,860 
    
    
  24,047,000 
Common stock sold, net of offering costs
    
    
  10,678,571 
  1,068 
  54,907,282 
    
    
  54,908,350 
Common stock issued for convertible preferred stock
  (43,948)
  (8)
  9,056,415 
  906 
  (898)
    
    
  - 
Common stock issued as interest on convertible debt
    
    
  4,881 
  1 
  220,040 
    
    
  220,041 
Common stock issued as dividend on convertible preferred stock
    
    
  1,407,485 
  140 
  (140)
    
    
  - 
Compensation on options and restricted stock issued
    
    
  50,144 
  5 
  8,131,619 
    
    
  8,131,624 
Common stock issued for services rendered
    
    
  198,668 
  20 
  499,980 
    
    
  500,000 
Exercise of warrants
    
    
  3,161,145 
  316 
  7,135,753 
    
    
  7,136,069 
Reclassification of warrants from equity to derivative liability
    
    
    
    
  (233,036)
    
    
  (233,036)
Fractional shares of common stock due to reverse stock split
    
    
  3,769 
    
    
    
    
  - 
Net loss
    
    
    
    
    
    
  (19,541,839)
  (19,541,839)
Balance at April 30, 2014
  - 
 $- 
  27,858,000 
 $2,786 
 $219,468,498 
 $- 
 $(136,585,923)
 $82,885,361 
Compensation on options and restricted stock issued
    
    
  29,956 
  3 
  465,151 
    
    
  465,154 
Common stock issued for services rendered
    
    
  22,079 
  2 
  99,998 
    
    
  100,000 
Common stock issued as interest on convertible debt
    
    
  255 
  - 
  11,500 
    
    
  11,500 
Issuance of warrants
    
    
    
    
  478,115 
    
    
  478,115 
Exercise of warrants
    
    
  209,230 
  21 
  543,977 
    
    
  543,998 
Unrealized gain (loss) on marketable securities
    
    
    
    
    
  26,718 
  - 
  26,718 
Net loss
    
    
    
    
    
    
  (14,081,812)
  (14,081,812)
Balance at April 30, 2015
  - 
 $- 
  28,119,520 
 $2,812 
 $221,067,239 
 $26,718 
 $(150,667,735)
 $70,429,034 
Compensation on options and restricted stock issued
    
    
  174 
  - 
  218,438 
    
    
  218,438 
Unrealized gain (loss) on marketable securities
    
    
    
    
    
  (156,160)
    
  (156,160)
Net loss
    
    
    
    
    
    
  (10,067,964)
  (10,067,964)
Balance at December 31, 2015
  - 
 $- 
  28,119,694 
 $2,812 
 $221,285,677 
 $(129,442)
 $(160,735,699)
 $60,423,348 
Compensation on options and restricted stock issued
    
    
  327 
  - 
  530,770 
    
    
  530,770 
Unrealized gain (loss) on marketable securities
    
    
    
    
    
  110,724 
    
  110,724 
Net loss
    
    
    
    
    
    
  (43,923,904)
  (43,923,904)
Balance at December 31, 2016
  - 
 $- 
  28,120,021 
 $2,812 
 $221,816,447 
 $(18,718)
 $(204,659,603)
 $17,140,938 

 

 

Preferred Stock

 

 

Common Stock

 

 

Additional

 

 

 

 

Total

 

 

 

Number

of Shares

 

 

Amount

 

 

Number

of Shares

 

 

Amount

 

 

paid-in

capital

 

 

Accumulated deficit

 

 

stockholders'

equity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2021

 

 

210

 

 

$-

 

 

 

15,754

 

 

$2

 

 

$282,738,851

 

 

$(278,494,185)

 

$4,244,668

 

Pre-funded warrants and warrants sold, net of offering costs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7,930,653

 

 

 

 

 

 

 

7,930,653

 

Exercise of pre-funded warrants

 

 

 

 

 

 

 

 

 

 

12,893

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

1

 

Compensation on options issued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

365,314

 

 

 

 

 

 

 

365,314

 

Net loss

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(11,047,895)

 

 

(11,047,895)

Balance at December 31, 2022

 

 

210

 

 

$-

 

 

 

28,647

 

 

$3

 

 

$291,034,818

 

 

$(289,542,080)

 

$1,492,741

 

Public offering sale of common stock and warrants

 

 

 

 

 

 

 

 

 

 

86,994

 

 

 

9

 

 

 

13,897,203

 

 

 

 

 

 

 

13,897,212

 

Offering costs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(282,647)

 

 

 

 

 

 

(282,647)

Exercise of pre-funded warrants for cash

 

 

 

 

 

 

 

 

 

 

18,076

 

 

 

2

 

 

 

511,309

 

 

 

 

 

 

 

511,311

 

Exercise of pre-funded warrants, cashless

 

 

 

 

 

 

 

 

 

 

3,259

 

 

 

-

 

 

 

-

 

 

 

 

 

 

 

-

 

Exercise of warrants, cashless

 

 

 

 

 

 

 

 

 

 

161,131

 

 

 

16

 

 

 

(16)

 

 

 

 

 

 

-

 

Stock split and fractional shares issued

 

 

 

 

 

 

 

 

 

 

174

 

 

 

 

 

 

 

(687)

 

 

 

 

 

 

(687)

Compensation on options issued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

190,850

 

 

 

 

 

 

 

190,850

 

Net loss

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(7,710,673)

 

 

(7,710,673)

Balance at December 31, 2023

 

 

210

 

 

$-

 

 

 

298,281

 

 

$30

 

 

$305,350,830

 

 

$(297,252,753)

 

$8,098,107

 

The accompanying notes are an integral part of these Consolidated Financial Statements.

46
Statements

F-7

Table of Contents

TENAX THERAPEUTICS, INC.

CONSOLIDATED STATEMENTS OF CASH FLOWS

 
 Year ended
December 31,
 
 
Eight months ended December 31,
 
 
Year ended April 30,  
 
 
 2016 
 2015 
 2015 
 2014 
 
 
 
 
 
 
 
 
 
 
 
 
 
CASH FLOWS FROM OPERATING ACTIVITIES
 
 
 
 
 
 
 
 
 
 
 
 
Net Loss
 $(43,923,904)
 $(10,067,964)
 $(14,081,812)
 $(19,541,839)
Adjustments to reconcile net loss to net cash used in operating activities
    
    
    
    
Depreciation and amortization
  18,952 
  31,224 
  148,140 
  150,489 
Interest on debt instruments
  - 
  - 
  45,606 
  2,181,955 
Loss on impairment, disposal and write down of long-lived assets
  33,265,100 
  - 
  1,034,863 
  - 
Gain on disposal of property and equipment
  (74,388)
  - 
  (6,050)
  2,519 
Issuance and vesting of compensatory stock options and warrants
  529,708 
  217,736 
  769,906 
  8,042,662 
Issuance of common stock as compensation
  1,062 
  703 
  117,295 
  651,460 
Change in the fair value of warrants
  (298,248)
  (48,105)
  (382,431)
  721,840 
Amortization of premium on marketable securities
  652,861 
  669,915 
  674,378 
  - 
Deferred income taxes
  (7,962,100)
  - 
  - 
  - 
Changes in operating assets and liabilities
    
    
    
    
Accounts receivable, prepaid expenses and other assets
  23,801 
  13,197 
  (793,148)
  519,255 
Inventory
  - 
  - 
  - 
  99,204 
Accounts payable and accrued liabilities
  1,895,856 
  232,684 
  2,724,459 
  (2,089,116)
Net cash used in operating activities
  (15,871,300)
  (8,950,610)
  (9,748,794)
  (9,261,571)
 
    
    
    
    
CASH FLOWS FROM INVESTING ACTIVITIES
    
    
    
    
Purchase of marketable securities
  (7,255,578)
  (5,554,385)
  (55,142,333)
  - 
Sale of marketable securities
  29,390,264 
  10,355,805 
  14,319,630 
  - 
Purchase of property and equipment
  (2,884)
  (16,688)
  (4,234)
  (9,804)
Proceeds from the sale of property and equipment
  75,000 
  - 
  6,500 
  - 
Capitalization of patent costs and license rights
  - 
  - 
  (105,423)
  (137,234)
Net cash provided by (used in) investing activities
  22,206,802 
  4,784,732 
  (40,925,860)
  (147,038)
 
    
    
    
    
CASH FLOWS FROM FINANCING ACTIVITIES
    
    
    
    
Proceeds from sale of common stock and exercise of stock options and warrants, net of related expenses and payments
  - 
  - 
  543,998 
  62,044,419 
Proceeds from issuance of notes payable, net of issuance costs
  - 
  - 
  172,025 
  141,320 
Payments on notes - short-term
  - 
  (100,160)
  (435,433)
  (135,291)
Net cash (used in) provided by financing activities
  - 
  (100,160)
  280,590 
  66,945,636 
 
    
    
    
    
Net change in cash and cash equivalents
  6,335,502 
  (4,266,038)
  (50,394,064)
  57,537,027 
Cash and cash equivalents, beginning of period
  3,660,453 
  7,926,491 
  58,320,555 
  783,528 
Cash and cash equivalents, end of period
 $9,995,955 
 $3,660,453 
 $7,926,491 
 $58,320,555 
 
    
    
    
    
Cash paid for:
    
    
    
    
Interest
 $- 
 $1,507 
 $3,475 
 $30,328 
The accompanying notes are an integral part of these Consolidated Financial Statements.
47

 

 

Year ended December 31,

 

 

 

2023

 

 

2022

 

 

 

 

 

 

 

 

CASH FLOWS FROM OPERATING ACTIVITIES

 

 

 

 

 

 

Net Loss

 

$(7,710,673)

 

$(11,047,895)

Adjustments to reconcile net loss to net cash used in operating activities

 

 

 

 

 

 

 

 

Depreciation and amortization

 

 

7,570

 

 

 

5,143

 

Interest on debt instrument

 

 

23,967

 

 

 

4,443

 

Amortization of right of use asset

 

 

-

 

 

 

108,189

 

(Gain)/Loss on sale of equipment

 

 

1,125

 

 

 

(2,901)

Issuance and vesting of compensatory stock options and warrants

 

 

190,850

 

 

 

365,314

 

Changes in operating assets and liabilities

 

 

 

 

 

 

 

 

Accounts receivable, prepaid expenses and other assets

 

 

(305,694)

 

 

(356,520)

Accounts payable and accrued liabilities

 

 

1,889,323

 

 

 

(344,951)

Long term portion of lease liability

 

 

-

 

 

 

(119,393)

Net cash used in operating activities

 

 

(5,903,532)

 

 

(11,388,571)

 

 

 

 

 

 

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES

 

 

 

 

 

 

 

 

Proceeds from sale/(purchase) of property and equipment

 

 

2,843

 

 

 

(2,323)

Net cash (used in) provided by investing activities

 

 

2,843

 

 

 

(2,323)

 

 

 

 

 

 

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES

 

 

 

 

 

 

 

 

Proceeds from issuance of warrants and pre-funded warrants, net of issuance costs

 

 

14,192,278

 

 

 

7,928,591

 

Proceeds from the exercise of warrants

 

 

1,161

 

 

 

2,063

 

Payments on short-term note

 

 

(624,302)

 

 

-

 

Net cash provided by financing activities

 

 

13,569,137

 

 

 

7,930,654

 

 

 

 

 

 

 

 

 

 

Net change in cash and cash equivalents

 

 

7,668,448

 

 

 

(3,460,240)

Cash and cash equivalents, beginning of period

 

 

2,123,682

 

 

 

5,583,922

 

Cash and cash equivalents, end of period

 

$9,792,130

 

 

$2,123,682

 

 

 

 

 

 

 

 

 

 

Non-cash operating activity

 

 

 

 

 

 

 

 

Addition to prepaids for insurance premium

 

$(500,903)

 

$(624,302)

 

 

 

 

 

 

 

 

 

Non-cash financing activity

 

 

 

 

 

 

 

 

Addition to notes payable for financing insurance premium

 

$500,903

 

 

$624,302

 

F-8

Table of Contents

TENAX THERAPEUTICS, INC.

CONSOLIDATED STATEMENTS OF CASH FLOWS, continued
Non-cash financing activities during the year ended April 30, 2015:
-
The Company issued 255 shares of restricted common stock for the payment of interest accrued on convertible notes. The shares were issued at a conversion price of $45.10 per share for the payment of $11,500 interest payable on convertible notes with a gross carrying value of $300,000.
Non-cash financing activities during the year ended April 30, 2014:
-
TheCompany issued 4,881 shares of restricted common stock for the payment of interest accrued on convertible notes. The shares were issued at a conversion price of $45.10 for the payment of $220,041 interest payable on convertible notes with a gross carrying value of $4,900,000.
-
The Company issued 831,401 shares of its common stock for the payment of $1,300,204 as dividends on the Series C 8% Convertible Preferred stock.
-
The Company issued 4,600 shares of Series D 8% Convertible Preferred Stock as consideration for cancellation of $4.6 million in outstanding principal amount of a convertible promissory note issued by the Company on July 1, 2011.
-
The Company issued 576,084 shares of its common stock for the payment of $1,104,000 as dividends on the Series D 8% Convertible Preferred stock.
-
The Company issued 1,366,844 shares of its common stock that had a fair value of approximately $8.7 million and 32,992 shares of its Series E Convertible Preferred Stock, which are convertible into an aggregate of 3,299,200 shares of common stock that had a fair value of approximately $15.3 million in exchange for the assets of Phyxius Pharma, Inc. The Company recorded Goodwill of $11,265,100 as a result of this issuance.
The accompanying notes are an integral part of these Consolidated Financial Statements.
48
TENAX THERAPEUTICS, INC.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

NOTE A—DESCRIPTION OF BUSINESS

Description of Business—

Tenax Therapeutics, Inc. (the “Company”) was originally formed as a New Jersey corporation in 1967 under the name Rudmer, David & Associates, Inc., and subsequently changed its name to Synthetic Blood International, Inc. On June 17, 2008, the stockholders of Synthetic Blood International approved the Agreement and Plan of Merger dated April 28, 2008, between Synthetic Blood International and Oxygen Biotherapeutics, Inc., a Delaware corporation. Synthetic Blood International formed Oxygen Biotherapeutics was formed on April 17, 2008 by Synthetic Blood International to participate in the merger for the purpose of changing the state of domicile of Synthetic Blood International from New Jersey to Delaware. Certificates of Merger were filed with the states of New Jersey and Delaware and the merger was effective June 30, 2008. Under the Plan of Merger, Oxygen Biotherapeutics was the surviving corporation and each share of Synthetic Blood International common stock outstanding on June 30, 2008 was converted tointo one share of Oxygen Biotherapeutics common stock. On September 19, 2014, the Company changed its name to Tenax Therapeutics, Inc.

On October 18,November 13, 2013, the Company, created a wholly ownedthrough its wholly-owned subsidiary, Life Newco, Inc., a Delaware corporation, (“Life Newco”), to acquireacquired certain assets of Phyxius Pharma, Inc., a Delaware corporation (“Phyxius”), pursuant to an Asset Purchase Agreement dated October 21, 2013 (the “Asset Purchase Agreement”), by and among the Company, Life Newco, Phyxius and the stockholders of Phyxius (the “Phyxius Stockholders”Phyxius. Among these assets was a license with Orion Corporation (as amended, the “License”). As further discussed in Note D below, on November 13, 2013,, a global healthcare company incorporated under the terms and subject tolaws of Finland (“Orion”) for the conditions of the Asset Purchase Agreement, Life Newco acquired certain assets, including a license granting Life Newco an exclusive, sublicenseablesublicensable right to develop and commercialize pharmaceutical products containing Levosimedan,levosimendan, 2.5 mg/ml concentrate for solution for infusion / 5ml vial in the United States and Canada.

Reverse Stock Split
On October 9, 2020 and January 25, 2022, the Company entered into an amendment to the License to include in the scope of the License two new oral product formulations containing levosimendan, in capsule and solid dosage form (TNX-103), and a subcutaneously administered dosage form (TNX-102), subject to specified limitations (together, the “Product”). In February 2024, the Company entered into an additional amendment to the License, providing global rights to oral and subcutaneous formulations of levosimendan used in the treatment of PH-HFpEF, revising the royalty structure, lowering the royalty rates, modifying milestones associated with certain regulatory and commercial achievements, and excluding from the Company’s right of first negotiation the right to commercialize new applications of levosimendan for neurological diseases and disorders developed by Orion. Pursuant to the License, the Company and Orion will agree to a new trademark when commercializing levosimendan in either of these forms. The term of the License has been extended until 10 years after the launch of the Product in the territory, provided that the License will continue after the end of the term in each country in the territory until the expiration of Orion’s patent rights in the Product in such country. In the event that no regulatory approval for the Product has been granted in the United States on or before September 20, 2030, however, either party will have the right to terminate the License with immediate effect. The Company initiatedintends to conduct two upcoming Phase 3 studies in pulmonary hypertension patients utilizing one of these oral formulations. See “Note–F - Commitments and Contingencies” below for a 1-for-20 reverse stock split effective May 10, 2013. All sharesfurther discussion of the License.

On January 15, 2021, the Company, Life Newco II, Inc., a Delaware corporation and per share amountsa wholly-owned, subsidiary of the Company (“Life Newco II”), PHPrecisionMed Inc., a Delaware corporation (“PHPM”) and Dr. Stuart Rich, solely in these Consolidated Financial Statementshis capacity as holders’ representative ( the “Representative”), entered into an Agreement and notes theretoPlan of Merger (the “Merger Agreement”) pursuant to which the Company acquired all of the equity of PHPM, a company developing pharmaceutical products containing imatinib for the treatment of PAH (“PAH”) in the United States and the rest of the world. Under the terms of the Merger Agreement, Life Newco II merged with and into PHPM, with PHPM surviving as a wholly-owned subsidiary of the Company (the “Merger”).

Going Concern

Management believes the accompanying financial statements have been retroactively adjusted to give effect to the reverse stock split.

NOTE B—SUMMARY OF CRITICAL ACCOUNTING POLICIES
Use of Estimates
The preparation of the accompanying consolidated financial statementsprepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”), which contemplate continuation of the Company as a going concern. The Company has an accumulated deficit of $297,252,753 and $289,542,080 on December 31, 2023 and 2022, respectively, and used cash in operations of $5,903,532 and $11,388,571 during the years ended December 31, 2023 and 2022, respectively. The Company requires substantial additional funds to complete clinical trials and pursue regulatory approvals. Management is actively seeking additional sources of equity and/or debt financing; however, there is no assurance that any additional funding will be available.

In view of the matters described above, recoverability of a major portion of the recorded asset amounts shown in the accompanying December 31, 2023 balance sheet is dependent upon continued operations of the Company, which in turn is dependent upon the Company’s ability to meet its financing requirements on a continuing basis, to maintain present financing, and to generate cash from future operations. These factors, among others, raise substantial doubt about the Company’s ability to continue as a going concern. The financial statements do not include any adjustments relating to the recoverability and classification of recorded asset amounts or amounts and classification of liabilities that might be necessary should the Company be unable to continue in existence.

F-9

Table of Contents

NOTE B—SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Use of Estimates

The preparation of the accompanying consolidated financial statements in conformity with GAAP requires management to make certain estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and reported amounts of expenses during the reporting period. Actual results could differ from those estimates.

On an ongoing basis, management reviews its estimates to ensure that these estimates appropriately reflect changes in the Company’s business and new information as it becomes available. If historical experience and other factors used by management to make these estimates do not reasonably reflect future activity, the Company’s results of operations and financial position could be materially impacted.

Principles of Consolidation

The accompanying consolidated financial statements include the accounts and transactions of Tenax Therapeutics, Inc., Life Newco, Inc. and Life Newco,PHPrecisionMed Inc. All material intercompany transactions and balances have been eliminated in consolidation.

Goodwill
Acquired businesses are accounted for usingconsolidation. 

Reverse Stock Splits

The Company has adjusted the acquisition methodfinancial statements to reflect that on January 2, 2024, we effected a 1-for-80 reverse stock split (the “Reverse Stock Split”).  The Company has also adjusted the financial statements to reflect that on January 4, 2023, we effected a 1-for-20 reverse stock split (the “Prior Reverse Stock Split”, together with the Reverse Stock Split, the “Reverse Stock Splits”). The Reverse Stock Splits did not change the number of accounting, which requires that assets acquired, including identifiable intangible assets, and liabilities assumed be recorded at fair value, with limited exceptions. Any excessauthorized shares of capital stock or cause an adjustment to the purchase price over the fairpar value of our capital stock. Pursuant to their terms, a proportionate adjustment was made to the net assets acquired is recorded as goodwill. If the acquired net assets do not constitute a business, the transaction is accountedper share exercise price and number of shares issuable under our outstanding stock options and warrants. The number of shares authorized for as an asset acquisition and no goodwill is recognized.

