UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, DCD.C. 20549

FORM 10-Q

(Mark One)

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

For the quarterly period ended September 30, 20172023

OR

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

For the transition period from ______ to ______

Commission file number:File Number: 001-34810

Picture 17

Aspira Women’s Health Inc.

(Exact name of registrant as specified in its charter)

Vermillion, Inc.Delaware

33-0595156

(Exact Name of Registrant as Specified in Its Charter)

Delaware

33-0595156

(State or Other Jurisdictionother jurisdiction of Incorporationincorporation or Organization)organization)

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

12117 Bee Caves Road, Building Three,III, Suite 100, Austin, Texas

78738

(Address of Principal Executive Offices)principal executive offices)

(Zip Code)

Registrant’s telephone number, including area code: (512) 519-0400

(Registrant’s Telephone Number, Including Area Code)Securities registered pursuant to Section 12(b) of the Act:

Title of each class

Trading Symbol(s)

Name of each exchange on which registered

Common Stock, par value $0.001 per share

AWH

The Nasdaq Capital Market

1


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 þNo ¨

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 þNo ¨

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

Large accelerated filer ¨

Accelerated filer ¨

Non-accelerated filer þ

Non-accelerated filer  ☐

Smaller reporting company þ

Emerging growth company

¨

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

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

Indicate by check mark whether the registrant has filed all documents and reports required to be filed by Sections 12, 13 or 15(d) of the Securities Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court.  Yes ☑ No ☐

As of October 31,  2017,November 9, 2023, the registrant had 59,998,74810,336,834 shares of common stock, par value $0.001 per share, outstanding.

2

1


VERMILLION,ASPIRA WOMEN’S HEALTH INC.

FORM 10-Q

For the Quarter Ended September 30, 2023

Table of Contents

Page

PART I

Financial Information

4

Page

PART I

Financial Information

3

Item 1

Financial Statements (unaudited)

43

Condensed Consolidated Balance Sheets as of September 30, 20172023 and December 31, 2016 (unaudited)2022

43

Condensed Consolidated Statements of Operations for the three and nine months ended September 30, 20172023 and 2016 (unaudited)2022

64

Condensed Consolidated Statements of Changes in Stockholders’ (Deficit)Equity for the three and nine months ended September 30, 2023 and 2022

5

Condensed Consolidated Statements of Cash Flows for the nine months ended September 30, 20172023 and 2016 (unaudited)2022

7

Notes to Condensed Consolidated Financial Statements (unaudited)

9

Item 2

8

Item 2

Management's Discussion and Analysis of Financial Condition and Results of Operations

32

Item 3

15

Item 3

Quantitative and Qualitative Disclosures About Market Risk

49

Item 4

26Controls and Procedures

49

Item 4PART II

Controls and ProceduresOther Information

52

Item 1

26Legal Proceedings

52

PART IIItem 1A

Other InformationRisk Factors

52

Item 2

27Unregistered Sales of Equity Securities, Use of Proceeds, and Issuer Purchases of Equity Securities

53

Item 13

Legal ProceedingsDefaults Upon Senior Securities

53

Item 4

27Mine Safety Disclosures

54

Item 1A5

Risk FactorsOther Information

54

Item 6

27Exhibits

55

Item 6SIGNATURES

Exhibits

28

SIGNATURES

2957

Vermillion, OVA1 and OveraThe following are registered and unregistered trademarks and service marks of Vermillion, Aspira Women’s HealthInc.: VERMILLION SM, Aspira Women’s Health®, OVA1®, OVERA®, ASPiRA LABS SM, OvaCalc®, OVASUITESM, ASPiRA GenetiXSM , OVA1PLUS®,OVAWATCHSM, EndoCheckSM, OVAInheritSM, Aspira SynergySM,, OVA360SM, ASPIRA IVD® , and YOUR HEALTH, OUR PASSION®.

3

2


PART I - FINANCIAL INFORMATION

ITEM 1.FINANCIAL STATEMENTS

Vermillion,Aspira Women’s Health Inc.

Condensed Consolidated Balance Sheets (unaudited)

(Amounts in Thousands, Except Share and Par Value Amounts)

(Unaudited)

 

 

 

 

 

September 30,

 

December 31,

September 30,

December 31,

2017

 

2016

2023

2022

Assets

 

 

 

 

 

Current assets:

 

 

 

 

 

Cash and cash equivalents

$

7,752 

 

$

5,242 

$

5,100

$

13,306

Accounts receivable

 

221 

 

 

275 

Accounts receivable, net of reserves of $35 and $9, at September 30, 2023 and December 31, 2022, respectively

1,590

1,245

Prepaid expenses and other current assets

 

175 

 

 

498 

581

1,442

Inventories

 

155 

 

 

93 

301

316

Total current assets

 

8,303 

 

 

6,108 

7,572

16,309

Property and equipment, net

 

1,364 

 

 

1,911 

221

368

Right-of-use assets

600

282

Restricted cash

256

251

Other assets

 

11 

 

 

 -

13

163

Total assets

$

9,678 

 

$

8,019 

$

8,662

$

17,373

 

 

 

 

 

Liabilities and Stockholders’ Equity

 

 

 

 

 

Liabilities and Stockholders’ (Deficit) Equity

Current liabilities:

 

 

 

 

 

Accounts payable

$

514 

 

$

881 

$

1,382

$

881

Accrued liabilities

 

1,430 

 

 

1,464 

3,089

3,402

Deferred Revenue

 

62 

 

 

 -

Current portion of long-term debt

378

403

Short-term debt

 

191 

 

 

182 

77

764

Other current liabilities

 

32 

 

 

34 

Current maturities of lease liabilities

236

77

Total current liabilities

 

2,229 

 

 

2,561 

5,162

5,527

Non-current liabilities:

 

 

 

 

 

Long-term debt

 

1,528 

 

 

1,667 

1,217

2,315

Other non-current liabilities

 

 -

 

 

29 

Non-current maturities of lease liabilities

429

272

Warrant liabilities

2,513

2,280

Total liabilities

 

3,757 

 

 

4,257 

9,321

10,394

Commitments and contingencies (Note 3)

 

 

 

 

 

Stockholders’ equity:

 

 

 

 

 

Common stock, par value $0.001 per share, 150,000,000 shares authorized at

 

 

 

 

 

September 30, 2017 and December 31, 2016; 59,998,748 and 52,328,492 shares

 

 

 

 

 

issued and outstanding at September 30, 2017 and December 31, 2016,

 

 

 

 

 

respectively

 

60 

 

 

52 

Commitments and contingencies (Note 4)

 

 

Stockholders’ (deficit) equity:

Common stock, par value $0.001 per share, 200,000,000 and 150,000,000 shares authorized at September 30, 2023 and December 31, 2022, respectively; 10,287,182 and 8,306,326 shares issued and outstanding at September 30, 2023 and December 31, 2022, respectively

11

8

Additional paid-in capital

 

398,959 

 

 

389,266 

514,544

508,584

Accumulated deficit

 

(393,098)

 

 

(385,556)

(515,214)

(501,613)

Total stockholders’ equity

 

5,921 

 

 

3,762 

Total liabilities and stockholders’ equity

$

9,678 

 

$

8,019 

Total stockholders’ (deficit) equity

(659)

6,979

Total liabilities and stockholders’ (deficit) equity

$

8,662

$

17,373

4


See accompanying notes to the unaudited condensed consolidated financial statements.

5

3


Aspira Women’s Health Inc.

Vermillion, Inc.

Condensed Consolidated Statements of Operations (unaudited)

(Amounts in Thousands, Except Share and Per Share Amounts)

(Unaudited)

Three Months Ended

Nine Months Ended

 

 

 

 

 

 

 

 

 

 

 

September 30,

September 30,

Three Months Ended September 30,

 

Nine Months Ended September 30,

2023

2022

2023

2022

2017

 

2016

 

2017

 

2016

(as restated)

(as restated)

Revenue:

 

 

 

 

 

 

 

 

 

 

 

Product

$

657 

 

$

581 

 

$

2,195 

 

$

1,640 

$

2,217

$

2,037

$

7,023

$

5,890

Service

 

42 

 

 

42 

 

 

128 

 

 

197 

Genetics

-

35

1

141

Total revenue

 

699 

 

 

623 

 

 

2,323 

 

 

1,837 

2,217

2,072

7,024

6,031

Cost of revenue:(1)

 

 

 

 

 

 

 

 

 

 

 

Cost of revenue(1):

Product

 

495 

 

 

461 

 

 

1,345 

 

 

1,516 

910

875

2,981

2,768

Service

 

284 

 

 

356 

 

 

855 

 

 

416 

Genetics

-

41

-

180

Total cost of revenue

 

779 

 

 

817 

 

 

2,200 

 

 

1,932 

910

916

2,981

2,948

Gross profit (loss)

 

(80)

 

 

(194)

 

 

123 

 

 

(95)

Gross profit

1,307

1,156

4,043

3,083

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

Research and development(2)

 

192 

 

 

370 

 

 

685 

 

 

1,868 

998

2,157

2,958

4,915

Sales and marketing(3)

 

1,050 

 

 

1,606 

 

 

3,114 

 

 

5,514 

1,702

3,950

6,069

12,027

General and administrative(4)

 

1,177 

 

 

1,295 

 

 

3,825 

 

 

4,645 

2,723

3,629

9,733

12,188

Total operating expenses

 

2,419 

 

 

3,271 

 

 

7,624 

 

 

12,027 

5,423

9,736

18,760

29,130

Loss from operations

 

(2,499)

 

 

(3,465)

 

 

(7,501)

 

 

(12,122)

(4,116)

(8,580)

(14,717)

(26,047)

Interest income (expense), net

 

(10)

 

 

(11)

 

 

(32)

 

 

(16)

Change in fair value of warrant liabilities

(1,201)

1,236

(233)

1,236

Interest income, net

12

18

46

(10)

Other income (expense), net

 

 -

 

 

 -

 

 

(9)

 

 

16 

599

(457)

1,303

(473)

Net loss

$

(2,509)

 

$

(3,476)

 

$

(7,542)

 

$

(12,122)

$

(4,706)

$

(7,783)

$

(13,601)

$

(25,294)

Deemed dividend on warrant repricing

 

(942)

 

 

 -

 

 

(942)

 

 

 -

Net loss attributable to common stockholders

$

(3,451)

 

$

(3,476)

 

$

(8,484)

 

$

(12,122)

Net loss per share attributable to common stockholders - basic and diluted

$

(0.06)

 

$

(0.07)

 

$

(0.15)

 

$

(0.23)

Net loss per share - basic and diluted

$

(0.48)

$

(1.00)

$

(1.54)

$

(3.33)

Weighted average common shares used to compute basic and diluted net loss per common share

 

57,455,786 

 

 

52,237,287 

 

 

55,909,788 

 

 

52,167,543 

9,776,436

7,807,876

8,838,342

7,590,872

Non-cash stock-based compensation expense included in cost of revenue and operating expenses:

 

 

 

 

 

 

 

 

 

 

 

(1) Cost of revenue

$

29 

 

$

27 

 

$

108 

 

$

73 

$

7

$

(23)

$

26

$

64

(2) Research and development

 

 

 

10 

 

 

 

 

63 

65

65

224

114

(3) Sales and marketing

 

38 

 

 

14 

 

 

115 

 

 

70 

(105)

76

19

281

(4) General and administrative

 

257 

 

 

210 

 

 

767 

 

 

655 

451

428

1,033

1,535

See accompanying notes to the unaudited condensed consolidated financial statements.

6

4


Vermillion,Aspira Women’s Health Inc.

Condensed Consolidated Statements of Changes in Stockholders’ (Deficit) Equity (unaudited)

(Amounts in Thousands, Except Share Amounts)

Common Stock

Shares

Amount

Additional Paid-In Capital

Accumulated Deficit

Total Stockholders’ (Deficit) Equity

Balance at December 31, 2022

8,306,326 

$

$

508,584 

$

(501,613)

$

6,979 

Net loss

-

-

-

(6,578)

(6,578)

Common stock issued under an at the market offering agreement, net of issuance costs

23,217 

-

30 

-

30 

Stock-based compensation expense

-

-

396 

-

396 

Balance at March 31, 2023

8,329,543 

$

$

509,010 

$

(508,191)

$

827 

Net loss

-

-

-

(2,317)

(2,317)

Common stock issued under an at the market offering agreement, net of issuance costs

12,335 

-

38

-

38

Common stock issued under an equity line of credit agreement, net of issuance costs

53,335 

-

178

-

178

Common stock issued for entering into equity line of credit with Lincoln Park

47,733 

258 

258 

Common stock issued for vested restricted stock awards

30,441 

263 

-

264 

Stock-based compensation expense

-

-

224 

-

224 

Fractional shares adjustment related to reverse stock split

(24)

-

-

-

-

Balance at June 30, 2023

8,473,363 

$

$

509,971 

$

(510,508)

$

(528)

Net loss

-

-

-

(4,706)

(4,706)

Common stock issued under a registered direct offering, net of issuance costs

1,694,820 

2

4,155

-

4,157

Common stock issued for vested restricted stock awards

118,999 

-

421

-

421

Stock-based compensation expense

-

-

(3)

-

(3)

Balance at September 30, 2023

10,287,182 

$

11

$

514,544

$

(515,214)

$

(659)


5


Aspira Women’s Health Inc.

Condensed Consolidated Statements of Changes in Stockholders’ (Deficit) Equity (unaudited) (continued)

(Amounts in Thousands, Except Share Amounts)

Common Stock

Shares

Amount

Additional Paid-In Capital

Accumulated Deficit

Total Stockholders’ (Deficit) Equity

Balance at December 31, 2021

7,475,916 

$

$

501,893 

$

(471,728)

$

30,172 

Net loss

-

-

-

(9,268)

(9,268)

Common stock issued in conjunction with exercise of stock options

200 

-

-

Stock-based compensation expense

-

-

838 

-

838 

Balance at March 31, 2022

7,476,116 

$

$

502,733 

$

(480,996)

$

21,744 

Net loss

-

-

-

(8,243)

(8,243)

Common stock issued in conjunction with exercise of stock options

1,333 

-

11 

-

11 

Common stock issued for vested restricted stock awards

8,977 

-

140 

-

140 

Stock-based compensation expense

-

-

470 

-

470 

Balance at June 30, 2022

7,486,426 

$

$

503,354 

$

(489,239)

$

14,122 

Net loss (as restated)

-

-

-

(7,783)

(7,783)

Common stock and warrants issued in conjunction with follow-on public offering, net of issuance costs (as restated)

800,000 

4,292 

-

4,293 

Common stock issued for vested restricted stock awards

9,950 

-

95 

-

95 

Stock-based compensation expense

-

-

451 

-

451 

Balance at September 30, 2022 (as restated)

8,296,376 

$

$

508,192 

$

(497,022)

$

11,178 

See accompanying notes to the unaudited condensed consolidated financial statements.

6


Aspira Women’s Health Inc.

Condensed Consolidated Statements of Cash Flows (unaudited)

(Amounts in Thousands)

(Unaudited)



 

 

 

 

 



Nine Months Ended



September 30,



2017

 

2016

Cash flows from operating activities:

 

 

 

 

 

Net loss

$

(7,542)

 

$

(12,122)

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

 

 

 

 

 

Depreciation and amortization

 

599 

 

 

523 

Stock-based compensation expense

 

997 

 

 

861 

Loss on sale and disposal of property and equipment

 

 

 

Changes in operating assets and liabilities:

 

 

 

 

 

Accounts receivable

 

54 

 

 

(44)

Prepaid expenses and other assets

 

312 

 

 

354 

Inventories

 

(62)

 

 

(5)

Accounts payable, accrued liabilities and other liabilities

 

(401)

 

 

(769)

Deferred revenue

 

62 

 

 

 -

Net cash used in operating activities

 

(5,977)

 

 

(11,199)

Cash flows from investing activities:

 

 

 

 

 

Purchase of property and equipment

 

(56)

 

 

(1,240)

Net cash used in investing activities

 

(56)

 

 

(1,240)

Cash flows from financing activities:

 

 

 

 

 

Proceeds from private placement offering of common stock, net of issuance costs

 

5,127 

 

 

 -

Proceeds from exercise of common stock warrants, net of issuance costs

 

3,577 

 

 

 -

Proceeds from issuance of DECD loan, net of issuance costs

 

 -

 

 

1,967 

Principal repayment of DECD loan

 

(136)

 

 

(73)

Repayment of capital lease obligations

 

(25)

 

 

(22)

Proceeds from issuance of common stock from exercise of stock options

 

 -

 

 

Net cash provided by financing activities

 

8,543 

 

 

1,877 

Net increase (decrease) in cash and cash equivalents

 

2,510 

 

 

(10,562)

Cash and cash equivalents, beginning of period

 

5,242 

 

 

18,642 

Cash and cash equivalents, end of period

$

7,752 

 

$

8,080 

Supplemental disclosure of cash flow information:

 

 

 

 

 

Cash paid during the period for interest

 

36 

 

 

24 

Supplemental disclosure of non-cash investing and financing activities:

 

 

 

 

 

Deemed dividend on warrant repricing

 

942 

 

 

 -

Nine Months Ended

September 30,

2023

2022

(as restated)

Cash flows from operating activities:

Net loss

$

(13,601)

$

(25,294)

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

Non-cash lease expense

(2)

4

Depreciation and amortization

162

195

Stock-based compensation expense

1,302

1,994

Change in fair value of warrant liabilities

233

(1,236)

Other expenses representing transaction costs allocated to the issuance of warrants

-

574

Loss on impairment and disposal of property and equipment

(3)

10

Forgiveness of DECD loan

(1,000)

-

Financing expense for entering into equity line of credit with Lincoln Park

258

-

Changes in operating assets and liabilities:

Accounts receivable

(345)

(174)

Prepaid expenses and other assets

1,011

694

Inventories

15

(106)

Accounts payable, accrued liabilities and other liabilities

(474)

(653)

Net cash used in operating activities

(12,444)

(23,992)

Cash flows from investing activities:

Purchase of property and equipment

(12)

(158)

Net cash used in investing activities

(12)

(158)

Cash flows from financing activities:

Principal repayment of DECD loan

(148)

(196)

Proceeds from issuance of common stock from exercise of stock options

-

13

Proceeds from at the market offering

202

-

Payment of issuance costs for at the market offering

(134)

-

Proceeds from equity line of credit

178

-

Proceeds from registered direct offering

4,716

-

Payment of issuance costs for registered direct offering

(559)

-

Proceeds from public offering

-

9,000

Payment of issuance costs for public offering

-

(1,296)

Net cash provided by financing activities

4,255

7,521

Net decrease in cash, cash equivalents and restricted cash

(8,201)

(16,629)

Cash, cash equivalents and restricted cash, beginning of period

13,557

37,430

Cash, cash equivalents and restricted cash, end of period

$

5,356

$

20,801

Reconciliation to Consolidated Balance Sheet:

Cash and cash equivalents

$

5,100

$

20,551

Restricted cash

256

250

Unrestricted and restricted cash and cash equivalents

$

5,356

$

20,801

Supplemental disclosure of cash flow information:

7


Cash paid during the period for interest

$

41

$

57

Supplemental disclosure of noncash investing and financing activities:

Forgiveness of DECD loan

$

(1,000)

$

-

Commitment shares for equity line of credit

258

-

Net increase in right-of-use assets

318

-

Fair value of warrants issued in conjunction with common stock offering

-

3,984

See accompanying notes to the unaudited condensed consolidated financial statements.


7

8


Vermillion,Aspira Women’s Health Inc.

Notes to Condensed Consolidated Financial Statements

(Unaudited)

1.    ORGANIZATION, BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING AND REPORTING POLICIES

Organization

Vermillion,Aspira Women’s Health Inc. (“Vermillion”; VermillionAspira” and its wholly-owned subsidiaries are collectively referred to as the “Company, “we” or “our”) is incorporated in the state of Delaware, and is engaged in the business of discovering, developing and commercializing risk assessment and diagnostic tests for gynecologic disease.diseases. The Company sells OVA1™currently markets and Overa™distributes the following products and related services: (1) Ova1Plus, a non-invasive blood test that combines two FDA-cleared tests for women with pelvic masses who are planned for surgery: Ova1, leveraging its high sensitivity, and Overa, with its high specificity; and (2) OvaWatch, a non-invasive blood test used to assess the risk of malignancy tests for ovarian cancer (“OVA1”for women with adnexal masses, evaluated by initial clinical assessment as likely benign or indeterminant with a negative predictive value of 99%.

Collectively, these tests are referred to and “Overa,” respectively) through Vermillion’s wholly-owned Clinical Laboratory Improvement Amendmentsmarketed as OvaSuite.Revenue from these sources is included in total revenue in the results of 1988 (“CLIA”operations for the three and nine months ended September 30, 2023 and 2022, respectively.

Reverse Stock Split

On May 9, 2023, the Company’s board of directors approved a one-for-fifteen reverse stock split (the “Reverse Stock Split”) certified clinical laboratory, ASPiRA LABS, Inc. (“ASPiRA LABS”).  of the Company’s common stock without any change to its par value, which became effective on May 12, 2023. All references to share and per share amounts for all periods presented in these unaudited condensed consolidated financial statements have been retrospectively restated to reflect the Reverse Stock Split. Par values were not adjusted.

The

Liquidity

As of September 30, 2023, the Company also offers in-vitro diagnostic (“IVD”) trial services to third-party customers through its wholly-owned subsidiary, ASPiRA IVD, Inc. (“ASPiRA IVD”)had approximately $5,100,000 of cash and cash equivalents (excluding restricted cash of $256,000), which commencedan accumulated deficit of approximately $515,214,000, and working capital of approximately $2,410,000. For the three and nine months ended September 30, 2023, the Company incurred a net loss of $4, 706,000 and $13,601,000, respectively, and used cash in operations in June 2016. ASPiRA IVD is a specialized, CLIA certified, laboratory provider dedicated to meeting the unique testing needs of IVD manufacturers seeking to commercialize high-complexity assays.

Going Concern

$3,321,000 and $12,444,000, respectively. The Company has incurred significant net losses and negative cash flows from operations since inception, and as a result has an accumulated deficit of approximately $393,098,000 at September 30, 2017.inception. The Company also expects to continue to incur a net loss and negative cash flows from operations for the remainder of 2017 and2023. In the foreseeable future. The Company’s management believesevent that successful achievement of the Company’s business objectivesexisting cash on hand is not sufficient to fund operations, meet its capital requirements or satisfy the anticipated obligations as they become due, the Company expects to take further action to protect its liquidity position, which include, but are not limited to:

Raising capital through equity or debt offerings either in the public markets or via private placement offering, including through financing facilities described elsewhere in the financial statements; however, no assurance can be given that capital will require additional financing.be available on acceptable terms or at all;

Reducing executive bonuses or replacing cash compensation with equity grants;

Reducing professional services and consulting fees and eliminating non-critical projects;

Reducing, eliminating or deferring discretionary marketing programs; and

Reducing travel and entertainment expenses.

The Company also has outstanding warrants to purchase shares of its common stock that may be exercised although there can be no assurance that the warrants will be exercised.

