Cytosorbents (CTSO) 10-K 9 Mar 23 2022 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2022	Mar. 07, 2023
Document and Entity Information
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Document Transition Report	false
Entity File Number	001-36792
Entity Registrant Name	CYTOSORBENTS CORPORATION
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	98-0373793
Entity Address, Address Line One	305 College Road East
Entity Address, City or Town	Princeton
Entity Address, State or Province	NJ
Entity Address, Postal Zip Code	08540
City Area Code	732
Local Phone Number	329-8885
Title of 12(b) Security	Common Stock, $0.001 par value
Trading Symbol	CTSO
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float	$ 61,461,000
Entity Common Stock, Shares Outstanding		43,663,009
Entity Central Index Key	0001175151
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Amendment Flag	false
Auditor Name	WithumSmith+Brown, PC
Auditor Firm ID	100
Auditor Location	East Brunswick, New Jersey

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Current Assets:
Cash and cash equivalents	$ 22,144,567	$ 52,137,707
Grants and accounts receivable, net of allowance for doubtful accounts of $76,041 and $60,539 at December 31, 2022 and 2021, respectively	5,664,941	4,523,430
Inventories	3,461,586	4,766,098
Prepaid expenses and other current assets	2,488,597	2,871,655
Total current assets	33,759,691	64,298,890
Property and equipment - net	10,743,032	5,150,886
Restricted cash	1,687,459	1,687,459
Right-of-use asset	12,603,901	13,423,472
Other assets	4,437,447	4,958,575
Total Assets	63,231,530	89,519,282
Current Liabilities:
Accounts payable	1,655,173	2,805,235
Accrued expenses and other current liabilities	7,950,440	10,314,341
Lease liability - current portion	108,939	570,566
Total current liabilities	9,714,552	13,690,142
Lease liability, net of current portion	13,142,005	13,250,943
Long-term debt	5,000,000
Total Liabilities	27,856,557	26,941,085
Commitments and Contingencies
Stockholders' Equity:
Preferred Stock, Par Value $0.001, 5,000,000 shares authorized; no shares issued and outstanding at December 31, 2022 and 2021
Common Stock, Par Value $0.001, 100,000,000 shares authorized; 43,635,715 and 43,478,487 shares issued and outstanding at December 31, 2022 and 2021, respectively	43,635	43,478
Additional paid-in capital	287,000,021	283,194,429
Accumulated other comprehensive income	2,329,195	525,585
Accumulated deficit	(253,997,878)	(221,185,295)
Total stockholders' equity	35,374,973	62,578,197
Total Liabilities and Stockholders' Equity	$ 63,231,530	$ 89,519,282

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
CONSOLIDATED BALANCE SHEETS
Grants and accounts receivable, net of allowance for doubtful accounts	$ 76,041	$ 60,539
Preferred Stock, Par Value	$ 0.001	$ 0.001
Preferred Stock, shares authorized	5,000,000	5,000,000
Preferred Stock, shares issued	0	0
Preferred Stock, shares outstanding	0	0
Common Stock, Par Value	$ 0.001	$ 0.001
Common Stock, shares authorized	100,000,000	100,000,000
Common Stock, shares issued	43,478,487	43,635,715
Common Stock, shares outstanding	43,478,487	43,635,715

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenue:
Total revenue	$ 34,688,809	$ 43,165,527	$ 41,004,601
Cost of revenue	13,955,752	11,047,350	11,052,409
Gross profit	20,733,057	32,118,177	29,952,192
Operating expenses:
Research and development	15,118,907	16,380,930	8,810,561
Legal, financial and other consulting	2,847,899	2,731,515	3,048,242
Selling, general and administrative	34,288,130	35,750,477	28,463,723
Total operating expenses	52,254,936	54,862,922	40,322,526
Loss from operations	(31,521,879)	(22,744,745)	(10,370,334)
Other income (expense):
Interest (expense), net	132,597	28,007	(1,201,067)
Gain (loss) on foreign currency transactions	(2,448,583)	(2,577,913)	2,607,139