49
TENAX THERAPEUTICS, INC.
Goodwill is reviewed for impairment on an annual basis or more frequently if events or circumstances indicate potential impairment. The Company’s goodwill evaluation is based on both qualitative and quantitative assessments regarding the fair value of goodwill relative to its carrying value. The Company assesses qualitative factors to determine if its sole reporting unit’s fair value is more likely than not to exceed its carrying value, including goodwill. In the event the Company determines that it is more likely than not that its reporting unit’s fair value is less than its carrying amount, quantitative testing is performed comparing recorded values to estimated fair values. If the fair value exceeds the carrying value, goodwill is not impaired. If the carrying value exceeds the fair value, an impairment charge is recognized through a charge to operations based upon the excess of the carrying value of goodwill over the implied fair value.  
During the year ended December 31, 2016, the Company recognized an impairment charge of $33.3 million relatedissuance pursuant to our levosimendan product in Phase III clinical trial, which represents approximately $22 million for in-process research and development (“IPR&D”) assets and approximately $11.3 million for goodwill.
The LEVO-CTS trial was completed in December of 2016. Based onequity incentive plans have also been adjusted proportionately to reflect the data from the trial, levosimendan, given prophylactically prior to cardiac surgery to patients with reduced left ventricular function, had no effect on the co-primary outcomes. The study did not achieve statistically significant reductions in the dual endpoint of death or use of a mechanical assist device at 30 days, nor in the quad endpoint of death, myocardial infarction, need for dialysis, or use of a mechanical assist device at 30 days. Based on the results of the LEVO-CTS trial, the Company does not anticipate additional development of levosimendan for the treatment of LCOS in patients undergoing cardiac surgery. As of December 31, 2016, management determined the IPR&D asset, and corresponding Goodwill, was more than temporarily impaired.
There was no impairment to goodwill recognized during 2015 and 2014.
Reverse Stock Splits.

Cash and Cash Equivalents

The Company considers all highly liquid instruments with a maturity date of three months or less, when acquired, to be cash equivalents.

Cash Concentration Risk

On July 21, 2010, the Wall Street Reform and Consumer Protection Act permanently increased the

The Federal Deposit Insurance Corporation (the “FDIC”) insurance limits toare $250,000 per depositor per insured bank. The Company had cash balances of $9,362,812$2,383,498 and $2,908,446$1,877,589 uninsured by the FDIC as of December 31, 20162023 and 2015,2022, respectively.

Liquidity and Capital Resources

The Company has financed its operations since September 1990 through the issuance of debt and equity securities and loans from stockholders. The Company had total current assets of $13,628,175approximately $11.7 million and $20,560,353$3.2 million and working capital of $7,428,937$8.1 million and $15,958,723 as of December 31, 2016 and 2015, respectively.

Cash resources, including the fair value of the Company’s available for sale marketable securities as of December 31, 2016 were approximately $21.9 million, compared to approximately $38.2$1.4 million as of December 31, 2015.
2023 and 2022, respectively.

The Company’s cash resources were approximately $9.8 million as of December 31, 2023, compared to cash resources of approximately $2.1 million as of December 31, 2022.

The Company expects to continue to incur expenses related to the development of levosimendan for heart failurepulmonary hypertension and other potential indications and, over the long term, imatinib for PAH, as well as identifying and developing other potential product candidates. Based on its resources aton December 31, 2016,2023, the Company believes that it has sufficient capital to fund its planned operations through the first half of calendar year 2018.2024. However, the Company will need substantial additional financing in order to fund its operations beyond such period and thereafter until it can achieve profitability, if ever. The Company depends on its ability to raise additional funds through various potential sources, such as equity and debt financing, or to license its product candidates to another pharmaceutical company. The Company will continue to fund operations from cash on hand and through sources of capital similar to those previously described. The Company cannot assureprovide assurance that it will be able to secure such additional financing, or if available, that it will be sufficient to meet its needs.

To the extent that the Company raises additional funds by issuing shares of its common stock or other securities convertible or exchangeable for shares of common stock, stockholders will experience dilution, which may be significant. In the event the Company raises additional capital through debt financings, the Company may incur significant interest expense and become subject to covenants in the related transaction documentation that may affect the manner in which the Company conducts its business. To the extent that the Company raises additional funds through collaboration and licensing arrangements, it may be necessary to relinquish some rights to its technologies or product candidates or grant licenses on terms that may not be favorable to the Company. Any or all of the foregoing may have a material adverse effect on the Company’s business and financial performance.

50
TENAX THERAPEUTICS, INC.
Deferred financing costs
Deferred financing costs represent legal, due diligence and other direct costs incurred to raise capital or obtain debt. Direct costs include only “out-of-pocket” or incremental costs directly related to the effort, such as a finder’s fee and accounting and legal fees. These costs will be capitalized if the efforts are successful, or expensed when unsuccessful. Indirect costs are expensed as incurred. Deferred financing costs related to debt are amortized over the life of the debt. Deferred financing costs related to issuing equity are charged to Additional Paid-in Capital.
Derivative financial instruments
The Company does not use derivative instruments to hedge exposures to cash flow, market or foreign currency risk. Terms of convertible promissory note instruments and other convertible equity instruments are reviewed to determine whether or not they contain embedded derivative instruments that are required under FASB ASC 815, Derivatives and Hedging (“ASC 815”) to be accounted for separately from the host contract, and recorded on the balance sheet at fair value. The fair value of derivative liabilities, if any, is required to be revalued at each reporting date, with corresponding changes in fair value recorded in current period operating results.
Freestanding warrants issued by the Company in connection with the issuance or sale of debt and equity instruments are considered to be derivative instruments, and are evaluated and accounted for in accordance with the provisions of ASC 815.
Beneficial conversion and warrant valuation
In accordance with FASB ASC 470-20, Debt with Conversion and Other Options, the Company records a beneficial conversion feature (“BCF”) related to the issuance of convertible debt that have conversion features at fixed rates that are in-the-money when issued and the fair value of warrants issued in connection with those instruments. The BCF for the convertible instruments is recognized and measured by allocating a portion of the proceeds to warrants, based on their relative fair value, and as a reduction to the carrying amount of the convertible debt equal to the intrinsic value of the conversion feature. As described in Note F, the discount recorded in connection with the BCF and warrant valuation is recognized as non-cash interest expense and is amortized over the life of the convertible note.

F-10

Table of Contents

Preclinical Study and Clinical Accruals

The Company estimates its preclinical study and clinical trial expenses based on the services received pursuant to contracts with several research institutions and contract research organizations (“CROs”) that do or may conduct and manage preclinical and clinical trials on its behalf. The financial terms of the agreements vary from contract to contract, may be estimated by Tenax Therapeutics and outside advisors prior to contracting with a CRO, and may result in uneven expenses and payment flows. Preclinical study and clinical trial expenses include the following:

-
fees paid to CROs in connection with clinical trials,
-
fees paid to research institutions in conjunction with preclinical research studies, and
-
fees paid to contract manufacturers and service providers in connection with the production and testing of active pharmaceutical ingredients and drug materials for use in preclinical studies and clinical trials.

-

fees paid to CROs in connection with clinical trials,

-

fees paid to research institutions in conjunction with preclinical and clinical research studies, and

-

fees paid to contract manufacturers and service providers in connection with the production and testing of active pharmaceutical ingredients and drug materials for use in preclinical studies and clinical trials.

Property and Equipment, Net

Property and equipment are stated at cost, subject to adjustments for impairment, less accumulated depreciation and amortization. Depreciation and amortization are computed using the straight-line method over the followingwith estimated useful lives:

Laboratory equipment3 – 5 years
Office equipment5 years
Office furniture and fixtures7 years
Computer equipment and software3 years
Leasehold improvementsShorter of useful life or remaining lease term
lives of three to seven years.

Maintenance and repairs are charged to expenseexpensed as incurred, and improvements to leased facilities and equipment are capitalized.

51
TENAX THERAPEUTICS, INC.
Revenue Recognition
Revenues from merchandise sales are recognized upon transfer of ownership, including passage of title to the customer and transfer of the risk of loss related to those goods. Revenues are reported on a net sales basis, which is computed by deducting from gross sales the amount of actual product returns received, discounts, incentive arrangements with retailers and an amount established for anticipated product returns. The Company’s practice is to accept product returns from retailers only if properly requested, authorized and approved.
Revenues from a cost-reimbursement grant sponsored by the United States Army (“Grant Revenue”), are recognized as milestones under the Grant program are achieved. Grant Revenue is earned through reimbursements for the direct costs of labor, travel, and supplies, as well as the pass-through costs of subcontracts with third-party CROs.

F-11

Table of Contents

Research and Development Costs

Research and development costs include, but are not limited to, (i) expenses incurred under agreements with CROs and investigative sites, which conduct our clinical trials and a substantial portion of our preclinical studies;trials; (ii) the cost of manufacturing and supplying clinical trial materials; (iii) payments to contract service organizations, as well as consultants; (iv) employee-related expenses, which include salaries and benefits; and (v) facilities, depreciation and other allocated expenses, which include direct and allocated expenses for rent and maintenance of facilities and equipment, depreciation of leasehold improvements, equipment, laboratory and other supplies. All research and development expenses are expensed as incurred.

Income Taxes

Deferred tax assets and liabilities are recorded for differences between the financial statement and tax bases of the assets and liabilities that will result in taxable or deductible amounts in the future based on enacted tax laws and rates applicable to the periods in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to the amount expected to be realized. Income tax expense is recorded for the amount of income tax payable or refundable for the period increased or decreased by the change in deferred tax assets and liabilities during the period.

Stock-Based Compensation

The Company accounts for stock based compensationstock-based awards to employees in accordance with ASC 718, Compensation — Stock Compensation, which requiresprovides for the use of the fair value-based method to determine compensation for all arrangements where shares of stock or equity instruments are issued for compensation. Fair values of equity securities are determined by management based predominantly on the trading price of the Company’s common stock. The values of these awards are based upon their grant-date fair value. That cost is recognized over the period during which the employee is required to provide service in exchange for the reward.

The Company accounts for equity instruments issued to non-employees in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Board (“ASC”) 505-50, Equity-Based Payments to Non-Employees. The Company records equity instruments at their fair value on the measurement date and recognition of compensation expense for all stock-based payment awards granted, modified and settled to our employees and directors. The Company choseperiodically adjust them as the “straight-line” attribution method for allocating compensation costs of each stock option on a straight-line basis over the requisite service period using the Black-Scholes Option Pricing Model to calculate the grant date fair value.

underlying equity instruments vest.

Loss Per Share

Basic loss per share, which excludes antidilutive securities, is computed by dividing net loss by the weighted-average number of common shares outstanding for that particular period. In contrast, diluted loss per share considers the potential dilution that could occur from other equity instruments that would increase the total number of outstanding shares of common stock. Such amounts include shares potentially issuable under outstanding options, restricted stock and warrants.

The following outstanding options, restricted stock grants, convertible notepreferred shares and warrants were excluded from the computation of basic and diluted net loss per share for the periods presented because including them would have had an anti-dilutive effect.

 
 
Year ended
December 31,
 
 
Eight months ended December 31,
 
 
Year ended April 30,  
 
 
 
2016
 
 
2015
 
 
2015
 
 
2014
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Options to purchase common stock
  4,742,032 
  4,032,698 
  3,718,298 
  3,647,858 
Warrants to purchase common stock
  2,415,675 
  2,728,236 
  2,728,236 
  2,762,466 
Restricted stock grants
  214 
  394 
  90 
  42,629 
Convertible note shares outstanding
  - 
  - 
  - 
  6,652 
52
TENAX THERAPEUTICS, INC.

 

 

Year ended December 31,

 

 

 

2023

 

 

2022

 

 

 

 

 

 

 

 

Warrants to purchase common stock

 

 

19,694

 

 

 

19,703

 

Pre-funded warrants to purchase common stock

 

 

-

 

 

 

-

 

Options to purchase common stock

 

 

936

 

 

 

968

 

Convertible preferred shares outstanding

 

 

210

 

 

 

210

 

F-12

Table of Contents

Operating Leases

The Company maintainsdetermines if an arrangement includes a lease at inception. Operating leases are included in operating lease right-of-use assets, other current liabilities, and long-term lease liabilities in the Company’s consolidated balance sheet as of December 31, 2022. Right-of-use assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Operating lease right-of-use assets and liabilities are recognized at the lease commencement date based on the present value of lease payments over the lease term. In determining the net present value of lease payments, the Company uses the incremental borrowing rate based on the information available at the lease commencement date. The operating lease right-of-use assets also include any lease payments made and exclude lease incentives. The Company’s leases may include options to extend or terminate the lease which are included in the lease term when it is reasonably certain that the Company will exercise any such option. Lease expense is recognized on a straight-line basis over the expected lease term. The Company has elected to account for leases with an initial term of 12 months or less similar to previous guidance for operating leases, for its officeunder which the Company will recognize those lease payments in the consolidated statements of operations and laboratory facilities. The lease agreements may include rent escalation clauses and tenant improvement allowances. The Company recognizes scheduled rent increasescomprehensive loss on a straight-line basis over the lease term beginning with the date the company takes possession of the leased space. Differences between rental expense and actual rental payments are recorded as deferred rent liabilities and are included in “Other liabilities” on the consolidated balance sheets.

term.

Recent Accounting Pronouncements

In January 2017, the Financial Accounting Standards Board (the “FASB”), issued a new accounting standard that provides guidance for evaluating whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The guidance provides a screen to determine when an integrated set of assets and activities, or a set, does not qualify to be a business. The screen requires that when substantially all of the fair value of the gross assets acquired (or disposed of) is concentrated in an identifiable asset or a group of similar identifiable assets, the set is not a business. If the screen is not met, the guidance requires a set to be considered a business to include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create outputs and removes the evaluation as to whether a market participant could replace the missing elements. The new standard will be effective for the Company on January 1, 2018 and will be adopted on a prospective basis. Early adoption is permitted. The Company is currently evaluating the effect that the standard will have on its consolidated financial statements and related disclosures.

In AugustJune 2016, the FASB issued a newan accounting standard that clarifies how companies present and classify certain cash receipts and cash payments in the statementupdate, ASU-2016-13, Financial Instruments-Credit Losses (Topic 326): Measurement of cash flows where diversity in practice exists. The new standard is effective for the Company in its first quarter of fiscal 2018 and earlier adoption is permitted. The Company is currently evaluating the effect that the updated standard will haveCredit Losses on its consolidated financial statements and related disclosures.
In June 2016, the FASB issued a new accounting standardFinancial Instruments, that amends how credit losses are measured and reported for certain financial instruments that are not accounted for at fair value through net income. This new standard will requirerequires that credit losses be presented as an allowance rather than as a write-down for available-for-sale debt securities and will be effective for interim and annual reporting periods beginning January 1, 2020,2023, with early adoption permitted, but not earlier than annual reporting periods beginningpermitted. We adopted this standard on January 1, 2019. A modified retrospective approach is to be used for certain parts of this guidance, while other parts of the guidance are to be applied using a prospective approach. The Company is currently evaluating the impact that this new standard will have on its consolidated financial statements and related disclosures.
In March 2016, the FASB issued a new accounting standard intended to simplify various aspects related to how share-based payments are accounted for and presented in the financial statements. The new guidance includes provisions to reduce the complexity related to income taxes, statement of cash flows, and forfeitures when accounting for share-based payment transactions. The new standard is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. Early2023. Our adoption is permitted. The Company does not believe adoption of this standard will have a material impact on its consolidated financial statements and related disclosures.
In May 2014, the FASB issued a new accounting standard that supersedes nearly all existing revenue recognition guidance under GAAP. The new standard is principles-based and provides a five-step model to determine when and how revenue is recognized. The core principle of the new standard is that revenue should be recognized when a company transfers promised goods or services to customers in an amount that reflects the consideration to which the Company expects to be entitled in exchange for those goods or services. In March 2016, the FASB issued a new standard to clarify the implementation guidance on principal versus agent considerations, and in April 2016, the FASB issued a new standard to clarify the implementation guidance on identifying performance obligations and licensing. The new standard also requires disclosure of qualitative and quantitative information surrounding the amount, nature, timing and uncertainty of revenues and cash flows arising from contracts with customers. In July 2015, the FASB agreed to defer the effective date of the standard from annual periods beginning after December 15, 2016, to annual periods beginning after December 15, 2017, with an option that permits companies to adopt the standard as early as the original effective date. Early application prior to the original effective date is not permitted. The standard permits the use of either the retrospective or cumulative effect transition method. The Company has not yet selected a transition method and the Company does not believe adoption of this standard will have a material impact on its consolidated financial statements and related disclosures.
53
TENAX THERAPEUTICS, INC.
In February 2016, the FASB issued a new accounting standard intended to improve financial reporting regarding leasing transactions. The new standard will require the Company to recognize on the balance sheet the assets and liabilities for the rights and obligations created by all leased assets. The new standard will also require it to provide enhanced disclosures designed to enable users of financial statements to understand the amount, timing, and uncertainty of cash flows arising from all leases, operating and capital, with lease terms greater than 12 month. The new standard is effective for financial statements beginning after December 15, 2018, and interim periods within those annual periods. Early adoption is permitted. See Note H for the Company’s current lease commitments. The Company is currently evaluating the impact that this new standard will have on its financial statements and related disclosures.
In January 2016, the FASB issued a new accounting standard that will enhance the Company’s reporting for financial instruments. The new standard is effective for financial statements issued for annual periods beginning after December 15, 2017, and interim periods within those annual periods. Earlier adoption is permitted for interim and annual reporting periods as of the beginning of the fiscal year of adoption. The Company does not believe the adoption of this standard will have a material impact on its consolidated financial statements.
In November 2015, the FASB issued a new accounting standard that changes the balance sheet classifications of deferred income taxes. This standard amends existing guidance to require that deferred tax liabilities and assets be classified as noncurrent in a classified statement of financial position. It is effective for annual reporting periods beginning after December 15, 2016, and interim periods within those annual periods. Early adoption is permitted. The Company does not expect adoption of this standard will have a material impact on its consolidated financial statements.
In August 2014, the FASB issued a new accounting standard that will require management to assess and evaluate whether conditions or events exist, considered in the aggregate, that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the financial statements issue date. It is effective for annual periods ending after December 15, 2016 and for annual and interim periods thereafter; early adoption is permitted. The adoption of this new standard did not have a material effectsignificant impact on the Company’sour consolidated financial statements.

Fair Value

The Company determines the fair value of its financial assets and liabilities in accordance with the FASB Accounting Standards Codification (“ASC”)ASC 820, Fair Value Measurements. The Company’s balance sheet includes the following financial instruments: cash and cash equivalents, investments in marketable securities and short-term notes payable, and warrant liabilities.payable. The Company considers the carrying amount of its cash and cash equivalents and short-term notes payable to approximate fair value due to the short-term nature of these instruments.

Accounting for fair value measurements involves a single definition of fair value, along with a conceptual framework to measure fair value, with a fair value defined as “the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date.”date”. The fair value measurement hierarchy consists of three levels:

Level one

Quoted market prices in active markets for identical assets or liabilities;

Level two

Inputs other than level one inputs that are either directly or indirectly observable; and

Level three

Unobservable inputs developed using estimates and assumptions; which are developed by the reporting entity and reflect those assumptions that a market participant would use.

The Company applies valuation techniques that (1) place greater reliance on observable inputs and less reliance on unobservable inputs and (2) are consistent with the market approach, the income approach and/or the cost approach, and include enhanced disclosures of fair value measurements in the Company’s consolidated financial statements.

Investments in Marketable Securities
The Company classifies all

Reclassification of its investments as available-for-sale. Unrealized gains and lossesPrior Year Presentation

Certain prior year amounts have been reclassified for consistency with the current year presentation.  These reclassifications had no effect on investments are recognized in comprehensive income/(loss), unless an unrealized loss is consideredthe financial position or reported results of operations for the periods presented.  An adjustment has been made to be other than temporary, in which case the unrealized loss is charged to operations. The Company periodically reviews its investments for other than temporary declines in fair value below cost basis and whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. The Company believes the individual unrealized losses represent temporary declines primarily resulting from interest rate changes. Realized gains and losses are reflected in other income (expense) in the Consolidated Statements of Operations and Comprehensive Loss and are determined using the specific identification method with transactions recorded on a settlement date basis.