9


There can be no assurance that the Company will achieve or sustain profitability or positive cash flow from operations. Given thesethe above conditions, there is substantial doubt about the Company’s ability to continue as a going concern.concern within one year after the consolidated interim financial statements are issued. The unaudited condensed consolidated financial statements have been prepared on a going concern basis and do not include any adjustments that might result from these uncertainties.

TheOn June 1, 2022, the Company expects to raise capital throughreceived a varietydeficiency letter from the Listing Qualifications Department of sources, which may include the exercise ofNasdaq Stock Market notifying the Company that, for the preceding 30 consecutive business days, the closing bid price for the Company’s common stock warrants,  equity offerings, debt financing, collaborations, licensing arrangements, grants and government funding and strategic alliances. However,was below the minimum $1.00 per share requirement for continued inclusion on The Nasdaq Capital Market pursuant to Nasdaq Listing Rule 5550(a)(2) (the “Minimum Bid Price Rule”). On November 29, 2022, the Company was granted an additional funding may not be available when needed180-calendar day compliance period, or on terms acceptableuntil May 29, 2023, to regain compliance with the minimum bid price requirement. On May 26, 2023, the Company received notice from Nasdaq that it had regained compliance.

On July 11, 2023, the Company received a second deficiency letter from the Listing Qualifications Department of the Nasdaq Stock Market notifying the Company that, for the 30 consecutive business days prior to the Company. Ifdate of the deficiency letter, the Company’s Market Value of Listed Securities was below the minimum of $35 million requirement for continued inclusion on The Nasdaq Capital Market pursuant to Nasdaq Listing Rule 5550(b)(2) (the “MVLS Requirement”). In accordance with Nasdaq Listing Rule 5810(c)(3)(C), Nasdaq provided the Company is unablewith 180 calendar days, or until January 8, 2024, to obtain additional capital, it may not be able to continue sales and marketing, research and development, or other operations onregain compliance with the scope or scale of current activity and that could have a material adverse effect on the Company’s business, results of operations and financial condition.

As discussed in Note 4, on August 31, 2017, certain investors exercised outstanding warrants for common stock for net proceeds of approximately $3,577,000 after deducting offering expenses.

As discussed in Note 4, on February 17, 2017,MVLS Requirement. On September 12, 2023, the Company completed a private placement pursuant to which certain investors purchased Vermillion common stock and warrants to purchase shares of Vermillion common stock for net proceeds of approximately $5,127,000 after deducting offering expenses.

As discussed in Note 3, in March 2016,received notice from Nasdaq that it had regained compliance. There is no assurance that the Company entered into an agreement (the “Loan Agreement”) pursuant to which it may borrow up to $4,000,000 fromwill maintain compliance with the StateMVLS Requirement or any of Connecticut Department of Economic and Community Development (the “DECD”). An initial disbursement of $2,000,000 was made to the Company in April 2016 under the Loan Agreement. The Loan Agreement provides that the remaining $2,000,000 will be disbursed if and when the Company achieves certain future milestones. other Nasdaq continued listing requirements.

8


Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 8-03 of Regulation S-X. Accordingly, they do not include all of the information and footnotesnotes required by GAAP for complete financial statements. In the opinion of management of the Company, all adjustments, consisting of normal recurring adjustments necessary for the fair statement of results for the periods presented, have been included. The results of operations of any interim period are not necessarily indicative of the results of operations for the full year or any other interim period.

The unaudited condensed consolidated financial statements and related disclosures have been prepared with the presumption that users of the interim unaudited condensed consolidated financial statements have read or have access to the audited consolidated financial statements for the preceding fiscal year. The condensed consolidated balance sheet at December 31, 20162022 included in this report has been derived from the audited consolidated financial statements at that date, but does not include all the information and footnotesnotes required by GAAP. Accordingly, these unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto for the year ended December 31, 20162022 included in Vermillion’sthe Company’s Annual Report on Amendment No. 1 to Annual Report on Form 10-K which was/A, filed with the Securities and Exchange CommissionSEC on March 31,  2017 (the “2016 Annual Report”).October 26, 2023.

The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimated results.

10


Significant Accounting and Reporting Policies

Revenue Recognition

Product Revenue

– OvaSuite: The Company has adopted ASC 954-605,Health Care Entities—Revenue Recognition, as revenue from laboratory services has become significant to the Company.The Company'srecognizes product revenue in accordance with the provisions of Financial Accounting Standards Board Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers (“ASC 606”). Product revenue is generated by performing diagnostic services using its OVA1recognized upon completion of the OvaSuite test and Overa tests, and the service is completed upon the delivery of test results to the prescribing physician. The Company recognizes revenue related to billings for Medicare and commercial payersphysician based on an accrual basis, netestimates of contractual and other adjustments, when amounts that will ultimately be realized canrealized. In determining the amount of revenue to be estimated. Untilrecognized for a contract has been negotiated with a commercial payer or governmental program, the OVA1 and Overa tests may or may not be covered by these entities' existing reimbursement policies. In addition, patients do not enter into direct agreements withdelivered test result, the Company that commit them to pay any portion ofconsiders factors such as payment history and amount, payer coverage, whether there is a reimbursement contract between the cost of the tests in the event that their insurance declines to reimburse the Company. In the absence of an agreement with the patient or other clearly enforceable legal right to demand payment from the patient, the related revenue is only recognized upon cash receipt.

Estimates of amounts thatpayer and the Company, will ultimately realizeand any developments or changes that could impact reimbursement. These estimates require significant judgment by management. Some patients have out-of-pocket costs for amounts not covered by their insurance carrier,management as the collection cycle on some accounts can be as long as one year. The effect of any change made to an estimated input component and, therefore revenue recognized, would be recorded as a change in estimate at the Company may billtime of the patient directly for these amounts in the form of co-payments and co-insurance in accordance with the patient’s health plan. Some payers may not cover the OVA1 and Overa tests as ordered by the prescribing physician under their reimbursement policies. change.

The Company pursues reimbursement from such patients on a case-by-case basis. In the absence of contracted reimbursement coverage or the ability to estimate the amount that will ultimately be realized for the Company's services, revenue is recognized when cash is received.

 See discussion of ASU No. 2014-09 (defined below) included in Recent Accounting Pronouncements below.  

9


Service Revenue

The Company’s service revenue is generated by performing IVD trial services for third-party customers. In accordance with SAB Topic 13, service revenue is recognized when the following revenue recognition criteria are met: (1) persuasive evidence of an arrangement exists; (2) delivery has occurred or services have been rendered; (3) the fee is fixed or determinable; and (4) collectability is reasonably assured. 

See discussion of ASU No. 2014-09 included in Recent Accounting Pronouncements below.

The Company has made no other significant changes in its critical accounting policies and estimates from those disclosed in the 2016 Annual Report. 

Recent Accounting Pronouncements

In March 2016, the Financial Accounting Standards Board (“FASB”) issued ASU 2016-09, Improvements to Employee Share-Based Payment Accounting (Topic 718), Compensation - Stock Compensation (“ASU 2016-09”). The new guidance simplifies several aspects of the accounting for share-based payments, including immediate recognition of all excess tax benefits and deficiencies in the income statement, changing the threshold to qualify for equity classification up to the employees' maximum statutory tax rates, allowing an entity-wide accounting policy election to either estimate the number of awards that are expected to vest or account for forfeitures as they occur, and clarifying the classification on the statement of cash flows for the excess tax benefit and employee taxes paid when an employer withholds shares for tax-withholding purposes. ASU 2016-09 is effective for annual reporting periods beginning after December 15, 2016 and interim periods within that reporting period. The adoption of this standard is not expected to have a material effect on our financial statements.

In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASU 2014-09”), which removes inconsistencies and weaknesses in revenue requirements, provides a more robust framework for addressing revenue issues, improves comparability of revenue recognition practices across entities, industries, jurisdictions and capital markets, provides more useful information to users of financial statements through improved disclosure requirements and simplifies the preparation of financial statements by reducing the number of requirements to which an entity must refer. This guidance requires that an entity depict the consideration by applying a five-step analysis in determining when and how revenue is recognized. The new model will require revenue recognition to depict the transfer of promised goods or services to customers in an amount that reflects the consideration a company expects to receive in exchange for those goods or services. On April 1, 2015, the FASB voted for a one-year deferral of the effective date of the new revenue recognition standard, ASU No. 2014-09. On July 15, 2015, the FASB affirmed these changes, which requires public entities to apply the amendments in ASU 2014-09 for annual reporting beginning after December 15, 2017. Early adoption is permitted beginning after December 31, 2016, the original effective date in ASU 2014-09.

The Company is in the early stages of its analysis of the effect ASU 2014-09 will have on its Service Revenue, but expects to complete its analysis during the fourth quarter of 2017.

The Company is also continuing its analysis of the effect ASU 2014-09 will have on its Product Revenue and also expects to complete this analysis in the fourth quarter of 2017. Revenue that is recognized upon the ultimate receipt of cash under the Company’s existing revenue recognition policy will have to be reassessed under the new standard. The Company’s implementation process is to reviewreviews its patient account population to determine theand determines an appropriate distribution of patient accounts by payer (i.e.i.e., Medicare, patient pay, other third-party payer, etc.etc.) into portfolios with similar collection experienceexperience. The Company has elected this practical expedient that, when evaluated for collectability, will resultresults in a materially

10


consistent revenue amount for such portfolios as if each patient account were evaluated on an individual contract basis. During the period ended September 30, 2023, there were no adjustments to estimates of variable consideration to derecognize revenue for services provided in a contract-by-contract basis.prior period; however, additional revenue of approximately $5,000 and $115,000 was recognized for amounts collected in excess of revenue estimated for prior periods during the three and nine months ended September 30, 2023, respectively. There were no impairment losses on accounts receivable recorded during the three and nine months ended September 30, 2023 and 2022, respectively.

Genetics Revenue – Aspira GenetiX: Under ASC 606, the Company’s genetics revenue was recognized upon completion of the Aspira GenetiX test and delivery of results to the physician based on estimates of amounts that will ultimately be realized. In determining the amount of revenue to be recognized for a delivered test result, the Company considered factors such as payment history and amount, payer coverage, whether there was a reimbursement contract between the payer and the Company, and any developments or changes that could impact reimbursement. These estimates require significant judgment by management.

In September 2022, the Company received a notice of cancellation from its only Aspira Synergy genetics carrier screening customer, Axia Women’s Health. As a result of this cancellation, along with the general deterioration of commercial opportunities in the genetics carrier screening market, the Company has ceased providing Aspira GenetiX, including genetics carrier screening, on the Aspira Synergy platform, effective September 30, 2022. The Company had previously recognized genetics revenue under ASC 606 upon completion of the Aspira GenetiX test and delivery of results to the physician based on estimates of amounts that would ultimately have been realized. The Company did not incur any termination penalties nor did the Company accrue any expenses as a result of the cancellation. This is not expected to have a material impact on the Company’s revenues in any future periods.

Accounts Receivable: Virtually all accounts receivable are derived from sales made to customers located in North America. The Company performs ongoing credit evaluations of its customers’ financial condition and generally does not require collateral. The Company maintains an allowance for credit losses based upon the expected collectability of accounts receivable.In determining the amount of the allowance for credit losses, the Company considers historical collectability based on past due status and makes judgments about the creditworthiness of customers based on ongoing credit evaluations. The Company also considers customer-specific information, current market conditions, and reasonable and supportable forecasts of future economic conditions.

Correction of Errors

On October 13, 2023, the Audit Committee of the Board of Directors (the “Audit Committee”) of the Company and the Company’s management determined that its previously issued financial statements in its Annual Report on Form 10-K for the year ended December 31, 2022, as well as the previously filed Quarterly Report on

11


Form 10-Q for the quarterly period ended September 30, 2022 (collectively, the “Prior Period Financial Statements”), should be restated and should no longer be relied upon due to an error in the Company’s accounting for certain warrants issued in August 2022 as part of its underwritten offering with William Blair & Company, LLC.

The Company identified material errors in its accounting for warrants (the “Warrants”) issued pursuant to the underwriting agreement with William Blair & Company LLC in August 2022 (the “2022 Underwriting Agreement”). Specifically, when calculating the issuance date fair value of the Warrants, the Company used assumptions in the Black Scholes Valuation calculation that were associated with the incorrect Warrant issuance date. The Company used the 2022 Underwriting Agreement date of August 22, 2022, instead of the Warrant issuance date per the Common Stock Purchase Warrant Agreement dated August 25, 2022. The incorrect warrant issuance date resulted in an inaccurate market closing price, risk free interest rate, and stock price volatility assumptions used in the Black Scholes Valuation calculation. The initial calculation based upon the August 22, 2022 assumptions calculated an issuance date fair value of the warrant liability of approximately $7,752,000, whereas the updated calculation with the August 25, 2022 assumptions calculated an issuance date fair value of the warrant liability of approximately $3,984,000, which results in a difference of approximately $3,768,000.

The change in the initial fair value of the warrant liability resulted in an adjustment of previously reported change in fair value of warrant liabilities in the amount of $3,768,000 on the consolidated statement of operations for the three and nine months ended September 30, 2022, with a corresponding adjustment in consolidated statement of cash flows for the nine months ended September 30, 2022.

Additionally, upon the initial recording of this transaction, total offering costs of $1,296,000 were allocated between expense included in the consolidated statements of operations and stockholders’ equity included in the consolidated balance sheets based on the percentage of the Warrant fair value of $7,752,000 and total gross proceeds of $9,000,000. $1,117,000 of offering costs were initially allocated to the Warrants and expensed immediately to general and administrative (“G&A”) expense instead of as a non-operating expense in the consolidated statements of operations and comprehensive loss, and the remaining offering costs had a net impact to stockholders’ equity of $179,000. The updated allocation using the August 25, 2022 issuance date fair value of $3,984,000 resulted in a reallocation of offering costs of $543,000 from G&A expense to equity, and an adjustment of $574,000 from G&A expense to non-operating expense; $574,000 of the offering costs are now expensed immediately as other income (expense) on the consolidated statements of operations for the year ended December 31, 2022, and offering costs of $543,000 are recorded in stockholders’ equity on the consolidated balance sheet as of December 31, 2022. As a result of the change there was an adjustment in the presentation of the offering costs related to the warrant liability of $1,117,000 from cash flows used in operating activities to cash flows provided by financing activities on the Company’s consolidated statement of cash flows.

As a result of the material error discussed above, the Company restated its financial statements for the year ended December 31, 2022 and the unaudited interim financial statements for the three and nine months ended September 30, 2022 to reflect the correction of the error.

In addition to the errors identified above, the restated consolidated financial statements for the year ended December 31, 2022 also included adjustments to correct certain other immaterial errors.

These errors, discussed below, both individually and in the aggregate, had no material impact on earnings per share for the year ended December 31, 2022.

The effects of the restatement on the unaudited interim financial statements as of and for the three and nine months ended September 30, 2022 are set forth as follows.


12


Aspira Women’s Health Inc.

Condensed Consolidated Balance Sheets

(Amounts in Thousands, Except Share and Par Value Amounts)

(Unaudited)

September 30, 2022

As Previously Reported

Adjustment for Warrant Liability

As Restated

Assets

Current assets:

Cash and cash equivalents

$

20,551

$

-

$

20,551

Accounts receivable, net of allowance of $6

1,201

-

1,201

Prepaid expenses and other current assets

944

-

944

Inventories

280

-

280

Total current assets

22,976

-

22,976

Property and equipment, net

417

-

417

Right-of-use assets

299

-

299

Restricted cash

250

-

250

Total assets

$

23,942

$

-

$

23,942

Liabilities and Stockholders’ Equity

Current liabilities:

Accounts payable

$

1,893

$

-

$

1,893

Accrued liabilities

4,988

-

4,988

Current portion of long-term debt

343

-

343

Lease liability

73

-

73

Total current liabilities

7,297

-

7,297

Non-current liabilities:

Long-term debt

2,426

-

2,426

Lease liability

293

-

293

Warrant liabilities

2,748

-

2,748

Total liabilities

12,764

-

12,764

Commitments and contingencies

 

 

 

Stockholders’ equity:

Common stock, par value $0.001 per share, 150,000,000 shares authorized at September 30, 2022 and December 31, 2021; 8,296,376 and 7,475,916 shares issued and outstanding at September 30, 2022 and December 31, 2021, respectively

8

-

8

Additional paid-in capital

504,967

3,225

508,192

Accumulated deficit

(493,797)

(3,225)

(497,022)

Total stockholders’ equity

11,178

-

11,178

Total liabilities and stockholders’ equity

$

23,942

$

-

$

23,942


13


Aspira Women’s Health Inc.

Condensed Consolidated Statements of Operations

(Amounts in Thousands, Except Share and Per Share Amounts)

(Unaudited)

Three Months Ended

September 30, 2022

As Previously Reported

Adjustment for Warrant Liability

As Restated

Revenue:

Product

$

2,037

$

-

$

2,037

Genetics

35

-

35

Total revenue

2,072

-

2,072

Cost of revenue(1):

Product

875

-

875

Genetics

41

-

41

Total cost of revenue

916

-

916

Gross profit

1,156

-

1,156

Operating expenses:

Research and development(2)

2,157

-

2,157

Sales and marketing(3)

3,950

-

3,950

General and administrative(4)

4,746

(1,117)

3,629

Total operating expenses

10,853

(1,117)

9,736

Loss from operations

(9,697)

1,117

(8,580)

Change in fair value of warrant liabilities

5,004

(3,768)

1,236

Interest income (expense), net

18

-

18

Other income (expense), net

117

(574)

(457)

Net loss

$

(4,558)

$

(3,225)

$

(7,783)

Net loss per share - basic and diluted

$

(0.58)

$

(0.42)

$

(1.00)

Weighted average common shares used to compute basic and diluted net loss per common share

7,807,876

7,807,876

7,807,876

Non-cash stock-based compensation expense included in cost of revenue and operating expenses:

(1) Cost of revenue

$

(23)

$

-

$

(23)

(2) Research and development

65

-

65

(3) Sales and marketing

76

-

76

(4) General and administrative

428

-

428


14


Aspira Women’s Health Inc.

Condensed Consolidated Statements of Operations

(Amounts in Thousands, Except Share and Per Share Amounts)

(Unaudited)

Nine Months Ended

September 30, 2022

As Previously Reported

Adjustment for Warrant Liability

As Restated

Revenue:

Product

$

5,890

$

-

$

5,890

Genetics

141

-

141

Total revenue

6,031

-

6,031

Cost of revenue(1):

Product

2,768

-

2,768

Genetics

180

-

180

Total cost of revenue

2,948

-

2,948

Gross profit

3,083

-

3,083

Operating expenses:

Research and development(2)

4,915

-

4,915

Sales and marketing(3)

12,027

-

12,027

General and administrative(4)

13,305

(1,117)

12,188

Total operating expenses

30,247

(1,117)

29,130

Loss from operations

(27,164)

1,117

(26,047)

Change in fair value of warrant liabilities

5,004

(3,768)

1,236

Interest income (expense), net

(10)

-

(10)

Other income (expense), net

101

(574)

(473)

Net loss

$

(22,069)

$

(3,225)

$

(25,294)

Net loss per share - basic and diluted

$

(2.91)

$

(0.42)

$

(3.33)

Weighted average common shares used to compute basic and diluted net loss per common share

7,590,872

7,590,872

7,590,872

Non-cash stock-based compensation expense included in cost of revenue and operating expenses:

(1) Cost of revenue

$

64

$

-

$

64

(2) Research and development

114

-

114

(3) Sales and marketing

281

-

281

(4) General and administrative

1,535

-

1,535


15


Aspira Women’s Health Inc.

Condensed Consolidated Statements of Changes in Stockholders’ Equity

(Amounts in Thousands, Except Share Amounts)

(Unaudited)

Total

Common

Additional

Accumulated

Stockholders'

Stock

Paid-in-Capital

Deficit

Equity

(As Previously Reported)

Balance at December 31, 2021

$

$

501,893 

$

(471,728)

$

30,172 

Net loss

-

-

(9,268)

(9,268)

Common stock issued in conjunction with exercise of stock options

-

-

Stock-based compensation expense

-

838 

-

838 

Balance at March 31, 2022

$

$

502,733 

$

(480,996)

$

21,744 

Net loss

-

-

(8,243)

(8,243)

Common stock issued in conjunction with exercise of stock options

-

11 

-

11 

Common stock issued for restricted stock awards

-

-

-

140 

-

-

-

140 

Stock-based compensation expense

-

470 

-

470 

Balance at June 30, 2022

$

$

503,354 

$

(489,239)

$

14,122 

Net loss

-

-

(4,558)

(4,558)

Common stock and warrants issued in conjunction with follow-on public offering, net of issuance costs

1,067 

-

1,068 

Common stock issued for restricted stock awards

-

95 

-

95 

Stock-based compensation expense

-

451 

-

451 

Balance at September 30, 2022

$

$

504,967 

$

(493,797)

$

11,178 

(Adjustments)

Balance at June 30, 2022

$

-

$

-

$

-

$

-

Net loss

-

-

(3,225)

(3,225)

Common stock and warrants issued in conjunction with follow-on public offering, net of issuance costs

-

3,225 

-

3,225 

Balance at September 30, 2022

$

-

$

3,225 

$

(3,225)

$

-

(As Restated)

Balance at December 31, 2021

$

$

501,893 

$

(471,728)

$

30,172 

Net loss

-

-

(9,268)

(9,268)

Common stock issued in conjunction with exercise of stock options

-

-

Stock-based compensation expense

-

838 

-

838 

Balance at March 31, 2022

$

$

502,733 

$

(480,996)

$

21,744 

Net loss

-

-

(8,243)

(8,243)

Common stock issued in conjunction with exercise of stock options

-

11 

-

11 

Common stock issued for restricted stock awards

-

140 

-

140 

Stock-based compensation expense

-

470 

-

470 

Balance at June 30, 2022

$

$

503,354 

$

(489,239)

$

14,122 

Net loss

-

-

(7,783)

(7,783)

16


Common stock and warrants issued in conjunction with follow-on public offering, net of issuance costs

4,292 

-

4,293 

Common stock issued for restricted stock awards

-

95 

-

95 

Stock-based compensation expense

-

451 

-

451 

Balance at September 30, 2022

$

$

508,192 

$

(497,022)

$

11,178 


17


Aspira Women’s Health Inc.