Miscellaneous expense	(67,303)
Total other income (expense), net	(2,383,289)	(2,549,906)	1,406,072
Loss before benefit from income taxes	(33,905,168)	(25,294,651)	(8,964,262)
Benefit from income taxes	1,092,585	736,003	1,127,074
Net loss attributable to common stockholders	$ (32,812,583)	$ (24,558,648)	$ (7,837,188)
Basic net loss per common share	$ (0.75)	$ (0.57)	$ (0.20)
Diluted net loss per common share	$ (0.75)	$ (0.57)	$ (0.20)
Weighted average number of shares of common stock outstanding, basic	43,573,215	43,359,186	38,818,990
Weighted average number of shares of common stock outstanding, diluted	43,573,215	43,359,186	38,818,990
Comprehensive loss:
Net loss	$ (32,812,583)	$ (24,558,648)	$ (7,837,188)
Other comprehensive income (loss):
Foreign currency translation adjustment	1,803,610	2,259,663	(2,260,056)
Comprehensive loss	(31,008,973)	(22,298,985)	(10,097,244)
Total product sales
Revenue:
Total revenue	29,359,910	40,108,567	39,452,502
CytoSorb sales
Revenue:
Total revenue	28,572,709	39,996,700	39,342,102
Other sales
Revenue:
Total revenue	787,201	111,867	110,400
Grant income
Revenue:
Total revenue	$ 5,328,899	$ 3,056,960	$ 1,552,099

CONSOLIDATED STATEMENTS OF CHAN

CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY - USD ($)	Common Stock	Paid-In Capital	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit	Total
Balance at Dec. 31, 2019	$ 32,616	$ 191,648,907	$ 525,978	$ (188,789,459)	$ 3,418,042
Balance (in shares) at Dec. 31, 2019	32,616,107
Stock-based compensation - employees, consultants and directors		3,513,671			3,513,671
Issuance of common stock - offerings, net of fees incurred	$ 10,162	80,203,846			80,214,008
Issuance of common stock - offerings, net of fees incurred (in shares)	10,163,256
Issuance of restricted stock options	$ 88	657,692			657,780
Issuance of restricted stock options (in shares)	87,728
Proceeds from exercise of stock options	$ 342	1,508,980			1,509,322
Proceeds from exercise of stock options (in shares)	341,507
Cashless exercise of stock options	$ 14	(14)
Cashless exercise of stock options (in shares)	13,401
Other comprehensive income (loss), foreign currency translation adjustment			(2,260,056)		(2,260,056)
Net loss				(7,837,188)	(7,837,188)
Balance at Dec. 31, 2020	$ 43,222	277,533,082	(1,734,078)	(196,626,647)	79,215,579
Balance (in shares) at Dec. 31, 2020	43,221,999
Stock-based compensation - employees, consultants and directors		4,020,819			4,020,819
Issuance of common stock - offerings, net of fees incurred		(90,000)			(90,000)
Issuance of restricted stock options	$ 107	928,310			928,417
Issuance of restricted stock options (in shares)	106,662
Proceeds from exercise of stock options	$ 139	805,060			805,199
Proceeds from exercise of stock options (in shares)	139,102
Cashless exercise of stock options	$ 10	(2,842)			(2,832)
Cashless exercise of stock options (in shares)	10,724
Other comprehensive income (loss), foreign currency translation adjustment			2,259,663		2,259,663
Net loss				(24,558,648)	(24,558,648)
Balance at Dec. 31, 2021	$ 43,478	283,194,429	525,585	(221,185,295)	62,578,197
Balance (in shares) at Dec. 31, 2021	43,478,487
Stock-based compensation - employees, consultants and directors		3,423,517			3,423,517
Legal/audit fees related to ATM offering		(40,358)			(40,358)
Issuance of restricted stock options	$ 145	379,946			380,091
Issuance of restricted stock options (in shares)	144,728
Other comprehensive income (loss), foreign currency translation adjustment			1,803,610		1,803,610
Stock issued to vendor in lieu of cash payment	$ 12	42,487			42,499
Stock issued to vendor in lieu of cash payment (in shares)	12,500
Net loss				(32,812,583)	(32,812,583)
Balance at Dec. 31, 2022	$ 43,635	$ 287,000,021	$ 2,329,195	$ (253,997,878)	$ 35,374,973