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TENAX THERAPEUTICS, INC.
For theCash Flows for fiscal year ended December 31, 2016,2022, to identify the Company recognizednon-cash expense related to a lossfinancing arrangement for prepaid insurance and notes payable amount of $41,955, and a loss of $43,871 for the eight months ended December 31, 2015. For the fiscal years ended April 30, 2015 and 2014, the Company recognized a gain of $1,025, and $0, respectively.
Investments with original maturities at date of purchase beyond three months and which mature at or less than 12 months from the balance sheet date are classified as current. Investments with a maturity beyond 12 months from the balance sheet date are classified as long-term. At December 31, 2016, the Company believes that the costs of its investments are recoverable in all material respects.
The following tables summarize the fair value of the Company’s investments by type. The estimated fair value of the Company’s fixed income investments are classified as Level 2 in the fair value hierarchy as defined in U.S. GAAP. These fair values are obtained from independent pricing services which utilize Level 2 inputs:
 
 
December 31, 2016
 
 
 
Amortized Cost
 
 
Accrued Interest
 
 
Gross
Unrealized
Gains
 
 
Gross
Unrealized
Losses
 
 
Estimated Fair
Value
 
Corporate debt securities
 $11,780,631 
 $108,813 
 $5,385 
 $(24,103)
 $11,870,726 
The following table summarizes the scheduled maturity for the Company’s investments at December 31, 2016 and 2015, respectively:
 
 
December 31, 2016
 
 
December 31, 2015
 
Maturing in one year or less
 $3,284,616 
 $16,528,494 
Maturing after one year through three years
  8,586,110 
  18,019,054 
Total investments
 $11,870,726 
 $34,547,548 
Warrant liability
On July 23, 2013, the Company issued common stock warrants in connection with the issuance of Series C 8% Preferred Stock (the “Series C Warrants”). As part of the offering, the Company issued 2,753,348 warrants at an exercise price of $2.60 per share and contractual term of 6 years. On November 11, 2013, the Company satisfied certain contractual obligations pursuant to the Series C offering which caused certain “down-round” price protection clauses in the outstanding warrants to become effective on that date. In accordance with ASC 815-40-35-9, the Company reclassified these warrants as a current liability and recorded a warrant liability of $1,380,883, which represents the fair market value of the warrants at that date. The initial fair value recorded as warrants within stockholders’ equity of $233,036 was reversed and the subsequent changes in fair value are recorded as a component of other expense.
Financial assets or liabilities are considered Level 3 when their fair values are determined using pricing models, discounted cash flow methodologies or similar techniques and at least one significant model assumption or input is unobservable. The Series C Warrants are measured using the Monte Carlo valuation model which is based, in part, upon inputs for which there is little or no observable market data, requiring the Company to develop its own assumptions.  The assumptions used in calculating the estimated fair value of the warrants represent the Company’s best estimates; however, these estimates involve inherent uncertainties and the application of management judgment.  As a result, if factors change and different assumptions are used, the warrant liabilities and the$624,302.  This change in estimated fair value of the warrants could be materially different.
Inherent in the Monte Carlo valuation model are assumptions related to expected stock-price volatility, expected life, risk-free interest rateclassification affects previously reported cash flows from operating activities and dividend yield.  The Company estimates the volatility of its common stock based on historical volatility that matches the expected remaining life of the warrants. The risk-free interest rate is based on the U.S. Treasury zero-coupon yield curve on the grant date for a maturity similar to the expected remaining life of the warrants.  The expected life of the warrants is assumed to be equivalent to their remaining contractual term.  The dividend rate is based on the historical rate, which the Company anticipates to remain at zero.
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TENAX THERAPEUTICS, INC.
The Monte Carlo model is used for the Series C Warrants to appropriately value the potential future exercise price adjustments triggered by the anti-dilution provisions. This requires Level 3 inputs which are based on the Company’s estimates of the probability and timing of potential future financings and fundamental transactions.  The other assumptions used by the Company are summarized in the following table for the Series C Warrants that were outstanding as of December 31, 2016 and December 31, 2015:
Series C Warrants
 
December 31, 2016
 
 
December 31, 2015
 
Closing stock price
 $1.95 
 $3.28 
Expected dividend rate
  0%
  0%
Expected stock price volatility
  79.60%
  84.08%
Risk-free interest rate
  1.35%
  1.44%
Expected life (years)
  2.56 
  3.56 
 
    
    

As of December 31, 2016, the fair value of the warrant liability was $226,092. The Company recorded a gain of $298,248 for the change in fair value as a component of other expense on the consolidated statement of comprehensive loss for the year ended December 31, 2016.
The Company recorded a gain of $48,105 for the change in fair value as a component of other expense on the consolidated statement of comprehensive loss for the eight months ended December 31, 2015.
For the fiscal years ended April 30, 2015 and 2014, the Company recognized a gain of $382,431 and a loss of $721,840, respectively, for the change in fair value as a component of other expense on the consolidated statement of operations.
A roll-forward of fair value measurements using significant unobservable inputs (Level 3) for the warrants for the year ended December 31, 2016, for the eight months ended December 31, 2015 and the year ended April 30, 2015 are as follows:
Balance, at April 30, 2014
$954,876
Issuance of warrants
-
Exercise of warrants
-
Gain included in income from change in fair value of warrants for the period
(382,431)
Balance, at April 30, 2015
$572,445
Issuance of warrants
-
Exercise of warrants
-
Gain included in income from change in fair value of warrants for the period
(48,105)
Balance, at December 31, 2015
$524,340
Issuance of warrants
-
Exercise of warrants
-
Gain included in income from change in fair value of warrants for the period
(298,248)
Balance, at December 31, 2016
$226,092
As of December 31, 2016, 240,523 Series C Warrants are outstanding.
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TENAX THERAPEUTICS, INC.
The following tables summarize information regarding assets and liabilities measured at fair value on a recurring basis as of December 31, 2016 and December 31, 2015:
 
 
 
 
 
 Fair Value Measurements at Reporting Date Using
 
 
 
 Balance as of
December 31, 2016
 
 
 Quoted prices in Active Markets for Identical Securities (Level 1)
 
 
Significant Other Observable Inputs (Level 2)
 
 
 Significant Unobservable Inputs (Level 3)
 
Current Assets
 
 
 
 
 
 
 
 
 
 
 
 
Cash and cash equivalents
 $9,995,955 
 $9,995,955 
 $- 
 $- 
Marketable securities
 $3,284,616 
 $- 
 $3,284,616 
 $- 
 
    
    
    
    
Long-term Assets
    
    
    
    
Marketable securities
 $8,586,110 
 $- 
 $8,586,110 
 $- 
 
    
    
    
    
Current Liabilities
    
    
    
    
Warrant liabilities
 $226,092 
 $- 
 $- 
 $226,092 
 
 
 
 
 
 Fair Value Measurements at Reporting Date Using
 
 
 
 Balance as of
December 31, 2015
 
 
 Quoted prices in Active Markets for Identical Securities (Level 1)
 
 
Significant Other Observable Inputs (Level 2)
 
 
 Significant Unobservable Inputs (Level 3)
 
Current Assets
 
 
 
 
 
 
 
 
 
 
 
 
Cash and cash equivalents
 $3,660,453 
 $3,660,453 
 $- 
 $- 
Marketable securities
 $16,528,494 
 $- 
 $16,528,494 
 $- 
 
    
    
    
    
Long-term Assets
    
    
    
    
Marketable securities
 $18,019,054 
 $- 
 $18,019,054 
 $- 
 
    
    
    
    
Current Liabilities
    
    
    
    
Warrant liabilities
 $524,340 
 $- 
 $- 
 $524,340 
There were no significant transfers between levels during the year ended December 31, 2016.
Change in Fiscal Year
In 2015, the Company’s Board of Directors approved a change in the Company’s fiscal year to a fiscal year beginning on January 1 and ending on December 31 of each year, such change beginning as of January 1, 2016. Accordingly, this annual report on Form 10-K includes financial statements as of and for (i) the calendar year ended December 31, 2016; (ii) the eight months ended December 31, 2015; and (iii) the fiscal years ended April 30, 2015 and 2014.
For comparative purposes, an unaudited consolidated statement of operations and comprehensive loss has been included for the year ended December 31, 2015 and for the eight month periodcash flows from May 1, 2014 to December 31, 2014. The financial information for the year ended December 31, 2015 and the eight months ended December 31, 2014 has not been audited and is derived from the Company’s books and records. In the opinion of management, the financial information for the year ended December 31, 2015 and the eight months ended December 31, 2014 reflects all adjustments necessary to present the financial position and results of operations in accordance with generally accepted accounting principles. Prior to the year-end change, the Company’s fiscal year ended on April 30 of each year.
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TENAX THERAPEUTICS, INC.
financing activities.

NOTE C—BALANCE SHEET COMPONENTS

Property and equipment, net

Property and equipment primarily consist of the following:

 
 
December 31, 2016
 
 
December 31, 2015
 
Laboratory equipment
 $354,861 
 $514,214 
Computer equipment and software
  101,677 
  139,984 
Office furniture and fixtures
  130,192 
  130,192 
  
  586,730 
  784,390 
Less: Accumulated depreciation
  (567,625)
  (748,604)
  
 $19,105 
 $35,786 
office furniture and fixtures.

F-13

Table of Contents

Depreciation and amortization expense was $18,952were $7,570 and $31,224$5,143 for the yearyears ended December 31, 20162023 and for the eight months ended December 31, 2015,2022, respectively.

For the fiscal years ended April 30, 2015 and 2014, depreciation and amortization expense was $77,836 and $88,300, respectively.

Accrued liabilities

Accrued liabilities consist of the following:

 
 
December 31, 2016
 
 
December 31, 2015
 
Operating costs
 $4,361,538
 $2,559,092 
Employee related
 884,008
  545,715 
  
 $5,245,546
 $3,104,807 

 

 

December 31,

2023

 

 

December 31,

2022

 

Operating costs

 

$236,878

 

 

$245,391

 

Lease liability

 

 

-

 

 

 

119,393

 

Employee related

 

 

775,590

 

 

 

410,261

 

 

 

$1,012,468

 

 

$775,045

 

NOTE D��ACQUISITION

D—NOTE PAYABLE

Premium Finance Agreement

On November 13, 2013,December 31, 2023, the Company through its wholly owned subsidiary, Life Newco, acquired certain assets of Phyxius pursuant toexecuted a premium finance agreement with Premium Funding Associates, Inc. The agreement financed the Asset Purchase Agreement. The acquisition was accounted for under the acquisition method of accounting for business combinations in accordance with FASB ASC 805,Business Combinations,which requires, among other things that the assets acquiredCompany’s Directors and liabilities assumed be recognized at their fair valuesOfficers Insurance Policy as of the acquisition date.  Acquisition-related costs are not included as a component of the acquisition accounting, but are recognized as expenses in the periods in which the costs are incurred.  Any changes within the measurement period resulting from facts and circumstances that existed as of the acquisition date may result in retrospective adjustments to the provisional amounts recorded at the acquisition date.

Under the terms and subject to the conditions of the Asset Purchase Agreement, Life Newco acquired (the “Acquisition”) certain assets, including that certain License Agreement (the “License”), dated September 20, 2013 by and between Phyxius and Orion Corporation, a global healthcare company incorporated under the laws of Finland (“Orion”), and that certain Side Letter, dated October 15, 2013 by and between Phyxius and Orion.  The License grants Life Newco an exclusive, sublicenseable right to develop and commercialize pharmaceutical products containing Levosimedan, 2.5 mg/ml concentrate for solution for infusion / 5ml vial (the “Product”) in the United States and Canada (the “Territory”).  Pursuant to the License, Life Newco must use Orion’s “Simdax®” trademark to commercialize the Product.  The License also grants to Life Newco a right of first refusal to commercialize new developments of the Product, including developments as to the formulation, presentation, means of delivery, route of administration, dosage or indication.  Orion’s ongoing role under the License includes sublicense approval, servingwell as the sole sourceErrors and Omissions policy. The total amount financed was $548,750. The Company paid a down payment of manufacture, holding$47,847 at execution leaving a first right to enforce intellectual property rightsbalance of $500,903 payable in the Territory, and certain regulatory participation rights.  Additionally, Life Newco must grant back to Orion a broad non-exclusive license to any patents or clinical trial data related to the Product developed by Life Newco under the License.monthly installments of $47,847 through December 1, 2024. The Licenseagreement has a fifteen (15) year term, provided, however, that the License will continue after the endan interest rate of the fifteen year term in each country in the Territory until the expiration of Orion’s patent rights in the Product in such country (the “Term”)9.95%.   Orion had the right to terminate the License if the human clinical trial using the Product and studying reduction in morbidity and mortality of cardiac surgery patients at risk of low cardiac output syndrome (LCOS) as described in the US Food and Drug Administration (the “FDA”) agreed upon clinical study protocol (the “Study”) was not started by July

On December 31, 2014. While2022, the Company did not commenceexecuted a premium finance agreement with Premium Funding Associates, Inc. The agreement financed the trial by that date, on September 9, 2014, Orion notified the Company in writing that it did not intend to terminate the License so longCompany’s Directors and Officers Insurance Policy as well as the trialErrors and Omissions policy. The total amount financed was commenced on or before October 31, 2014.$693,669. The Company subsequently commenced the human clinical trial for levosimendan on September 18, 2014 when the first patient was enrolled.

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TENAX THERAPEUTICS, INC.
paid a down payment of $69,367 at execution leaving a balance of $624,302 payable in monthly installments of $58,873 through December 1, 2023. The following table summarizes the consideration transferred to acquire Phyxius and the amounts of identified assets acquired and liabilities assumed at the acquisition date.
Fair Value of Consideration Transferred:
Common stock
8,747,802
Series E convertible preferred stock
15,299,198
   Total
24,047,000
The Company issued 1,366,844 shares of its common stock that had a total fair value of approximately $8.7 million based on the closing market price on November 13, 2013, the acquisition date. The Company also issued 32,992 shares of its Series E Convertible Preferred Stock (the “Series E Stock”), which are convertible intoagreement has an aggregate of 3,299,200 shares of common stock that had a total fair value of approximately $15.3 million.
The rights, preferences and privileges of the Series E Stock are set forth in the Certificate of Designation of Series E Convertible Preferred Stock that the Company filed with the Secretary of State of the State of Delaware on November 13, 2013.  Each share of Series E Stock automatically converted into 100 shares of common stock following receipt of stockholder approval for the transaction at the special meeting of stockholders held on March 13, 2014.  Approximately 11% of the shares of converted common stock vested immediately upon receipt of stockholder approval for the transaction, while the remainder vested upon the closing of the Company’s underwritten offering of 9,285,714 shares of common stock on March 21, 2014, which resulted in net proceeds of approximately $55 million.  
The Series E Stock was convertible into restricted common shares using a 100-for-one ratio at any time and in accordance with a vesting schedule contingent upon achievement of Company-specific non-financial conditions. As a result, the fair value of the Preferred Shares was inferred based on their common stock equivalent value given the conversion terms. The conditional vesting of the Series E Stock was accounted for by subtracting the fair value of an equal number of put options that would effectively protect the common stock equivalent stock value as of the closing date. The terms of the put options were as follows:
Exercise price equal to the common stock price as of the Valuation Date.
Term based on management’s risk-adjusted expected time to meeting the vesting condition, which was further increased by 6 months to reflect the marketability restriction of the unregistered stock, consistent with SEC Rule 144 of the Securities Act.
Volatility was consistent with the term for the individual milestone payments derived from the median historical asset volatility for a set of comparable guideline companies. The volatility was then relevered to estimate the equity volatility of the Company.
In accordance with the provisions of FASB ASC 805, the following table presents the preliminary allocation of the total fair value of consideration transferred, as discussed above, to the acquired tangible and intangible assets and assumed liabilities of Phyxius based on their estimated fair values as of the closing date of the transaction, measurement period adjustments recorded since the acquisition date and the adjusted allocation of the total fair value:
 
 
 
November 13, 2013
(As initially reported)
 
 
 
Measurement Period Adjustments (1)
 
 
 
November 13, 2013
(As adjusted)
 
IPR&D
 $22,000,000 
 $- 
 $22,000,000 
Trade and other payables
  (256,000)
  - 
  (256,000)
Liabilities arising from a contingency
  (1,000,000)
  - 
  (1,000,000)
Deferred tax liability related to intangibles acquired
  - 
  (7,962,100)
  (7,962,100)
Total identifiable net assets
  20,744,000 
  (7,962,100)
  12,781,900 
Goodwill
  3,303,000 
  7,962,100 
  11,265,100 
Total fair value of consideration
 $24,047,000 
 $- 
 $24,047,000 
(1)The measurement period adjustments primarily reflect the recording of a deferred tax liability and resulting goodwill.  The measurement period adjustments were made to reflect facts and circumstances existing as of the acquisition date and did not result from intervening events subsequent to the acquisition date.
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TENAX THERAPEUTICS, INC.
The fair value of the acquired IPR&D, intangible asset of approximately $22.0 million was determined using the multi-period excess earnings method. The Company did not acquire any other class of assets as a result of the acquisition.
Pursuant to the terms of the License, the Company paid to Orion a non-refundable up-front payment in the amount of $1 million.
The License also includes the following development milestones for which the Company shall make non-refundable payments to Orion no later than twenty-eight (28) days after the occurrence of the applicable milestone event: (i) $2.0 million upon the grant of FDA approval, including all registrations, licenses, authorizations and necessary approvals, to develop and/or commercialize the Product in the United States; and (ii) $1.0 million upon the grant of regulatory approval for the Product in Canada. Once commercialized, the Company is obligated to make certain non-refundable commercialization milestone payments to Orion, aggregating up to $13.0 million, contingent upon achievement of certain cumulative net sales amounts in the Territory. The Company must also pay Orion tiered royalties based on net sales of the Product in the Territory made by the Company and its sublicensees. After the end of the Term, the Company must pay Orion a royalty based on net sales of the Product in the Territory for as long as the Company sells the Product in the Territory.
In connection with the closing of the Acquisition, Phyxius’ co-founder, Chief Executive Officer and stockholder, John Kelley, became the Company’s Chief Executive Officer and two other Phyxius employees and stockholders, Doug Randall and Douglas Hay, PhD became employees of the Company as Vice President, Business and Commercial Operations and Vice President, Regulatory Affairs, respectively.  Michael Jebsen, the Company’s prior Interim Chief Executive Officer and current Chief Financial Officer, continued serving as the Company’s Chief Financial Officer.  In addition, Mr. Kelley was subsequently appointed to the Company’s Board of Directors, and Gerald T. Proehl, a designee of the Phyxius Stockholders, was appointed to the Board of Directors on April 3, 2014 following receipt of stockholder approval for the transaction.  Pursuant to the Asset Purchase Agreement, the Company agreed to propose that its stockholders approve an amendment to the Company’s 1999 Stock Plan to increase the amount of stock options authorized for issuance under the 1999 Stock Plan to not less than 4,000,000 shares of common stock. On March 13, 2014, the Company received stockholder approval to increase the option plan. In accordance with terms of the Acquisition, the Company issued an aggregate of 3,572,880 stock options with a grant date fair value of $15,818,512, to the individuals described above. See Note G for additional details.
The common stock and Series E Stock issued as the consideration in the Acquisition were issued and sold without registration under the Securities Act of 1933 (the “Securities Act”) in reliance on the exemptions provided by Section 4(a)(2) of the Securities Act and/or Regulation D promulgated thereunder and in reliance on similar exemptions under applicable state laws.  Accordingly, the Phyxius Stockholders may sell the shares of common stock and Series E Stock only pursuant to an effective registration statement under the Securities Act covering the resale of those securities, an exemption under Rule 144 under the Securities Act or another applicable exemption under the Securities Act.
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TENAX THERAPEUTICS, INC.
NOTE E—INTANGIBLE ASSETS
The following table summarizes our intangible assets as of December 31, 2016:
Asset Category
 Weighted Average Amortization Period (in Years) 
 Value Assigned 
 Accumulated Amortization 
 Impairments 
 Carrying Value (Net of Impairments and Accumulated Amortization) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IPR&D
  N/A 
 $22,000,000 
 $- 
 $(22,000,000)
 $- 
Total
    