Condensed Consolidated Statements of Cash Flows

(Amounts in Thousands)

(Unaudited)

Nine Months Ended September 30, 2022

As Previously Reported

Adjustment for Warrant Liability

As Restated

Cash flows from operating activities:

Net loss

$

(22,069)

$

(3,225)

$

(25,294)

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

Non-cash lease expense

4

-

4

Depreciation and amortization

195

-

195

Stock-based compensation expense

1,994

-

1,994

Change in fair value of warrant liabilities

(5,004)

3,768

(1,236)

Other expenses representing transaction costs allocated to the issuance of warrants

-

574

574

Loss on sale and disposal of property and equipment

10

-

10

Changes in operating assets and liabilities:

Accounts receivable

(174)

-

(174)

Prepaid expenses and other assets

694

-

694

Inventories

(106)

-

(106)

Accounts payable, accrued liabilities and other liabilities

(653)

-

(653)

Net cash used in operating activities

(25,109)

1,117

(23,992)

Cash flows from investing activities:

Purchase of property and equipment

(158)

(158)

Net cash used in investing activities

(158)

-

(158)

Cash flows from financing activities:

Principal repayment of DECD loan

(196)

-

(196)

Proceeds from issuance of common stock from exercise of stock options

13

-

13

Proceeds from public offering

9,000

-

9,000

Payment of issuance costs for public offering

(179)

(1,117)

(1,296)

Net cash provided by financing activities

8,638

(1,117)

7,521

Net (decrease) increase in cash, cash equivalents and restricted cash

(16,629)

-

(16,629)

Cash, cash equivalents and restricted cash, beginning of period

37,430

-

37,430

Cash, cash equivalents and restricted cash, end of period

$

20,801

$

-

$

20,801

Reconciliation to Condensed Consolidated Balance Sheet:

Cash and cash equivalents

$

20,551

$

-

$

20,551

Restricted cash

250

-

250

Unrestricted and restricted cash and cash equivalents

$

20,801

$

-

$

20,801


18


During the three months ended March 31, 2023, the Company identified an immaterial error related to the accounting for forfeitures in stock-based compensation that impacted previously issued 2022 consolidated financial statements. As a result, the Company corrected the error in its restated consolidated financial statements for the year ended December 31, 2022. The Company had initially recorded an out-of-period adjustment to reduce stock-based compensation in the amount of $262,000 during the three months ended March 31, 2023, which has been retrospectively reversed during the three months ended March 31, 2023. Management evaluated the impact on the 2022 and 2023 consolidated financial statements and concluded it was not material.

In addition, the Company identified an error in the recording of its accrued liability as of December 31, 2022 related to a reduction in force. Initially, the Company recorded an accrued liability of $248,000 as of December 31, 2022 for the reduction in force that took place on January 3, 2023. Since the affected employees were not notified until after December 31, 2022, the impact of the error was an overstatement of expense in the consolidated financial statements for the year ended December 31, 2022 of $248,000. The restated consolidated financial statements for the year ended December 31, 2022 included the correction of this immaterial error. As a result of the restatement, the Company has retrospectively recorded the expense of $248,000 in the three months ended March 31, 2023. Management evaluated the impact on the 2022 and 2023 consolidated financial statements and concluded that the error was not material.

Recent Accounting Pronouncements

In June 2016, the Financial Accounting Standards Board issued Accounting Standard Update No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”). ASU 2016-13 requires timelier recording of credit losses on loans and other financial instruments held. Instead of reserves based on a current probability analysis, ASU 2016-13 requires the measurement of all expected credit losses for financial assets held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. All organizations will now use forward-looking information to better inform their credit loss estimates. ASU 2016-13 requires enhanced disclosures regarding significant estimates and judgments used in estimating credit losses, as well as the credit quality and underwriting standards of an organization’s portfolio. These disclosures include qualitative and quantitative requirements that provide information about the amounts recorded in the financial statements. In addition, ASU 2016-13 amends the accounting for credit losses on available-for-sale debt securities and purchased financial assets with credit deterioration. In April 2019, the FASB issued ASU No. 2019-04, Codification Improvements to Topic 326 Financial Instruments—Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825,Financial Instruments (“ASU 2019-05”), to introduce amendments which will affect the recognition and measurement of financial instruments, including derivatives and hedging. In May 2019, the FASB issued ASU No. 2019-05, Financial Instruments – Credit Losses (Topic 326); Targeted Transition Relief. The amendments in ASU 2019-05 provide entities that have certain instruments within the scope of Subtopic 326-20 with an option to irrevocably elect the fair value option in Subtopic 825-10, applied on an instrument-by-instrument basis for eligible instruments upon adoption of ASU 2016-13. This standard and related amendments were effective for the Company’s fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. ASU 2019-05 was effective January 1, 2023 for smaller reporting companies, which includes the Company. The adoption of ASU 2016-13 did not have a material impact on the Company’s results of operations, financial position, or cash flows.

In March 2020, FASB issued ASU No. 2020-03, Codification Improvements to Financial Instruments. This ASU improves and clarifies various financial instruments topics, including the current expected credit losses standard issued in 2016 (ASU No. 2016-13). The ASU includes seven different issues that describe the areas of improvement and the related amendments to GAAP, intended to make the standards easier to understand and apply by eliminating inconsistencies and providing clarifications. The amendments have different effective dates. The issues 1-5 are conforming amendments, which are effective upon issuance of this final update. The Company determined that issues 1-5 have no impact on its financials. The amendments related to issue 6 and 7 effect ASU No. 2016-13, Financial instruments – credit losses (Topic 326): measurement of credit losses on financial statements. Effective dates of issue 6 and 7 are the same as the effective date of ASU No. 2016-13. The Company has not yet determined if it plans to utilize the full retrospective or modified retrospective method of adoption, but anticipates adoptingadopted the new standard in the first quarter of 2018.

2.   AGREEMENTS WITH QUEST DIAGNOSTICS INCORPORATED

In March 2015,fiscal year 2023. The adoption of this standard by the Company entered intodid not have a commercial agreementmaterial impact on the Company’s results of operations, financial position, or cash flows.

19


In August 2020, the Financial Accounting Standards Board issued Accounting Standard Update No. 2020-06, Debt – Debt with Quest Diagnostics, Incorporated (“Quest Diagnostics”Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity (“ASU 2020-06”). PursuantThis update was issued to assist in simplifying the accounting for convertible instruments. This ASU 2020-06 is scheduled to be effective for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years. Early adoption is permitted. The Company is in the process of evaluating the impact of this agreement,  all OVA1 U.S. testing servicesstandard on its consolidated financial statements.

2. FAIR VALUE MEASUREMENTS

Fair Value of Financial Instruments

Financial instruments of the Company consist primarily of cash and cash equivalents, restricted cash accounts, receivable, and accounts payable, and warrant liability. These items are considered Level 1 due to their short-term nature and their market interest rates, except for Quest Diagnostics customers were transferredwarrant liability, which is considered Level 2 and is recorded at fair value at the end of each reporting period.

The Company records Warrants in connection with the 2022 offering, discussed in Note 6 toVermillion’swholly-owned subsidiary, ASPiRA LABS, our unaudited condensed consolidated financial statements, as a liability. The fair values of the Warrants as of August 2015. PursuantSeptember 30, 2023 and December 31, 2022 were approximately $2,513,000 and $2,280,000, respectively. The fair value of the Warrants was estimated using Black-Scholes pricing model based on the following assumptions.

September 30, 2023

December 31, 2022

Dividend yield

-

%

-

%

Volatility

105.4

%

96.8

%

Risk-free interest rate

4.70

%

3.99

%

Expected lives (years)

3.89

4.64

Weighted average fair value

$

3.141

$

2.850

The fair value of the Warrants was deemed to this agreement, as amended asbe derivative instruments due to certain contingent put features. The fair value of March 11, 2017, Quest Diagnostics has agreedthe Warrants was determined using the Black-Scholes option pricing model, deemed to provide blood draw and logistics support by transporting specimens from its clientsbe an appropriate model due to ASPiRA LABS for testing through at least March 11, 2018 in exchange for a market value fee. Per the terms of this agreement,the Warrants issued, including a fixed term and exercise price.

The fair value of the Warrants was affected by changes in inputs to the Black-Scholes option pricing model including the Company’s stock price, expected stock price volatility, the contractual term, and the risk-free interest rate. This model uses Level 2 inputs, including stock price volatility, in the fair value hierarchy established by ASC 820 Fair Value Measurement. At September 30, 2023, the fair value of all Warrants was approximately $2,513,000, which are classified as a long-term Warrant liability on the Company’s balance sheet.

The carrying value of the Company’s insurance promissory note approximates fair value as ofSeptember 30, 2023 and December 31, 2022, due to the short-term nature of the insurance note and are classified as Level 2 within the fair value hierarchy.

The DECD loan is classified within Level 3 of the fair value hierarchy. The following table presents the carrying value and fair value of the DECD loan. The fair value of the DECD loan is estimated based on discounted cash flows using the prevailing market interest rates.

September 30,

December 31,

2023

2022

(in thousands)

Fair Value Hierarchy

Carrying Value

Fair Value

Carrying Value

Fair Value

DECD loan

Level 3

$

1,604

$

1,392

$

2,729

$

2,110

20


3. PREPAID AND OTHER CURRENT ASSETS

Prepaid and other current assets at September 30, 2023 and December 31, 2022 consist of the following:

September 30,

December 31,

(in thousands)

2023

2022

Prepaid insurance

$

78

$

767

Software licenses

155

269

Subscriptions

4

211

Other

344

195

Total prepaid and other current assets

$

581

$

1,442

4.COMMITMENTS AND CONTINGENCIES

Coronavirus Aid, Relief, and Economic Security (CARES) Act and Paycheck Protection Program Loan

On May 1, 2020, the Company obtained a Paycheck Protection Program loan (the “PPP Loan”) from BBVA USA in the aggregate amount of approximately $1,006,000. The Company applied for forgiveness of the PPP Loan in March 2021, and, effective May 27, 2021, the U.S. Small Business Administration confirmed the waiver of the Company’s repayment of the PPP Loan, which was recognized as a gain in other income in 2021. The Company remains subject to an audit of the PPP loan. There is no assurance that the Company will not offerbe required to existingrepay all or future Quest Diagnostics customers tests that Quest Diagnostics offers.a portion of the PPP Loan as a result of any such audit.

3.COMMITMENTS AND CONTINGENCIESLoan Agreement

Development Loan

On March 22, 2016, the Company entered into a loan agreement (as amended, the “DECD Loan Agreement,Agreement”) with the State of Connecticut Department of Economic and Community Development (the “DECD”), pursuant to which the Company may borrow up to $4,000,000 from the DECD. Proceeds from the $2,000,000 April 2016 initial disbursement under the Loan Agreement were utilized primarily to fund the build-out, information technology infrastructure and other costs related to the Company’s Trumbull, Connecticut facility and operations. The loan bears interest at a fixed rate of 2.0% per annum and requires equal monthly payments of principal and interest until maturity, which occurs on April 15, 2026. As security for the loan, the Company has granted the DECD a blanket security interest in the Company’s personal and intellectual property. The DECD’s security interest in the Company’s intellectual property may be subordinated to a qualified institutional lender. Under the terms of the Loan Agreement, the Company

The loan may be eligible for forgiveness of up to $2,000,000 of the principal amount of the loan if the Company achieves certain job creation and retention milestones by March 1, 2018. Conversely, if the Company is unable to meet these job creation milestones, namely, hiring 40 full-time employees with a specified average annual salary within the allotted timeframe and retaining those employees for a two-year periodprepaid at any time without premium or does not maintain the Company’s Connecticut operations for a period of 10 years, the DECD may require early repayment of a portion or all of the loan plus a penalty of 5%. 

As discussed above, anpenalty. An initial disbursement of $2,000,000 was made to the Company on April 15, 2016 under the DECD Loan Agreement. The Loan Agreement provides thatOn December 3, 2020, the Company received a disbursement of the remaining $2,000,000 will be disbursed if and whenunder the DECD Loan Agreement, as the Company achieveshad achieved the target employment milestone necessary to receive an additional $1,000,000 under the DECD Loan Agreement and the DECD determined to fund the remaining $1,000,000 under the DECD Loan Agreement after concluding that the required revenue target would likely have been achieved in the first quarter of 2020 in the absence of the impacts of COVID-19.

Under the terms of the DECD Loan Agreement, the Company was eligible for forgiveness of up to $1,500,000 of the principal amount of the loan if it was able to achieve certain job creation and retention milestones by December 31, 2022. On June 26, 2023, the Company was notified by the DECD that the Company satisfied all job creation and retention requirements under the loan agreement to receive forgiveness of $1,000,000. During the three months ended June 30, 2023, the Company recorded the $1,000,000 as other income in the unaudited condensed statement of operations. If the Company fails to maintain its Connecticut operations through March 22, 2026, the DECD may require early repayment of a portion or all of the remaining amount of the loan plus a penalty of 5% of the total funded loan.

21


Long-term debt consisted of the following.

September 30,

December 31,

2023

2022

(in thousands)

DECD loan, net of issuance costs

$

1,595

$

2,718

Less: Current portion, net of issuance costs

(378)

(403)

Total long-term debt, net of issuance costs

$

1,217

$

2,315

On June 6, 2023, the Company was granted a deferral of interest and principal payments on a portion of the remaining outstanding balances through December 1, 2023. The Company determined the loan deferral met the definition of a troubled debt restructuring under ASC 470-60, Troubled Debt Restructurings by Debtors, as the Company was experiencing financial difficulties and the lenders granted a concession. The future milestones. undiscounted cash flows of the DECD loan after the loan deferral exceeded the carrying value of the DECD loan prior to the loan deferral. As such no gain was recognized as a result of the deferral.

As of September 30, 2023, the annual amounts of future minimum principal payments due under the Company’s contractual obligation are shown in the table below. Unamortized debt issuance costs for the DECD loan were $9,000. 

Payments Due by Period

(in thousands)

Total

2023

2024

2025

2026

2027

Thereafter

DECD Loan

$

1,604

$

26

$

475

$

485

$

477

$

141

$

-

Total

$

1,604

$

26

$

475

$

485

$

477

$

141

$

-

Insurance Notes

During 2022, the Company entered into an insurance promissory note for the payment of insurance premiums at an interest rate of 5.48%, with an aggregate principal amount outstanding of approximately $77,000 and $764,000 as of September 30, 2023 and December 31, 2022, respectively. The loan mayamount outstanding in 2023 could be substantially offset by the cancellation of the related insurance coverage which is classified in prepaid at any time without premiuminsurance. This note is payable in ten monthly installments with a maturity date of October 1, 2023 and has no financial or penalty.operational covenants.

Operating Leases

The Company leases facilities to support its business of discovering, developing and commercializing diagnostic tests in the fields of gynecologic disease.business. The Company’s principal facility, including the CLIAClinical Laboratory Improvements Amendments of 1988 (“CLIA”) laboratory used by ASPiRA LABS,Aspira Labs, Inc., is located in Austin, Texas, and the CLIA laboratory used by ASPiRA IVD isadministrative offices are located in Trumbull, Connecticut.Connecticut and Palo Alto, California.

In September 2020, the Company exercised the renewal option for its Trumbull, Connecticut lease. On May 30, 2023, the Company entered into an agreement with the owner of its Trumbull, Connecticut offices to move to a more economical location in Shelton, Connecticut and replacing the Trumbull, Connecticut office lease. The Austin, Texasnew lease includes an aggregate annual base rent of $85,000term is for five years, and annual estimated common area charges, taxesits commencement date was October 1, 2023. Beginning on October 1, 2023, the fixed lease payment was reduced from approximately $8,900 per month to $5,000 per month for the first year, and insurance of $46,000to $5,383 per month for years two through four and expires on$5,768 per month for the fifth year.

In January 31, 2019.    

In October 2015,2023, the Company entered into a leasenew sublease agreement for aan administrative facility in Trumbull, Connecticut.Palo Alto, California. The Company’s sublease term commenced in April 2023 and expires on May 31, 2024, with no option for renewal with the sublessor. The fixed lease required initial paymentspayment will initially be approximately $9,000 per month and will increase to approximately $10,000 per month for the buildout of leasehold improvements to the office space, which were approximately $596,000. The termremainder of the lease is five years beginning after the initial date of occupancy in January 2024. Future undiscounted lease payments are approximately $125,000.

11

22


2016 and a rent abatement period of fiveIn July 2023, the Company extended the Austin, Texas lease for an additional 37 months. The Company’s renewed lease includesexpires on February 28, 2027, with the option to extend the lease for an aggregate annual base rent of $32,000additional three years. Beginning February 1, 2024, the fixed lease payment will be reduced from approximately $9,490 per month to approximately $7,100 per month for the first year (except for August 2024, which will be $0), approximately $8,600 per month for the second year, approximately $8,900 per month for the third year and annual estimated common area charges, taxes and insurance of $95,000.  approximately $9,100 for the final month. The Company is not reasonably certain that it will exercise the three-year renewal option beginning on March 1, 2027.

Building rentThe expense associated with these operating leases for the three months ended September 30, 20172023 and 2016 totaled $66,000 and $71,000, respectively. Building rent for2022 is shown in the nine months ended September 30, 2017 and 2016 totaled $189,000 and $175,000, respectively.table below (in thousands).

Capital Lease

Three Months Ended September 30,

Lease Cost

Classification

2023

2022

Operating rent expense

Cost of revenue

$

18

$

20

Research and development

19

6

Sales and marketing

4

9

General and administrative

35

16

Variable rent expense

Cost of revenue

$

11

$

10

Research and development

4

5

Sales and marketing

3

8

General and administrative

21

16

In April 2015,Based on the Company leased a laboratory instrument for a total initial payment of $125,000 and ongoing payments of approximately $3,500 per month for 36 months after delivery. The agreement also requires minimum annual purchases of reagents from the manufacturer of the equipment. The laboratory instrument was placed into service on July 1, 2015.

The accumulated amortization of assets under capital lease obligations was $174,000 and $97,000Company’s leases as of September 30, 20172023, the table below sets forth the approximate future lease payments related to operating leases with initial terms of one year or more (in thousands).

Year

Payments

2023 (remaining three months)

$

85

2024

245

2025

225

2026

170

2027

18

Total Operating Lease Payments

743

Less: Imputed Interest

(78)

Present Value of Lease Liabilities

665

Less: Operating Lease Liability, current portion

(236)

Operating Lease Liability, non-current portion

$

429

Weighted-average lease term and 2016, respectively. The net book value of assets under capital lease obligations was $58,000 and $135,000discount rate were as ofSeptember 30, 2017 and 2016, respectively.  follows.

Three Months Ended September 30,

2023

2022

Cash paid for amounts included in measurement of lease liabilities:

Operating cash outflows relating to operating leases

$

123

$

89

Weighted-average remaining lease term (in years)

2.8

3.7

Weighted-average discount rate

8.08%

9.31%

23


Non-cancelableNon-cancellable Royalty Obligations

The Company is a party to an amended research collaboration agreement with The Johns Hopkins University School of Medicine under which the Company licenses certain of its intellectual property. directed at the discovery and validation of biomarkers in human subjects, including but not limited to clinical application of biomarkers in the understanding, diagnosis and management of human disease. Under the terms of the amended research collaboration agreement, VermillionAspira is required to pay the greater of 4% royalties on net sales of diagnostic tests using the assigned patents or annual minimum royalties of $57,500. Royalty expense for the three months ended September 30, 20172023 and 2016 totalled $30,0002022 totaled $75,000 and $24,000, respectively. Royalty$82,000, respectively, and royalty expense for the nine months ended September 30, 20172023 and 2016 totalled $94,0002022 totaled $253,000 and $66,000, respectively.$236,000, respectively, and are recorded in cost of revenue in the unaudited condensed consolidated statements of operations.

4.   STOCKHOLDERS’ EQUITYBusiness Agreements

2017 Warrant Repricing and Exercise

In December 2014,On August 8, 2022, the Company entered into a sponsored research agreement with Harvard’s Dana-Farber Cancer Institute, Brigham & Women’s Hospital, and Medical University of Lodz (the “Dana-Faber, Brigham, Lodz Research Agreement”), for the generation of a multi-omic, non-invasive diagnostic aid to identify endometriosis based on circulating microRNAs and proteins. The Dana-Faber, Brigham, Lodz Research Agreement requires payments to be made upon the achievement of certain milestones. Under the terms of and as further described in the Dana-Faber, Brigham, Lodz Research Agreement, payments of approximately $1,252,000 have or will become due from the Company to the counterparties upon successful completion of certain deliverables in 2022 and 2023 as follows: 68% was paid in August 2022, with two additional payments of 15% and 17% to become payable upon completion of certain deliverables defined in the contract. During the three and nine months ended September 30, 2023, approximately $17,000 and $64,000, respectively, has been recorded as research and development expense in the unaudited condensed consolidated financial statement of operations for the project. During the three and nine months ended September 30, 2023, approximately $852,000, was recorded as research and development expense in the unaudited condensed consolidated financial statement of operations for the project. From the inception of the Dana-Faber, Brigham, Lodz Research Agreement through September 30, 2023, research and development expenses in the cumulative amount of $931,000 have been recorded.

On March 20, 2023, the Company entered into a licensing agreement (“Dana-Faber, Brigham, Lodz License Agreement”) with Harvard’s Dana-Farber Cancer Institute, Brigham & Women’s Hospital, and Medical University of Lodz under which the Company will license certain of its intellectual property to be used in the Company’s OvaSuite product portfolio. Under the Dana-Faber, Brigham, Lodz License Agreement, the Company paid an initial license fee of $75,000 and then will pay a license maintenance fee of $50,000 on each anniversary of the date of the Dana-Faber, Brigham, Lodz License Agreement. The Dana-Faber, Brigham, Lodz License Agreement also requires non-refundable royalty payments of up to $1,350,000 based on certain regulatory approvals and commercialization milestones and further royalty payments based on the net sales of the Company’s products included under the Dana-Faber, Brigham, Lodz License Agreement. No milestones have been reached as of September 30, 2023.

Contingent Liabilities

From time to time, the Company is involved in legal proceedings and regulatory proceedings arising from operations. The Company establishes reserves for specific liabilities in connection with legal actions that management deems to be probable and estimable. The Company is not currently a party to any proceeding, the adverse outcome of which would have a material adverse effect on the Company’s financial position or results of operations.

24


5. ACCRUED LIABILITIES


The following table describes the principal components of accrued liabilities on the Company’s unaudited condensed consolidated balance sheet as of September 30, 2023 and December 31, 2022.

September 30,

December 31,

(in thousands)

2023

2022

Payroll and benefits related expenses

$

1,640

$

1,803

Collaboration and research agreements expenses

121

404

Professional services

669

556

Other accrued liabilities

659

639

Total accrued liabilities

$

3,089

$

3,402

6.    STOCKHOLDERS’ (DEFICIT) EQUITY

Additional Shares Authorized

On February 6, 2023, the Company filed with the Secretary of State of the State of Delaware a Certificate of Amendment to the Company’s Fourth Amended and Restated Certificate of Incorporation, as amended, to increase the authorized number of shares of the Company’s common stock from 150,000,000 shares to 200,000,000 shares.

2023 Reverse Stock Split

At the Company’s annual meeting on May 9, 2023, the stockholders of the Company approved the proposal to authorize the Board of Directors in its discretion, without further authorization of the Company’s stockholders, to amend the Company’s Certificate of Incorporation to effect a reverse split of the Company’s common stock by a ratio of between one-for-ten and one-for-twenty. On May 9, 2023, the Company’s board of directors approved a one-for-fifteen reverse stock split of the Company’s common stock without any change to its par value, which became effective on May 12, 2023.

2023 Registered Direct Offering

On July 20, 2023, the Company entered into a securities purchase agreement (the “Direct Offering Agreement”), with several investors relating to the issuance and sale of 1,694,820 shares of its common stock, par value $0.001 per share (the “Direct Offering”).

Pursuant to the Direct Offering Agreement, the Company issued 1,650,473 shares of common stock to certain investors at an offering price of $2.75 per share, and 44,347 shares of common stock to its directors and executive officers at an offering price of $3.98 per share, which was the consolidated closing bid price of our common stock on The Nasdaq Capital Market on July 19, 2023. The aggregate gross proceeds to the Company from the Direct Offering were approximately $4.7 million, before deducting placement agent fees and other estimated expenses of $559,000 payable by the Company.