Balance (in shares) at Dec. 31, 2022	43,635,715

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net loss	$ (32,812,583)	$ (24,558,648)	$ (7,837,188)
Adjustments to reconcile net loss to net cash used in operating activities:
Non-cash compensation	376,574	2,183,317	1,193,949
Depreciation and amortization	882,621	731,578	660,788
Amortization of right-of-use asset	249,008	398,035
Bad debt expense (recovery)	(8,354)	(512)	(102,310)
Loss on disposal of fixed assets	132,303
Impairment of patents	635,606
Foreign currency transaction (gains) losses	2,448,583	2,577,913	(2,607,139)
Stock-based compensation	3,423,517	4,020,819	3,513,671
Amortization of loan acquisition costs			322,812
Changes in operating assets and liabilities:
Grants and accounts receivable	(1,288,422)	420,578	(326,860)
Inventories	945,352	(2,350,547)	(461,512)
Prepaid expenses and other current assets	(22,187)	280,915	(1,076,849)
Other assets	52,678	(135,857)
Accounts payable and accrued expenses	(3,248,978)	2,426,810	1,107,352
Net cash used in operating activities	(28,234,282)	(14,005,599)	(5,613,286)
Cash flows from investing activities:
Purchases of property and equipment	(6,087,365)	(3,641,248)	(708,395)
Patent costs	(368,211)	(640,013)	(967,823)
Net cash used in investing activities	(6,455,576)	(4,281,261)	(1,676,218)
Cash flows from financing activities:
Proceeds from long-term debt	5,000,000		1,410,900
Repayment of long-term debt			(16,410,900)
Final fee on long-term debt			(375,000)
Equity contributions - net of fees incurred	(40,358)	(90,000)	80,214,008
Proceeds from exercise of stock options		805,199	1,509,322
Net cash provided by financing activities	4,959,642	715,199	66,348,330
Effect of exchange rates on cash	(262,924)	(24,774)	130,357
Net change in cash, cash equivalents and restricted cash	(29,993,140)	(17,596,435)	59,189,183
Cash, cash equivalents and restricted cash at beginning of year	53,825,166	71,421,601	12,232,418
Cash, cash equivalents and restricted cash at end of year	23,832,026	53,825,166	71,421,601
Supplemental disclosure of cash flow information:
Cash paid during the year for interest			1,127,647
Supplemental disclosure of non-cash financing activities:
Issuance of common stock to vendor in lieu of cash payment	42,499
Capital expenditures included in accounts payable	359,965
Settlement of accrued bonuses with restricted stock units	$ 380,091	$ 928,417	$ 657,780

BASIS OF PRESENTATION

BASIS OF PRESENTATION	12 Months Ended
	Dec. 31, 2022
BASIS OF PRESENTATION
BASIS OF PRESENTATION	1. BASIS OF PRESENTATION: The accompanying consolidated financial statements include the results of CytoSorbents Corporation (the “Parent”), CytoSorbents Medical Inc., its wholly owned operating subsidiary (the “Subsidiary”), and CytoSorbents Europe GmbH, its wholly owned European subsidiary (the “European Subsidiary”). In addition, the consolidated financial statements include CytoSorbents Switzerland GmbH, CytoSorbents Poland Sp. z.o.o., CytoSorbents Medical UK Limited, and CytoSorbents France SAS, the wholly owned subsidiaries of CytoSorbents Europe GmbH, and CytoSorbents UK Limited, a wholly owned subsidiary of CytoSorbents Medical, Inc. These entities are collectively referred to as the “Company”. In years prior to December 31, 2020, the Company’s consolidated financial statements were prepared on a going concern basis, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. As of December 31, 2022, the Company’s cash, cash equivalents and restricted cash balances were approximately $23.8 million, which the Company expects will fund the Company’s operations beyond twelve months from the issuance of these consolidated financial statements. As a result, the Company has determined that the going concern risk has been substantially mitigated.