 $22,000,000 
    
 $(22,000,000)
 $- 
The following table summarizes our intangible assets as of December 31, 2015:
Asset Category
 Weighted Average Amortization Period (in Years) 
 Value Assigned 
 Accumulated Amortization 
 Impairments 
 Carrying Value (Net of Impairments and Accumulated Amortization) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IPR&D
  N/A 
 $22,000,000 
 $- 
 $- 
 $(22,000,000)
Total
    
 $22,000,000 
    
 $- 
 $(22,000,000)
There was no amortization expense for the year ended December 31, 2016 and the eight months ended December 31, 2015.
For the fiscal years ended April 30, 2015 and 2014 the aggregate amortization expense on intangible assets was $70,304 and $62,189, respectively.
In Process Research and Development— The levosimendan product in Phase III clinical trial represents an IPR&D asset. The IPR&D asset is a research and development project rather than a product or processes already in service or being sold. Research and development intangible assets are considered indefinite-lived until the abandonment or completion of the associated research and development efforts. If abandoned, the assets would be impaired. Research and development expenditures that are incurred after the acquisition, including those for completing the research and development activities related to the acquired intangible research and development assets, are generally expensed as incurred.
During the year ended December 31, 2016, the Company recognized an impairment charge of $33.3 million related to our levosimendan product in Phase III clinical trial, which represents approximately $22 million for IPR&D assets and approximately $11.3 million for goodwill.
The LEVO-CTS trial was completed in December of 2016. Based on the data from the trial, levosimendan, given prophylactically prior to cardiac surgery to patients with reduced left ventricular function, had no effect on the co-primary outcomes. The study did not achieve statistically significant reductions in the dual endpoint of death or use of a mechanical assist device at 30 days, nor in the quad endpoint of death, myocardial infarction, need for dialysis, or use of a mechanical assist device at 30 days. Based on the results of the LEVO-CTS trial, the Company does not anticipate additional development of levosimendan for the treatment of LCOS in patients undergoing cardiac surgery. As of December 31, 2016, the Company determined the IPR&D asset, and corresponding Goodwill, was more than temporarily impaired.
Patents and License Rights—The Company currently holds, has filed for, or owns exclusive rights to, U.S. and worldwide patents covering 9 various methods and uses of its perfluorocarbon (“PFC”) technology. It capitalizes amounts paid to third parties for legal fees, application fees and other direct costs incurred in the filing and prosecution of its patent applications. These capitalized costs are amortized on a straight-line method over their useful life or legal life, whichever is shorter. For the fiscal years ended April 30, 2015 and 2014, the Company capitalized patent costs of approximately $105,000 and $137,000, respectively.
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TENAX THERAPEUTICS, INC.
The Company completed its annual impairment test of its patents and license rights during the fourth quarter of fiscal years 2015 and 2014. The Company wrote-off approximately $929,000 and $0 of capitalized costs for patent applications that were withdrawn or abandoned during the years ended April 30, 2015 and 2014, respectively. These asset impairment charges primarily related to the Company’s Oxycyte and other PFC formulations which were determined not to be a core component of the Company’s development strategy.
Trademarks—The Company currently holds, or has filed for, trademarks to protect the use of names and descriptions of its products and technology. It capitalizes amounts paid to third parties for legal fees, application fees and other direct costs incurred in the filing and prosecution of its trademark applications. These trademarks are evaluated annually for impairment in accordance with ASC 350, Intangibles – Goodwill and other. The Company evaluates (i) its expected use of the underlying asset, (ii) any laws, regulations, or contracts that may limit the useful life, (iii) the effects of obsolescence, demand, competition, and stability of the industry, and (iv) the level of costs to be incurred to commercialize the underlying asset. The Company wrote-off trademark costs of approximately $106,000 and $0, for the years ended April 30, 2015 and 2014, respectively. These asset impairment charges primarily related to the Company’s Oxycyte and other PFC formulations which were determined not to be a core component of the Company’s development strategy.
NOTE F—NOTES PAYABLE
Convertible Note
On June 29, 2011, the Company issued a note (the “June Note”) with a principal amount of approximately $300,000 and Warrants to purchase 6,652 shares of common stock. On July 1, 2011, the Company issued a separate note (together with the June Note, the “Notes”) with a principal amount of $4,600,000 and warrants to purchase 101,996 shares of common stock. The aggregate gross proceeds to the Company from the offering were approximately $4.9 million, excluding any proceeds from the exercise of any warrants. The aggregate placement agent fees were $297,000 and legal fees associated with the offering were $88,839. These costs have been capitalized as debt issue costs and will be amortized as interest expense over the life of the Notes. The Company recorded amortization of debt issue costs of $21,427 and $128,616, for the years ended April 30, 2015 and 2014, respectively. All debt issue costs were fully amortized in the first quarter of fiscal year ending April 30, 2015.
Interest on the Notes accrues at a rate of 15% annually and will be paid in quarterly installments commencing on the third month anniversary of issuance. The Notes were scheduled to mature 36 months from the date of issuance. The Notes may be converted into shares of common stock at a conversion price of $45.10 per share (subject to adjustment for stock splits, dividends and combinations, recapitalizations and the like) (the "Conversion Price") in whole or in part, at any time at the option of the holders of the Notes. The Notes also will automatically convert into shares of common stock at the Conversion Price at the election of a majority-in-interest of the holders of notes issued under the purchase agreement or upon the acquisition or sale of all or substantially all of the assets of the Company. The Company could make each applicable interest payment or payment of principal in cash, shares of common stock at the Conversion Price, or any combination thereof. The Company could elect to prepay all or any portion of the Notes without prepayment penalties only with the approval of a majority-in-interest of the note holders under the purchase agreement at the time of the election.   The Notes contained various events of default such as failing to timely make any payment under the Note when due, which would have resulted in all outstanding obligations under the Note becoming immediately due and payable.
On August 22, 2013 holders of $4.6 million of the Notes received 4,600 shares of the Company’s Series D 8% Convertible Preferred Stock (the “Series D Stock”) as consideration for cancelling their outstanding Notes. On that date, the Company recognized non-cash interest expense of $1,311,847 for the remaining unamortized debt discount associated with this Notes.
On June 29, 2014, the Company paid the remaining principal balance of $300,000 to the June Note holders upon maturity.
The Company recorded interest expense of $45,606 and $2,181,955 for the years ended April 30, 2015 and 2014, respectively.
The total value allocated to the warrants was $1,960,497 and was recorded as a debt discount against the proceeds of the notes. In addition, the beneficial conversion features related to the Notes were determined to be $2,939,504.  As a result, the aggregate discount on the Notes totaled $4,900,001, and was amortized over the term of the notes. For the fiscal years ended April 30, 2015 and 2014, the Company recorded interest expense for the amortization of debt discount of $16,678 and $483,330, respectively.
62
TENAX THERAPEUTICS, INC.
7.39%.

NOTE G—E—STOCKHOLDERS’ EQUITY

Preferred Stock

Under the Company’s Certificate of Incorporation, the Board of Directors is authorized, without further stockholder action, to provide for the issuance of up to 10,000,000 shares of preferred stock, par value $0.0001 per share, in one or more series, to establish from time to time the number of shares to be included in each such series, and to fix the designation, powers, preferences and rights of the shares of each such series and the qualifications, limitations and restrictions thereof.

On November 13, 2013, the Company filed a Certificate of Designation with the Secretary of State of the State of Delaware designating 32,992 shares of its authorized but unissued shares of preferred stock as

Series E Stock.

On August 22, 2013, the Company filed a Certificate of Designation with the Secretary of State of the State of Delaware designating 4,600 shares of its authorized but unissued shares of preferred stock as Series D Stock.
On July 22, 2013, the Company filed a Certificate of Designation with the Secretary of State of the State of Delaware designating 5,369 shares of its authorized but unissued shares of preferred stock as Series C Stock.
On February 25, 2013, the Company filed a Certificate of Designation with the Secretary of State of the State of Delaware designating 1,600 shares and 500 shares of its authorized but unissued shares of preferred stock as Series B-1 Convertible PreferredA Stock (the “Series B-1 Stock”) and Series B-2 Convertible Preferred Stock (the “Series B-2 Stock” and together with the Series B-1 Stock, the “Series B Stock”), respectively.

On December 8, 2011, the Company filed a Certificate of Designation with the Secretary of State of the State of Delaware designating 7,500 shares of its authorized but unissued shares of preferred stock as Series A Stock.

Series E Stock
As further discussed in Note D above, on November 13, 2013 the Company issued 32,992 shares of its Series E Stock, which were convertible into an aggregate of 3,299,200 shares of common stock, as partial consideration to acquire certain assets of Phyxius Pharma, Inc. pursuant to the Asset Purchase Agreement.
The rights, preferences and privileges of the Series E Stock are set forth in the Certificate of Designation of Series E Convertible Preferred Stock (the “Certificate of Designation”) that the Company filed with the Secretary of State of the State of Delaware on November 13, 2013.  Each share of Series E Stock will automatically convert into 100 shares of common stock following receipt of stockholder approval for the transaction.  Approximately 11% of the shares of converted common stock vest immediately upon receipt of stockholder approval for the transaction, while the remainder will vest upon achievement of certain performance milestones related to the development and commercialization of the levosimendan product in North America.   In addition, all unvested converted common stock will vest if certain change of control transactions or significant equity financings occur within 24 months of the closing of the Acquisition.  The number of shares of common stock into which the Series E Stock converts is subject to adjustment in the case of stock splits, stock dividends, combinations of shares and similar recapitalization transactions.  The Series E Stock does not carry dividend or a liquidation preference.  The Series E Stock carries voting rights aggregating 4.99% of the Company’s common stock voting power immediately prior to the closing of the Acquisition.
During the year ended April 30, 2014, all 32,992 shares of Series E Stock were converted into 3,299,200 shares of common stock. As of December 31, 2016 and December 31, 2015 there were no shares of Series E Stock outstanding.
Series D Stock
On August 22, 2013,11, 2018, the Company closed its private placement of an aggregate of $4.6 million of shares of the Company’s Series D Stock to JP SPC 3 obo OXBT FUND, SP (“OXBT Fund”).  In connection with the purchase of shares of Series D Stock, OXBT Fund received a warrant to purchase 2,358,975 shares of common stock at an exercise price equal to $2.60 (the “Series D Warrant”).  As consideration for the sale of the Series D Stock and Series D Warrant, $4.6 million in outstanding principal amount of a Note issued by the Company on July 1, 2011 and held by OXBT Fund was cancelled.  The Note carried interest at a rate of 15% per annum and matured on July 1, 2014.  Mr. Gregory Pepin, one of the Company’s directors, is the investment manager of OXBT Fund.  Pursuant to the terms of a lock-up agreement (the “Lock-Up Agreement”) executed prior to the closing, OXBT Fund and its affiliates are prohibited from engaging in certain transactions with respect to shares of the Company’s common stock and common stock equivalents until such time as the lead investor in the Company’sunderwritten offering of Series C Stock ceases to own at least 25% of the shares of Series C Stock originally issued to such investor.
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TENAX THERAPEUTICS, INC.
The table below sets forth a summary of the designation, powers, preferences and rights of the Series D Stock.
Conversion
Subject to certain ownership limitations, the Series D Stock is convertible at any time at the option of the holder into shares of the Company’s common stock at a conversion ratio determined by dividing the stated value of the Series C Stock (or $1,000) by a conversion price of $1.95 per share. The conversion price is subject to adjustment in the case of stock splits, stock dividends, combinations of shares and similar recapitalization transactions.
Until such time that for at least 25 trading days during any 30 consecutive trading days, the volume weighted average price of the Company’s common stock exceeds 250% of the initial conversion price, if the Company sells or grants any option to purchase or sell any common stock or common stock equivalents entitling any person to acquire shares of common stock at an effective price per share that is lower than the then conversion price, or the Base Conversion Price, then the conversion price shall be reduced to equal the Base Conversion Price.
Dividends and Make-Whole Payment
Until the third anniversary of the date of issuance of the Series D Stock, the holder of the Series D Stock is entitled to receive dividends at the rate of 8% per annum of the stated value for each share of Series D Stock held by such holder payable quarterly on January 1, April 1, July 1 and October 1, beginning on the first such date after the original issue date, and on each dividend payment date.  The Company can elect to pay the dividends in cash or in duly authorized, validly issued, fully paid and non-assessable shares of common stock, or a combination thereof.  If the Company pays the dividends in shares of common stock, the shares used to pay the dividends will be valued at 90% of the average volume weighted average price for the 20 consecutive trading days ending on the trading day immediately prior to the applicable dividend payment date.  From and after the third anniversary of the date of issuance of the Series D Stock, the holder of Series D Stock will be entitled to receive dividends equal, on an as-if-converted to common stock basis, to and in the same form as dividends actually paid on shares of common stock when, as, and if such dividends are paid on shares of common stock.  The Company has never paid dividends on its common stock and the Company does not intend to do so for the foreseeable future.
In the event OXBT Fund converts its Series D Stock prior to the third anniversary of the date of issuance of the Series D Stock, the Company must also pay to OXBT Fund in cash, or at the Company’s option in common stock valued as described above, or a combination of cash and shares of common stock, with respect to the Series D Stock so converted, an amount equal to $240 per $1,000 of the stated value of the Series D Stock, less the amount of any dividends paid in cash or in common stock on such Series D Stock on or before the date of conversion.
Liquidation
Upon any liquidation, dissolution or winding up of the Company after payment or provision for payment of debts and other liabilities of the Company, but before any distribution or payment is made to the holders of any junior securities, the holder of Series D Stock shall be entitled to be paid out of the assets of the Company available for distribution to its stockholders an amount equal to $1,000 per share, after which any remaining assets of the Company shall be distributed among the holders of the other class or series of stock in accordance with the Company’s Certificate of Incorporation.
Voting rights
Shares of Series D Stock will generally have no voting rights, except as required by law and except that the consent of the holder of the outstanding Series D Stock will, among other things, be required to amend the terms of the Series D Stock.
During the year ended April 30, 2014, 4,600 shares of Series D Stock were converted into 2,358,974 shares of common stock and the Company issued 576,084 shares of its common stock in the form of Series D Stock dividends. As of December 31, 2016 and December 31, 2015 there were no shares of Series D Stock outstanding.
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TENAX THERAPEUTICS, INC.
Series C Stock
 On July 21, 2013, the Company entered into a Securities Purchase Agreement with certain investors providing for the issuance and sale by the Company (the “Series C Offering”) of an aggregate of approximately $5.4 million of shares of the Company’s Series C Stock, which are convertible into a combined total of 2,753,348 shares of common stock (the “Conversion Shares”).  In connection with the purchase of shares of Series C Stock in the Series C Offering, each investor will receive a warrant to purchase a number of shares of common stock equal to 100% of the number of Conversion Shares at an exercise price equal to $2.60 (the “Warrants”).  On July 23, 2013, the Company sold 5,3695,181,346 units for net proceeds of approximately $4.9 million.
The table below sets forth a summary of the designation, powers, preferences and rights of the Series C Stock.
 Conversion
Subject to certain ownership limitations, the Series C Stock is convertible at any time at the option of the holder into shares of the Company’s common stock at a conversion ratio determined by dividing the stated value of the Series C Stock (or $1,000) by a conversion price of $1.95 per share. The conversion price is subject to adjustment in the case of stock splits, stock dividends, combinations of shares and similar recapitalization transactions.
Until such time that for at least 25 trading days during any 30 consecutive trading days, the volume weighted average price of the Company’s common stock exceeds 250% of the initial conversion price, if the Company sells or grants any option to purchase or sell any common stock or common stock equivalents entitling any person to acquire shares of common stock at an effective price per share that is lower than the then conversion price, or the Base Conversion Price, then the conversion price shall be reduced to equal the Base Conversion Price.
Dividends and Make-Whole Payment
Until the third anniversary of the date of issuance of the Series C Stock, each holder of the Series C Stock is entitled to receive dividends at the rate of 8% per annum of the stated value for each share of Series C Stock held by such holder payable quarterly on January 1, April 1, July 1 and October 1, beginning on the first such date after the original issue date, and on each dividend payment date.  The Company can elect to pay the dividends in cash or in duly authorized, validly issued, fully paid and non-assessable shares of common stock, or a combination thereof.  If the Company pays the dividends in shares of common stock, the shares used to pay the dividends will be valued at 90% of the average volume weighted average price for the 20 consecutive trading days ending on the trading day immediately prior to the applicable dividend payment date.  From and after the third anniversary of the date of issuance of the Series C Stock, each holder of Series C Stock will be entitled to receive dividends equal, on an as-if-converted to common stock basis, to and in the same form as dividends actually paid on shares of common stock when, as, and if such dividends are paid on shares of common stock.  The Company has never paid dividends on its common stock and the Company does not intend to do so for the foreseeable future.
In the event a holder converts his, her or its Series C Stock prior to the third anniversary of the date of issuance of the Series C Stock, the Company must also pay to the holder in cash, or at the Company’s option in common stock valued as described above, or a combination of cash and shares of common stock, with respect to the Series C Stock so converted, an amount equal to $240 per $1,000 of the stated value of the Series C Stock, less the amount of any dividends paid in cash or in common stock on such Series C Stock on or before the date of conversion.
Liquidation
Upon any liquidation, dissolution or winding up of the Company after payment or provision for payment of debts and other liabilities of the Company, but before any distribution or payment is made to the holders of any junior securities, the holders of Series C Stock shall be entitled to be paid out of the assets of the Company available for distribution to its stockholders an amount equal to $1,000 per share, after which any remaining assets of the Company shall be distributed among the holders of the other class or series of stock in accordance with the Company’s Certificate of Incorporation.
Voting rights
Shares of Series C Stock will generally have no voting rights, except as required by law and except that the consent of holders of a majority of the outstanding Series C Stock will, among other things, be required to amend the terms of the Series C Stock.
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TENAX THERAPEUTICS, INC.
During the year ended April 30, 2014, 5,369 shares of Series C Stock were converted into 2,753,327 shares of common stock and the Company issued 831,401 shares of its common stock for the payment of $1,288,560 as dividends on the Series C Stock. As of December 31, 2016 and December 31, 2015 there were no shares of Series C Stock outstanding.
Series B Stock
On February 22, 2013, the Company entered into a Securities Purchase Agreement with an institutional investor providing for the issuance and sale by the Company of $1.6$9.0 million of shares of the Company’s Series B-1 Stock and $0.5 million of shares of the Company's Series B-2 Stock which are convertible into a combined total of 420,000 shares of common stock, subject to adjustment for subsequent equity sales.
On February 27, 2013, the Company sold 2,100 units for net proceeds of approximately $1.9 million.(the “2018 Offering”). Each unit sold consisted of (i) one share of the Company’s Series B Stock andA convertible preferred stock, par value $0.0001 per share (the “Series A Stock”), (ii) a Warrant representing the righttwo-year warrant to purchase 300 shares1/1600th of a share of common stock at aan exercise price of $1,000 per unit, less issuance costs. The shares of Series B Stock were immediately convertible upon issuance.
The table below sets forth$1.93, and (iii) a summary of the designation, powers, preferences and rights of the Series B Stock.
Dividends
No dividends shall be paid on shares of Preferred Stock.
Conversion
Holders may elect to convert shares of Series B Stock into shares of common stock at the then-existing conversion price at any time. The initial conversion price is $5.00 per share of common stock, and is subject to certain adjustments, including an anti-dilution provision that reduces the conversion price upon the issuance of any common stock or securities convertible into common stock at an effective price per share less than the conversion price and a one-time price reset following the effectiveness of a reverse split of the Company’s outstanding common stock.
Liquidation preference
In the event of the Company’s voluntary or involuntary dissolution, liquidation or winding up, each holder of Series B Stock will be entitled to be paid a liquidation preference equal to the initial stated value of such holder’s Series B Stock of $1,000 per share, plus accrued and unpaid dividends and any other payments that may be due on such shares, before any distribution of assets may be made to holders of capital stock ranking junior to the Series B Stock.
Voting rights
Shares of Series B Stock will generally have no voting rights, except as required by law and except that the consent of holders of a majority of the outstanding Series B Stock will among other things, be required to amend the terms of the Series B Stock.
The Company will not affect any conversion of the Series B Stock, nor shall a holder convert its shares of Series B Stock,five-year warrant to the extent that such conversion would cause the holder to have acquired, through conversion of the Series B Stock or otherwise, beneficial ownershippurchase 1/1600th of a number sharesshare of common stock in excessat an exercise price of 4.99%$1.93. In accordance with ASC 480, Distinguishing Liabilities from Equity, the estimated fair value of $1,800,016 for the common stock outstanding immediately precedingbeneficial conversion feature was recognized as a deemed dividend on the conversion.
DuringSeries A Stock during the year ended April 30, 2014, 987 shares of Series B Stock were converted into 644,915 shares of common stock. December 31, 2018.