The Company engaged Alliance Global Partners to act as sole placement agent in the Direct Offering. The Company paid the placement agent a cash fee equal to 7.0% of the aggregate gross proceeds generated from the Direct Offering, except that, with respect to proceeds from the sale of 182,447 shares of common stock to certain investors, including directors and executive officers of the Company, the placement agent’s cash fee was 3.5%. The Company also reimbursed the placement agent for its accountable offering-related legal expenses of $75,000 and a non-accountable expense allowance of $30,000.

2023 At the Market Offering

25


On February 10, 2023, the Company entered into a Controlled Equity OfferingSM Sales Agreement, (the “Cantor Sales Agreement”), with Cantor Fitzgerald & Co., (“Cantor”), as agent, pursuant to which it may offer and sell, from time to time, through Cantor, shares of the Company’s common stock, par value $0.001 per share, having an aggregate offering price of up to $12.5 million, (the “Placement Shares”). The Placement Shares were issued and sold pursuant to the Company’s effective registration statement on Form S-3 (Registration Statement No. 333-252267), as previously filed with, and declared effective by, the SEC. The Company filed a prospectus supplement, dated February 10, 2023, with the SEC in connection with the offer and sale of the Placement Shares.

Under the Cantor Sales Agreement, Cantor may sell the Placement Shares by any method permitted by law and deemed to be an “at the market offering” as defined in Rule 415 promulgated under the Securities Act of 1933, as amended, or the Securities Act, including sales made directly on the Nasdaq Capital Market, on any other existing trading market for our common stock or to or through a market maker or in privately negotiated transactions. From time to time, the Company may instruct Cantor not to sell the Placement Shares if the sales cannot be effected at or above the price designated by the Company.Cantor receives a Placement Fee of 3% for each completed sale of Placement Shares under the Cantor Sales Agreement.

The Company is not obligated to make any sales of the Placement Shares under the Cantor Sales Agreement. The offering of the Placement Shares pursuant to the Cantor Sales Agreement will terminate upon the earlier of (a) the sale of all of the Placement Shares subject to the Cantor Sales Agreement or (b) the termination of the Cantor Sales Agreement by Cantor or the Company, as permitted therein.As of September 30, 2023, and December 31, 2022, the Company had $0 and $150,000, respectively, of deferred transaction-related offering costs recorded in other assets in the unaudited condensed consolidated balance sheet.

The Company incurred incremental transaction-related offering costs of approximately $0 and $143,000 in connection with the execution of the Cantor Sales Agreement during the three and nine months ended September 30, 2023, respectively. 

During the three and nine months ended September 30, 2023, the Company sold 0 shares and 35,552 shares of the Placement Shares, respectively, as adjusted for the Reverse Stock Split, for gross proceeds of approximately $0 and $211,000, respectively. For the three and nine months ended September 30, 2023, the Company recorded $0 and $134,000, respectively, as an offset to additional paid-in capital representing transaction-related offering costs of the Placement Shares.

In connection with the Direct Offering on July 24, 2023, the Company delivered written notice to Cantor on July 19, 2023 that it was suspending the prospectus supplement, dated February 10, 2023, related to the Company’s common stock issuable under the Cantor Sales Agreement. The Company will not make any sales of common stock pursuant to the Cantor Sales Agreement unless and until a new prospectus supplement is filed with the SEC. The Cantor Sales Agreement remains in full force and effect during the suspension.

2023 Equity Line of Credit

On March 28, 2023, the Company entered into a purchase agreement (the “LPC Purchase Agreement”) with Lincoln Park Capital Fund, LLC (“Lincoln Park”) and a registration rights agreement (the “LPC Registration Rights Agreement”), pursuant to which the Company has the right, in its sole discretion, to sell to Lincoln Park shares of the Company’s common stock, par value $0.001 per share (the “Common Stock”), having an aggregate value of up to $10,000,000 (the “Purchase Shares”), subject to certain limitations and conditions set forth in the LPC Purchase Agreement. The Company will control the timing and amount of any sales of Purchase Shares to Lincoln Park pursuant to the LPC Purchase Agreement.

Under the LPC Purchase Agreement, on any business day after March 28, 2023 selected by the Company over the 36-month term of the LPC Purchase Agreement (each, a “Purchase Date”), the Company may direct Lincoln Park to purchase up to 6,667 shares of Common Stock on such Purchase Date (a “Regular Purchase”); provided, however, that (i) a Regular Purchase may be increased to up to 13,333 shares, if the closing sale price per share of the Common Stock on The Nasdaq Capital Market is not below $7.50 on the applicable Purchase Date; (ii) a Regular Purchase may be increased to up to 16,666 shares, if the closing sale price per share of the Common Stock on The Nasdaq Capital Market is not below $11.25 on the applicable Purchase Date; and (iii) a

26


Regular Purchase may be increased to up to 20,000 shares, if the closing sale price per share of the Common Stock on The Nasdaq Capital Market is not below $15.00 on the applicable Purchase Date. All terms of the LPC Purchase Agreement have been adjusted for the Reverse Stock Split. In any case, Lincoln Park’s maximum obligation under any single Regular Purchase will not exceed $1,000,000. The above-referenced share amount limitations and closing sale price thresholds are subject to adjustment for any reorganization, recapitalization, non-cash dividend, stock split, reverse stock split or other similar transaction as provided in the LPC Purchase Agreement. The purchase price per share for each such Regular Purchase will be equal to the lesser of:

1.the lowest sale price for the Common Stock on The Nasdaq Capital Market on the date of sale; and

2.the average of the three lowest closing sale prices for the Common Stock on The Nasdaq Capital Market during the 10 consecutive business days ending on the business day immediately preceding the purchase date.

The Company also has the right to direct Lincoln Park, on any business day on which the Company has properly submitted a Regular Purchase notice for the maximum amount the Company is then permitted to sell to Lincoln Park in such Regular Purchase, to purchase an additional amount of the Common Stock (an “Accelerated Purchase”) of additional shares based on criteria established in the LPC Purchase Agreement. An Accelerated Purchase, which is at the Company’s sole discretion, may be subject to additional requirements and discounts if certain conditions are met as defined in the LPC Purchase Agreement.

During the three and nine months ended September 30, 2023, the Company sold 0 and 53,335 shares, respectively, under the LPC Purchase Agreement for gross proceeds of approximately $170,000. The Company incurred approximately $326,000 of costs related to the execution of the LPC Purchase Agreement, all of which are reflected in the unaudited condensed consolidated financial statements. Of the total costs incurred, approximately $258,000 was paid in common stock to Lincoln Park for a commitment fee and $30,000 was accrued for Lincoln Park expenses. These transaction costs were included in other expense in the unaudited condensed statement of operations. Approximately $0 and $38,000 was incurred for legal fees during the three and nine months ended September 30, 2023, respectively, and were included in general and administrative expenses on the unaudited condensed statement of operations.

2022 Public Offering

On August 22, 2022, the Company, entered into an underwriting agreement (the “2022 Underwriting Agreement”) with William Blair & Company, L.L.C., as the sole underwriter (the “2022 Underwriter”). Pursuant to the 2022 Underwriting Agreement, the Company agreed to issue and sell, in an underwritten public offering (the “2022 Offering”), 799,985 shares, as adjusted for the reverse stock split, of the Company’s common stock, par value $0.001 per share and warrants to purchase up to an aggregate of 4,166,659799,985 shares of VermillionCommon Stock (the “Warrants”). Each share of Common Stock was sold at a price to the public of $11.25 per share, as adjusted for the reverse stock split, together with one Warrant to purchase one share of Common Stock and related Warrant.

The Warrants were issued pursuant to a common stock atpurchase warrant (the “Form of Warrant”). Each Warrant has an initial exercise price of $2.00 per share in conjunction with a December 2014 private placement of Vermillion common stock.  The warrants expire by their original terms on December 23, 2017.

On August 31, 2017, certain holders exercised warrantsequal to purchase 3,796,818 shares of Vermillion common stock in consideration for the Company agreeing to reduce the exercise price to $1.00$13.20 per share of Vermillion common stock.

The Company issued 3,796,818 shares of Vermillion commonCommon Stock, as adjusted for the reverse stock split, and received $3,796,818 in aggregate gross proceeds (approximately $3,577,000 net of transaction costs). The incremental non-cash fair value of approximately $942,000 from the modification of the warrants was calculated using the Black-Scholes model and recorded as a deemed dividend to the warrant holders within stockholders’ equity.

2017 Private Placement

On February 17, 2017, the Company completed a private placement pursuant to which certain investors purchased 3,747,125 shares of Vermillion common stock at a price of $1.40 per share. Vermillion also issued warrants to purchase shares of Vermillion common stock at a price of $0.125 per warrant share in the private placement. Net proceeds of the private placement were approximately $5,127,000 after deducting offering expenses. The warrants are exercisable for 2,810,338 shares of Vermillion common stock at $1.80 per share. The warrants expire on the fifth anniversary offive years from the date of issuance issuance. The exercise price and the number of shares of Common Stock issuable upon exercise of the Warrants are subject to adjustment in the event of certain subdivisions and combinations, including by any stock split or reverse stock split, stock dividend, recapitalization or otherwise. The exercise of the Warrants may be limited in certain circumstances if, earlier, five business days after Vermillion delivers notice thatgiving effect to such exercise, the closing price per shareholder or any of its affiliates would beneficially own (as determined in accordance with the terms of the Warrants) more than 4.99% (or, at the election of the holder, 9.99%) of the outstanding Common Stock immediately after giving effect to the exercise. There is no established trading market available for the Warrants on any securities exchange or nationally recognized trading system.

The Company accounts for common stock exceededwarrants as either equity-classified or liability-classified instruments based on an assessment of the exercise price for 20 consecutive trading days during the exercise period.

12


The sale of common stock and issuance of warrants qualified for equity treatment under GAAP. The respective valuesspecific terms of the warrants and common stock were calculated using their relative fair valuesapplicable authoritative guidance in ASC 480, Distinguishing Liabilities from Equity (“ASC 480”) and classifiedASC 815-40, Contracts in Entity’s Own Equity (“ASC 815-40”). The assessment considers whether the warrants are freestanding financial instruments pursuant

27


to ASC 480, meet the definition of a liability pursuant to ASC 480, and meet all of the requirements for equity classification under commonASC 815-40, including whether the warrants are indexed to the Company’s own stock and additional paid-in capital. The value ascribed towhether the events where holders of the warrants could potentially require net cash settlement are within the Company’s control, among other conditions for equity classification. This assessment, which requires the use of professional judgment, is $804,000conducted at the time of warrant issuance and toas of each subsequent quarterly period end date while the warrants are outstanding. The Form of Warrant requires that, if the Company consummates any merger, consolidation, sale or other reorganization event, including the sale of all or substantially all of the Company’s assets, in which its common stock is converted into or exchanged for securities, cash or other property (“Fundamental Transaction”), then the Company shall pay at the holder’s option, exercisable at any time commencing on the occurrence or the consummation of the Fundamental Transaction (or, if later, the date of public announcement) and continuing up to 30 days, an amount of cash equal to the value of the remaining unexercised portion of the Warrant as determined in accordance with the Black-Scholes option pricing model on the date of such Fundamental Transaction provided; however, that if the Fundamental Transaction is not within the Company’s control, including not approved by the Board of Directors, the holder of the Warrant shall only be entitled to receive the same type or form of consideration (and in the same proportion), at the Black Scholes Value of the unexercised portion of the Warrant, that is being offered and paid to the holder of the Common Stock of the Company in connection with the Fundamental Transaction. The Black-Scholes option pricing model, as defined in the Form of Warrant, includes as an input, the highest volume weighted average price (“VWAP”) for a period of one trading day preceding the consummation or announcement of a Fundamental Transaction up to 30 days after a Fundamental Transaction. The Company has determined that an adjustment based on this input is not limited to the effect that is attributable to the Fundamental Transaction and therefore causes the Warrants to fail the indexation guidance under ASC 815-40. As a result, the Company has determined that the Warrants must be recorded as derivative liabilities upon issuance and marked to market on a quarterly basis in the Company’s unaudited condensed consolidated statement of operations until their exercise or expiration.

The 2022 Offering resulted in net proceeds to the Company of approximately $4,296,000.$7,675,000, after deducting underwriting discounts and offering expenses of $1,325,000. Offering costs were allocated between liability expense and equity based on the fair value of the Warrants of approximately $3,984,000 and the total gross proceeds of $9,000,000. $574,000 of offering costs were allocated to the Warrants and were expensed immediately and recorded as other income (expense) in the consolidated statement of operations for the year ended December 31, 2022, resulting in a net impact to the Company’s equity of $751,000.

2010 Stock Incentive Plan

The Company’s employees, directors, and consultants arewere eligible to receive awards under the Vermillion, Inc. Second Amended and Restated 2010 Stock Incentive Plan (the “2010 Plan”). , which was replaced by the 2019 Plan (as defined below) with respect to future equity grants. As of September 30, 2023, there were no shares of the Company’s common stock available for future grants under the 2010 Plan.

The following table summarizes stock option activity for the 2010 Plan permits the granting of a variety of awards, including stock options, share appreciation rights, restricted shares, restricted share units, unrestricted shares, deferred share units, performance and cash-settled awards, and dividend equivalent rights. The 2010 Plan provides for issuance of up to 8,122,983 shares of Vermillion common stock, subject to adjustment as provided in the 2010 Plan.

Stock-Based Compensation

Duringduring the nine months ended September 30, 2017,2023.

Options outstanding at December 31, 2022

287,104

Options forfeited or expired

(41,751)

Options outstanding at September 30, 2023

245,353

2019 Stock Incentive Plan

At the Company’s 2019 annual meeting of stockholders, the Company’s stockholders approved the Vermillion, Inc. 2019 Stock Incentive Plan, the name of which was subsequently changed to the Aspira Women’s Health Inc. 2019 Stock Incentive Plan (the “2019 Plan”). The purposes of the 2019 Plan are (i) to align the interests of the Company’s stockholders and recipients of awards under the 2019 Plan by increasing the proprietary interest of such recipients in the Company’s growth and success; (ii) to advance the interests of the Company awarded to Vermillion’sby attracting and retaining non-employee directors, 131,250officers, other employees, consultants, independent contractors and agents; and (iii) to motivate such persons to act in the long-term best interests of the Company and

28


its stockholders. The 2019 Plan allows the Company to grant stock options, stock appreciation rights, restricted stock, restricted stock units and performance awards to participants.

Subject to the terms and conditions of the 2019 Plan, the initial number of shares authorized for grants (as adjusted for the reverse stock split) under the 2019 Plan is 699,485. On May 9, 2023, the Company’s stockholders approved an increase of 5,000,000 shares (333,333 shares as adjusted for the reverse stock split) in the number of shares available for issuance under the 2019 Plan for a total of 1,032,818 shares. To the extent an equity award granted under the 2019 Plan expires or otherwise terminates without having been exercised or paid in full, or is settled in cash, the shares of common stock subject to such award will become available for future grant under the 2019 Plan. As of September 30, 2023, 449,788 shares of Aspira common stock were subject to outstanding stock options, and 49,957 shares of Aspira common stock were subject to unreleased restricted stock awards and a total of 284,768 shares of Aspira common stock were reserved for future issuance under the 20102019 Plan.

The following table summarizes stock option activity for the 2019 Plan having aduring the nine months ended September 30, 2023.

Options outstanding at December 31, 2022

368,124

Options granted

311,431

Options forfeited or expired

(229,767)

Options outstanding at September 30, 2023

449,788

The following table summarizes RSU activity for the 2019 Plan during the nine months ended September 30, 2023.

RSUs outstanding at December 31, 2022

-

RSUs granted

205,235

RSUs vested and issued

(155,278)

RSUs outstanding at September 30, 2023

49,957

RSUs vested and unissued at September 30, 2023

8,615

Stock-Based Compensation

During the three months ended March 31, 2023, the Company granted the following awards under the 2019 Plan. Assumptions included in the fair value per share calculations were (i) expected terms of approximately $281,000one to four years, (ii) one- to five-year treasury interest rates of 4.01% to 4.87% and (iii) market close prices ranging from $4.80 to $8.70, as paymentadjusted for services to be rendered in 2017. These shares of restrictedthe reverse stock vested 50% on June 1, 2017 and 25% on September 1, 2017, and the remaining 25% will vest on December 1, 2017.split. The Company also issued to certain consultants 27,878 shares of restricted stockrecorded $598,000 in forfeitures for the three months ended March 31, 2023.

Grant Date

Number of Shares (post-reverse stock split)

Type of Award

Exercise Price / Share

Fair Value / Share

1/3/2023

333

Options

$               4.80

$           1.95

1/20/2023

24,333

Options

$               7.50

$           4.16

2/1/2023

333

Options

$               7.65

$           3.08

2/8/2023

99,166

Options

$               8.70

$           4.83

2/8/2023

13,333

Options

$             15.30

$           5.92

2/8/2023

5,737

Restricted Stock Units

$                    -

$                -

2/9/2023

25,964

Options

$               8.55

$           4.76

2/9/2023

64,611

Options

$               8.55

$           6.08

2/9/2023

11,675

Restricted Stock Units

$                    -

$                -

245,485

29


During the three months ended June 30, 2023, the Company granted the following awards under the 2010 Plan having a2019 Plan. Assumptions included in the fair value per share calculations were (i) expected terms of approximately $48,000.one to four years, (ii) one- to five-year treasury interest rates of 3.74% to 5.02% and (iii) market close prices ranging from $2.99 to $4.25. The Company recorded $51,000 in forfeitures for the three months ended June 30, 2023.

Grant Date

Number of Shares

Type of Award

Exercise Price

Fair Value / Share

5/18/2023

4,400 

Options

$               4.25

$           3.76

5/18/2023

7,415 

Options

$               4.25

$           2.02

6/1/2023

30,342 

Options

$               2.99

$           2.14

6/1/2023

102,388 

Restricted Stock Units

$                    -

$                -

144,545 

During the three months ended September 30, 2017,2023, the Company issued to certain consultants 5,037 shares of restricted stockgranted the following awards under the 2010 Plan having a2019 Plan. Assumptions included in the fair value per share calculations were (i) expected terms of approximately $9,000.two years, (ii) one- to five-year treasury interest rates of 4.85% to 498% and (iii) market close prices ranging from $2.40 to $3.75. The Company did not make any awards of restricted stock to non-employee directors duringrecorded $30,000 in forfeitures for the three months ended September 30, 2017. 2023.

During the nine months ended September 30, 2017, the Company also granted certain consultants options to purchase 70,000 shares of Vermillion common stock with an exercise price of $2.14 per share.  The Company also granted certain officers and employees options to purchase approximately 916,000 shares of Vermillion common stock with an exercise price of $2.14 per share. In addition, the Company granted certain officers and employees options to purchase 14,500 shares of Vermillion common stock with an exercise price of $1.83 per share.  These stock options generally vest 25% on each of the four anniversaries of the grant date.  

Grant Date

Number of Shares

Type of Award

Exercise Price

Fair Value / Share

7/25/2023

20,801 

Options

$               2.40

$           2.14

7/25/2023

15,777 

RSU

$                    -

$                -

8/21/2023

21,032 

RSU

$                    -

$                -

8/24/2023

400 

Options

$               3.35

$           2.98

8/29/2023

20,000 

Options

$               3.75

$           3.34

8/29/2023

26,467 

RSU

$                    -

$                -

9/28/2023

22,159

RSU

$                    -

$                -

126,636

During the nine months ended September 30, 2017, the Company also granted certain officers and employees options to purchase 250,000 shares of Vermillion common stock with an exercise price of approximately $2.14 per share with performance-based vesting based on certain metrics through December 31, 2017. These options vest 25% on each of the four anniversaries of the grant date if the performance-based metrics are met.

During the three months ended September 30, 2017, the Company granted certain officers and employees options to purchase 22,500 shares of Vermillion common stock with an exercise price of $1.32 per share. These stock options vest 25% on each of the four anniversaries of the vesting commencement date for each such stock option. 

During the three months ended September 30, 2017, the Company granted certain consultants of the Company options to purchase 120,000 shares of Vermillion common stock with an exercise price of $1.32 per share. These stock options vest in 24 equal monthly installments beginning on the vesting commencement date for each such stock option.

The allocation of employee stock-based compensation expense, including expense reversals due to forfeitures, by functional area for the three and nine months ended September 30, 20172023 and 20162022 was as follows:follows.

Three Months Ended

Nine Months Ended

September 30,

September 30,

(in thousands)

2023

2022

2023

2022

Cost of revenue

$

6

$

(27)

$

20

$

52

Research and development

70

31

213

21

Sales and marketing

26

76

13

281

General and administrative

377

428

744

1,445

Total

$

479

$

508

$

990

$

1,799

13




 

 

 

 

 

 

 

 

 

 

 

 



 

Three Months Ended September 30,

 

Nine Months Ended September 30,

(in thousands)

 

2017

 

2016

 

2017

 

2016

Cost of revenue

 

$

21 

 

$

24 

 

$

61 

 

$

70 

Research and development

 

 

 —

 

 

10 

 

 

 

 

63 

Sales and marketing

 

 

38 

 

 

10 

 

 

108 

 

 

66 

General and administrative

 

 

216 

 

 

198 

 

 

630 

 

 

623 

Total

 

$

275 

 

$

242 

 

$

804 

 

$

822 



 

 

 

 

 

 

 

 

 

 

 

 

5.   7.    LOSS PER SHARE

The Company calculates basic loss per share using the weighted average number of shares of VermillionAspira common stock outstanding during the period. Because the Company is in a net loss position, diluted loss per share is calculated using the weighted average number of shares of VermillionAspira common stock (as adjusted for the reverse stock split) outstanding and excludes the anti-dilutive effects of 7,971,860 and  7,485,6321,545,083 potential shares of VermillionAspira common stock for the three and nine months ending September 30, 2023 and 1,768,074 potential shares of Aspira common stock for the three and nine months ending September 30 2022, inclusive of 799,985 and 799,985 shares of Aspira common stock, as adjusted for the reverse stock split, issuable upon the exercise of the warrants outstanding as of September 30, 20172023 and 2016, respectively, that are anti-dilutive.2022, respectively. Potential shares of VermillionAspira common stock and warrants include

30


incremental shares of VermillionAspira common stock issuable upon the exercise of outstanding warrants, stock options and warrants and the vesting of unvested restricted stock units.

Three Months Ended

Nine Months Ended

September 30,

September 30,

2023

2022

2023

2022

(as restated)

(as restated)

Numerator:

Net Loss

$

(4,706)

$

(7,783)

$

(13,601)

$

(25,294)

Denominator:

Shares used in computing net loss per share, basic and diluted

9,776,436

7,807,876

8,838,342

7,590,872

Net loss per share, basic and diluted

$

(0.48)

$

(1.00)

$

(1.54)

$

(3.33)

8.    SUBSEQUENT EVENTS

On October 30, 2023, the Company resumed selling shares under the LPC Purchase Agreement, exercising the option for an Accelerated Purchase as allowed under the LPC Purchase Agreement. As of November 9, 2023, the Company has sold 69,520 shares for an aggregate gross proceeds of approximately $300,000 subsequent to the quarter ended September 30, 2023.