PRINCIPAL BUSINESS ACTIVITY AND

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	12 Months Ended
	Dec. 31, 2022
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	2. PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: Nature of Business The Company is a leader in the treatment of life-threatening conditions in intensive care and cardiac surgery using blood purification. The Company, through its subsidiary CytoSorbents Medical, Inc. (formerly known as CytoSorbents, Inc.), is engaged in the research, development and commercialization of medical devices with its blood purification technology platform which incorporates a proprietary adsorbent, porous polymer technology. The Company, through its wholly owned European subsidiary, CytoSorbents Europe GmbH, conducts sales and marketing related operations for the CytoSorb device. In March 2016, the Company formed CytoSorbents Switzerland GmbH, a wholly owned subsidiary of CytoSorbents Europe GmbH. This subsidiary, which began operations during the second quarter of 2016, provides marketing and direct sales services in Switzerland. In November 2018, the Company formed CytoSorbents Poland Sp. z.o.o., a wholly owned subsidiary of CytoSorbents Europe GmbH. This subsidiary, which began operations during the first quarter of 2019, provides marketing and direct sales services in Poland. In the third quarter of 2019, the Company formed CytoSorbents UK Limited, a wholly owned subsidiary of CytoSorbents Medical, Inc., which is responsible for the management of the Company’s clinical trial activities in the United Kingdom. In March 2022, the Company formed CytoSorbents Medical UK Limited to provide marketing and direct sales services in the United Kingdom and the Republic of Ireland. In October 2022, the Company formed CytoSorbents France SAS to provide marketing and direct sales services in France. CytoSorb, the Company’s flagship product, was approved in the European Union (“EU”) in March 2011 and is currently being marketed and distributed in more than 75 countries around the world, as an effective extracorporeal cytokine absorber, designed to reduce the “cytokine storm” or “cytokine release syndrome” seen in critical illnesses that may result in massive inflammation, organ failure, and patient death. In May 2018, the Company received a label extension for CytoSorb covering use of the device for the removal of bilirubin and myoglobin which allows for the use of the device in the treatment of liver failure and trauma, respectively. CytoSorb is also being used during and after cardiac surgery to remove inflammatory mediators that can lead to post-operative complications, including multiple organ failure. In January 2020, CytoSorb received EU CE Mark label expansion to include the removal of ticagrelor during cardiopulmonary bypass in patients undergoing cardiothoracic surgery. In May 2020, CytoSorb also received EU CE Mark label expansion to include rivaroxaban removal for the same indication. In April 2020, CytoSorb received United States Food and Drug Administration (“FDA”) Emergency Use Authorization (“EUA”) of CytoSorb for use in adult critically-ill COVID-19 patients with imminent or confirmed respiratory failure. The CytoSorb device has neither been cleared nor approved for the indication to treat patients with COVID-19 infection. The EUA will be effective until a declaration is made that the circumstances justifying the EUA have terminated or until revoked by the FDA. In April 2020, the Company also announced that the FDA had granted Breakthrough Designation for its DrugSorb-ATR Antithrombotic Removal System for the removal of ticagrelor in a cardiopulmonary bypass circuit during emergent and urgent cardiothoracic surgery. The Breakthrough Devices Program provides for more effective treatment of life-threatening or irreversibly debilitating disease or conditions, in this case the need to reverse the effects of ticagrelor in emergent or urgent cardiac surgery that can otherwise cause a high risk of serious or life-threatening bleeding. Through Breakthrough Designation, the FDA intends to work with CytoSorbents to expedite the development, assessment, and regulatory review of CytoSorbents’ technology for the removal of ticagrelor, while maintaining statutory standards of regulatory approval (e.g., 510(k), de novo In August 2021, the Company announced that it was granted a second Breakthrough Device designation for its DrugSorb-ATR Antithrombotic Removal System by the FDA. This Breakthrough Device designation covers the removal of the Direct Oral Anticoagulants (DOACs) apixaban and rivaroxaban in a cardiopulmonary bypass circuit to reduce the likelihood of serious perioperative bleeding during urgent cardiothoracic surgery. In October 2021, the Company also received full FDA approval of an IDE application to conduct a double-blind, randomized, controlled clinical study for up