F-14

Table of Contents

As of December 31, 20162023, and December 31, 20152022 there were no210 shares of Series B Stock outstanding.

On February 23, 2015, the Company filed certificates of elimination (the “Certificates of Elimination”) with the Secretary of State of Delaware effecting the elimination of the Certificates of Designations with respect to the Series A Stock Series B-1 Stock, Series B-2 Stock, Series C Stock, Series Doutstanding convertible into one share of common stock.

Common Stock and Series E Stock. No shares of the Preferred Stock were outstanding at the time of the filing of the Certificates of Elimination. The Certificates of Elimination, which were effective upon filing, canceled the Company’s Series A Stock, Series B-1 Stock, Series B-2 Stock, Series C Stock, Series D Stock and Series E Stock. At the time of filing the Certificates of Elimination, no shares of preferred stock remained outstanding. As of December 31, 2016, 10,000,000 shares of preferred stock are undesignated.

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TENAX THERAPEUTICS, INC.
Common Stock
Pre-Funded Warrants

The Company’s Certificate of Incorporation authorizes it to issue 400,000,000 shares of $0.0001 par value common stock. As of December 31, 20162023, and December 31, 20152022, there were 28,120,021298,281 and 28,119,69428,648 shares of common stock issued and outstanding.

Warrants
outstanding, respectively.

F-15

Table of Contents

February 2023 Registered Public Offering (the “February 2023 Offering”)

On November 11, 2014,February 3, 2023, the Company issuedentered into a securities purchase agreement with certain purchasers for the purchase and sale, in a registered public offering by the Company of (i) an aggregate of 86,994 shares of its common stock, and pre-funded warrants to purchase an aggregate of 21,341 shares of common stock and (ii) accompanying warrants to purchase up to an aggregate of 216,667 shares of its common stock at a combined offering price of $144 per share of common stock and associated common warrant, or $143.92 per pre-funded warrant and associated common warrant, resulting in gross proceeds of approximately $15.6 million. The net proceeds of the February 2023 Offering after deducting placement agent fees and direct offering expenses were approximately $14.1 million. The fair value allocated to the common stock, pre-funded warrants and warrants was $5.0 million, $1.2 million and $9.4 million, respectively.

May 2022 Private Placement (the “May 2022 Offering”)

On May 17, 2022, the Company entered into a securities purchase agreement with an institutional investor, pursuant to which the Company agreed to sell and issue to the investor 6,623 units in a private placement at a purchase price of $1,240 per unit. Each unit consisted of (i) one unregistered pre-funded warrant to purchase one share of common stock and (ii) one unregistered warrant to purchase one share of common stock (together with the pre-funded warrants, the “2022 Warrants”). In the aggregate, 13,246 shares of the Company’s common stock are underlying the 2022 Warrants. The net proceeds from the private placement, after direct offering expenses, were approximately $7.9 million. The fair value allocated to the pre-funded warrants and warrants was $4.2 million and $3.8 million, respectively.

Also, on May 17, 2022 and in connection with the executionMay 2022 Offering, the Company entered into a registration rights agreement (the “May 2022 Registration Rights Agreement”) with the investor, pursuant to which the Company agreed to register for resale the shares of common stock issuable upon exercise of the 2022 Warrants within 120 days following the effective date of the May 2022 Registration Rights Agreement. Pursuant to the May 2022 Registration Rights Agreement, on May 25, 2022, the Company filed a serviceresale registration statement on Form S-3 with the SEC, which went effective on June 3, 2022.

Additionally, in connection with the May 2022 Offering, the Company entered into a warrant amendment agreement with the investor, in consideration for investor relationsthe investor’s purchase of units in the May 2022 Offering, pursuant to which the Company agreed to amend certain previously issued warrants held by the investor.

Warrants

During the year ended December 31, 2023, the Company received approximately $511 and corporate communications. issued 21,335 shares of common stock upon the exercise of previously outstanding pre-funded warrants issued in connection with the Company’s February 7, 2023 offering.

During the year ended December 31, 2023, the Company issued 161,306 shares of common stock upon the alternative cashless exercise of previously outstanding warrants issued in connection with the Company’s February 7, 2023 offering.

During the year ended December 31, 2022, the Company received approximately $526 and issued 3,288 shares of common stock upon the exercise of previously outstanding pre-funded warrants issued in connection with the Company’s July 2020 offering.

During the year ended December 31, 2022, the Company received approximately $477 and issued 2,984 shares of common stock upon the exercise of previously outstanding pre-funded warrants issued in connection with the Company’s July 2021 Offering.

During the year ended December 31, 2022, the Company received approximately $1,060 and issued 6,623 shares of common stock upon the exercise of previously outstanding pre-funded warrants issued in connection with the Company’s May 2022 Offering.

F-16

Table of Contents

As of December 31, 2023, the Company has 19,694 warrants outstanding. The following table summarizes the Company’s warrant activity for the year ended December 31, 2022 and 2023:

 

 

Warrants

 

 

Weighted Average

Exercise Price

 

Outstanding at December 31, 2021

 

 

13,080

 

 

$2,323.10

 

Issued

 

 

6,623

 

 

 

1,008.00

 

Amended and restated

 

 

(5,754)

 

 

2,756.09

 

Amended and restated

 

 

5,754

 

 

 

1,008.00

 

Outstanding at December 31, 2022

 

 

19,703

 

 

$1,370.58

 

Issued

 

 

216,667

 

 

 

180.00

 

Exercised

 

 

(214,842)

 

 

180.00

 

Canceled

 

 

(1,834)

 

 

3,142.54

 

Outstanding at December 31, 2023

 

 

19,694

 

 

$1,095.27

 

February 2023 Warrants

As described above, as a part of the compensation under the agreement,February 2023 Offering, the Company issued upregistered warrants to 175,000 warrantspurchase 216,667 shares of its common stock at an exercise price of $4.00$180.00 per share and contractual term of 5five years. The warrant is initially exercisable for 25,000 shares of common stock, and the number of shares of common stock exercisable under this warrant will be automatically increased by 50,000 upon the first occurrence of market price goals of $6.00, $8.00 and $10.00, respectively, during the eighteen month period beginning on the effective date. In accordance with ASC 815, Derivatives and Hedging, these warrants are classified as equity and their estimated fair-valuerelative fair value of $478,115approximately $10.6 million was recorded as an operating expense in the consolidated statement of operations andrecognized as additional paid in capital during the year ended April 30, 2015.capital. The estimated fair value is determined using the Black-Scholes Option Pricing Model which is based on the value of the underlying common stock at the valuation measurement date, the remaining contractual term of the warrants, risk-free interest rates, expected dividends and expected volatility of the price of the underlying common stock.

Series D

Remaining contractual term

5 Years

Risk free interest rate

2.23%

Expected dividends

-

Expected Volatility

105.69%

May 2022 Warrants

On August 22, 2013,

As described above, as a part of the May 2022 Offering, the Company closed its private placement of an aggregate of $4.6 millionissued unregistered warrants to purchase 6,623 shares of the Company’s Series D Stock to OXBT Fund.  In connection with the purchase of shares of Series D Stock, OXBT Fund received the Series D Warrant to purchase 2,358,975 shares ofits common stock at an exercise price equal to $2.60of $1,008.00 per share and contractual term of 6 years.five and one-half years. The unregistered warrants were offered in a private placement under Section 4(a)(2) of the Securities Act of 1933, as amended (the “Securities Act”) and Regulation D promulgated thereunder. In accordance with ASC 815, Derivatives and Hedging, these warrants are classified as equity and their relative fair-valuefair value of $1,531,167approximately $3.8 million was recognized as a deemed dividend on the Series D Stock during the year ended April 30, 2014.additional paid in capital. The estimated fair value is determined using the Black-Scholes Option Pricing Model which is based on the value of the underlying common stock at the valuation measurement date, the remaining contractual term of the warrants, risk-free interest rates, expected dividends and expected volatility of the price of the underlying common stock.

The Series D Warrant is exercisable beginning on the date of issuance and expires on August 22, 2019.  The exercise price and the number of shares issuable upon exercise of Series D Warrant is subject to appropriate adjustment in the event of recapitalization events, stock dividends, stock splits, stock combinations, reclassifications, reorganizations or similar events affecting the Company’s common stock, and also upon any distributions of assets, including cash, stock or other property to the Company’s stockholders.  In addition, if stockholder approval for the transaction is obtained, the Series D Warrant will be subject to anti-dilution provisions until such time that for 25 trading days during any 30 consecutive trading day period, the volume weighted average price of the Company’s common stock exceeds $6.50 and the daily dollar trading volume exceeds $350,000 per trading day.
On January 30, 2014, the Company entered into an agreement with the OXBT Fund to amend the terms of the outstanding Series D Warrants. The amendment replaced the price protection anti-dilution provision of each warrant with a covenant that the Company will not issue common stock or common stock equivalents at an effective price per share below the exercise price of such warrant without prior written consent, subject to certain exceptions.
The Series D

Stock and the Series D Warrant were issued and sold without registration under the Securities Act in reliance on the exemptions provided by Section 4(a)(2) of the Securities Act and/or Regulation D promulgated thereunder and in reliance on similar exemptions under applicable state laws.  Accordingly, OXBT Fund may exercise the Warrant and sell the Series D Stock and underlying shares only pursuant to an effective registration statement under the Securities Act covering the resale of those securities, an exemption under Rule 144 under the Securities Act or another applicable exemption under the Securities Act.

During the year ended April 30, 2015, the Company received proceeds of $544,000 and issued 209,230 shares of common stock upon the exercise of the Series D warrants. As of December 31, 2016, 2,149,745 Series D Warrants are outstanding.
Series C Warrants
On July 23, 2013, as part of the offering of Series C Stock, the Company issued 2,753,348 Series C Warrants at an exercise price of $2.60 per share and contractual term of 6 years. In accordance with ASC 815, these warrants are classified as equity and their relative fair-value of $1,867,991 was recognized as a deemed dividend on the Series C Stock during the year ended April 30, 2014. The estimated fair value is determined using the Black-Scholes Option Pricing Model which is based on the value of the underlying common stock at the valuation measurement date, the remaining contractual term of the warrants, risk-free interest rates, expected dividends and expected volatility of the price of the underlying common stock.
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TENAX THERAPEUTICS, INC.
In connection with the Series C Offering described above, the Company entered into a Placement Agency Agreement (the “Placement Agency Agreement”) with Ladenburg Thalmann & Co. Inc. (the “Placement Agent”) pursuant to which the Placement Agent agreed to act as the Company’s exclusive placement agent for the Series C Offering. In accordance with the Placement Agency Agreement, on July 23, 2013 the Company issued to the Placement Agent warrants to purchase 53,539 shares of common stock at an exercise price of $2.4375 per share and a contractual term of 3 years. In accordance with ASC 815, these warrants are classified as equity and their relative fair-value of $51,231 was recognized as additional paid in capital during the year ended April 30, 2014. The estimated fair value is determined using the Black-Scholes Option Pricing Model which is based on the value of the underlying common stock at the valuation measurement date, the remaining contractual term of the warrants, risk-free interest rates, expected dividends and expected volatility of the price of the underlying common stock.
During the year ended April 30, 2014, the Company received cash of approximately $6.5 million and issued 2,512,825 shares of common stock upon the exercise of outstanding Series C Warrants. As of December 31, 2016, 240,523 Series C Warrants are outstanding.
In accordance with ASC 815-40-35-8, the Company reassessed the classification of the remaining Series C Warrants. On November 11, 2013, the Company satisfied certain contractual obligations pursuant to the Series C offering which caused certain “down-round” price protection clauses in the outstanding warrants to become effective on that date. In accordance with ASC 815-40-35-9, on November 11, 2013, the Company reclassified these warrants as a current liability and recorded a warrant liability of $1,082,941 which represents the fair market value of the warrants at that date. The initial fair value recorded as warrants within stockholders’ equity of $233,036 was reversed and the change in fair value was recorded as a component of other expense.
The estimated fair value is determined using the Monte Carlo Model which is based on the value of the underlying common stock at the valuation measurement date, the remaining contractual term of the warrants, risk-free interest rates, expected dividends, expected volatility of the price of the underlying common stock as well as other estimates and assumptions.
As of December 31, 2016, the fair value of the warrant liability was $226,092. The Company recorded a gain of $298,248 for the change in fair value as a component of other expense on the consolidated statement of operations and comprehensive loss for the year ended December 31, 2016.
For the eight months ended December 31, 2015, the Company recognized a gain of $48,105 for the change in fair value as a component of other expense on the consolidated statements of operations and comprehensive loss.
For the fiscal years ended April 30, 2015 and 2014, the Company recognized a gain of $382,431 and a loss of $721,840, respectively, for the change in fair value as a component of other expense on the consolidated statements of operations and comprehensive loss.
Series B Warrants
In connection with the issuance of 2,100 shares of Series B Preferred Stock described above, on February 27, 2013 the Company issued Class A and Class B warrants to purchase an aggregate of 630,000 shares of common stock. The warrants were issued at an initial exercise price equal to $10.00 and were immediately exercisable. The Class A warrants were issued with a six-year term and the Class B warrants were issued with a two-year term.
During the year ended April 30, 2014, the Company received proceeds of $567,000 and issued 630,000 shares of common stock upon the exercise of the Series B warrants. As of December 31, 2016, there were no Series B warrants outstanding.
As of December 31, 2016, the Company has 2,415,675 warrants outstanding. During the year ended December 31, 2016, no warrants were issued or exercised.
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TENAX THERAPEUTICS, INC.
Options

The following table summarizes the Company’s warrant activity for the year endedall options outstanding as of December 31, 2016, the eight months ended2023:

 

 

 

 

 

 

Options Outstanding at

December 31, 2023

 

 

Options Exercisable and Vested at

December 31, 2023

 

Exercise Price

 

 

 

 

 

Number of

Options

 

 

Weighted Average Remaining Contractual Life (Years)

 

 

Number of

Options

 

 

Weighted Average

Exercise Price

 

$

992.00

 

 

 

$

2,960.00

 

 

 

569

 

 

 

7.7

 

 

 

295

 

 

$

1,872.06

 

$

3,200.00

 

 

 

 

$

16,960.00

 

 

 

47

 

 

 

6.0

 

 

 

47

 

 

$

7,801.03

 

$

66,240.00

 

 

 

 

$

101,120.00

 

 

 

5

 

 

 

2.8

 

 

 

5

 

 

$

71,190.16

 

$

109,440.00

 

 

 

 

$

180,800.00

 

 

 

3

 

 

 

0.7

 

 

 

3

 

 

$

145,623.66

 

 

 

 

 

 

 

 

 

 

 

 

624

 

 

 

7.5

 

 

 

350

 

 

$

4,719.64

 

The following table summarizes options outstanding that have vested and are expected to vest based on options outstanding as of December 31, 2015 and the fiscal years ended April 30, 2015 and 2014:

 
 
Warrants
 
 
Weighted
Average
Exercise Price
 
Outstanding at April 30, 2013
  759,410 
 $11.00 
Issued
  5,165,862 
  2.60 
Exercised
  (3,161,145)
  2.26 
Forfeited
  (1,661)
  126.00 
Outstanding at April 30, 2014
  2,762,466 
 $4.28 
Issued
  175,000 
  4.00 
Exercised
  (209,230)
  2.60 
Outstanding at April 30, 2015
  2,728,236 
 $4.39 
Issued
  - 
  - 
Exercised
  - 
  - 
Outstanding at December 31, 2015
  2,728,236 
 $4.39 
Issued
  - 
  - 
Exercised
  - 
  - 
Forfeited
  (312,561)
  17.93 
Outstanding at December 31, 2016
  2,415,675 
 $2.64 
During the fiscal years ended April 30, 2015 and 2014, the Company received approximately $544,000 and $7.1 million, issuing 209,230 and 3,161,145 shares of common stock, respectively upon the exercise of outstanding warrants.
1999 Amended2023:

 

 

Number of

Options

 

 

 WA Exercise

Price

 

 

 Aggregate

Intrinsic Value

 

 

Weighted Average Remaining

Contractual

Life (Years)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vested

 

 

350

 

 

$4,719.64

 

 

$-

 

 

 

6.9

 

Vested & expected to vest

 

 

593

 

 

$3,299.59

 

 

$-

 

 

 

7.4

 

F-17

Table of Contents

2022 Stock Incentive Plan

In October 2000,June 2022, the Company adopted the 19992022 Stock Incentive Plan as amended and restated on June 17, 2008 (the “Plan”“2022 Plan”). Under the 2022 Plan, with the approval of the Board’s Compensation Committee, of the Board of Directors, the Company may grant stock options, restricted stock, stock appreciation rights, restricted stock, restricted stock units, performance shares, performance units, cash-based awards or other stock-based awards. On June 9, 2022, the Company’s stockholders approved the 2022 Plan, which authorizes for issuance under the 2022 Plan a total of 688 shares of common stock. Upon approval by the stockholders, the 2022 Plan superseded and newreplaced the Tenax Therapeutics, Inc. 2016 Stock Incentive Plan, as amended (the “2016 Plan”) and all shares of common stock upon exercise of stock options. On September 30, 2011, the Company’s stockholders approved an amendment to the Plan which increased the amount of sharesremaining authorized and available for issuance under the 2016 Plan and any shares subject to 300,000, up from 40,000 previously authorized.

Pursuant tooutstanding awards under the Asset Purchase Agreement described in Note D above, the Company agreed to propose2016 Plan that its stockholders approve an amendment to the Company’s 1999 Stock Plan to increase the amountsubsequently expire, terminate, or are surrendered or forfeited for any reason without issuance of stock options authorizedshares automatically become available for issuance under the 1999 Stock Plan to not less than 4,000,000 shares of common stock. On March 13, 2014, the Company’s stockholders approved an amendment to the Plan which increased the number of shares of common stock authorized for issuance to a total of 4,000,000 shares, up from 300,000 previously authorized.
In accordance with terms of the Acquisition, the Company issued an aggregate of 3,572,880 stock options with a grant date fair value of $15,818,512, to the Chief Executive Officer, the Chief Financial Officer, the Executive Vice President, Business and Commercial Operations and the Executive Vice President, Regulatory Affairs. These options were issued with a six-year term and subject to multiple performance-based vesting conditions. During the year ended April 30, 2014, the Company recorded approximately $7.9 million of compensation expense for the vested options in its consolidated statements of operations. An additional $7.9 million of compensation expense related to these grants will be recognized as performance vesting conditions are achieved.
On September 15, 2015, the Company’s stockholders approved an additional amendment to the Plan which increased the number of shares of common stock authorized for issuance to a total of 5,000,000 shares, up from 4,000,000 previously authorized.
As of December 31, 2016 the Company had 268,500 shares of common stock available for grant under theour 2022 Plan.
The following table summarizes the shares available for grant under the Plan for the year ended December 31, 2016, the eight months ended December 31, 2015 and the fiscal years ended April 30, 2015 and 2014:
69
TENAX THERAPEUTICS, INC.

Shares

Available

for

Grant

Balances, at April 30, 2013
282,726
Additional shares reserved
3,600,000
Options granted
(3,637,822)
Options cancelled/forfeited
1,300
Restricted stock granted
(135,662)
Restricted stock cancelled/forfeited
44,866
Balances, at April 30, 2014
155,408
Options granted
(50,225)
Options cancelled/forfeited
4,785
Restricted stock granted
(2,624)
Restricted stock cancelled/forfeited
15,055
Balances, at April 30, 2015
122,399
Additional shares reserved
1,187,192
Options granted
(315,050)
Options cancelled/forfeited
650
Restricted stock granted
(610)
Restricted stock cancelled/forfeited
132

Balances, at December 31, 20152021

994,713

-

Options granted

Shares reserved under 2022 Plan

(726,000)

688

Restricted stock granted

Shares rolled over from 2016 Plan

(430)

512

Restricted stock cancelled/forfeited

Options granted

217

(357)

Options cancelled/forfeited

127

Balances, at December 31, 20162022

268,500

970

Options granted

-

Options cancelled/forfeited

30

Balances, at December 31, 2023

1,000

2022 Plan Stock Options

Stock options granted under the 2022 Plan may be either incentive stock options (“ISOs”), or nonqualified stock options (“NSOs”). ISOs may be granted only to employees. NSOs may be granted to employees, consultants and directors. Stock options under the 2022 Plan may be granted with a term of up to ten years and at prices no less than fair market value for ISOs and no less than 85%at the time of the fair market value for NSOs.grant. Stock options granted generally vest over one to threefour years.