14

31


ITEM 2.    MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITIONCONDITION AND RESULTS OF OPERATIONS

Forward-Looking Statements

This Quarterly Report on Form 10-Q contains forward-looking statements, as defined in the Private Securities Litigation Reform Act of 1995.

These statements involve a number of risks and uncertainties. Words such as “may,” “expects,” “intends,” “anticipates,” “believes,” “estimates,” “plans,” “seeks,” “could,” “should,” “continue,” “will,” “potential,” “projects”“targeted,” “projects,” “aim” and similar expressions are intended to identify such forward-looking statements. Readers are cautioned that these forward-looking statements speak only as of the date on which this Quarterly Report on Form 10-Q is filed with the Securities and Exchange Commission (“SEC”(the “SEC”), and, except as required by law, Vermillion,Aspira Women’s Health Inc. (“Vermillion”Aspira” and, together with its subsidiaries, the “Company,” “we,” “our,” or “us”) does not assume any obligation to update, amend or clarify them to reflect events, new information or circumstances occurring after such date.

Examples of forward-looking statements include, without limitation:

projections or expectations regarding our future test volumes, revenue, price, cost of revenue, operating expenses, research and development expenses, gross profit margin, cash flow, results of operations and financial condition;

listing of our common stock on the Nasdaq Capital Market;

our plan to broaden our commercial focus from ovarian cancer to differential diagnosis of women with a range of gynecological diseases, including additional pelvic disease conditions such as endometriosis and, benign pelvic mass monitoring;

our planned business includestrategy and the following:anticipated effects thereof, including partnerships such as those based on our Aspira Synergy platform, specimen or research collaborations, licensing arrangements and distribution agreements;

plans to expand to markets outside of the United States;

plans to develop new algorithms, molecular diagnostic tests, products and tools and otherwise expand our product offerings;

plans related to our registry study for OvaWatch longitudinal monitoring and testing;

plans related to acceptance of the OvaWatch longitudinal monitoring and testing manuscript for peer review publication;

plans to develop, launch and establish payer coverage and secure contracts for current and new products, including EndoCheck;

plans to expand coverage and secure additional contracts for OvaSuite offerings;

expectations regarding local and/or national coverage under Novitas, the Company’s Medicare Administrative Carrier;

anticipated efficacy of our products, product development activities and product innovations, including our ability to improve sensitivity and specificity over traditional diagnostics;

expected competition in the markets in which we operate;

plans with respect to Aspira Labs, Inc. (“Aspira Labs”), including plans to expand or consolidate Aspira Labs’ testing capabilities, specifically molecular lab capabilities;

expectations regarding continuing future services provided by Quest Diagnostics Incorporated;

expectations regarding continuing future services provided by BioReference Health, LLC;

plans to develop informatics products as laboratory developed tests (“LDTs”) and potential Food and Drug Administration (“FDA”) oversight changes of LDTs;

expectations regarding existing and future collaborations and partnerships for our products, including plans to enter into decentralized arrangements for our Aspira Synergy platform to and provide and expand access to our risk assessment tests;

plans regarding future publications; 

·

projections or expectations regarding our future test volumes, revenue, cost of revenue, operating expenses, cash flow, results of operations and financial condition;

·

our plan to broaden our commercial focus from ovarian cancer to differential diagnosis of women with a range of gynecological disorders;

·

our planned business strategy and the anticipated timing of the implementation thereof;

·

plans with respect to our market expansion and growth, including plans to market Overa outside the United States;

·

plans to develop new algorithms and molecular diagnostic tests; 

·

plans to develop a product or tool combining an OVA1 with results of a symptom index;

·

plans to establish our own payer coverage for OVA1 and Overa;

·

intentions to address clinical questions related to early disease detection, treatment response, monitoring of disease progression, prognosis and other issues in the fields of oncology and women’s health;

·

plans to leverage infrastructure and enhance our pipeline of future technologies by fostering relationships with in vitro diagnostic (“IVD”) companies;

·

plans with respect to ASPiRA IVD, Inc. (“ASPiRA IVD”);

·

expected service revenue growth based on ASPiRA IVD;

·

expected license revenue in future periods;

·

our planned focus on the execution of five core strategic business drivers in ovarian cancer diagnostics and specialized laboratory services to address unmet medical needs for women faced with gynecologic disease and other conditions and the continued development of our business;

·

anticipated efficacy of our products, product development activities and product innovations;

·

expected competition in the markets in which we compete;

·

plans with respect to ASPiRA LABS, Inc. (“ASPiRA LABS”);

·

expectations regarding future services provided by Quest Diagnostics Incorporated (“Quest Diagnostics”);

·

plans to expand our ovarian cancer franchise beyond OVA1, including with respect to Overa and OvaX;

15

32


·

plans regarding the commercialization of Overa;

·

plans to develop and perform laboratory developed tests (“LDTs”);

·

plans with respect to the Company’s pelvic mass registry, including anticipated sources of funding;  

·

anticipated effects on reimbursement for OVA1 from changes to Novitas Solutions’ administrative requirements;

·

expectations regarding the Company’s monitoring and combining multiple protein biomarkers to create diagnostic tests to aid physicians considering treatment options for patients with complex diseases, and the Company’s future development of new In Vitro Diagnostic Multivariate Index Assays (IVDMIA);

·

expectations regarding existing and future collaborations and partnerships, including OVA1 and Overa distribution agreements;

·

plans regarding future publications;

·

our continued ability to comply with applicable governmental regulations,  expectations regarding pending regulatory submissions and plans to seek regulatory approvals for our tests outside the United States;

·

our ability to obtain and maintain the regulatory approvals required to market Overa in other countries;

·

our continued ability to expand and protect our intellectual property portfolio;

·

anticipated liquidity and capital requirements;

·

anticipated future losses and our ability to continue as a going concern; 

·

expectations regarding the second disbursement from our financing arrangement with the State of Connecticut Department of Economic and Community Development (the “DECD”);

·

expected expenditures, including the expected decrease in expenses related to research and development in 2017;

·

our ability to use our net operating loss carryforwards;

·

expected market adoption of our diagnostic tests, including OVA1 and Overa;

·

expectations regarding our ability to launch new products developed, licensed, co-marketed or acquired;

·

expectations regarding raising capital and the amount of financing anticipated to be required to fund our planned operations; and

·

expectations regarding reimbursement for our products, and our ability to obtain such reimbursement, from third-party payers such as private insurance companies and government insurance plans.

expectations regarding potential collaborations with governments, legislative bodies and advocacy groups to enhance awareness and drive policies to provide broader access to our tests;

our ability to continue to comply with applicable governmental regulations, including regulations applicable to the operation of our clinical lab, expectations regarding pending regulatory submissions and plans to seek regulatory approvals for our tests within the United States and internationally, as applicable;

our continued ability to expand and protect our intellectual property portfolio;

anticipated liquidity and capital requirements;

anticipated future losses and our ability to continue as a going concern;

expectations regarding raising capital and the amount of financing anticipated to be required to fund our planned operations; 

our ability to attract and retain top talent;

expectations regarding the results of our clinical research studies and our ability to recruit patients to participate in such studies;

our ability to use our net operating loss carryforwards and anticipated future tax liability under U.S. federal and state income tax legislation;

expected market adoption of our diagnostic tests, including Ova1, Overa, Ova1Plus and OvaWatch, as well as our Aspira Synergy platform;

expected market adoption of future products, including EndoCheck;

expectations regarding our ability to launch new products we develop, license, co-market or acquire;

expectations regarding the size of the markets for our products;

expectations regarding reimbursement for our products, and our ability to obtain such reimbursement, from third-party payers such as private insurance companies and government insurance plans;

potential plans to pursue clearance designation with the FDA with respect to EndoCheck and OvaWatch;

expected target launch timing for OvaWatch longitudinal testing and EndoCheck;

expectations regarding compliance with federal and state laws and regulations relating to billing arrangements conducted in coordination with laboratories;

plans to advocate for legislation and professional society guidelines to broaden access to our products and services;

ability to protect and safeguard against cybersecurity risks and breaches;

plans to use samples received from the University of Oxford in verifying and validating our endometriosis blood test algorithms; and

expectations regarding the results of our academic research agreements.

We caution you that the foregoing list may not contain all of the forward-looking statements made in this Quarterly Report on Form 10-Q.

Other sections of this Quarterly Report on Form 10-Q may include additional factors that could harm our business and financial performance. Moreover, we operate in a very competitive and rapidly changing environment. New risk factors emerge from time to time, and it is not possible for our management to predict all risk factors, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ from those contained in, or implied by, any forward-looking statements.

Forward-looking statements are subject to significant risks and uncertainties, including those discussed in Part I Item 1A, “Risk Factors”Factors,” of our Annual Report on Form 10-K for the year ended December 31, 2016 (our “2016 Annual Report”) and Part II, Item 1A.2022, as amended by Form 10-K/A filed on October 26, 2023, as supplemented by the section titled “Risk Factors” of ourin this Quarterly Report on Form 10-Q, for the three months ended March 31, 2017 (our “2017 First Quarterly Report”), that could cause actual results to differ materially from those projected in such forward-looking statements due to various factors, including our ability to continue as a going concern; our ability to comply with Nasdaq’s continued listing requirements; impacts resulting from potential changes to coverage of Ova1 through our Medicare Administrative Carrier for Ova1; anticipated use of capital and its effects; our ability

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to increase the volume of OVA1 or Overaour product sales; our ability to market our test through sales channels other than Quest Diagnostics including ASPiRA LABS; failures by third-party payers to reimburse OVA1 or Overafor our products and services or changes or variances into reimbursement rates; our ability to secure additional capital on acceptable termscontinue developing existing technologies and to executedevelop, protect and promote our business plan;proprietary technologies; plans to develop and perform LDTs; our ability to comply with FDA regulations that relate to our products and to obtain any FDA clearance or approval required to develop and commercialize OVA1 and/or Overa both within and outside the United States; in the event that we succeed in commercializing OVA1 and/or Overa outside the United States, the political, economic and other conditions affecting other countries (including foreign exchange rates);medical devices; our ability to develop and commercialize additional diagnostic products and achieve market acceptance with respect to these products; our ability to compete successfully; our ability to obtain any regulatory approval required for our future diagnostic products; our or our

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suppliers’ ability to comply with United States Food and Drug Administration (“FDA”)FDA requirements for production, marketing and post-market monitoring of our products; additional costs that may be required to make further improvements to our manufacturing operations; our ability to maintain sufficient or acceptable supplies of immunoassay kits from our suppliers; in the event that we succeed in commercializing our ability to continue to develop, protectproducts outside the United States, the political, economic and promote our proprietary technologies; future litigation against us, including infringement of intellectual property and product liability exposure; our ability to retain key employees; business interruptions; legislative actions resulting in higher compliance costs;other conditions affecting other countries; changes in healthcare policy; our ability to comply with environmental laws; our ability to generate sufficient demand for ASPiRA LABS’ services to cover its operating costs; our ability to comply with the additional laws and regulations that apply to us in connection with the operation of ASPiRA LABS;Aspira Labs; our ability to complyuse our net operating loss carryforwards; our ability to use intellectual property; our ability to successfully defend our proprietary technology against third parties; our ability to obtain licenses in the event a third party successfully asserts proprietary rights; the liquidity and trading volume of our common stock; the concentration of ownership of our common stock; our ability to retain key employees; our ability to secure additional capital on acceptable terms to execute our business plan; business interruptions; the effectiveness and availability of our information systems; our ability to integrate and achieve anticipated results from any acquisitions or strategic alliances; future litigation against us, including infringement of intellectual property and product liability exposure; and additional costs that may be required to make further improvements to our laboratory operations.

Company Overview

Corporate Vision

Our core mission is to transform women’s gynecologic health through the development of technology-enabled diagnostic tools, starting with FDA regulationsovarian cancer. We aim to eradicate late-stage detection of ovarian cancer and to ensure that relateour solutions can meet the needs of women of all ages, races, ethnicities and stages of the disease.

We plan to broaden our focus to the differential diagnosis of other gynecologic diseases that typically cannot be assessed through traditional non-invasive clinical procedures. We expect to continue commercializing our existing and new technology and to distribute our tests through our decentralized technology transfer service platform, Aspira Synergy. We also intend to continue to raise public awareness regarding the diagnostic superiority of Ova1Plus as compared to cancer antigen 125 (“CA-125”) on its own for all women with adnexal masses, as well as the superior performance of machine learning algorithms in detecting ovarian cancer in different racial and ethnic populations. We plan to continue to expand access to our tests among Medicaid patients as part of our corporate mission to make the best care available to all women, and we plan to advocate for legislation and the adoption of our technology in professional society guidelines to provide broad access to our products and services.

We continue to obtain any FDA clearance or approval requiredfocus on three key initiatives: growth, innovation, and operational excellence.

Growth. The steady adoption of Ova1Plus creates a solid foundation for the introduction of new products. The OvaSuite portfolio continues to developdemonstrate growth, including a 4.7% increase in volume and perform LDTs; ASPiRA IVD’s lack of operating history; ASPiRA IVD’s ability to generate and maintain business; fluctuations over time with respect to ASPiRA IVD’s operating results; ASPiRA IVD’s ability to enter into profitable contracts; ASPiRA IVD’s ability to maintain effective information systems without significant interruption; ASPiRA IVD’s ability to perform its servicesan 8.8% increase in compliance with contractual requirements, regulatory standards and ethical considerations; and our ability to continue as a going concern.   

Overview

Our vision is to drive the advancement of women’s health by providing innovative methods to detect, monitor and manage the treatment of both benign and malignant gynecologic disease, with our primary focus being diseases of the female pelvic cavity.

We have expanded our corporate strategy with the goal of transforming Vermillion from a technology license company to a diagnostic service and bio-analytic solutions provider. Our plan is to broaden our commercial focus from ovarian cancer to differential diagnosis of women with a range of gynecological disorders. Our strategy is being deployed in three phases. The three phases are a rebuild phase, which was completedrevenue in the third quarter of 2015, a transformation phase, which is now virtually complete except for continuing expansion2023 when compared with the same period in 2022. OvaWatch volume grew by more than 15% in the third quarter when compared with the second quarter of payer coverage, and a market expansion and growth phase, which2023, as physicians recognized its ability to fill an unmet need in the management of adnexal masses. OvaWatch’s contribution to revenue has also increased since we began billing with its unique Proprietary Laboratory Assay, (“PLA Code”), on April 1, 2023. The average selling price for OvaWatch increased 6% sequentially in 2017.  the third quarter of 2023 to $347 as payments have generally been consistent with the Ova1Plus historical reimbursement experience.

During

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Innovation. Innovation is fundamental to the first phase, we expandedlong-term success of any diagnostics company. We believe the Company’s competitive positioning is superior as our leadership team by hiring severalprocesses to develop and validate new senior leaders includingLDTs are performed in a chief executive officer.  In addition, we expanded our commercial strategy, reestablished medicalCLIA laboratory environment. This allows for the acceleration of assay commercialization and advisory support, rebuilt ouroutstanding patient advocacy strategy and established a billing system and a payer strategy outside of our relationship with Quest Diagnostics.  care.

During the second quarter of 2023, the American Society of Clinical Oncology published three abstracts related to our OvaSuite ovarian cancer portfolio, providing further evidence of the clinical usefulness of our proprietary multivariate index assays. OvaWatch,a non-invasive ovarian cancer risk assessment for women with adnexal masses to be used by physicians as part of initial clinical assessment, significantly expands the patient population that will benefit from our testing. OvaWatch was designed to be launched in two phases. The first phase, wea one-time use test for initial clinical assessment, was launched in the fourth quarter of 2022. We intend to launch the second phase, which will be used for longitudinal testing, in the fourth quarter of 2023.

We remain committed to launching EndoCheck, the first-of-its-kind noninvasive blood test for the diagnosis of endometriosis in the fourth quarter of this year. We have completed the process of obtaining licensure of ASPiRA LABS in alldevelopment phase of the statestest, achieving preliminary performance that require licenses,is superior to invasive laparoscopy, the current standard of care. While sample acquisition remains a challenge due to our intention to use only histologically-confirmed cases for clinical validation, we believe we will be successful in obtaining sufficient evidence to support provider and payer adoption. We believe that the proliferation of commercially available and in-development therapeutics for the treatment of endometriosis will create even greater demand for the diagnosis of a disease that affects six-and-a-half million American women according to the U.S. Department of Health and Human Services.

We are also in the processlate stages of establishingdevelopment for OvaMDx and EndoMDx, molecular diagnostics offerings, which combine both miRNA and proteins.

We plan to accelerate the development of our endometriosis product portfolio by supplementing our internal development and validation program through our partnership with Harvard’s Dana-Farber Cancer Institute (“DFCI”), Brigham & Women’s Hospital (“BWH”), and Medical University of Lodz under a sponsored research agreement that we entered into in the third quarter of 2022.

Operational Excellence. We expect to achieve our cash utilization goals for 2023 by focusing on spending that fuels innovation and growth. We have achieved significant reductions in cash used in operations during the nine months ended September 30, 2023, while simultaneously increasing sales and accelerating product development. Gross margins increased to over 58% for the third quarter of 2023. We raised gross proceeds of $4.7 million in July 2023 in the Direct Offering, and intend to utilize existing facilities and non-dilutive sources of liquidity to provide the resources needed to execute our strategic priorities.

During 2023, unprofitable sales territories were reviewed for remediation or elimination, resulting in consolidations that continued a trend that started in the spring of 2022.

Our Business and Products

We currently market and distribute the following products and related services: (1) Ova1Plus, a non-invasive blood test that combines two FDA-cleared tests for women with pelvic masses who are planned for surgery: Ova1, a highly sensitive multivariate index assay, and Overa, which demonstrates higher specificity and reduces false elevations by 40%; and (2) OvaWatch, a non-invasive lab developed blood test used to assess the risk of ovarian cancer for women with adnexal masses, evaluated by initial clinical assessment as likely benign or indeterminant with a negative predictive value of 99%. Collectively, these tests are referred to and marketed as OvaSuite.Revenue from these sources is included in total revenue in the results of operations for the three and nine months ended September 30, 2023 and 2022, respectively.

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Our products are distributed through our own payer coverage for OVA1, Multivariate Index Assay (MIA)national sales force, through our decentralized testing platform and cloud service, (“Aspira Synergy”), and our second-generation OVA1through a marketing and distribution agreement with BioReference Health, LLC.

Our Ova1 test trademarked Overa, Multivariate Index Assay, 2nd Generation (MIA2G). Overa has been launched on a targeted basis.  In the third phase, we plan to fully commercialize OVA1 and Overa by utilizing the full national licensure of ASPiRA LABS, select laboratories for distribution, managed care coverage in select markets, our sales force and existing customer base.  Unlike OVA1, Overa uses a global testing platform, which will allow Overa to be deployed internationally.  We initiated the targeted launch of Overa in October 2016 with two key accounts converting from OVA1 to Overa. In October 2015, we announced registration of the CE mark for and clearance to market Overa in the European Union.  We also plan to develop an LDT product series, which we refer to internally as OvaX.  We anticipate that OvaX will include not only biomarkers, but also clinical risk factors, other diagnostics and patient history data in order to boost predictive value. 

We are dedicated to the discovery, development and commercialization of novel high-value diagnostic and bio-analytical solutions that help physicians diagnose, treat and improve outcomes for women. Our tests are intended to detect, characterize and stage disease, and to help guide decisions regarding patient treatment, which may include decisions to refer patients to specialists, to perform additional testing, or to assist in monitoring response to therapy. A distinctive feature of our approach is to combine multiple biomarkers, other modalities and diagnostics, clinical risk factors and patient data into a single, reportable index score that has higher diagnostic accuracy than its constituents. We concentrate on our development of novel diagnostic tests for gynecologic disease, with an initial focus on ovarian cancer. We also intend to address clinical questions related to early disease detection, treatment response, monitoring of disease progression, prognosis and others through collaborations with leading academic and research institutions.

Our initial product, OVA1, is an FDA cleared blood test designed to, in addition to a physician’s clinical assessment of a woman with a pelvic mass, identify women who are at high risk of having a malignant ovarian

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tumor prior to planned surgery. We have launched on a targeted basis a second-generation biomarker panel known as Overa, which is intended to maintain our product’s high sensitivity while improving specificity. We received FDA de novo classification in September 2009. Ova1 comprises instruments, assays, reagents, and the OvaCalc software, which includes a proprietary algorithm that produces a risk score. Our Overa test, which includes an updated version of OvaCalc, received FDA 510(k) clearance for Overa in March 2016. Ova1, Overa usesand OvaWatch each use the Roche cobasCobas 4000, 6000 platform.  and 8000 platforms for analysis of proteins. Revenue from these sources is included in the results of operations in total revenue for the nine months ended September 30, 2023.

OvaWatch has been developed and is validated for use in Aspira’s CLIA-certified lab as a non-invasive blood-based risk assessment test for use in conjunction with clinical assessment and imaging to determine ovarian cancer risk for patients with an adnexal mass whose adnexal mass has been determined by an initial clinical assessment as indeterminate or benign. The commercialization plan for OvaWatch will occur in two phases. Phase I was completed in the fourth quarter of 2022 with the launch of OvaWatch, a single use risk assessment test. Phase II will allow for longitudinal testing and is targeted for the fourth quarter of 2023 following the expected publication of data from the ongoing prospective clinical study.

With the addition of OvaWatch to the OvaSuite portfolio, we now offer a comprehensive set of high performing non-invasive diagnostic technologies for the 1.2 to 1.5 million women per year who present with an adnexal pelvic mass. No other diagnostic tools exist for the assessment of malignancy risk in this patient population.

In June 2014, Vermillion2021, we began entering into decentralized arrangements with large healthcare networks and physician practices for our Aspira Synergy platform, our decentralized testing platform and cloud service for decentralized global access of protein biomarker testing. Ova1, Overa, and Ova1Plus continue to be available through the Aspira Synergy platform. We have entered into a technology transfer agreement with one of the nation’s largest and leading independent women’s healthcare groups which has launched ASPiRA LABS, a Clinical Laboratory Improvements Amendments of 1988 (“CLIA”) certified national laboratoryand is contributing to our Ova1Plus volume.

We own and operate Aspira Labs, based in Austin, Texas, a Clinical Chemistry and Endocrinology Laboratory accredited by the College of American Pathologists, which specializes in applying biomarker-based technologies to address critical needs in the management of gynecologic cancers and disease. ASPiRA LABSdiseases. Aspira Labs provides expert diagnostic services using a state-of-the-art biomarker-based diagnostic algorithmrisk assessment to aid in clinical decision making and to advance personalized treatment plans. The lab currently processesperforms our OVA1Ova1, Overa, Ova1Plus and OveraOvaWatch testing as well as additional tumour and hormone tests, and we plan to develop and perform LDTs at ASPiRA LABS inexpand the future. ASPiRA LABStesting to other gynecologic conditions with high unmet need. Aspira Labs holds a CLIA Certificate of RegistrationAccreditation and a state laboratory license in California, Florida, Maryland, New York, Pennsylvania and Rhode Island. The Centers for Medicare & Medicaid Services (“CMS”) issued a providersupplier number to ASPiRA LABSAspira Labs in March 2015.Aspira Labs also holds a current ISO 13485 certification which is the most accepted standard worldwide for medical devices.