to 120 patients entitled, “Safe and Timely Antithrombotic Removal – Direct Oral Anticoagulants (STAR-D),” in the United States to support FDA marketing approval. If FDA marketing approval is obtained for either the removal of ticagrelor or direct oral anticoagulants indications, the device would be marketed as DrugSorb-ATR in the United States. The DrugSorb-ATR Antithrombotic Removal System is based on the same polymer technology as CytoSorb. In May 2022, the Company announced that the Company entered into a 3-year preferred supplier agreement with Asklepios, making CytoSorb available without restrictions to all of the approximate 170 healthcare facilities across 14 states throughout Germany at which Asklepios operates. This includes Asklepios Klinik St. Georg in Hamburg, Germany, which pioneered the use of CytoSorb to remove antithrombotic drugs during cardiothoracic surgery, and is well-known for their seminal publication on CytoSorb use for this application during emergency cardiac surgery in patients at high risk of bleeding. In June 2022, the Company announced that, following a successful pilot program in three countries, the Company signed an expanded non-exclusive agreement with Nikkiso Europe GmbH (“Nikkiso”) to distribute Nikkiso’s PureADJUST stand-alone hemoperfusion pump and accessories in a total of 14 countries. In addition to securing the rights to sell Nikkiso’s stand-alone pump and accessories in Germany, Austria, and Luxembourg, the Company entered into an expanded multi-country reseller agreement with Nikkiso covering the following countries: Belgium, Bosnia and Herzegovina, Croatia, Finland, France, Iceland, Lichtenstein, Poland, Serbia, Slovenia and Switzerland. The Company will also be able to provide field support services in these countries. In August 2022, the Company entered into a Marketing Agreement (the “Marketing Agreement”) with Fresenius Medical Care Deutschland GmbH (“Fresenius”), which expands the Company’s strategic partnership with Fresenius by establishing a multi-stage global collaboration to combat life-threatening diseases in critical care. The Marketing Agreement provides for the combined marketing and promotion of CytoSorb with Fresenius’ critical care products by Fresenius’ marketing organization worldwide, excluding the United States. The Marketing Agreement has an initial term of three years, with an automatic renewal for an additional two years at the end of such initial term, subject to earlier termination by either of the parties (the “Term”). Compared to the prior co-marketing agreement between the parties, the Marketing Agreement intends to increase the commitments from both parties and to ensure an ongoing and consistent level of marketing and promotional activity specifically focused around CytoSorb, where Fresenius will actively market and promote CytoSorb as the featured blood purification therapy for removal of cytokines, bilirubin, and myoglobin on its critical care platforms. Specifically, the Marketing Agreement provides that various Fresenius-led in-person, virtual, social media, and web-based marketing programs and events will feature the CytoSorb therapy and highlight the cooperation between the two companies in the field of critical care during the Term. To help support the increased marketing and promotional efforts of the expanded collaboration, CytoSorbents has agreed to subsidize a portion of the marketing costs through a royalty payment to Fresenius Medical Care based on CytoSorb sales in the intensive care unit on Fresenius Medical Care platforms, excluding the United States. In addition to strengthening and expanding the global marketing of CytoSorb, the Company and Fresenius also plan to work together to bring new innovative solutions to the market. The Marketing Agreement also includes the certification of compatibility of CytoSorb for usage on Fresenius’ current critical care platforms. Certain initial activities have been completed with the formal launch of this program expected to occur sometime in 2023. The technology is based upon biocompatible, highly porous polymer sorbent beads that can actively remove toxic substances from blood and other bodily fluids by pore capture and surface adsorption. The Company has numerous products under development based upon this unique blood purification technology, which is protected by 18 issued U.S. patents and multiple international patents, with applications pending both in the U.S. and internationally, including HemoDefend, ContrastSorb, DrugSorb, DrugSorb-ATR and others. These patents and patent applications are directed to various compositions and methods of use related to the Company’s blood purification technologies and are expected to expire between 2023 and 2038, absent any patent term extensions. Management believes that any near-term expiring patents will not have a significant impact on the Company’s ongoing