The following table summarizes the outstanding stock options under the 2022 Plan for the year ended December 31, 2023.

 

 

Outstanding Options

 

 

 

Number of

Shares

 

 

Weighted Average

Exercise Price

 

Balances at December 31, 2021

 

 

-

 

 

$-

 

Options granted

 

 

357

 

 

$992.00

 

Options cancelled/forfeited

 

 

(5)

 

$992.00

 

Balances at December 31, 2022

 

 

352

 

 

$992.00

 

Options cancelled/forfeited

 

 

(21)

 

$992.00

 

Balances at December 31, 2023

 

 

331

 

 

$992.00

 

2016 Stock Incentive Plan

In June 2016, the eight months ended December 31, 2015Company adopted the 2016 Stock Incentive Plan (the “2016 Plan”). Under the 2016 Plan, with the approval of the Board’s Compensation Committee, the Company may grant stock options, stock appreciation rights, restricted stock, restricted stock units, performance shares, performance units, cash-based awards or other stock-based awards. On June 16, 2016, the Company’s stockholders approved the 2016 Plan and authorized for issuance under the fiscal2016 Plan a total of 94 shares of common stock. On June 13, 2019, the Company’s stockholders approved an amendment to the 2016 Plan which increased the number of shares of common stock authorized for issuance under the 2016 Plan to a total of 469 shares, up from 94 shares previously authorized.  On June 10, 2021, the Company’s stockholders approved an amendment to the 2016 Plan which increased the number of shares of common stock authorized for issuance under the 2016 Plan to a total of 938 shares, up from 469 shares previously authorized. In June 2022, the 2016 Plan was superseded and replaced by the 2022 Plan and no new awards will be granted under the 2016 Plan going forward. Any awards outstanding under the 2016 Plan on the date of approval of the 2022 Plan remain subject to the 2016 Plan. Upon approval of the 2022 Plan, all shares of common stock remaining authorized and available for issuance under the 2016 Plan and any shares subject to outstanding awards under the 2016 Plan that subsequently expire, terminate, or are surrendered or forfeited for any reason without issuance of shares automatically become available for issuance under our 2022 Plan.

F-18

Table of Contents

2016 Plan Stock Options

Stock options granted under the 2016 Plan could be either ISOs or NSOs. ISOs could be granted only to employees. NSOs could be granted to employees, consultants and directors. Stock options under the 2016 Plan could be granted with a term of up to ten years ended April 30, 2015 and 2014:

 
 
Outstanding Options
 
 
 
 
Number of Shares
 
 
Weighted Average
Exercise Price
 
Aggregate Intrinsic Value
Balances, at April 30, 2013
  11,336 
 $57.00 
 
Options granted
  3,637,822 
 $5.64 
 
Options cancelled
  (1,300)
 $43.90 
 
Balances, at April 30, 2014
  3,647,858 
 $5.79 
 
Options granted
  50,225 
 $4.82 
 
Options cancelled
  (4,785)
 $63.84 
 
Balances, at April 30, 2015
  3,693,298 
 $5.70 
 
Options granted
  315,050 
 $3.25 
 
Options cancelled
  (650)
 $35.09 
 
Balances at December 31, 2015
  4,007,698 
 $5.50 
 
Options granted
  726,000 
 $2.12 
 
Options cancelled
  - 
 $- 
 
Balances at December 31, 2016
  4,733,698 
 $4.98 
 $                      - (1)
(1)Amount represents the difference between the exercise price and $1.95, the closing price of Tenax Therapeutics’ stock on December 31, 2016, as reported on the Nasdaq Capital Market, for all in-the-money options outstanding.
70
TENAX THERAPEUTICS, INC.
at prices no less than fair market value at the time of grant. Stock options granted generally vest over three to four years. 

The following table summarizes allthe outstanding stock options outstanding as ofunder the 2016 Plan for the year ended December 31, 2016:

 
 
 
 
Options Outstanding at
December 31, 2016
 
 
Options Exercisable and Vested at
December 31, 2016
 
 
Exercise Price
 
 
Number of
Options
 
 
Weighted Average Remaining
Contractual Life (Years)
 
 
Number of
Options
 
 
Weighted Average
Exercise Price
 
 $2.07 to $3.16 
  956,000 
  9.7 
  76,666 
 $3.16 
 $3.35 to $4.76 
  124,938 
  7.8 
  124,838 
 $3.31 
 $4.82 to $5.65 
  3,647,880 
  3.3 
  1,861,440 
 $5.63 
 $14.80 to $138.00 
  4,880 
  4.4 
  4,880 
 $54.07 
 
  4,733,698 
  4.7 
  2,067,824 
 $5.54 
The following table summarizes options outstanding that have vested and are expected to vest based on options outstanding as of December 31, 2016:
 
 
Number of
Option Shares
 
 
Weighted Average
Exercise Price
 
 
Aggregate Intrinsic
Value (1)
 
 
Weighted Average Remaining Contractual Life (Years)
 
Vested
  2,067,824 
 $5.54 
 $- 
  3.9 
Vested and expected to vest
  2,743,720 
 $4.75 
 $- 
  5.3 

(1)Amount represents the difference between the exercise price and $1.95, the closing price of Tenax Therapeutics’ stock on December 31, 2016, as reported on the Nasdaq Capital Market, for all in-the-money options outstanding.
2023.

 

 

Outstanding Options

 

 

 

Number of

Shares

 

 

Weighted Average

Exercise Price

 

Balances at December 31, 2021

 

 

415

 

 

$3,040.00

 

Options cancelled/forfeited

 

 

(122)

 

$2,593.60

 

Balances at December 31, 2022

 

 

293

 

 

$3,210.40

 

Options cancelled/forfeited

 

 

(9)

 

$1,888.00

 

Balances at December 31, 2023

 

 

284

 

 

$3,251.77

 

The Company chose the “straight-line” attribution method for allocating compensation costs of each stock option over the requisite service period using the Black-Scholes Option Pricing Model to calculate the grant date fair value.

The Company used the following assumptions to estimate the fair value of options granted under its stock option plansthe 2016 Plan for the yearyears ended December 31, 2022.  The Company had no option issuances under the 2016 plan during the eight months endedyear ending December 31, 2015 and the fiscal years ended April 30, 2015 and 2014:

 
 
For the year ended December 31,
 
 
For the eight months ended December 31,
 
 
For the year ended April 30
 
 
 
2016
 
 
2015
 
 
2015
 
 
2014
 
Risk-free interest rate (weighted average)
  2.28%
  1.99%
  2.23%
  1.80%
Expected volatility (weighted average)
  83.38%
  85.45%
  98.43%
  98.20%
Expected term (in years)
  7 
  7 
  7 
  6 
Expected dividend yield
  0.00%
  0.00%
  0.00%
  0.00%
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TENAX THERAPEUTICS, INC.
2023.

For the year ended December 31,

2022

Risk-free interest rate (weighted average)

3.08%

Expected volatility (weighted average)

102.01%

Expected term (in years)

7.0

Expected dividend yield

0.00%

F-19

Table of Contents

Risk-Free Interest Rate

The risk-free interest rate assumption was based on U.S. Treasury instruments with a term that is consistent with the expected term of the Company’s stock options.

Expected Volatility

The expected stock price volatility for the Company’s common stock was determined by examining the historical volatility and trading history for its common stock over a term consistent with the expected term of its options.

Expected Term

The expected term of stock options represents the weighted average period the stock options are expected to remain outstanding. It was calculated based on the Company’s historical experience that the Company has had with its stock option grants.

Expected Dividend Yield

The expected dividend yield of 0% is based on the Company’s history and expectation of dividend payouts. The Company has not paid and dodoes not anticipate paying any dividends in the near future.

Forfeitures

As stock-based compensation expense recognized in the statement of operations for the yearyears ended December 31, 2016, the eight months ended December 31, 20152023 and the fiscal years ended April 30, 2015 and 20142022 is based on awards ultimately expected to vest, it has been reduced for estimated forfeitures. ASC 718 requires forfeitures to be estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from those estimates. Forfeitures were estimated based on the Company’s historical experience.

The weighted-average grant-date fair value of options granted during the year ended December 31, 2016 was $2.12.
The weighted-average grant-date fair value of options granted during the eight months ended December 31, 2015 was $3.25.
The weighted-average grant-date fair value of options granted during the years ended April 30, 2015 and 2014 was $4.82 and $5.64, respectively.

The Company recorded compensation expense for these stock options grants of $529,708$116,089 and $223,277 for the yearyears ended December 31, 2016.

2023 and 2022, respectively.

As of December 31, 2016,2023, there were unrecognized compensation costs of approximately $963,000$73,701 related to non-vested stock option awards under the 2022 Plan that will be recognized on a straight-line basis over the weighted average remaining vesting period of 2.11.42 years. Additionally, there were unrecognized

1999 Stock Plan

In October 2000, the Company adopted the 1999 Stock Plan, as amended and restated on June 17, 2008 (the “1999 Plan”). Under the 1999 Plan, with the approval of the Compensation Committee of the Board of Directors, the Company could grant stock options, restricted stock, stock appreciation rights and new shares of common stock upon exercise of stock options. On March 13, 2014, the Company’s stockholders approved an amendment to the 1999 Plan which increased the number of shares of common stock authorized for issuance under the 1999 Plan to a total of 125 shares, up from 10 previously authorized. On September 15, 2015, the Company’s stockholders approved an additional amendment to the 1999 Plan which increased the number of shares of common stock authorized for issuance under the 1999 Plan to a total of 157 shares, up from 125 previously authorized. The 1999 Plan expired on June 17, 2018 and no new grants may be made under that plan after that date. However, unexpired awards granted under the 1999 Plan remain outstanding and subject to the terms of the 1999 Plan.

1999 Plan Stock Options

Stock options granted under the 1999 Plan may be ISOs or NSOs. ISOs could be granted only to employees. NSOs could be granted to employees, consultants and directors. Stock options under the 1999 Plan could be granted with a term of up to ten years and at prices no less than fair market value for ISOs and no less than 85% of the fair market value for NSOs. Stock options granted generally vest over one to three years.

F-20

Table of Contents

The following table summarizes the outstanding stock options under the 1999 Plan for the years ended December 31, 2023 and 2022:

 

 

Outstanding Options

 

 

 

 

 

Number of

Shares

 

 

Weighted Average

Exercise Price

 

 

Aggregate

Intrinsic Value

 

Balances at December 31, 2021

 

 

23

 

 

$67,616.00

 

 

 

 

Options cancelled

 

 

(11)

 

$44,667.20

 

 

 

 

Balances at December 31, 2022

 

 

12

 

 

$89,820.00

 

 

 

 

Options cancelled

 

 

(3)

 

$100,165.31

 

 

 

 

Balances at December 31, 2023

 

 

9

 

 

$86,108.80

 

 

$-

 

The Company chose the “straight-line” attribution method for allocating compensation costs of approximately $8.1 millioneach stock option over the requisite service period using the Black-Scholes Option Pricing Model to calculate the grant date fair value.

The Company had no compensation expense for stock options grants for the years ended December 31, 2023 and 2022, respectively.

As of December 31, 2023, there were no unrecognized compensation costs related to non-vested stock option awards subjectunder the 1999 Plan.

In connection with the retirement of the Company’s former Chief Executive Officer (“CEO”), effective July 13, 2021 (the “Modification Date”), the Company modified the terms of the former CEO’s outstanding stock awards to: (1) accelerate the 1,906 unvested shares underlying his outstanding stock awards immediately as of the Modification Date and (2) extend the period during which his outstanding stock awards for an aggregate of 2,734 shares may be exercised through the earlier of the stock award’s original termination date or the five-year anniversary of the Modification Date.

The Company determined that the extension of the period during which the vested shares may be exercised was a Type 1 modification pursuant to performance-basedASC 718, Compensation-Stock Compensation. However, acceleration of vesting milestones withand extension of the exercise period for the remaining Stock Awards was a weighted average remaining lifeType 3 modification pursuant to ASC 718 because absent the modification terms, those Stock Awards would have been forfeited as of 3.3 years. Asthe former CEO’s retirement date.

On the Modification Date, the Company recognized approximately $187,000 of compensation expense, which is included in General and administrative expense for the year ended December 31, 2016, none of2022, with respect to these milestones have been achieved.

modifications.

Inducement Stock Options

The table below summarizes theCompany granted two employment inducement stock option awardawards, one for 25,00063 shares of common stock madeand the other for 156 shares of common stock, to our Chief Medical Officerits new CEO on February 15, 2015. ThisJuly 6, 2021.

The employment inducement stock option for 63 shares of common stock was awarded in accordance with the employment inducement award exemption provided by Nasdaq Listing Rule 5635(c)(4) and was therefore not awarded under the Company’s stockholder approved equity plan. The option award willwas to vest overas follows: 50% upon initiation of a three year period, with one-third vesting per year, beginning one year from the grant date.Phase 3 trial for levosimendan by June 30, 2022; and 50% upon initiation of a Phase 3 trial for imatinib by June 30, 2022. The options havehad a 10-year term and an exercise price of $3.22$3,152.00 per share, the February 13, 2015July 6, 2021 closing price of the Company’sour common stock.

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TENAX THERAPEUTICS, INC.
A summary As of December 31, 2022, none of the activityvesting milestones had been achieved and related information for our stockthe options follows:
 
 
Number of
Shares
 
 
Weighted Average
Exercise Price  
 
Inducement Stock Options outstanding at April 30, 2014
  - 
 $- 
Options granted
  25,000 
  3.22 
Options exercised
  - 
  - 
Options forfeited or expired
  - 
  - 
Inducement Stock Options outstanding at April 30, 2015
  25,000 
 $3.22 
Options granted
  - 
  - 
Options exercised
  - 
  - 
Options forfeited or expired
  - 
  - 
Inducement Stock Options outstanding at December 31, 2015
  25,000 
 $3.22 
Options granted
  - 
  - 
Options exercised
  - 
  - 
Options forfeited or expired
  (16,666)
  3.22 
Inducement Stock Options outstanding at December 31, 2016
  8,334 
 $3.22 
Options exercisable at December 31, 2016
  8,334 
 $3.22 

Inducementwere subsequently cancelled. The estimated fair value of this inducement stock option compensation expenseaward was approximately $20,000 for the year ended December 31, 2016.
Inducement stock option compensation expense was approximately $26,000 for the eight months ended December 31, 2015.
For the years ended April 30, 2015 and 2014 Inducement stock option compensation expense totaled $9,830 and $0, respectively.
At December 31, 2016, there was $8,641 of remaining unrecognized compensation expense related to the inducement stock options. Inducement stock options outstanding as of December 31, 2016 had a weighted average remaining contractual life of two months.
The estimated weighted average fair value per inducement option share granted was $64,343 in 2015$178,291 using a Black-Scholes option pricing model based on market prices and the following assumptions at the date of inducement option grant: weighted average risk-free interest rate of 1.84%1.37%, dividend yield of 0%, volatility factor for our common stock of 93.90%103.50% and an expected life of 10 years.

F-21

Table of Contents

The employment inducement stock option award for 156 shares of common stock also was awarded in accordance with the employment inducement award exemption provided by Nasdaq Listing Rule 5635(c)(4) and was therefore not awarded under the Company’s stockholder approved equity plan. The option award will vest as follows: 25% on the one-year anniversary of the CEO’s employment start date and an additional 25% on each of the following three anniversaries of the CEO’s employment start date, subject to continued employment. The options have a weighted average10-year term and an exercise price of $3,152 per share, the July 6, 2021 closing price of our common stock. As of December 31, 2023, half of the vesting milestones have been achieved.

The estimated fair value of this inducement stock option award was $403,180 using a Black-Scholes option pricing model based on market prices and the following assumptions at the date of inducement option grant: risk-free interest rate of 1.13%, dividend yield of 0%, volatility factor for our common stock of 99.36% and an expected life of 7 yearsyears.

The Company granted an employment inducement stock option award for 156 shares of common stock to our Chief Medical Officer on January 15, 2021. This employment inducement optionsstock option was awarded in accordance with the employment inducement award exemption provided by Nasdaq Listing Rule 5635(c)(4) and was therefore not forfeited.

Restricted Stock Grants
The following table summarizes the outstanding restricted stockawarded under the PlanCompany’s stockholder approved equity plan. The option award will vest as follows: 25% upon initiation of a Phase 3 trial; 25% upon database lock; 25% upon acceptance for review of an investigational NDA; and 25% upon approval. The options have a 10-year term and an exercise price of $2,848 per share, the January 15, 2021 closing price of our common stock. As of December 31, 2023, one of the vesting milestones have been achieved. The estimated fair value of the inducement stock option award granted was $402,789 using a Black-Scholes option pricing model based on market prices and the following assumptions at the date of inducement option grant: risk-free interest rate of 11%, dividend yield of 0%, volatility factor for our common stock of 103.94% and an expected life of 10 years.

Inducement stock option compensation expense totaled $74,761 for the year ended December 31, 2016, the eight months ended December 31, 2015 and the fiscal years ended April 30, 2015 and 2014:

73
TENAX THERAPEUTICS, INC.
 
 
Outstanding Restricted Stock
 
 
 
Number of Shares
 
 
Weighted Average Grant Date Fair Value
 
Balances, at April 30, 2013
  1,917 
 $48.40 
Restricted stock granted
  135,662 
 $3.00 
Restricted stock vested
  (50,235)
 $2.30 
Restricted stock cancelled
  (31,503)
 $1.67 
Restricted stock forfeited
  (13,363)
 $4.49 
Balances, at April 30, 2014
  42,478 
 $6.39 
Restricted stock granted
  2,624 
 $4.90 
Restricted stock vested
  (29,957)
 $5.99 
Restricted stock cancelled
  (15,055)
 $6.95 
Balances, at April 30, 2015
  90 
 $4.01 
Restricted stock granted
  610 
 $3.37 
Restricted stock vested
  (174)
 $3.61 
Restricted stock cancelled
  (132)
 $3.57 
Balances, at December 31, 2015
  394 
 $3.34 
Restricted stock granted
  430 
 $2.72 
Restricted stock vested
  (327)
 $3.11 
Restricted stock cancelled
  (283)
 $3.13 
Balances, at December 31, 2016
  214 
 $2.72 
The Company recorded compensation expense for these restricted stock grants of $1,758 for the year ended December 31, 2016.
The Company recorded compensation expense for these restricted stock grants of $1,439 for the eight months ended December 31, 2015.
For the fiscal years ended April 30, 2015 and 2014, the Company recorded compensation expense for these restricted stock grants of $18,092 and $356,639 respectively.
2023. As of December 31, 2016,2023, there werewas $356,685 of remaining unrecognized compensation costs of approximately $400expense related to these inducement stock options.

NOTE F—COMMITMENTS AND CONTINGENCIES

Operating Leases

In January 2011, the non-vested restricted stock grantsCompany entered into a lease (the “Lease”) with Concourse Associates, LLC (the “Landlord”) for its headquarters located at ONE Copley Parkway, Suite 490, Morrisville, North Carolina (the “Premises”). The Lease was amended in August 2015, March 2016 and April 2021 to extend the term for the 5,954 square foot rental. Pursuant to the Amendment dated April 2021, the existing lease term was extended through June 30, 2024 and the annual base rent of $125,034 would increase 2.5% annually for lease years two and three. On February 7, 2023, the Company entered into a Lease Termination Agreement with the Landlord, with respect to the Premises. As consideration for the Landlord’s entry into the Lease Termination Agreement, including a release of any claims the Landlord may have had against the Company under the Lease, the Company paid the Landlord $169,867. Pursuant to the Lease Termination Agreement, effective February 8, 2023, the Company has no remaining rent or further obligations to the Landlord pursuant to the Lease.

The Company performed an evaluation of its other contracts with customers and suppliers in accordance with ASC 842, Leases, and determined that, will be recognized on a straight-line basis overexcept for the remaining vesting period.

2016 Stock Incentive Plan
On June 16, 2016,Prior Lease described above, none of the Company’s stockholders approved the 2016 Stock Incentive Plan (the “2016 Plan”), which provides for the issuancecontracts contain a lease.