In 2016, we created a new service within the ASPiRA channel strategy, “an ASPiRA IVD Services Program”. In April 2016, we formed ASPiRA IVD to offer IVD trial services toUnited States, revenue for diagnostic tests comes from several sources, including third-party customers. ASPiRA IVD is a specialized laboratory provider dedicated to meeting the unique testing needs of IVD manufacturers seeking to commercialize high-complexity assays. ASPiRA IVD was built around a core of laboratory expertisepayers such as insurance companies, government healthcare programs, such as Medicare and an FDA-compliant quality system,Medicaid, client bill accounts and strives to deliver accurate and reliable results to its third-party customers suitable for FDA submission.  ASPiRA IVD received  a CLIA laboratory license in June 2016 and commenced operations in the second quarter of 2016.

In this program, we also plan to leverage our existing infrastructure and enhance our pipeline of future technologies by fostering relationships with IVD companies who are developing new diagnostics including companion diagnostics platforms. We believe this plan will allow us to continue to be innovative in evaluating potential diagnostics. Our goal with the addition of this line of business is to invest in our short-term and long-term enterprise value while leveraging our specimen bank, database, FDA experience, laboratory informatics and operating efficiency.

Strategy:

We are focused on the execution of five core strategic business drivers in ovarian cancer diagnostics and specialized laboratory services to build long-term value for our investors:

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Maximizing the existing OVA1 opportunity in the United States by taking the lead in payer coverage and commercialization of OVA1. This strategy included the launch of a CLIA certified clinical laboratory, ASPiRA LABS, in June 2014;

·

Expanding the distribution platform beyond the U.S. by launching Overa, a next generation biomarker panel, while building the clinical utility and health economics foundation of both OVA1 and Overa, which we believe may allow for better domestic market penetration and international expansion (FDA clearance for Overa was received in March 2016);

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Leveraging our existing database and specimen bank while building the largest specimen and data repository of gynecologic pelvic mass patients worldwide;

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Expanding our product offerings to additional pelvic disease conditions such as endometriosis and polycystic ovarian syndrome by adding additional gynecologic bio-analytic solutions involving biomarkers, other modalities (e.g., imaging), clinical risk factors and patient data to aid diagnosis and risk stratification of women presenting with a pelvic mass disease; and

·

Expanding our customer offerings with the launch of our ASPiRA IVD laboratory services.

We believe that these business drivers will contribute significantly to addressing unmet medical needs for women faced with gynecologic disease and other conditions and the continued development of our business.

OVA1 addresses a clear clinical need, namely the pre-surgical identification of women who are at risk of having a malignant ovarian tumor. Numerous studies have documented the benefit of referral of these women to gynecologic oncologists for their initial surgery. Prior to the clearance of OVA1, no blood test had been cleared by

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the FDA for physicians to use in the pre-surgical management of ovarian adnexal masses. OVA1 is a qualitative serum test that utilizes five well-established biomarkers and proprietary software cleared as part of the OVA1 510(k) to determine the likelihood of malignancy in women over age 18, with a pelvic mass for whom surgery is planned. OVA1 should not be used without an independent clinical/radiological evaluation and is not intended to be a screening test or to determine whether a patient should proceed to surgery. Incorrect use of OVA1 carries the risk of unnecessary testing, surgery and delayed diagnosis.  OVA1 was developed through large pre-clinical studies in collaboration with numerous academic medical centers encompassing over 2,500 clinical samples. OVA1 was fully validated in a prospective multi-center clinical trial encompassing 27 sites reflective of the diverse nature of the clinical centers at which ovarian adnexal masses are evaluated.

patients. Novitas Solutions, thea Medicare contractor, covers and reimburses for OVA1.  ThisOva1 tests performed in certain states, including Texas. Due to Ova1 tests billed by the Company being performed exclusively at Aspira Labs in Texas, the local coverage determination from Novitas Solutions essentially provides national coverage for patients enrolled in Medicare as well as Medicare Advantage health plans. However, ASPiRA LABS initially experienced difficultyAspira Labs also bills third-party commercial and other government payers as well as client bill accounts and patients for Ova1.

In September 2023, CMS issued a preliminary approval of our request to cover OvaWatch using the same price assigned to Ova1 of $897. This preliminary approval was subject to a 30-day public comment period that ended on October 27, 2023, thereafter the final fee schedule for new laboratory tests will be published. If approved, this pricing will be effective in obtaining payment from Novitas Solutions for most claims submitted due to Novitas Solutions’ administrative requirements. In October 2016, Novitas Solutions updated its administrative requirements for OVA1 reimbursement which has improved our ability to obtain reimbursement for OVA1 from Novitas Solutions.2024.

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In October 2016, we launched our pelvic mass specimen and data repository and began the collection of Institutional Review Board patient consents for collection and cataloguing of serum samples for future research purposes.

In November 2016, Thethe American College of Obstetricians and Gynecologists ("(“ACOG”) issued Practice Bulletin Number 174 which included OVA1Ova1, defined as athe “Multivariate Index Assay”. This bulletin outlines ACOG's “new”Assay,” outlining ACOG’s clinical management guidelines for adnexal mass management.

These new clinical management guidelines replace the July 2007 version, Practice Bulletin 83. Number 174 recommends that obstetricians and gynecologists evaluating women with adnexal masses who do not meet Level A criteria of a low-risk transvaginal ultrasound should proceed with Level B clinical guidelines. Level B guidelines state that the physician may use risk-assessment tools such as existing CA-125 technology or Ova1 (“Multivariate Index Assay”) as listed in the bulletin. Based on this, Ova1 achieved parity with CA-125 as a Level B clinical recommendation for the management of adnexal masses.

Practice Bulletins summarize current information on techniques and clinical management issues for the practice of obstetrics and gynecology. Practice Bulletins are evidence-based documents, and recommendations are based on the evidence. This is also the only clinical management tool used for adnexal masses. GuidelinesAlthough there are Practice Bulletins, guidelines do not exist for adnexal masses, only Practice Bulletins. Guidelinesmasses. ACOG guidelines do exist, however, for ovarian cancer management.

Product Pipeline

We are well-positioned to introduce new gynecologic diagnostic products and we plan to expand our product offerings to additional women’s gynecologic health diseases by adding additional gynecologic bio-analytic solutions involving biomarkers, genetics, other modalities (e.g., imaging), clinical risk factors and patient data to aid diagnosis and risk stratification. Future product expansions will be accelerated by the development of lab developed testing in a CLIA environment, or relationships with strategic research and development partners, and access to specimens in our biobank.

About OvaWatch longitudinal testing: OvaWatch is a non-invasive blood-based risk-assessment test to determine ovarian cancer risk for patients with an adnexal mass that has been determined by an initial clinical assessment as indeterminate or benign. Indeterminate masses, which make up between 18% and 50% of the cases in practice, are those for which a provider is unable to assess the risk of malignancy based on an ultrasound and physical examination alone. With a 99% negative predictive value, OvaWatch is designed to support a physician’s planned clinical management when traditional methods are inadequate. In addition to supporting earlier identification of ovarian cancer, OvaWatch may reduce unnecessary or premature surgery and the related long-term health risks associated with surgical menopause.

The Practice Bulletin recommendstest was developed through a rigorous scientific and clinical-based process and validated in a CLIA environment utilizing large retrospective cohorts of over 3,000 patients and multi-site prospective clinical studies. OvaWatch technology was validated for this application in two separate prospective cohorts of women. The first cohort was patients with an identified pelvic mass and symptoms. The second cohort was women whose pelvic mass was found incidentally and are asymptomatic, and that obstetriciansare also not scheduled for surgery.

OvaWatch was designed for launch in two stages. Phase I, which was launched during the fourth quarter of 2022 is a single use point in time test, and gynecologists evaluatingPhase II will allow Aspira to market the test for longitudinal testing and is targeted for the fourth quarter of 2023 upon obtaining sufficient data from the ongoing prospective clinical study.

About EndoCheck: EndoCheck, an in-development non-invasive blood test to be used in conjunction with other non-surgical modalities, is designed as an aid in the identification of endometriosis to guide clinical care for patients with suspected endometriosis earlier in their prognosis journey. Current detection methods for endometriosis require surgery and a surgical biopsy diagnosis and/or visualization diagnosis. EndoCheck is intended to address this large patient population by using a non-invasive solution with comparable sensitivity and specificity when compared to invasive methods such as surgical biopsy and/or visualization.

On August 24, 2023, we entered into a Material Transfer Agreement with The University of Oxford, (“Oxford”) for the procurement of serum samples to be used to verify and validate our endometriosis blood test algorithms, at a price of GBP 400.00 per sample. We began receiving samples from Oxford on October 5, 2023 and

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expects to use the samples to support the launch of EndoCheck, our first-generation blood test to aid in the diagnosis of endometriosis. We intend to have a limited launch of EndoCheck with clinicians who have been involved in the development of the test in the fourth quarter of 2023.

We ultimately plan to commercialize OvaSuite and EndoCheck on a global scale and hold CE marks for Ova1 and Overa.

Recent Developments

Business Updates

On August 8, 2022, we entered into a sponsored research agreement with DFCI, BWH, and Medical University of Lodz for the generation of a multi-omic, non-invasive diagnostic aid to identify endometriosis based on circulating microRNAs and proteins. Under the terms of the agreement, payments of approximately $1,252,000 have or will become due from us to the counterparties upon the successful completion of deliverables as defined in the agreement in 2022 and 2023 as follows: 68% was paid in August 2022, 15% will become payable upon completion of certain deliverables which occurred in the second quarter of 2023, and 17% will become payable upon completion of certain deliverables estimated to occur in the fourth quarter of 2023. During the three and nine months ended September 30, 2023, approximately $17,000 and $64,000, respectively, has been recorded as research and development expense in the unaudited condensed consolidated statement of operations for the project. During the three and nine months ended September 30, 2023, approximately $852,000, was recorded as research and development expense in the unaudited condensed consolidated financial statement of operations for the project. From the inception of the agreement through September 30, 2023, research and development expenses in the cumulative amount of $931,000 have been recorded.

On March 20, 2023, we entered into a licensing agreement (“Dana-Faber, Brigham, Lodz License Agreement”) with DFCI, BWH, and Medical University of Lodz under which the Company will license certain of our intellectual property to be used in the Company’s OvaSuite product portfolio. Under the Dana-Faber, Brigham, Lodz License Agreement, the Company paid an initial license fee of $75,000 and then will pay a license maintenance fee of $50,000 on each anniversary of the date of the Dana-Faber, Brigham, Lodz License Agreement. The Dana-Faber, Brigham, Lodz License Agreement also requires non-refundable royalty payments of up to $1,350,000 based on certain regulatory approvals and commercialization milestones and further royalty payments based on the net sales of the Company’s products included under the Dana-Faber, Brigham, Lodz License Agreement. No milestones have been reached as of September 30, 2023.

We prepared an application for a Proprietary Laboratory Analyses (“PLA Code”) with the American Medical Association for OvaWatch to distinguish it from Ova1Plus with the expectation that Novitas and other payers will apply the Ova1Plus Centers for Medicare & Medicaid Services fee to OvaWatch, ensuring consistent coverage and pricing for both Ova products. In December 2022, we received the approval of PLA Code for OvaWatch from the American Medical Association. Since we began billing OvaWatch with the PLA Code on April 1, 2023, our reimbursement has been consistent with historical Ova1Plus experience, resulting in the OvaWatch average unit price (“AUP”) of $347.

On July 11, 2023, we received written notice from the Listing Qualifications Department of the Nasdaq Stock Market notifying us that, for the last 30 consecutive business days, our Market Value of Listed Securities was below the minimum of $35 million requirement for continued inclusion on The Nasdaq Capital Market pursuant to Nasdaq Listing Rule 5550(b)(2). On September 12, 2023, we were notified by Nasdaq that we had regained compliance. There is no assurance that the Company will otherwise maintain compliance with this or any of the other Nasdaq continued-listing requirements.

In August 2023, we received an insurance reimbursement check in the amount of $250,000 related to research samples lost in a power outage in the Trumbull, Connecticut office in January 2023.

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In August 2023, we received approximately $347,000 from the Internal Revenue Service for payroll tax refunds related to Employee Retention Tax Credits for 2020.

Effective September 15, 2023, Dr. Ryan Phan resigned as our Chief Scientific and Operating Officer. On September 7, 2023, we entered into a consulting agreement with Dr. Phan. Under this agreement, Dr. Phan will provide advice on clinical and scientific programs, as well as on regulatory requirements for clinical lab regulations. He will also continue to serve as our lab medical director through January 15, 2024. Under the consulting agreement, Dr. Phan will be entitled to receive $20,000 per month, prorated for partial months. He was replaced as Chief Scientific Officer by Dr. Jody Berry on September 18, 2023.

On October 13, 2023, the Audit Committee of the Board and our management determined that our previously issued financial statements in its Annual Report on Form 10-K for the year ended December 31, 2022, as well as the previously filed Quarterly Report on Form 10-Q for the quarterly period ended September 30, 2022 , should be restated and should no longer be relied upon due to an error in the accounting for certain warrants issued in August 2022 as part of our underwritten offering with William Blair & Company, LLC. We restated our financial statements for the year ended December 31, 2022 and the unaudited interim financial statements for the three and nine months ended September 30, 2022 to reflect the correction of the error on October 26, 2023.

Recent Publications

On January 6, 2023, we announced that a manuscript, “Validation of Deep Neural Network-based Algorithm Supporting Clinical Management of Adnexal Mass,” had been published in the peer-reviewed journal, Frontiers in Medicine. The paper presents findings from the multi-site clinical study of our new assay, OvaWatch, describing real-world evidence supporting the use of OvaWatch for the clinical management of adnexal masses.

For the 2023 American Society of Clinical Oncology (ASCO) Meeting, which took place on June 2-6, 2023, we published three abstracts online. These are (1) Multivariate index assay (MIA3G) to reduce preventive surgery for ovarian cancer, (2) Serial monitoring of ovarian cancer risk in women with adnexal mass, and (3) Multivariate index assay MIA3G vs other assessment tools for the ovarian cancer risk assessment of indeterminate masses. The interim data presented in these abstracts support the clinical utility of the newly released OvaWatchby demonstrating that OvaWatch may safely reduce premature surgeries in the managementt of adnexal masses. Reported interim data from a multi-center clinical study also indicate that OvaWatch may be utilized as a serial monitoring tool for women with adnexal masses who doare not meet Level A criteria ofcandidates for surgical intervention.

The OvaWatch longitudinal study manuscript is being submitted to a low risk transvaginal ultrasound should proceed with Level B clinical guidelines. Level B guidelines statescientific journal for peer-review prior to publication. The findings demonstrate that the physician may use risk assessment tools such as existing CA125 technology or OVA1 (“Multivariate Index Assay”) as listedOvaWatch could be an effective tool in the bulletin.  Based on this, OVA1 has now achieved parity with CA125 as a Level B recommendation for the management of adnexal masses.

In December 2016, we received an FDA Clarification Letter regarding OVA1 and Overa. This letter was in reference to the September 7, 2016 FDA Safety Communication advising women and their physicians against the uselongitudinal monitoring of ovarian cancer screening tests for asymptomatic women.risk among women with low or indeterminate risk pelvic masses. The utilization of OvaWatch might help to reduce surgical backlogs and unnecessary surgery.

In order to avoid any confusion, as well as to document the FDA position on OVA1 and Overa, Jeffrey Shuren, M.D., J.D., Director for the Center for Devices and Radiological Health at the FDA, sent a letter to Vermillion, dated December 21, 2016. In the letter, Dr. Shuren stated:

We agree that this safety communication does not apply to Vermillion’s FDA-cleared tests, OVA1 (MIA) and Overa (MIA2G), which are not screening tests for ovarian cancer.

FDA cleared OVA1 (MIA) and Overa (MIA2G) as aids to further assess the likelihood that malignancy is present when the physician’s independent clinical and radiological evaluation does not indicate malignancy. The intended uses of the two assays are the same—to help physicians more reliably identify which patients would benefit from consultation with or referral to a gynecologic oncologist. OVA1 (MIA) and Overa (MIA2G) are indicated for women who present with an adnexal mass.

In March 2015, we entered into a new commercial agreement with Quest Diagnostics.  Pursuant to this agreement, all OVA1 U.S. testing services for Quest Diagnostics customers were transferred to Vermillion’s wholly-owned subsidiary, ASPiRA LABS, as of August 10, 2015.  Pursuant to this agreement, as amended as of March 11, 2017, Quest Diagnostics has agreed to provide blood draw and logistics support by transporting specimens from its clients to ASPiRA LABS for testing through at least March 11, 2018 in exchange for a market value fee.   Per the

19


terms of this agreement, we will not offer to existing or future Quest Diagnostics customers CA 125-II or other tests that Quest Diagnostics offers.

In 2016, we continued to make progress with increased payer positive medical polices and in network agreements for a total of over 80 million covered lives.

In the first half of 2017, ASPiRA IVD services landed two top pharmaceutical trial service agreements including one enrollment study.

In July 2017 ASPiRA LABS expanded its patient advocacy program nationally to assist patients with proactive benefit checks, with over 90% resulting in OVA1 utilization.

In September 2017, the preliminary Protecting Access to Medicare Act of 2014 (PAMA) price for OVA1 and Overa was published by the Center for Medicare and Medicaid Service (CMS). The preliminary OVA1 rate is based on the median of private payer payments submitted by Vermillion as part of the market-based payment reforms mandated through PAMA. The Overa price was benchmarked to the only proteomic test currently on the fee schedule, which uses biomarkers and an algorithm to produce a prognostic score. The new rates, once finalized, are scheduled to become effective January 1, 2018.

In 2017, we continued to make progress with increased payer positive medical polices and in network agreements for a total of over 123 million covered lives, expected effective by February 2018.

Critical Accounting Policies and Estimates

There have been no material changes to ourthe Company’s critical accounting policiesestimates described in our Annual Report, as amended on Form 10-K/A, filed with the SEC on October 26, 2023.

Our product revenue is generated by performing diagnostic services using our OvaSuite tests, and the service is completed upon the delivery of the test result to the prescribing physician.The entire transaction price is allocated to the single performance obligation contained in a contract with a patient. Under ASC Topic 606, Revenue from Contracts with Customers, all revenue is recognized upon completion of the OvaSuite test and delivery of test results to the physician based on estimates from those disclosed in Item 7 of amounts that will ultimately be realized. In determining the amount of revenue to be recognized for a delivered test result, we consider factors such as payment history and amount, payer coverage, whether there is a reimbursement contract between the payer and us, and any developments or changes that could impact reimbursement. These estimates require significant judgment by management. For OvaSuite tests, we also review our 2016 Annual Report.patient account population and determine an appropriate

20

39


distribution of patient accounts by payer (i.e., Medicare, patient pay, other third-party payer, etc.) into portfolios with similar collection experience. When evaluated for collectability, this results in a materially consistent revenue amount for such portfolios as if each patient account were evaluated on an individual contract basis.


40


Results of Operations - Three Months Ended September 30, 20172023 Compared to Three Months Ended September 30, 20162022

The selected summary financial and operating data of the Company for the three months ended September 30, 20172023 and 2016 2022 were as follows:follows.

Three Months Ended

 

 

 

 

 

 

 

 

 

 

 

September 30,

 

Three Months Ended September 30,

 

Increase (Decrease)

2023

2022

Increase (Decrease)

(dollars in thousands)

 

2017

 

2016

 

Amount

 

%  

(as restated)

Amount

%

Revenue:

 

 

 

 

 

 

 

 

 

 

 

Product

 

$

657 

 

$

581 

 

$

76 

 

13 

$

2,217

$

2,037

$

180

9

Service

 

 

42 

 

 

42 

 

 

 -

 

 -

Genetics

-

35

(35)

-

Total revenue

 

 

699 

 

 

623 

 

 

76 

 

12 

2,217

2,072

145

7

Cost of revenue:

 

 

 

 

 

 

 

 

 

 

 

Product

 

 

495 

 

 

461 

 

 

34 

 

910

875

35

4

Service

 

 

284 

 

 

356 

 

 

(72)

 

(20)

Genetics

-

41

(41)

-

Total cost of revenue

 

 

779 

 

 

817 

 

 

(38)

 

(5)

910

916

(6)

(1)

Gross profit

 

 

(80)

 

 

(194)

 

 

114 

 

(59)

1,307

1,156

151

13

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

Research and development

 

 

192 

 

 

370 

 

 

(178)

 

(48)

998

2,157

(1,159)

(54)

Sales and marketing

 

 

1,050 

 

 

1,606 

 

 

(556)

 

(35)

1,702

3,950

(2,248)

(57)

General and administrative

 

 

1,177 

 

 

1,295 

 

 

(118)

 

(9)

2,723

3,629

(906)

(25)

Total operating expenses

 

 

2,419 

 

 

3,271 

 

 

(852)

 

(26)

5,423

9,736

(4,313)

(44)

Loss from operations

 

 

(2,499)

 

 

(3,465)

 

 

966 

 

(28)

(4,116)

(8,580)

4,464

(52)

Interest income (expense), net

 

 

(10)

 

 

(11)

 

 

 

(9)

Change in fair value of warrant liabilities

(1,201)

1,236

(2,437)

197

Interest income, net

12

18

(6)

33

Other income (expense), net

 

 

 -

 

 

 -

 

 

 -

 

 -

599

(457)

1,056

231

Net loss

 

 

(2,509)

 

 

(3,476)

 

 

967 

 

(28)

$

(4,706)

$

(7,783)

$

3,077

(40)

Product Revenue. Product revenue was $657,000$2,217,000 for the three months ended September 30, 20172023, compared to $581,000$2,037,000 for the same period in 2016.2022. Revenue for ASPiRA LABSAspira Labs is being recognized when the OVA1Ova1, Overa, Ova1Plus or OvaWatch test is being performed or when amounts that willcompleted based on estimates of what we expect to ultimately be realized can be estimated. All other ASPiRA LABS revenue is being recognized on a cash basis and thus recognition of revenue lags the performance of some OVA1 tests.realize. The 13%9% product revenue growthincrease is due to improvementan increase in OvaSuite test volume compared to the prior year and the addition of our OvaWatch product, as well as an increased revenue average unit price received per test compared to the same quarter(“AUP”), which increased from $369 in the prior year. The increasethird quarter of 2022 to $383 in average unit price was driven by an increasethe third quarter of 2023. We expect product pricing to be volatile during 2023, as we seek broad payer adoption of the OvaWatch test launched in client bill contracts, expansionthe fourth quarter of positive medical policy and contracting with payers, and improved billing and collection practices.2022.

The number of OVA1OvaSuite tests performed decreased 13%increased 4.7% to approximately 1,954 OVA1 tests5,783 during the three months ended September 30, 20172023, compared to approximately 2,257 OVA15,524 product tests for the same period in 2016. The volume decrease was primarily due to the previously announced loss2022. This increase is a result of a client bill customer in July 2017,  which was concentrated in uncovered territories (territories not covered by an ASPiRA sales representative) and, to a lesser extent, the impact of hurricanes in two key areas (Texas and Florida).  Partially affecting the volume decrease was modest year-over-year growth in covered territories (territories covered by an ASPiRA sales representative).We expect the test volume to improve in the fourth quarter relative to volume347 OvaWatch tests performed in the third quarter of 2017. 

Service Revenue.  Service revenue was $42,000 for the three months ended September 30, 2017 compared 2023, increased access to $42,000 for the same periodprovider offices following COVID-19 restrictions in 2016.  Service revenue will vary from quarter to quarter basedplace in 2022 and our focus on the size of ongoing customer projects. Revenue for ASPiRA IVD is being recognized once certain revenue recognition criteria has been met (see Note 1 to the financial statements included in Part I, Item I of this Form 10-Q).improving field sales efficiencies. We expect service revenue to continue to increase in the fourth quarter of 2017 relative to service revenue in the third quarter of 2017 due to the performance of certain anticipated projects.our investment in key salesforce hires and strategic product development.

21

41


Cost of Revenue - Product.  Cost of product revenue was $495,000The volume and AUP for the three months ended September 30, 20172023 and 2022 were as follows:

Three Months Ended

September 30,

2023

2022

Product Volume:

Ova1Plus

4,768

5,524

OvaWatch

1,015

-

Total OvaSuite

5,783

5,524

Average Unit Price (AUP):

Ova1Plus

$

391

$

369

OvaWatch

347

-

Total OvaSuite

$

383

$

369

Genetics Revenue.Genetics revenue was $0 for the three months ended September 30, 2023, compared to $461,000$35,000 for the same period in 2016, representing an increase2022. Revenue for Aspira GenetiX was recognized when the Aspira GenetiX test was completed based on estimates of 7% due primarilywhat we expect to some equipment maintenance costs and increased consultant fees incurred in the third quarter. We expect the costultimately realize. The Company discontinued offering genetics testing effective September 30, 2022.

Cost of Revenue – Product. Cost of product revenue to decrease modestly in the fourth quarter of 2017 compared to the third quarter of 2017 as one-time costs incurred in the third quarter of 2017 are not expected to be repeated.

Cost of Revenue - Service.    Cost of service revenue was $284,000$910,000 for the three months ended September 30, 20172023, compared to $356,000$875,000 for the same period in 2016. The 20% decrease related2022, representing an increase of $35,000, or 4%, due primarily to increased personnel and lab supply costs, resulting from the increase in tests performed compared to the prior year, as well as the launch of OvaWatch, offset by a decrease in shipping and software costs.

Cost of Revenue – Genetics.Cost of genetics revenue, which consisted primarily of personnel costs and consulting costsexpense related to the openinglaunch of Aspira GenetiX, was $0 for the lab in the third quarter of 2016, which were not repeated in 2017. We expect the cost of service revenue to increase in the fourth quarter of 2017three months ended September 30, 2023, compared to $41,000 for the third quarter of 2017 duesame period in 2022. The Company discontinued the genetics testing offering effective September 30, 2022.

Gross Profit Margin.  Gross profit margin for product revenue increased to expected variable costs relating58.7% for the three months ended September 30, 2023, compared to performance of certain projects.     55.8% for the same period in 2022.

Research and Development Expenses.Expenses.  Research and development expenses represent costs incurred to develop our technology and carry out clinical studies, and include personnel-related expenses, regulatory costs, reagents and supplies used in research and development laboratory work, infrastructure expenses, contract services and other outside costs. Research and development expenses for the three months ended September 30, 20172023 decreased $178,000,by $1,159,000, or 48%54%, compared to the same period in 2016.2022. This decrease was primarily due to a reductiondecreases in personnelcosts related to our collaboration with DFCI, BWH and Medical University of Lodz, which relates to our endometriosis product portfolio of $952,000, consulting costs of $141,000 and personnel related expenses.costs of $42,000. We expect research and development expenses to remain consistent with third quarter 2017 levels inincrease over the fourth quarter of 2017.2023, as a result of the addition of sites in our EndoCheck clinical study and anticipated milestones in our research collaboration agreements.

Sales and Marketing Expenses.Expenses.  Our sales and marketing expenses consist primarily of personnel-related expenses, education and promotional expenses, and infrastructure expenses. These expenses include the costs of educating physicians laboratory personnel and other healthcare professionals regarding OVA1 and Overa.our products. Sales and marketing expenses also include the costs of sponsoring continuing medical education, medical meeting participation, and dissemination of scientific and health economic publications. Sales and marketing expenses for the three months ended September 30, 20172023 decreased $556,000,by $2,248,000, or 35%57%, compared to the same period in 2016.2022. This decrease was primarily due to a reduction in consultingdecreased personnel costs of $1,634,000, travel costs of $336,000 and other marketing services and lower health economic study costs in the third quarter of 2017 compared to 2016.$170,000. We

42


expect sales and marketing expenses to modestly increase modestly over the remainderfourth quarter of 20172023 as we continue to focus efforts on the commercialization of OVA1 and Overa.OvaWatch.

General and Administrative Expenses.Expenses.  General and administrative expenses consist primarily of personnel-related expenses, professional fees and other costs, including legal, finance and accounting expenses and other infrastructure expenses. General and administrative expenses for the three months ended September 30, 20172023 decreased by $118,000,$906,000, or 9%25%, compared to the same period in 2016.  The2022. This decrease was primarily due to a reductiondecrease in consulting services.personnel expenses of $841,000 and outside legal costs of $129,000. We expect general and administrative expenses to remain consistent with third quarter 2017 levels inflat for the fourth quarter of 2017.2023.

Change in fair value of Warrant liabilities.  The change in the fair value of Warrant liabilities for the three months ended September 30, 2023 was a decrease of approximately $1,201,000, compared with an increase of $1,236,000 for the three months ended September 30, 2022. The change in fair value during the three months ended September 30, 2023 was primarily due to an increase in the Company’s stock price during the quarter.


22

43


Results of Operations - Nine Months Ended September 30, 20172023 Compared to Nine Months Ended September 30, 20162022

The selected summary financial and operating data of the Company for the nine months ended September 30, 20172023 and 2016 2022 were as follows:follows.

Nine Months Ended

September 30,

2023

2022

Increase (Decrease)

(dollars in thousands)

(as restated)

Amount

%

Revenue:

Product

$

7,023

$

5,890

$

1,133

19

Genetics

1

141

(140)

(99)

Total revenue

7,024

6,031

993

16

Cost of revenue:

Product

2,981

2,768

213

8

Genetics

-

180

(180)

-

Total cost of revenue

2,981

2,948

33

1

Gross profit

4,043

3,083

960

31

Operating expenses:

Research and development

2,958

4,915

(1,957)

(40)

Sales and marketing

6,069

12,027

(5,958)

(50)

General and administrative

9,733

12,188

(2,455)

(20)

Total operating expenses

18,760

29,130

(10,370)

(36)

Loss from operations

(14,717)

(26,047)

11,330

(43)

Change in fair value of warrant liabilities

(233)

1,236

(1,469)

(119)

Interest income (expense), net

46

(10)

56

(560)

Other income (expense), net

1,303

(473)

1,776

(375)

Net loss

$

(13,601)

$

(25,294)

$

11,693

(46)



 

 

 

 

 

 

 

 

 

 

 



 

Nine Months Ended September 30,

 

Increase (Decrease)

(dollars in thousands)

 

2017

 

2016

 

Amount

 

%  

Revenue:

 

 

 

 

 

 

 

 

 

 

 

Product

 

$

2,195 

 

$

1,640 

 

$

555 

 

34 

Service

 

 

128 

 

 

197 

 

 

(69)

 

(35)

Total revenue

 

 

2,323 

 

 

1,837 

 

 

486 

 

26 

Cost of revenue:

 

 

 

 

 

 

 

 

 

 

 

Product

 

 

1,345 

 

 

1,516 

 

 

(171)

 

(11)

Service

 

 

855 

 

 

416 

 

 

439 

 

106 

Total cost of revenue

 

 

2,200 

 

 

1,932 

 

 

268 

 

14 

Gross profit

 

 

123 

 

 

(95)

 

 

218 

 

(229)

Operating expenses:

 

 

 

 

 

 

 

 

 

 

 

Research and development

 

 

685 

 

 

1,868 

 

 

(1,183)

 

(63)

Sales and marketing

 

 

3,114 

 

 

5,514 

 

 

(2,400)

 

(44)

General and administrative

 

 

3,825 

 

 

4,645 

 

 

(820)

 

(18)

Total operating expenses

 

 

7,624 

 

 

12,027 

 

 

(4,403)

 

(37)

Loss from operations

 

 

(7,501)

 

 

(12,122)

 

 

4,621 

 

(38)

Interest income (expense), net

 

 

(32)

 

 

(16)

 

 

(16)

 

100 

Other income (expense), net

 

 

(9)

 

 

16 

 

 

(25)

 

(156)

Net loss

 

 

(7,542)

 

 

(12,122)

 

 

4,580 

 

(38)

Product Revenue. Product revenue was $2,195,000$7,023,000 for the nine months ended September 30, 2023, compared to $5,890,000 for the same period in 2022. Revenue for Aspira Labs is recognized when the Ova1, Overa, Ova1Plus or OvaWatch test is completed based on estimates of what we expect to ultimately realize. The 19% product revenue increase is due to an increase in OvaSuite test volume compared to the prior year and the addition of our OvaWatch product, as well as an increase in AUP, which increased to $383 for the nine months ended September 30, 20172023, compared to $1,640,000$373 for the same period in 2016.  Revenue for ASPiRA LABS is being recognized when the OVA1 test is being performed or when amounts that will ultimately be realized can be estimated. All other ASPiRA LABS revenue is being recognized on a cash basis and thus recognition of revenue lags the performance of some OVA1 tests. The $555,000, or 34%, product revenue growth is due to improvement in the average unit price received per test compared to the same period in the prior year. The increase in average unit price was driven by an increase in client bill contracts, expansion of positive medical policy and contracting with payers, and improved billing and collection practices.2022.

The number of OVA1OvaSuite tests performed decreased 3%increased 16% to approximately 6,665 OVA1 tests18,331 during the nine months ended September 30, 20172023, compared to approximately 6,867 OVA115,781 product tests for the same period in 2016.  2022. This increase is a result of 2,390 OvaWatch tests performed in 2023, increased access to provider offices following COVID-19 restrictions in place in 2022 and our focus on improving field sales efficiencies.

44


The volume decrease was primarily due to the previously announced loss of a client bill customer in July 2017,  which was concentrated in uncovered territories (territories not covered by an ASPiRA sales representative) and to a lesser extent, the impact of hurricanes in two key areas (Texas and Florida).

Service Revenue.  Service revenue was $128,000AUP for the nine months ended September 30, 20172023 and 2022 were as follows.

Nine Months Ended

September 30,

2023

2022

Product Volume:

Ova1Plus

15,941

15,781

OvaWatch

2,390

-

Total OvaSuite

18,331

15,781

Average Unit Price (AUP):

Ova1Plus

$

396

$

373

OvaWatch

295

-

Total OvaSuite

$

383

$

373

Genetics Revenue.Genetics revenue was $1,000 for the nine months ended September 30, 2023, compared to $197,000$141,000 for the same period in 2016, a decrease of $69,000, or 35%.  Service revenue will vary from quarter to quarter2022. Revenue for Aspira GenetiX was recognized when the Aspira GenetiX test was completed based on the sizeestimates of ongoing customer projects. Revenue for ASPiRA IVD is being recognized once certain revenue recognition criteria has been met (see Note 1what we expect to the financial statements included in Part I, Item I of this Form 10-Q). ultimately realize. The Company discontinued offering genetics testing effective September 30, 2022.

Cost of Revenue - Product.Cost of product revenue was $1,345,000$2,981,000 for the nine months ended September 30, 20172023, compared to $1,516,000$2,768,000 for the same period in 2016,2022, representing a decreasean increase of $171,000,$213,000, or 11%8%, due primarily to operating efficienciesincreased shipping, lab supply and blood draw costs resulting from the increase in tests performed compared to the prior year. year, as well as the launch of OvaWatch, partially offset by a decrease in software costs.

23


Cost of Revenue - Service.– Genetics.Cost of servicegenetics revenue, which consisted primarily of personnel costs and consulting expense related to the launch of Aspira GenetiX, was $855,000$0 for the nine months ended September 30, 20172023, compared to $416,000$180,000 for the same period in 2016.  ASPiRA IVD did not commence operations until June 2016 and thus included only four2022. The Company discontinued the genetics testing offering effective September 30, 2022.

Gross Profit Margin.  Gross profit margin for product revenue increased to 57.5% for the nine months of expenseended September 30, 2023, compared to three full quarters of expense51.1% for the same period in 2017.2022.

Research and Development Expenses.Expenses.  Research and development expenses represent costs incurred to develop our technology and carry out clinical studies, and include personnel-related expenses, regulatory costs, reagents and supplies used in research and development laboratory work, infrastructure expenses, contract services and other outside costs. Research and development expenses through March 2016 also included costs related to activities performed under contracts with our collaborators and strategic partners. Research and development expenses for the nine months ended September 30, 20172023 decreased $1,183,000,by $1,957,000, or 63%40%, compared to the same period in 2016.2022. This decrease was primarily due to the expiration ofdecreases in costs related to our collaboration agreement with The Johns HopkinsDFCI, BWH and Medical University School of Medicine in March 2016 as well as lower personnelLodz, which relates to our endometriosis product portfolio of $922,000, other consulting costs of $642,000, clinical trials and personnel related expenses due to the clearancesupplies of Overa in March 2016.$258,000 and collaboration costs of $96,000.

Sales and Marketing Expenses.Expenses.  Our sales and marketing expenses consist primarily of personnel-related expenses, education and promotional expenses, and infrastructure expenses. These expenses include the costs of educating physicians laboratory personnel and other healthcare professionals regarding OVA1 and Overa.our products. Sales and marketing expenses also include the costs of sponsoring continuing medical education, medical meeting participation, and dissemination of scientific and health economic publications. Sales and marketing expenses for the nine months ended September 30, 20172023 decreased $2,400,000,by $5,958,000, or 44%50%, compared to the same period in 2016.2022. This decrease was primarily due to a reductiondecreased personnel costs of $5,238,000, which included severance and other costs related to our sales force reorganization in personnel2022, and personnel expenses and decreases in consulting and marketing services compared to the prior year period.other travel costs of $487,000.

45


General and Administrative Expenses.Expenses.  General and administrative expenses consist primarily of personnel-related expenses, professional fees and other costs, including legal, finance and accounting expenses and other infrastructure expenses. General and administrative expenses for the nine months ended September 30, 20172023 decreased by $820,000,$2,455,000, or 18%20%, compared to the same period in 2016. The2022. This decrease was primarily due to a decrease in personnel expenses of $2,544,000 and outside legal costs of $397,000, partially offset by increased consulting fees of $349,000 and audit fees of $202,000.

Change in fair value of Warrant liabilities.   The change in the reductionfair value of consulting services and ASPiRA IVD start-up expensesWarrant liabilities for the nine months ended September 30, 2023 was a decrease of approximately $233,000, compared with an increase of $1,236,000 for the three months ended September 30, 2022. The change in 2016 not being repeatedfair value during the nine months ended September 30, 2023 was primarily due to an increase in 2017. the Company’s stock price during the period.

Liquidity and Capital Resources

We plan to continue to expend resources selling and marketing OVA1 and Overa, operating our IVD trial services businessOvaSuite and developing additional diagnostic tests and service capabilities.

We have incurred significant net losses and negative cash flows from operations since inception. At September 30, 2017, we hadinception, and as a result have an accumulated deficit of $393,098,000 and stockholders’ equityapproximately $515,214,000 as of $5,921,000. As of September 30, 2017, we had $7,752,000 of cash and cash equivalents and $2,229,000 of current liabilities. Working capital was $6,074,000 and $3,547,000 at September 30, 2017 and December 31, 2016, respectively.

In December 2014, the Company issued warrants to purchase up to an aggregate of 4,166,659 shares of Vermillion common stock at an exercise price of $2.00 per share in conjunction with a December 2014 private placement of Vermillion common stock.  The warrants expire by their original terms on December 23, 2017.

On August 31, 2017, certain holders exercised warrants to purchase 3,796,818 shares of Vermillion common stock in consideration for the Company agreeing to reduce the exercise price to $1.00 per share of Vermillion common stock.

The Company issued 3,796,818 shares of Vermillion common stock and received  $3,796,818 in aggregate gross proceeds (approximately $3,577,000 net of transaction costs).

On February 17, 2017, the Company completed a private placement pursuant to which certain investors purchased Vermillion common stock and warrants to purchase shares of Vermillion common stock for net proceeds of approximately $5,127,000 after deducting offering expenses.

In March 2016, we entered into an agreement (the “Loan Agreement”) pursuant to which we may borrow up to $4,000,000 from the DECD.2023. We received an initial disbursement of $2,000,000 in April 2016 under this

24


agreement. The remaining $2,000,000 will be disbursed if and when we achieve certain future milestones. Under the terms of the Loan Agreement, the Company may be eligible for forgiveness of up to $2,000,000 of the principal amount of the loan if the Company achieves certain job creation and retention milestones by March 1, 2018 (the “Measurement Date”). Conversely, if the Company is unable to meet these job creation milestones, namely, hiring 40 full-time employees with a specified average annual salary within the allotted timeframe and retaining those employees for a two-year period or does not maintain the Company’s Connecticut operations for a period of 10 years, the DECD may require early repayment of a portion or all of the loan plus a penalty of 5%. The Company is continuing to monitor progress towards achieving the employment milestone noted above. See also Note 3  to the financial statements included in Part I, Item I of this Form 10-Q for further information regarding the Loan Agreement.

We expect to incur a net loss and negative cash flows from operations infor the remainder of 2017 and2023. Working capital levels may not be sufficient to fund operations as currently planned through the foreseeable future.  Our management believes that successful achievement of our business objectives will requirenext twelve months, absent a significant increase in revenue over historic revenue or additional financing. Given thesethe above conditions, there is substantial doubt about our ability to continue as a going concern. The condensed consolidated financial statements have been prepared on a going concern basis and do not include any adjustments that might result from these uncertainties.

The Company expects

We expect to raise capital through a variety of sources whichthat may include public or private equity offerings, debt financings, the exercise of common stock warrants, equity offerings, debt financing, collaborations, licensing arrangements, grants and government funding and strategic alliances.alliances, as well as our existing at-the-market and equity line of credit facilities. However, additional funding may not be available when needed or on terms acceptable to the Company.us. If the Company iswe are unable to obtain additional capital, itwe may not be able to continue sales and marketing, research and development, or other operations on the scope or scale of current activity, and that could have a material adverse effect on the Company’sour business, results of operations and financial condition.

Net cash used

As discussed in operating activities was $5,977,000 forNote 4 to our unaudited condensed consolidated financial statements, in March 2016, we entered into a loan agreement (as amended on March 7, 2018 and April 3, 2020, the nine months ended September 30,  2017, resulting primarily“DECD Loan Agreement”) with the State of Connecticut Department of Economic and Community Development (the “DECD”), pursuant to which we may borrow up to $4,000,000 from the DECD.  

The loan may be prepaid at any time without premium or penalty. An initial disbursement of $2,000,000 was made to us on April 15, 2016 under the DECD Loan Agreement. On December 3, 2020, we received a disbursement of the remaining $2,000,000 under the DECD Loan Agreement, as we had achieved the target employment milestone necessary to receive an additional $1,000,000 under the DECD Loan Agreement and the DECD determined to fund the remaining $1,000,000 under the DECD Loan Agreement after concluding that the required revenue target would likely have been achieved in the first quarter of 2020 in the absence of the impacts of COVID-19.

Under the terms of the DECD Loan Agreement, we would be eligible for forgiveness of up to $1,500,000 of the principal amount of the loan if we had achieved certain job creation and retention milestones by December 31, 2022. On June 26, 2023, the Company was notified by the DECD that we had satisfied all job creation and retention requirements under the loan agreement to receive forgiveness of $1,000,000. If we fail to maintain our Connecticut operations through March 22, 2026, the DECD may require early repayment of a portion or all of the loan plus a penalty of 5% of the total funded loan. For additional information, see Note 4 to our unaudited condensed consolidated financial statements.

As discussed in Note 6 to our unaudited condensed consolidated financial statements, on August 22, 2022, the Company completed a public offering (the “2022 Offering”) resulting in net loss reportedproceeds of $7,542,000approximately $7,675,000, after deducting underwriting discounts and changes in accounts payable, accrued and other liabilities of $401,000, partially offset by stock compensation expense of $997,000, depreciation and amortization of $599,000 and changes in prepaidoffering expenses of $312,000.$1,325,000. 

46


Net cash used

As discussed in operating activities was $11,199,000 forNote 6 to our unaudited condensed consolidated financial statements, on July 24, 2023, the nine months ended September 30, 2016Company completed a direct offering (the “Direct Offering”) resulting primarily from thein net loss reportedproceeds of $12,122,000approximately $4,157,000, after deducting underwriting discounts and changes in accounts payable, accrued and other liabilities of $769,000, partially offset by stock compensation expense of $861,000, depreciation and amortization of $523,000 and changes in prepaidoffering expenses of $354,000.$559,000. 

Net cash used in investing activities was $56,000 and $1,240,000 for the nine months ended September 30, 2017 and 2016, respectively. The higher costs in 2016 resulted from purchases of property and equipment for the ASPiRA IVD laboratory.

Net cash provided by financing activities was $8,543,000 for the nine months ended September 30, 2017, which consisted primarily of proceeds from the sale of Vermillion common stock in our February 2017In connection with a private placement net of issuance costs, as well proceeds from the exerciseoffering of common stock and warrants we completed in May 2013, we entered into a stockholders agreement which, among other things, granted two of the primary investors in that offering the right to participate in any future equity offerings by the Company on the same price and terms as other investors. In addition, the stockholders agreement prohibits us from taking certain material actions without the consent of at least one of the two primary investors in that offering. These material actions include:

Making any acquisition with a value greater than $2 million;

Offering, selling or issuing any securities senior to Aspira’s common stock or any securities that are convertible into or exchangeable or exercisable for securities ranking senior to Aspira’s common stock;

Taking any action that would result in a change in control of the Company or an insolvency event; and

Paying or declaring dividends on any securities of the Company or distributing any assets of the Company other than in the ordinary course of business or repurchasing any outstanding securities of the Company.

The foregoing rights terminate for a primary investor when that investor ceases to beneficially own less than 50% of the shares and warrants (taking into account shares issued upon exercise of the warrants), in the aggregate, that were purchased at the closing of the 2013 private placement. We believe that the rights of one of the primary investors have so terminated.

As discussed in Note 6 to our unaudited condensed consolidated financial statements, on February 10, 2023, we entered into a Controlled Equity Offering Sales Agreement with Cantor, as agent, pursuant to which we may offer and sell, from time to time, through Cantor, shares of our common stock, par value $0.001 per share, having an aggregate offering price of up to $12.5 million. In connection with the Direct Offering on July 24, 2023, the Company delivered written notice to Cantor on July 19, 2023 that it was suspending the prospectus supplement, dated February 10, 2023, related to the Company’s common stock issuable under the Cantor Sales Agreement. The Company will not make any sales of common stock pursuant to the Cantor Sales Agreement unless and until a new prospectus supplement is filed with the SEC. The Cantor Sales Agreement remains in full force and effect during the suspension.