The balance sheet classification of up to 3,000,000 shares of common stock. Under the 2016 Plan, with the approval of the Compensation Committee of the Board of Directors, the Company may grant stock options, stock appreciation rights, restricted stock, restricted stock units, performance shares, performance units, cash-based awards or other stock-based awards.

As of December 31, 2016 the Company had not issued any awards under the 2016 Plan and there were 3,000,000 shares of common stock available for grant under the 2016 Plan.
NOTE H—COMMITMENTS AND CONTINGENCIES
Operating Leases
our lease liabilities was as follows:

 

 

December 31,

2023

 

 

December 31,

2022

 

Current portion included in accrued liabilities

 

$-

 

 

$119,393

 

Long term lease liability

 

 

-

 

 

 

64,196

 

 

 

$-

 

 

$183,589

 

The Company leases itsowns no real property. Beginning November 1, 2022, we maintain a membership providing dedicated office space, under an operating lease that includes fixed annual increasesas well as shared services and expires in June 2021. Totalshared space for meetings, catering, and other business activities, at our principal executive office relocated to 101 Glen Lennox Drive, Suite 300, Chapel Hill, North Carolina 27517.

The current rent expense was $91,208 for the year ended December 31, 2016. Total rent expense was $75,933 for the eight months ended December 31, 2015.

For the fiscal years ended April 30, 2015 and 2014, total rent expense was $111,171 and $107,946, respectively.
The future minimum payments for the long-term, non-cancelable lease are as follows:
74
TENAX THERAPEUTICS, INC.
Year ending December 31,
 
 
 
2017
 $112,431 
2018
  115,220 
2019
  118,117 
2020
  121,084 
2021
  61,803 
 
 $528,655 
is approximately $800 per month.

F-22

Table of Contents

Simdax license agreement

As further discussed in Note D above, onLicense Agreement

On November 13, 2013, the Company acquired, through its wholly-owned subsidiary, Life Newco, that certain License Agreement, dated September 20, 2013, as amended on October 9, 2020 and January 25, 2022, by and between Phyxius and Orion (as amended, the “License”), and that certain Side Letter, dated October 15, 2013 by and between Phyxius and Orion. On February 19, 2024, the Company and Orion entered into a further amendment to the license, which terms are described below under “Note I—Subsequent Events”.

The License which granted itgrants the Company an exclusive, sublicenseablesublicensable right to develop and commercialize pharmaceutical

products containing Levosimedanlevosimendan in the United Statesterritory and, Canada.pursuant to the October 9, 2020 amendment, also includes two product dose forms containing levosimendan, in capsule and solid dosage form, and a subcutaneously administered product containing levosimendan, subject to specified limitations in the License. Pursuant to the License, the Company must use Orion’s “Simdax®”and Orion will agree to a new trademark to commercialize the Product.  when commercializing levosimendan in either of these forms.

The License also grants to the Company a right of first refusal to commercialize new developments of the Product, including developments as to the formulation, presentation, means of delivery, route of administration, dosage or indication.  

indication (i.e., line extension products).

Orion’s ongoing role under the License includes sublicense approval, serving as the sole source of manufacture, holding a first right to enforce intellectual property rights in the Territory,territory, and certain regulatory participation rights. Orion must notify the Company before the end of 2024 if it chooses not to exercise its right to supply oral formulations of levosimendan to the Company for commercialization in the territory. Additionally, the Company must grant back to Orion a broad non-exclusive license to any patents or clinical trial data related to the Product developed by the Company under the License. The term of the License has a fifteen (15) year term,extends until 10 years after the launch of the Product in the territory, provided however, that the License will continue after the end of the fifteen year term in each country in the Territoryterritory until the expiration of Orion’s patent rights in the Product in such country. Orion hadIn the event that no regulatory approval for the Product has been granted in the United States on or before September 20, 2030, however, either party will have the right to terminate the License ifwith immediate effect.

Pursuant to the Study is not started by July 31, 2014. Whileterms of the License, on November 13, 2013, the Company did not commencepaid to Orion a non-refundable up-front payment in the trial by that date, on September 9, 2014, Orion notified the Company in writing that it did not intend to terminate theamount of $1.0 million. The License so long as the trial was commenced on or before October 31, 2014. The Company subsequently commenced the human clinical trial for levosimendan on September 18, 2014 when the first patient was enrolled.

The Licensealso includes the following development milestones for which the Company shallmust make non-refundable payments to Orion no later than twenty-eight (28)28 days after the occurrence of the applicable milestone event: (i)(1) $2.0 million upon the grant of FDAUnited States Food and Drug Administration approval, including all registrations, licenses, authorizations and necessary approvals, to develop and/or commercialize the Product in the United States; and (ii)(2) $1.0 million upon the grant of regulatory approval for the Product in Canada. Once commercialized, the Company is obligated to make certain non-refundable commercialization milestone payments to Orion, aggregating to up to $13.0 million, contingent upon achievement of certain cumulative net sales amounts in the Territory.territory. The Company also must also pay Orion tiered royalties based on net sales of the Product in the Territoryterritory made by the Company and its sublicensees. After the end of the Term,License term, the Company must pay Orion a royalty based on net sales of the Product in the Territoryterritory for as long as Life Newcothe Company sells the Product in the Territory.
territory.

As of December 31, 2016,2023, the Company has not met any of the developmental milestones under the License and, accordingly, has not recorded any liability for the contingent payments due to Orion.

Agreement with Virginia Commonwealth University
In May 2008, the Company entered into a license agreement with Virginia Commonwealth University (“Licensor”, “VCU”) whereby it obtained a worldwide, exclusive license to valid claims under three of the Licensor's patent applications that relate to methods for non-pulmonary delivery of oxygen to tissue and the products based on those valid claims used or useful for therapeutic and diagnostic applications in humans and animals. The license includes the right to sub-license to third parties. The term of the agreement is the life of the patents covered by the patent applications unless the Company elects to terminate the agreement prior to patent expiration. Under the agreement, the Company has an obligation to diligently pursue product development and pursue, at its own expense, prosecution of the patent applications covered by the agreement. As part of the agreement, the Company is required to pay to VCU nonrefundable payments upon achieving development and regulatory milestones. As of April 30, 2015, the Company has not met any of the developmental milestones.
The agreement with VCU also requires the Company to pay royalties to VCU at specified rates based on annual net sales derived from the licensed technology. Pursuant to the agreement, the Company must make minimum annual royalty payments to VCU totaling $70,000 as long as the agreement is in force. These payments are fully creditable against royalty payments due for sales and sublicense revenue earned during the fiscal year as described above. This fee is recorded as an other current asset and is amortized over the fiscal year. Amortization expense was $70,000 for each of the years ended April 30, 2015 and 2014.
75
TENAX THERAPEUTICS, INC.
In September 2014, the Company discontinued the development of its Oxycyte product candidates.  As part of the this change in business strategy, on May 5, 2015 the Company provided VCU its 90 day notice terminating the license agreement entered into with the Licensor, whose effective date was May 21, 2008.  The license agreement gave the Company exclusive rights to intellectual property that was used for the development and commercialization of Oxycyte and is therefore no longer needed.

Litigation

The Company is subject to litigation in the normal course of business, none of which management believes will have a material adverse effect on the Company’s Consolidated Financial Statements.

consolidated financial statements.

F-23

Table of Contents

NOTE I—G—401(k) BENEFIT PLAN

The Company sponsors a 401(k) Retirement Savings Plan (the “401(k) Plan”) for all eligible employees. Full-time employees over the age of 18eighteen are eligible to participate in the 401(k) Plan after 90 days of continuous employment. Participants may elect to defer earnings into the 401(k) Plan up to the annual IRS limits and the Company provides a matching contribution up to 5% of the participants’ annual salary in accordance with the 401(k) Plan documents. TheA third-party trustee manages the 401(k) Plan is managed by a third-party trustee.

Plan.

For the yearyears ended December 31, 2016, the eight months ended December 31, 2015, the fiscal year ended April 30, 20152023 and the fiscal year ended April 30, 2014,2022, the Company recorded $83,589, $57,352, $82,185$66,196 and $47,087$90,873 for matching contributions expense, respectively.

NOTE J—H—INCOME TAXES

The Company has not recorded anany income tax benefit of $7,962,100expense (benefit) for the period ended December 31,2016.

The Company's provision for income taxes is summarized as follows:
 
 
 December 31,    
 
 
 
2016
 
 
2015
 
 
 
 
 
 
 
 
Current federal income tax expense
 $- 
 $- 
      Deferred federal income tax benefit
  (7,139,565)
  - 
      Provision for federal income taxes:
  (7,139,565)
  - 
 
    
    
Current state income tax expense
  - 
  - 
      Deferred state income tax benefit
  (822,535)
  - 
      Provision for state income taxes:
  (822,535)
  - 
 
    
    
Total
 $(7,962,100)
 $- 
31, 2023 due to its history of net operating losses.

The reconciliation of income tax expenses (benefit) at the statutory federal income tax rate of 34%21% for the periods ended December 31, 20162023 and December 31, 20152022 is as follows:

76
TENAX THERAPEUTICS, INC.
 
 
December 31,   
 
 
 
2016
 
 
2015
 
U.S. federal taxes (benefit) at statutory rate
 $(17,641,231)
 $(3,423,108)
State income tax benefit, net of federal benefit
  (2,031,238)
  (394,142)
Stock compensation
  141,807 
  37,264 
Other nondeductible, including goodwill impairment
  4,160,717 
  (15,287)
Change in state tax rate
  241,518 
  - 
Other, including effect of tax rate brackets
  (57,490)
  (72,808)
Change in valuation allowance
  7,223,817 
  3,868,081 
  
 $(7,962,100)
 $- 

 

 

December 31,

 

 

 

2023

 

 

2022

 

U.S. federal tax benefit at statutory rate

 

$(1,619,241)

 

$(2,320,057)

State income tax benefit, net of federal benefit

 

 

(33,357)

 

 

(218,196)

Stock compensation

 

 

43,148

 

 

 

79,090

 

Other nondeductible

 

 

428

 

 

 

-

 

Change in state tax rate

 

 

-

 

 

 

116,392

 

Expiration of NOL Carryforward

 

 

458,930

 

 

 

-

 

Federal and state net operating loss adjustments

 

 

909

 

 

 

423,066

 

Other, including effect of tax rate brackets

 

 

(7,152)

 

 

8,850

 

Change in realizability of IPR&D

 

 

-

 

 

 

-

 

Change in valuation allowance

 

 

1,156,336

 

 

 

1,910,855

 

The tax effects of temporary differences and carry forwards that give rise to significant portions of the deferred tax assets are as follows:

 
 
December 31,   
 
Deferred Tax Assets
 
2016
 
 
2015
 
Net operating loss carryforwards
 $46,227,681 
 $39,190,436 
Accruals and other
  902,546 
  691,341 
Capital loss carryforwards
  12,395 
  - 
Valuation allowance
  (47,086,442)
  (39,862,626)
Net deferred tax assets
  56,180 
  19,151 
Deferred Tax Liabilities
    
    
IPR&D
  - 
  (7,962,100)
Other liabilities
  (56,180)
  (19,151)
Net Deferred Tax Liabilities
 $- 
 $(7,962,100)

 

 

December 31,

 

Deferred Tax Assets

 

2023

 

 

2022

 

Net operating loss carryforwards

 

$36,835,386

 

 

$36,106,727

 

Accruals and other

 

 

307,305

 

 

 

300,353

 

Capitalized R&D

 

 

1,532,640

 

 

 

1,111,914

 

Contributions carryforwards

 

 

2,258

 

 

 

2,258

 

Valuation allowance

 

 

(38,677,587)

 

 

(37,521,252)

Net deferred tax assets

 

 

-

 

 

 

-

 

Deferred Tax Liabilities

 

 

 

 

 

 

 

 

Other liabilities

 

 

-

 

 

 

-

 

Net Deferred Tax Liabilities

 

$-

 

 

$-

 

The Company has established a valuation allowance against net deferred tax assets due to the uncertainty that such assets will be realized. The Company periodically evaluates the recoverability of the deferred tax assets. At such time that it is determined that it is more likely than not that deferred tax assets will be realizable, the valuation allowance will be reduced.

The net increase in the valuation allowance during 2023 was approximately $1.2 million.

F-24

Table of Contents

As of December 31, 2016,2023, the Company had Federal and State net operating loss carryforwards of approximately $124.0$166.7 million and $101.8$130.8 million available to offset future federal and state taxable income, respectively. The federal and stateFederal net operating loss carryforwardslosses of $120.7 million begin to expire in 2018 and valuation allowances have been provided.

2024, while the remaining $46.0 million carryforward indefinitely. State net operating losses begin to expire in 2024.

Utilization of the net operating loss carryforwards may be subject to an annual limitation due to the ownership percentage change limitations provided by the Internal Revenue Code of 1986, as amended, or the Code, and similar state provisions. The annual limitations may result in the expiration of the net operating losses before utilization.

Management has evaluated all

We have U.S. federal net operating loss carryforwards, or NOLs, which expire in various years if not utilized. Under Sections 382 and 383 of the Code, if a corporation undergoes an “ownership change,” the corporation’s ability to use its pre-change NOLs and other pre-change tax attributes, such as research tax credits, to offset its future post-change income and taxes may be limited. In general, an “ownership change” occurs if there is a cumulative change in our ownership by “5% shareholders” that exceeds 50 percentage points over a rolling three-year period. Similar rules may apply under state tax laws. We have not performed a formal study to determine whether any of our NOLs are subject to these limitations. We have recorded deferred tax assets for our NOLs and research and development credits and have recorded a full valuation allowance against these deferred tax assets. In the event that it is determined that we have in the past experienced additional ownership changes, or if we experience one or more ownership changes as a result of future transactions in our stock, then we may be further limited in our ability to use our NOLs and other tax positionsassets to reduce taxes owed on the net taxable income that could have a significant effectwe earn in the event that we attain profitability. Any such limitations on the ability to use our NOLs and other tax assets could adversely impact our business, financial condition, and operating results in the event that we attain profitability.

The Company follows the provisions of ASC Topic 740-10, “Accounting for Uncertainty in Income Taxes” which clarifies the accounting for uncertainty in income taxes recognized in an enterprise’s financial statements and determined the Company hadprescribes a recognition threshold and measurement process for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. This topic also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition. There were no uncertain income tax positions atas of December 31, 2016.

2023 and 2022.

The Company files U.S. and state income tax returns with varying statutes of limitations. The tax years 20012004 and forward remain open to examination due to the carryover of unused net operating losses or tax credits.

NOTE K—TRANSITION PERIOD COMPARATIVE BALANCES

In 2015, the Company’s Board of Directors approved a change in the Company’s fiscal year to a fiscal year beginning on January 1 and ending on December 31 of each year, such change beginning as of January 1, 2016. In accordance with certain rules promulgated under the Securities Exchange Act of 1934, as amended, the required transition period of May 1, 2015 to December 31, 2015 is included in these financial statements. For comparative purposes, the unaudited consolidated statements of operations and comprehensive loss for the year ended December 31, 2015 and for the eight months ended December 31, 2014 are as follows:
77
TENAX THERAPEUTICS, INC.
I—SUBSEQUENT EVENTS

Year ended

i.

The Company filed a Certificate of Amendment to the Company’s Certificate of Incorporation, as amended (the “Certificate of Amendment”) with the Secretary of State of Delaware for the purpose of effecting the Reverse Stock Split of the outstanding shares of the Company’s common stock at a ratio of one share for every 80 shares outstanding, so that every 80 outstanding shares of common stock before the Reverse Stock Split represents one share of common stock after the Reverse Stock Split. The Reverse Stock Split was approved by the Company’s stockholders at the special meeting of stockholders held on November 30, 2023 and the Company’s Board of Directors approved the Certificate of Amendment with a 1-for-80 ratio on December 31,8, 2023. The Reverse Stock Split was effective at 5:00 p.m. on January 2, 2024.

2015

(Unaudited)

ii.

On January 11, 2024, the Company received a letter from the Listing Qualifications Staff of The Nasdaq Stock Market LLC (“Nasdaq”) regarding compliance with Nasdaq Listing Rule 5550(a)(4) (the “Public Float Rule”) which requires the Company to have a minimum of 500,000 publicly held shares. The letter from Nasdaq indicated that according to its calculations, as of January 3, 2024, the day after the Company effected a 1-for-80 reverse split of its common stock, the Company no longer meets the requirements of the Rule. On February 22, 2024, the Company received written notification from the Nasdaq confirming that the Company had over 500,000 publicly held shares of its common stock and that as a result the Company had regained compliance with the Public Float Rule and that the matter was closed.

Government grant revenue
$49,286
Total net revenue
49,286
Operating expenses
General and administrative
6,671,568
Research and development
8,904,787
Loss on impairment of long-lived assets
1,034,863
Total operating expenses
16,611,218
Net operating loss
16,561,932
Interest expense
3,851
Other (income) expense
(633,632)
Net loss
$15,932,151
Unrealized (gain) loss on marketable securities
(29,332)
Total comprehensive loss
$15,902,819
Net loss per share, basic and diluted
$(0.57)
Weighted average number of common shares outstanding, basic and diluted
28,119,538

Eight months ended December 31,
2014
(Unaudited)
Operating expenses
General and administrative
$4,439,842
Research and development
4,240,467
Total operating expenses
8,680,309
Net operating loss
8,680,309
Interest expense
46,736
Other (income) expense
(509,420)
Net loss
$8,217,625
Unrealized loss (gain) on marketable securities
158,775
Total comprehensive loss
$8,376,400
Net loss per share, basic
$(0.29)
Weighted average number of common shares outstanding, basic and diluted
28,057,659
ITEM 9—CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE
None.
78
TENAX THERAPEUTICS, INC.
ITEM 9A—CONTROLS AND PROCEDURES
Disclosure Controls and Procedures
Our disclosure controls and procedures, as defined in Rule 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended, or the Exchange Act, are designed to ensure that information required to be disclosed in reports filed or submitted under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in rules and forms adopted by the Securities and Exchange Commission, or SEC, and that such information is accumulated and communicated to management, including the Chief Executive Officer and the Chief Financial Officer, to allow timely decisions regarding required disclosures.
Management, with the participation of our Chief Executive Officer and our Chief Financial Officer, has evaluated the effectiveness of our disclosure controls and procedures as of the end of the period covered by this Form 10-K. Based on such evaluation, our Chief Executive Officer and our Chief Financial Officer concluded that, as of December 31, 2016, our disclosure controls and procedures were effective at the reasonable assurance level.
Changes in Internal Controls over Financial Reporting
From time to time, we may review and make changes to our internal control over financial reporting that are intended to enhance the effectiveness of our internal control over financial reporting and which do not have a material effect on our overall internal control over financial reporting. During the three months ended December 31, 2016, we made no changes to our internal control over financial reporting, as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act, that we believe materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
Management’s Annual Report on Internal Control over Financial Reporting
Our management is responsible for establishing and maintaining adequate internal control over financial reporting. Internal control over financial reporting, as defined in rules promulgated under the Exchange Act, is a process designed by, or under the supervision of, our Chief Executive Officer and Chief Financial Officer and affected by our Board of Directors, management and other personnel to provide reasonable assurance regarding the reliability of financial reporting and the preparation of Consolidated Financial Statements for external purposes in accordance with GAAP. Internal control over financial reporting includes those policies and procedures that:
-
Pertain to the maintenance of records that in reasonable detail accurately and fairly reflect the transactions and dispositions of our assets;
-
Provide reasonable assurance that transactions are recorded as necessary to permit preparation of Consolidated Financial Statements in accordance with GAAP, and that our receipts and expenditures are being made only in accordance with authorizations of our management and our Board of Directors; and
-
Provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of our assets that could have a material effect on our Consolidated Financial Statements.
Internal control over financial reporting cannot provide absolute assurance of achieving financial reporting objectives because of its inherent limitations. Internal control over financial reporting is a process that involves human diligence and compliance and is subject to lapses in judgment and breakdowns resulting from human failures. Internal control over financial reporting can also be circumvented by collusion or improper override. Because of such limitations, there is a risk that material misstatements may not be prevented or detected on a timely basis by internal control over financial reporting. However, these inherent limitations are known features of the financial reporting process, and it is possible to design into the process safeguards to reduce, though not eliminate, this risk.
Our management assessed the effectiveness of our internal control over financial reporting as of December 31, 2016. In making its assessment, management used the criteria established by the Committee of Sponsoring Organizations of the Treadway Commission, or COSO in its 2013 Internal Control — Integrated Framework. Based on its assessment, management has concluded that our internal control over financial reporting was effective as of December 31, 2016.
The effectiveness of our internal control over financial reporting as of December 31, 2016 has been audited by Cherry Bekaert LLP, an independent registered public accounting firm, as stated in their report in Item 8 of this Annual Report on Form 10-K.
79
TENAX THERAPEUTICS, INC.
ITEM 9B—OTHER INFORMATION
There is no information to report under this item for the quarter ended December 31, 2016.
PART III
ITEM 10— DIRECTORS, EXECUTIVE OFFICERS, AND CORPORATE GOVERNANCE
The information required by this item is incorporated by reference to our Proxy Statement for our 2017 Annual Meeting of Stockholders, which will be filed with the SEC within 120 days after the end of fiscal 2016.
ITEM 11— EXECUTIVE COMPENSATION
The information required by this item is incorporated by reference to our Proxy Statement for our 2017 Annual Meeting of Stockholders, which will be filed with the SEC within 120 days after the end of fiscal 2016.
ITEM 12— SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS
The information required by this item is incorporated by reference to our Proxy Statement for our 2017 Annual Meeting of Stockholders, which will be filed with the SEC within 120 days after the end of fiscal 2016.
ITEM 13— CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS AND DIRECTOR INDEPENDENCE
The information required by this item is incorporated by reference to our Proxy Statement for our 2017 Annual Meeting of Stockholders, which will be filed with the SEC within 120 days after the end of fiscal 2016.
ITEM 14— PRINCIPAL ACCOUNTANT FEES AND SERVICES
The information required by this item is incorporated by reference to our Proxy Statement for our 2017 Annual Meeting of Stockholders, which will be filed with the SEC within 120 days after the end of fiscal 2016.
80
TENAX THERAPEUTICS, INC.
PART IV
ITEM 15—EXHIBITS AND FINANCIAL STATEMENT SCHEDULES
(A)(1) The Consolidated Financial Statements and information listed below are included in this report in Part II, Item 8.
-
Report of Independent Registered Public Accounting Firm.
-
Consolidated Balance Sheets as of December 31, 2016 and December 31, 2015.
-
Consolidated Statements of Operations and Comprehensive Loss for the year ended December 31, 2016, the eight months ended December 31, 2015 and each of the two years ended April 30, 2015 and April 30, 2014.
-
Consolidated Statements of Stockholders’ Equity for the year ended December 31, 2016, the eight months ended December 31, 2015 and each of the two years ended April 30, 2015 and April 30, 2014.
-
Consolidated Statements of Cash Flows for the year ended December 31, 2016, the eight months ended December 31, 2015 and each of the two years ended April 30, 2015 and April 30, 2014.
-
Notes to the Consolidated Financial Statements.
(A)(2) No schedules have been included because they are not applicable or the required information is shown in our Consolidated Financial Statements or our notes thereto.
(A)(3) The exhibits required by Item 601 of Regulation S-K are listed in the Exhibit Index immediately following the signature pages to this report.
ITEM 16—FORM 10-K SUMMARY
None.
81
TENAX THERAPEUTICS, INC.
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities and Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
TENAX THERAPEUTICS, INC. 
F-25

Table of Contents

iii.

On January 18, 2024, the Company received written notification from Nasdaq confirming that the Company’s common stock had a closing price of $1.00 or greater for the ten consecutive trading days from January 3, 2024 to January 17, 2024 and that as a result the Company had regained compliance with Nasdaq Listing Rule 5550(a)(2) and that the matter was closed.

iv.

On February 6, 2024, the Company received a notice of allowance from the United States Patent and Trademark Office (USPTO) of a patent with claims covering the use of TNX-103 (oral levosimendan), TNX-102 (subcutaneous levosimendan), TNX-101 (IV levosimendan), the active metabolites of levosimendan (OR1896 and OR18955) and various combinations of cardiovascular drugs with levosimendan when used to improve exercise performance in PH-HFpEF patients. 

v.

On February 8, 2024, the Company, entered into a placement agency agreement with Roth Capital Partners, LLC and a securities purchase agreement with certain purchasers for the purchase and sale, in a registered public offering by the Company, of (i) an aggregate of 421,260 shares of its common stock, par value $0.0001 per share and pre-funded warrants to purchase an aggregate of 1,178,740 shares of common stock  and (ii) accompanying warrants to purchase up to an aggregate of 3,200,000 shares of its common stock at a combined offering price of $5.65 per share of common stock and associated warrant, or $5.649 per pre-funded warrant and associated warrant, resulting in gross proceeds of approximately $9.0 million. Net proceeds of the Offering were approximately $8.0 million, after deducting the placement agent fees and estimated offering expenses payable by the Company. The offering closed on February 12, 2024.

vi.

On February 19, 2024, the Company and Orion entered into an amendment (the “Amendment”) to the License. The Amendment broadened the geographic scope of the original License, granting the Company the exclusive right to develop and commercialize certain levosimendan-based products worldwide, formerly rights limited to Canada and the United States, but excluded the treatment of neurological conditions from the Company’s right of first refusal under the Agreement to obtain rights to develop and commercialize new formulations, routes of administration, dosages, or indications of levosimendan-based products. The Amendment also reduced the tiered royalties based on worldwide net sales of the product by the Company and its sublicensees, increased the Agreement’s existing milestone payment due to Orion upon the grant of United States Food and Drug Administration approval of a levosimendan-based product to $10.0 million and added a milestone payment to Orion of $5.0 million due upon the grant of regulatory approval for a levosimendan-based product in Japan. The Amendment also (i) increased the Company’s obligations to make certain non-refundable commercialization milestone payments to Orion, aggregating to up to $45.0 million, contingent upon achievement of certain cumulative worldwide sales of the product by the Company, and (ii) reduced the maximum price per capsule payable by the Company to Orion, under a yet-to-be-negotiated supply agreement, for the commercial supply of oral levosimendan-based product.

 
Date: March 16, 2017By:  /s/ John P. KelleyF-26
John P. Kelley 
Chief Executive Officer
(Principal Executive Officer) 
82
TENAX THERAPEUTICS, INC.
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS that each individual whose signature appears below constitutes and appoints John P. Kelley and Michael B. Jebsen, and each of them, his true and lawful attorneys-in-fact and agents with full power of substitution and resubstitution, for him and in his name, place and stead, in any and all capacities, to sign any and all amendments to this report, and to file the same, with all exhibits thereto, and all documents in connection therewith, with the Securities and Exchange Commission, granting unto said attorneys-in-fact and agents full power and authority to do and perform each and every act and thing requisite and necessary to be done in and about the premises, as fully to all intents and purposes as he might or could do in person, hereby ratifying and confirming all that said attorneys-in-fact and agents, or their substitutes, may lawfully do or cause to be done by virtue hereof.
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.
Name
Title
Date
 /s/ John P. Kelley
Chief Executive Officer and Director
/s/ John P. Kelley
John P. Kelley

(Principal Executive Officer)
March 16, 2017
 /s/ Michael B. Jebsen
Chief Financial Officer
/s/ Michael B. Jebsen
Michael B. Jebsen
(Principal Financial Officer and Principal Accounting Officer)
March 16, 2017

/s/ Ronald R. Blanck, DODirector
Ronald R. Blanck, DO
March 16, 2017
/s/ Gregory Pepin
Director
Gregory Pepin
March 16, 2017
 /s/ James MitchumDirector
James Mitchum
March 16, 2017
 /s/ Chris A. RallisDirector
Chris A. Rallis
March 16, 2017
 /s/ Anthony DiTonnoDirector
Anthony DiTonno
March 16, 2017
 /s/ Gerald ProehlDirector
Gerald Proehl

March 16, 2017

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TENAX THERAPEUTICS, INC.
EXHIBIT INDEX
Exhibit No.
Exhibits Required by Item 601 of Regulation S-K
2.1Agreement and Plan of Merger dated April 28, 2008 (1)
2.2
Asset Purchase Agreement by and between Oxygen Biotherapeutics, Inc., Life Newco, Inc., Phyxius Pharma, Inc., and the stockholders of Phyxius Pharma, Inc. dated October 21, 2013 (33)
3.1
Certificate of Incorporation (1)
3.2Certificate of Amendment of the Certificate of Incorporation (14)
3.3Certificate of Amendment of the Certificate of Incorporation (30)
3.4Certificate of Amendment of the Certificate of Incorporation (37)
3.5Third Amended and Restated Bylaws (39)
4.1
Specimen Stock Certificate (19)
10.1
Agreement with Leland C. Clark, Jr., Ph.D. dated November 20, 1992 with amendments, Assignment of Intellectual Property/ Employment (2)
10.2
Agreement between the Registrant and Keith R. Watson, Ph.D. Assignment of Invention (2)
10.3
Children’s Hospital Research Foundation License Agreement dated February 28, 2001 (2)
10.4Exclusive License Agreement with Virginia Commonwealth University dated May 22, 2008 (9)
10.5Amendment no. 1 to the Exclusive License Agreement with Virginia Commonwealth University Intellectual Property Foundation (10)
10.6Amendment no. 2 to the Exclusive License Agreement with Virginia Commonwealth University Intellectual Property Foundation (10)
10.7Form of Option issued to Executive Officers and Directors (2) +
10.8
Form of Option issued to Employees (2) +
10.9Form of Option Agreement with Form of Notice of Grant * +
10.10
Form of Inducement Stock Option Award (40) +
10.11Restricted Stock Award Agreement (22) +
10.12
Form of Warrant issued to Unsecured Note Holders 2006-2007 (3)
10.13
Form of Convertible Note – 2008 (4)
10.14Form of Warrant issued to Convertible Note Holders (4)
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TENAX THERAPEUTICS, INC.
10.15
Form of Purchase Agreement – US Purchase (without exhibits, which are included as exhibits 10.16 and 10.17, above) (4)
10.16
Form of Purchase Agreement – Non-US Purchase (without exhibits, which are included as exhibits 10.16 and 10.17, above) (4)
10.17
Form of Purchase Agreement – US Note Exchange (without exhibits, which are included as exhibits 10.16 and 10.17, above) (4)
10.18
Form of Purchase Agreement – Non-US Note Exchange (without exhibits, which are included as exhibits 10.16 and 10.17, above) (4
10.19
Form of Warrant issued to Financing Consultants (5)
10.20
1999 Amended Stock Plan (amended 2008) (5) +
10.21
Amendment No. 1 to Oxygen Biotherapeutics, Inc. 1999 Amended Stock Plan (38) +
10.22
Amendment No. 2 to Oxygen Biotherapeutics, Inc. 1999 Amended Stock Plan (38) +
10.232016 Stock Incentive Plan (41) +
10.24Employment Agreement with John Kelley dated November 13, 2013 (34) +
10.25First Amendment to Employment Agreement with John Kelley dated June 18, 2015 (36) +
10.26Amended and Restated Employment Agreement with Michael B. Jebsen dated May 19, 2011 (20) +
10.27Second Amended and Restated Employment Agreement with Michael Jebsen dated November 13, 2013 (34) +
10.28First Amendment to Second Amended and Restated Employment Agreement with Michael Jebsen dated June 18, 2015 (36) +
10.29Form of Indemnification Agreement (20) +
10.30
Description of Non-Employee Director Compensation (25) +
10.31
Description of Non-Employee Director Compensation, effective June 15, 2015 (39) +
10.32
Securities Purchase Agreement (including exhibits) between Oxygen Biotherapeutics and Vatea Fund, Segregated Portfolio dated June 8, 2009 (6)
10.33
Amendment no. 1 to the Securities Purchase Agreement between Oxygen Biotherapeutics and Vatea Fund, Segregated Portfolio (11)
10.34
Amendment no. 2 to the Securities Purchase Agreement between Oxygen Biotherapeutics and Vatea Fund, Segregated Portfolio (12)
10.35Amendment no. 3 to the Securities Purchase Agreement between Oxygen Biotherapeutics and Vatea Fund, Segregated Portfolio (23)
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TENAX THERAPEUTICS, INC.
10.36Form of Exchange Agreement dated July 20, 2009 (7)
10.37Waiver—Convertible Note (10)
10.38Amendment—Common Stock Purchase Warrant (10)
10.39Form of Warrant for May 2010 offering (13)
10.40Form of Subscription Agreement for May 2010 offering (13)
10.41Warrant issued to Blaise Group International, Inc. (14)
10.41Note Purchase Agreement between Oxygen Biotherapeutics and JP SPC 1 Vatea, Segregated Portfolio (15)
10.42Form of Promissory Note under Note Purchase Agreement between Oxygen Biotherapeutics and JP SPC 1 Vatea, Segregated Portfolio (15)
10.44First Amendment to Note Purchase Agreement between Oxygen Biotherapeutics and JP SPC 1 Vatea, Segregated Portfolio (17)
10.45Lease Agreement for North Carolina corporate office (18)
10.46Standard Industrial Lease relating to OBI’s California facility (12)
10.47Task Order between the Company and NextPharma, dated November 15, 2011 (23)
10.48Form of Convertible Note for July 2011 offering (included in exhibit 10.48)
10.49Form of Warrant for July 2011 offering (included in exhibit 10.48)
10.50Form of Convertible Note and Warrant Purchase Agreement for July 2011 offering (21)
10.51Placement Agency Agreement, dated December 8, 2011, between Oxygen Biotherapeutics, Inc. and William Blair & Company, L.L.C., as placement agent (24)
10.52Form of Warrant for December 2011 offering (24)
10.53Form of Securities Purchase Agreement for December 2011 offering (24)
10.54Form of Amendment Agreement for December 2011 offering (26)
10.55Form of Lock-up Agreement for December 2011 offering (24)
10.56Form of Amendment Agreement for December 2011 offering (27)
10.57Fluoromed Supply Agreement (28)
10.58Form of Warrant for February 2013 offering (29)
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TENAX THERAPEUTICS, INC.
10.59Placement Agency Agreement, dated February 22, 2013, between Oxygen Biotherapeutics, Inc. and Ladenburg Thalmann & Co. Inc., as placement agent (29)
10.60Form of Securities Purchase Agreement for February 2013 offering (29)
10.61Form of Registration Rights Agreement for February 2013 offering (29)
10.62Form of Warrant Exchange Agreement, dated February 21, 2013, between Oxygen Biotherapeutics, Inc. and certain institutional investors party to the Securities Purchase Agreement for December 2011 Offering (29)
10.63License and Supply Agreement dated February 5, 2013, between Oxygen Biotherapeutics, Inc. and Valor SA (38)
10.64Settlement Agreement, dated March 14, 2013, among Oxygen Biotherapeutics, Inc., Tenor Opportunity Master Fund Ltd., Aria Opportunity Fund, Ltd., and Parsoon Opportunity Fund, Ltd. (38)
10.65Form of Warrant for Series C 8% Convertible Preferred Stock Offering (31)
10.66Placement Agency Agreement, dated July 21, 2013, between Oxygen Biotherapeutics, Inc. and Ladenburg Thalmann & Co. Inc., as placement agent (31)
10.67Form of Securities Purchase Agreement for Series C 8% Convertible Preferred Stock Offering (31)
10.68Lock-Up Agreement, dated August 16, 2013, between Oxygen Biotherapeutics, Inc. and JPS SPC 3 obo OXBT Fund, SP (32)
10.59Warrant for Series D 8% Convertible Preferred Stock Offering (32)
10.70Form of February Warrant Amendment (32)
10.71Form of July Warrant Amendment (32)
10.72Form of Securities Purchase Agreement for Series D 8% Convertible Preferred Stock Offering (33)
10.73License Agreement dated September 20, 2013 by and between Phyxius Pharma, Inc. and Orion Corporation (35)
10.74Amendment to Common Stock Purchase Agreement (35)
10.75Sales Agreement dated as of February 23, 2015, between Tenax Therapeutics, Inc. and Cowen and Company, LLC(40)
10.76First Amendment to Lease Agreement for North Carolina corporate office (42)
21.1Subsidiaries of Tenax Therapeutics, Inc.(40)
23.1Consent of Independent Registered Accounting Firm*
31.1Certification of Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002*
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TENAX THERAPEUTICS, INC.
31.2Certification of Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002*
32.1
Certification of Chief Executive Officer Pursuant to 18 U.S.C. Section 1350*
32.2
Certification of Chief Financial Officer Pursuant to 18 U.S.C. Section 1350*
101.INSXBRL Instance Document
101.SCH
XBRL Taxonomy Extension Schema Document
101.CAL
XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF
XBRL Taxonomy Extension Definition Linkbase Document
101.LAB
XBRL Taxonomy Extension Label Linkbase Document
101.PREXBRL Taxonomy Extension Presentation Linkbase Document
(1)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on June 30, 2008, and are incorporated herein by this reference.
(2)These documents were filed as exhibits to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on August 13, 2004, and are incorporated herein by this reference.
(3)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on September 6, 2006, and are incorporated herein by this reference.
(4)These documents were filed as exhibits to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on March 21, 2008, and are incorporated herein by this reference.
(5)These documents were filed as exhibits to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on August 13, 2008, and are incorporated herein by this reference.
(6)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on June 8, 2009, and is incorporated herein by this reference.
(7)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on July 21, 2009, and is incorporated herein by this reference.
(9)This document was filed as an exhibit to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on September 22, 2008, and is incorporated herein by this reference.
(10)These documents were filed as exhibits to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on March 19, 2010, and are incorporated herein by this reference.
(11)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on September 2, 2009, and is incorporated herein by this reference.
(12)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on April 28, 2010, and are incorporated herein by this reference.
(13)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on May 4, 2010, and are incorporated herein by this reference.
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TENAX THERAPEUTICS, INC.
(14)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on November 13, 2009, and are incorporated herein by reference.
(15)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on October 13, 2010, and are incorporated herein by this reference.
(16)These documents were filed as exhibits to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on December 9, 2010, and are incorporated herein by this reference.
(17)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on December 30, 2010, and is incorporated herein by this reference.
(18)These documents were filed as exhibits to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on March 21, 2011, and are incorporated herein by this reference.
(19)These documents were filed as exhibits to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on July 23, 2010, and are incorporated herein by this reference.
(20)This document was filed as an exhibit to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on July 15, 2011, and is incorporated herein by this reference.
(21)
This document was filed as an exhibit to the current report on Form 8-K/A filed by Tenax Therapeutics with the SEC on July 1, 2011, and is incorporated herein by this reference.
(22)This document was filed as an exhibit to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on December 15, 2011, and is incorporated herein by this reference.
(23)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on November 16, 2011, and are incorporated herein by this reference.
(24)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on December 9, 2011, and are incorporated herein by this reference.
(25)This document was filed as an exhibit to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on March 15, 2012, and is incorporated herein by this reference.
(26)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on June 15, 2012, and is incorporated herein by this reference.
(27)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on June 15, 2012, and is incorporated herein by reference.
(28)These documents were filed as exhibits to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on July 25, 2012, and are incorporated herein by this reference.
(29)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on February 25, 2013, and are incorporated herein by this reference.
(30)
This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on May 15, 2013, and is incorporated herein by this reference.
(31)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on July 25, 2013, and are incorporated herein by reference.
(32)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on August 26, 2013, and are incorporated herein by reference.
(33)This document was filed as an exhibit to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on October 25, 2013, and is incorporated herein by reference.
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TENAX THERAPEUTICS, INC.
(34)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on November 19, 2013, and are incorporated herein by reference
(35)These documents were filed as exhibits to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on March 17, 2014, and are incorporated herein by this reference.
(36)These documents were filed as exhibits to the current report on Form 8-K filed by Tenax Therapeutics with the SEC on June 19, 2015, and are incorporated herein by reference.
(37)This document was filed as an exhibit to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on December 15, 2014, and is incorporated herein by this reference.
(38)These documents were filed as exhibits to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on July 29, 2014, and are incorporated herein by this reference.
(39)These documents were filed as exhibits to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on September 9, 2015, and are incorporated herein by this reference.
(40)These documents were filed as exhibits to the annual report on Form 10-K filed by Tenax Therapeutics with the SEC on July 14, 2015, and are incorporated herein by this reference.
(41)This document was filed as an exhibit to the quarterly report on Form 10-Q filed by Tenax Therapeutics with the SEC on August 9, 2016, and is incorporated herein by this reference.
(42)This document was filed as an exhibit to the transition report on Form 10-KT filed by Tenax Therapeutics with the SEC on March 14, 2016, and is incorporated herein by this reference.
 *Filed herewith.
+Management contract or compensatory plan or arrangement.
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