As discussed in Note 6 to our unaudited condensed consolidated financial statements, on March 28, 2023, we entered into an agreement with Lincoln Park, pursuant to which we have the right to sell to Lincoln Park shares of our common stock, having an aggregate value of up to $10 million, subject to certain limitations and conditions, at our sole discretion during a 36-month period ending March 27, 2026.

As discussed in Note 8 to our unaudited condensed consolidated financial statements, on October 30, 2023, we resumed selling shares under the LPC Purchase Agreement. As of November 9, 2023, the Company has sold 69,520 shares for aggregate gross proceeds of approximately $300,000 during the fourth quarter.

As mentioned, we have incurred significant net of issuance costs. 

Netlosses and negative cash provided by financing activities of $1,877,000 for the nine months endedflows from operations since inception, and we expect to continue to incur a net loss and negative cash flows from operations in 2023. At September 30, 2016 consisted primarily2023 we had an accumulated deficit of proceeds$515,214,000 and stockholders’ deficit of $659,000. As of September 30, 2023, we had $5,100,000 of cash and cash equivalents (excluding restricted cash of $256,000), $5,162,000 of current liabilities, and working capital of $2,410,000.There can be no assurance that we will achieve or sustain profitability or positive cash flow from the DECD loan.      operations. While we expect to grow revenue through Aspira Labs, there is no assurance of our ability to generate substantial revenues and cash flows from Aspira Labs’ operations. We expect revenue from our products to be our only material, recurring source of cash in 2023.

47


Our future liquidity and capital requirements will depend upon many factors, including, among others:   

·

resources devoted to sales, marketing and distribution capabilities;

·

the rate of OVA1 and Overa product adoption by physicians and patients;

·

the insurance payer community’s acceptance of and reimbursement for OVA1 and Overa;

·

the successful targeted launch of Overa;

·

resources devoted to our IVD trials laboratory and services;

25


resources devoted to sales, marketing and distribution capabilities;

·

the revenue generated by our IVD trial services business;

·

the rate of OvaSuite product adoption by physicians and patients;

the rate of product adoption by healthcare systems and large physician practices of the decentralized distribution agreements for OvaSuite;

the insurance payer community’s acceptance of and reimbursement for our products;

our plans to acquire or invest in other products, technologies and businesses; and

the potential need to add study sites to access additional patients to maintain clinical timelines.

Net cash used in other products, technologies and businesses; and

·

the market price of our common stock.

We have significant net operating loss (“NOL”) carryforwards as ofactivities was $12,444,000 for the nine months ended September 30, 20172023, resulting primarily from the net loss reported of $13,601,000, which includes non-cash expenses in the amount of $1,011,000 related to changes in prepaid expense, $1,302,000 related to stock compensation expense, $258,000 related to commitment shares for the equity line, $233,000 related to the change in fair value of warrant liabilities and $162,000 related to depreciation and amortization, offset by the DECD loan forgiveness of $1,000,000, changes in accounts payable, accrued liabilities and other liabilities of $474,000 and changes in accounts receivable of $345,000.

Net cash used in operating activities was $23,992,000 for the nine months ended September 30, 2022, resulting primarily from the net loss reported of $25,294,000, which includes non-cash items in the amount of, $1,994,000 related to stock compensation expense, changes in prepaid expense and other assets of $694,000, $574,000 in other expenses representing transaction costs allocated to the issuance of warrants and $195,000 related to depreciation and amortization, offset by $1,236,000 relating to a change in warrant fair value (see Note 2 to the unaudited condensed consolidated financial statements), changes in accounts payable, accrued liabilities and other liabilities of $653,000, changes in accounts receivable of $174,000 and changes in inventory of $106,000.

Net cash used in investing activities was $12,000 and $158,000 for the nine months ended September 30, 2023 and 2022, respectively, which consisted of property and equipment purchases.

Net cash provided by financing activities was $4,25,000 for the nine months ended September 30, 2023, stemming primarily from a registered direct offering resulting in net proceeds of $4,157,000, after deducting placement agent costs and other expenses of $559,000, an at the market offering resulting in net proceeds of $68,000, after deducting transaction-related offering costs of $134,000, and an equity line of credit offering of $178,000, partially offset by principal payments on the DECD loan of $148,000. Net cash provided by financing activities was $7,521,000 for the nine months ended September 30, 2022,stemming primarily from the 2022 Offering, resulting in net proceeds of $7,704,000, after deducting allocated underwriting discounts and offering expenses of $1,296,000, in addition to principal payments on the DECD loan.

Based on the available objective evidence, we believe it is more likely than not that net deferred tax assets will not be fully realizable. Accordingly, we have provided a full valuation allowance has been providedagainst the Company’s net deferred tax assets. This was also the case at the beginning of the period; therefore, there was no deferred income tax expense or benefit for the period.

Legislation commonly referred to as the Tax Cuts and Jobs Act was enacted in December 2017. As a result of the Tax Cuts and Jobs Act of 2017, federal net operating losses (“NOLs”) arising before January 1, 2018, and federal NOLs arising after January 1, 2018, are subject to different rules. The Company’s pre-2018 federal NOLs will expire in varying amounts from 2023 through 2037, if not utilized; and can offset 100% of future taxable income for regular tax purposes. Any federal NOLs arising after January 1, 2018, can generally be carried forward indefinitely and can offset up to 80% of future taxable income. State NOLs will expire in varying amounts from 2023 through 2042 if not utilized. Our ability to use our NOLs during this period will be dependent on our ability to generate taxable income, and NOLs could expire or remain unutilized if the Company does not generate sufficient taxable income to use them.

48


Our ability to use the Company’s net operating loss and credit carryforwards to offset future taxable income is restricted due to our history of operating losses.ownership change limitations that have occurred in the past, as required by Section 382 of the Internal Revenue Code of 1986, as amended (“Section 382”), as well as similar state provisions may restrict our ability to use our NOL credit carryforwards due to ownership change limitations occurring in the past or that could occur in the future. These ownership changes may also limit the amount of NOL credit carryforwards that can be utilized annually to offsetprovisions. Net operating losses which are limited from offsetting any future taxable income andunder Section 382 are not included in the gross deferred tax respectively.

Off-Balance Sheet Arrangements

Asassets. Due to the existence of September 30, 2017, we had no off-balance sheet arrangementsa valuation allowance, it is not expected that are reasonably likely tosuch limitations, if any, will have a current or future material effectan impact on our condensed consolidated financial condition, results of operations liquidity, capital expenditures or capital resources.financial position.

ITEM 3.

QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Our unrecognized tax benefits attributable to research and development credits will increase during the period for tax positions taken during the year and will decrease for expiration of a portion of the carryforwards during the period. 

ITEM 3.    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Per Item 305(e) of Regulation S-K, the information called for by this Item 3 is not required.

ITEM 4.

CONTROLS AND PROCEDURES

ITEM 4.    CONTROLS AND PROCEDURES

Evaluation of disclosure controls and procedures.procedures

Our senior management is responsible for establishing and maintaining a system of disclosure controls and procedures (as defined in Rule 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the “Exchange Act”)) designed to ensure that information required to be disclosed by us in the reports that we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by an issuer in the reports that it files or submits under the Exchange Act is accumulated and communicated to the issuer’s management, including its principal executive officer and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure. Management, including our Chief Executive Officer and Chief AccountingFinancial Officer, performed an evaluation of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act) as of September 30, 2017.2023. Based on this evaluation, our Chief Executive Officer and Chief AccountingFinancial Officer have concluded that as of September 30, 2017,2023, our disclosure controls and procedures were not effective. This was due to four material weaknesses in the internal control over financial reporting that were identified as of December 31, 2022 and disclosed in our Annual Report, as amended on 2022 Form 10-K/A related to multiple deficiencies and a lack of timely operation of certain internal controls over financial reporting and disclosure that continue to exist as of September 30, 2023.

Material Weaknesses

We are responsible for establishing and maintaining adequate internal control over our financial reporting, as such term is defined in Exchange Act Rules 13a-15(f) and 15d-15(f). Our management has assessed the effectiveness of internal control over financial reporting as of December 31, 2022. Our assessment was based on criteria set forth by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”) titled “Internal Control – Integrated Framework (2013).”

Our internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with GAAP. Our internal control over financial reporting includes those policies and procedures that:

(i)pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect our transactions and dispositions of our assets;

(ii)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 board of directors; and

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

49


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.

We did not design general information technology controls, including user access, program change-management and data processing controls, nor did we adequately assess the controls of service organizations related to certain information technology systems that are used to process and record certain revenue and expense transactions and support the Company’s financial reporting processes or over data and reports accumulated in such information technology systems. Additionally, certain internal controls over financial reporting that ensure the completeness and accuracy of the consolidated financial statements were not performed timely in connection with the year-end close and reporting process. These weaknesses in our internal controls have resulted in material weaknesses in our internal control over financial reporting as of September 30, 2023. A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of our annual or interim financial statements will not be prevented or detected on a timely basis.

These material weaknesses contributed to an additional material weakness. Specifically, that we did not design controls to address risks related to the identification of and accounting for certain significant, non-routine or complex transactions, including warrant valuation. This material weakness resulted in adjustments primarily related to the valuation of warrants issued pursuant to an Underwriting Agreement in August 2022 and the subsequent revaluation of those warrants. The material weakness resulted in the restatement of the previously issued consolidated financial statements for the year ended December 31, 2022, and of the previously issued unaudited condensed consolidated financial statements for the three and nine months ended September 30, 2022 financial statements as disclosed in our 2022 Form 10-K/A and that continue to exist as of September 30, 2023.

Subsequent to the original evaluation, another material weakness was identified with respect to the design and implementation of our control activities over our revenue process. We did not adequately design controls to validate the delivery of the lab results to ordering physicians to ensure that revenue is being appropriately recognized.

Remediation Activities

In order to address the material weaknesses in internal control over financial reporting described above, management is performing, with direction from the audit committee, the following remediation activities:

Retain an internal controls specialist to complement the skills of the existing accounting and financial reporting staff, as well as implement key controls to improve business processes, including revenue and the IT environment.

Complete a preliminary process to identify all information technology applications that support the Company’s financial reporting processes and assess the risk of misstatement associated with each.

Perform a comprehensive review of the design and performance of internal controls related to information technology applications, including user access and program change controls.

Enhance controls that require the assessment of service organization controls prior to implementation and on an annual basis.

Implement additional consultation requirements for new contracts that involve information technology applications to ensure internal controls are designed and implemented at the time of integration.

Enhance procedures designed to annually review of the materiality of transactions that are processed by applications implemented in prior years to identify programs that have become material subsequent to their initial implementation.

Review timelines within our documented disclosure controls and procedures and adjust dates accordingly.

Retain additional accounting and financial reporting resources during the year-end close to improve our ability to perform our disclosure controls and procedures on a timely basis, particularly for certain significant, non-routine or complex transactions, including warrant valuation.

50


Provide additional training and continuing education to accounting staff regarding SEC requirements and required disclosures under generally accepted accounting principles.

Enhance the design of and implement controls around the rigor of the review process, and retention of sufficient appropriate evidence over the revenue process.

Management will continue to review and make necessary changes to the overall design of our internal control environment, as well as policies and procedures to improve the overall effectiveness of internal control over financial reporting. The material weaknesses will not be considered remediated, however, until the applicable controls operate for a sufficient period of time and management has concluded, through testing, that these controls are operating effectively.

Changes in internal controls over financial reporting.reporting

There

Other than the steps to remediate the weaknesses discussed above, there was no change in our internal control over financial reporting that occurred during the period covered by this Quarterly Report on Form 10-Qended September 30, 2023 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.


26

51


PART II - OTHER INFORMATION

ITEM 1.

LEGAL PROCEEDINGS

ITEM 1.    LEGAL PROCEEDINGS

In the ordinary course of business, we may periodically become subject to legal proceedings and claims arising in connection with ongoing business activities. The results of litigation and claims cannot be predicted with certainty, and unfavorable resolutions are possible and could materially and adversely affect our results of operations, cash flows and financial position. In addition, regardless of the outcome, litigation could have an adverse impact on us because of defense costs, diversion of management resources and other factors. While the outcome of these proceedings and claims cannot be predicted with certainty, there are no matters, as of September 30, 2017,2023, that, in the opinion of management, will have a material adverse effect on our financial position, results of operations or cash flows.

ITEM 1A.    RISK FACTORS

ThereExcept as set forth below, there have been no material changes to our risk factors from those disclosed under “Risk Factors” in Part I, Item 1A of our 2016 Annual Report andon Form 10-K for the year ended December 31, 2022, filed with the SEC on March 30, 2023 (the “2022 Annual Report”), as supplemented by the risk factors disclosed under “Risk Factors” in Part II,I, Item 1A of our 2017 First Quarterly Report.Annual Report on Form 10-K/A for the year ended December 31, 2022, filed with the SEC on October 26, 2023 (the “2022 Form 10-K/A”). The risks and uncertainties described in our 20162022 Annual Report and 2017 First Quarterly Report are not the only ones we face. Additional risks and uncertainties not presently known to us or that we currently deem immaterial may also materially adversely affect our business, financial condition or results of operations. We may disclose changes to such factors or disclose additional factors from time to time in our future filings with the SEC.

OvaWatch is an LDT and we are currently developing multiple additional tests as LDTs, and intend to develop and perform LDTs at Aspira Labs in the future. Should FDA disagree that our tests are LDTs or finalize regulations that require PMA approval or 510(k)clearance of such tests, their commercialization would be adversely affected, which would negatively affect our results of operations and financial condition.

The FDA considers an LDT to be a test that is designed, developed, validated, and used within a single laboratory. The FDA has historically taken the position that it has the authority to regulate LDTs as medical devices under the FDC Act, but it has generally exercised enforcement discretion with regard to LDTs. This means that even though the FDA believes it can impose regulatory requirements on LDTs, such as requirements to obtain premarket approval, de novo classification or 510(k) clearance of LDTs, it has generally chosen not to enforce those requirements. On October 3, 2023 FDA issued proposed regulations under which it would phase out its enforcement discretion approach to LDTs over a period of four years. Although the proposed regulation is subject to a period of notice and comment, if finalized as proposed, we would be required to obtain PMA approval, de novo classification or 510(k) clearance for certain of our LDTs by October 1, 2027. Any future rulemaking, guidance, or other oversight of LDTs and clinical laboratories that develop and perform them, if and when finalized, may affect the sales of our products and how customers use our products, and may require us to change our business model in order to maintain compliance with these laws.

Legislative proposals addressing the FDA’s oversight of LDTs have been previously introduced, and we expect that new legislative proposals will be introduced from time to time. The likelihood that Congress will pass such legislation and the extent to which such legislation may affect the FDA’s plans to regulate LDTs as medical devices, by either giving FDA explicit authority to do so or, alternatively, stating that FDA does not have authority to regulate LDTs, is difficult to predict. In June 2021, Congress introduced legislation called the Verifying Accurate, Leading-edge IVCT Development Act (the “VALID Act”), which would have established a new risk-based regulatory framework for in vitro clinical tests (“IVCTs”), a category which would have included IVDs, LDTs, collection devices and instruments used with such tests. This legislation was not enacted during that session of Congress, but could be introduced again in the future. If FDA premarket clearance, de novo classification or approval is required for any of the tests we are developing or may develop in the future as LDTs,

27

52


we may be forced to stop selling our tests or be required to modify claims or make such other changes while we work to obtain FDA clearance, approval or de novo classification. Our business, results of operations and financial condition would be negatively affected until such review were completed and clearance, approval or de novo classification to market were obtained. If premarket clearance, approval, or de novo classification is required by the FDA or if we decide to voluntarily pursue FDA premarket clearance, approval or de novo classification of our LDTs, there can be no assurance that any tests we develop will be cleared, approved or classified on a timely basis, if at all. Obtaining FDA clearance, approval or de novo classification for diagnostics can be expensive, time consuming and uncertain, and for higher-risk devices generally takes several years and requires detailed and comprehensive scientific and clinical data. In addition, medical devices are subject to ongoing FDA obligations and continued regulatory oversight and review. Ongoing compliance with FDA regulations for those tests would increase the cost of conducting our business and subject us to heightened regulation by the FDA and penalties for failure to comply with these requirements.

Failure to continue coverage of Ova1 through Novitas, the Company’s Medicare Administrative Carrier for Ova1, could materially and adversely affect our business, financial condition and results of operations.

Since 2013, Ova1 has been listed as a covered service in the Biomarkers for Oncology Local Coverage Determination (the “Biomarkers for Oncology LCD”) issued by Novitas, a Medicare Administrative Carrier. In June of 2023, in conjunction with the publication of a final “Genetic Testing for Oncology” LCD (the “Genetic Testing LCD”), Novitas announced that it intended to retire the Biomarkers for Oncology LCD effective July 17, 2023, and that at that time, non-genetic tests currently identified as covered in that LCDs (like Ova1) would be considered for payment based on Medicare medically reasonable and necessary threshold for coverage. 

On July 6, 2023, Novitas issued a statement announcing that the Genetic Testing LCD would not go into effect on July 17, 2023 as planned, and that a new proposed LCD would be published for public comment. Novitas has issued a replacement proposed LCD for public comment on July 27, 2023. The Biomarkers for Oncology LCD remains in effect.

All OvaSuite tests (Ova1, Overa, Ova1Plus and OvaWatch) are protein-based multivariate index assays and were not impacted by the now-withdrawn Genetic Testing LCD. While we do not believe Novitas intends to eliminate Ova1 coverage, it is impossible to assess the likelihood or potential impact, if any, of future actions to be taken by Novitas with respect to the release of a replacement Genetics Testing LCD, or a change to the content or status of the Biomarkers for Oncology LCD, on the coverage and related revenue of Ova1, and such impact may be material to our business, results of operations and financial condition. We are monitoring developments closely and believe additional due process would be required if the activities contemplated by Novitas change the coverage determination for Ova1.

Failure to secure Medicare coverage for OvaWatch could materially and adversely affect our business, financial condition and results of operations.

In August of 2022, we submitted a request to CMS to provide pricing for OvaWatch that is consistent with Ova1Plus, commonly referred to as a crosswalk request. As of the date of this filing, this request has not been approved. While we can make no assurances that CMS will approve our pricing request. Since April 1, 2023, we have billed Medicare for OvaWatch tests performed using a unique Proprietary Laboratory Analyses Code, (the “PLA Code”), assigned by the American Medical Association and have generally received payment for $897 from Novitas, an amount equal to reimbursement for Ova1Plus.

ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES, USE OF PROCEEDS AND ISSUER PURCHASES OF EQUITY SECURITIES.

None.

ITEM 3. DEFAULTS UPON SENIOR SECURITIES.

None.

53


ITEM 4. MINE SAFETY DISCLOSURES.

Not applicable.

ITEM 5. OTHER INFORMATION

None.


54


ITEM 6.    EXHIBITS

(a) The following exhibits are filed or incorporated by reference with this report as indicated below:



 

 

 

 

 

 

 

 

 

 

 

 

Exhibit

 

 

 

Incorporated by Reference

 

Filed

Number

 

Exhibit Description

 

Form

 

File No.

 

Exhibit

 

Filing Date

 

Herewith



 

 

 

 

 

 

 

 

 

 

 

 

3.1

 

Fourth Amended and Restated Certificate of Incorporation of Vermillion, Inc. dated January 22, 2010

 

8-K

 

000-31617

 

3.1 

 

January 25, 2010

 

 

3.2

 

Certificate of Amendment of Fourth Amended and Restated Certificate of Incorporation, effective June 19, 2014

 

10-Q

 

001-34810

 

3.2 

 

August 14, 2014

 

 

3.3

 

Fifth Amended and Restated Bylaws of Vermillion, Inc., effective June 19, 2014

 

 

 

 

10-Q

 

001-34810

 

3.3 

 

August 14, 2014

 

 

4.1

 

Form of Letter Agreement, by and between Vermillion, Inc. and certain warrant holders

 

8-K

 

001-34810

 

4.1

 

August 28, 2017

 

 

31.1

 

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

 

 

 

 

 

 

 

 

 

 √ 

31.2

 

Certification of the Chief Accounting Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

 

 

 

 

 

 

 

 

 

 √

32.1

 

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

 

 

 

 

 

 

 

 

 

(1)

101

 

Interactive Data Files

 

 

 

 

 

 

 

 

 

 

Incorporated by Reference

Exhibit

Filing

Filed

Number

Exhibit Description

Form

File No.

Exhibit

Date

Herewith

3.1

Fourth Amended and Restated Certificate of Incorporation of Vermillion, Inc. dated January 22, 2010

8-K

000-31617

3.1

January 25, 2010

3.2

Certificate of Amendment of Fourth Amended and Restated Certificate of Incorporation, effective June 19, 2014

10-Q

001-34810

3.2

August 14, 2014

3.3

Certificate of Amendment to Fourth Amended and Restated Certificate of Incorporation of Vermillion, Inc. dated June 11, 2020

8-K

001-34810

3.1

June 11, 2020

3.4

Certificate of Amendment to the Fourth Amended and Restated Certificate of Incorporation, as amended February 6, 2023

8-K

001-34810

3.1

February 7, 2023

3.5

Certificate of Designations, Preferences and Rights of Series B Convertible Preferred Stock

8-K

001-34810

4.1

April 17, 2018

3.6

Amended and Restated Bylaws of Aspira Women's Health Inc., effective February 23, 2022

8-K

001-34810

3.1

February 28, 2022

3.7

Certificate of Amendment to the Fourth Amended and Restated Certificate of Incorporation, as amended May 11, 2023

8-K

001-34810

3.1

May 11, 2023

10.1*

Amended Consulting Agreement between Aspira Women’s Health Inc. and NuPath, LLC

8-K

001-34810

10.1

September 12, 2023

31.1

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

31.2

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

32.1**

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

√√

101.INS

Inline XBRL Instance Document - (the instant document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document).

55


101.SCH

Inline XBRL Taxonomy Extension Schema Document

(1)101.CAL

Furnished herewith

Inline XBRL Taxonomy Extension Calculation Linkbase Document

101.DEF

Inline XBRL Taxonomy Extension Definition Linkbase Document

101.LAB

Inline XBRL Taxonomy Extension Labels Linkbase Document

101.PRE

Inline XBRL Taxonomy Extension Presentation Linkbase Document

104

Cover Page Interactive Data File (embedded within the Inline XBRL document)

Filed herewith

√√

Furnished herewith

*

Management contract or compensation plan or arrangement.

**

The certification attached as Exhibit 32.1 that accompany this Quarterly Report on Form 10-Q, is not deemed filed with the Securities and Exchange Commission and is not to be incorporated by reference into any filing of the Company under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended (whether made before or after the date of this Form 10-Q), irrespective of any general incorporation language contained in such filing.


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SIGNATURES

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

Vermillion,Aspira Women’s Health Inc.

Date: November 8, 201713, 2023

/s/ Valerie B. PalmieriNicole Sandford

Valerie B. PalmieriNicole Sandford

President and Chief Executive Officer

(Principal Executive Officer) and Director

Date: November 8, 201713, 2023

/s/ Eric J. SchoenTorsten Hombeck

Eric J. SchoenTorsten Hombeck

Senior Vice President, Finance and Chief AccountingFinancial Officer

(Principal Financial Officer and Principal Accounting Officer)

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