business. Stock Market Listing On December 17, 2014 the Company’s common stock was approved for listing on The Nasdaq Capital Market (“Nasdaq”), and it began trading on Nasdaq on December 23, 2014 under the symbol “CTSO”. Previously, the Company’s common stock traded in the over-the-counter-market on the OTC Bulletin Board. Basis of Consolidation and Foreign Currency Translation The consolidated financial statements include the accounts of CytoSorbents Corporation and its wholly owned subsidiaries, CytoSorbents Medical, Inc. and CytoSorbents Europe GmbH. In addition, the consolidated financial statements include CytoSorbents Switzerland GmbH, CytoSorbents Poland Sp. z.o.o., CytoSorbents Medical UK Limited and CytoSorbents France SAS, wholly owned subsidiaries of CytoSorbents Europe GmbH, and CytoSorbents UK Limited, a wholly owned subsidiary of CytoSorbents Medical, Inc. All significant intercompany transactions and balances have been eliminated in consolidation. Translation gains and losses resulting from the process of remeasuring into the United States of America dollar, the foreign currency financial statements of the European subsidiary, for which the United States of America dollar is the functional currency, are included in operations. Foreign currency transaction gain (loss) included in net loss amounted to approximately $(2,448,000), $(2,578,000) and $2,607,000 for the years ended December 31, 2022, 2021 and 2020, respectively. The Company translates assets and liabilities of the European subsidiary, whose functional currency is their local currency, at the exchange rate in effect at the balance sheet date. The Company translates revenue and expenses at the daily average exchange rates. The Company includes accumulated net translation adjustments in accumulated other comprehensive income (loss) as a component of stockholders’ equity. ​ Cash and Cash Equivalents The Company considers all highly liquid instruments purchased with an original maturity of three months or less to be cash equivalents. The following table provides a reconciliation of cash and cash equivalents and restricted cash and cash equivalents to amounts shown in the consolidated balance sheets and consolidated statements of cash flows: ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, ​ ​ ​ 2022 ​ 2021 Cash and cash equivalents ​ $ 22,144,567 ​ $ 52,137,707 Restricted cash ​ 1,687,459 ​ 1,687,459 Total cash, cash equivalents and restricted cash ​ $ 23,832,026 ​ $ 53,825,166 ​ Restricted Cash The Company’s total restricted cash in the amount of $1,687,459 consists of cash of $1,467,459 that the Company is obligated to maintain as collateral for the outstanding letter of credit with Bridge Bank that was provided to the landlord of the College Road facility as security and cash of $220,000 that the Company is obligated to maintain as collateral for the credit limit on the Company’s credit card account. Grants and Accounts Receivable Grants receivable represent amounts due from U.S. government agencies and are included in grants and accounts Receivable in the accompanying consolidated balance sheets. Accounts receivable are unsecured, non-interest-bearing customer obligations due under normal trade terms. The Company sells its devices to various hospitals and distributors. The Company performs ongoing credit evaluations of customers’ financial condition. Management reviews accounts receivable periodically to determine collectability. Balances that are determined to be uncollectible are reserved in the allowance for doubtful accounts. Inventories Inventories are valued at the lower of cost or net realizable value. Cost is determined using a first-in first-out (“FIFO”) basis. At December 31, 2022 and 2021, the Company’s inventory was comprised of finished goods, which amounted to $1,567,871 and $3,084,606, respectively, work in process which amounted to $1,280,368 and $1,322,736, respectively, and raw materials which amounted to $613,347 and $358,756, respectively. Devices used in clinical trials or for research and development purposes are removed from inventory and charged to research and development expenses at the time of their use. In September 2022, the Company experienced an equipment failure of a refrigeration unit at its new College Road manufacturing facility. This equipment stored various items of work-in-process inventory. The Company determined all the items that were stored in this unit were required to be scrapped. The value of this inventory was approximately $599,000. Accordingly, this inventory was written off and was included in cost of goods sold at the time of the loss in September 2022. The Company filed a claim with its insurance carrier related to this loss. In December 2022, the claim was approved in the amount of approximately $299,000 and, accordingly, has been recorded as a reduction to cost of goods sold in the accompanying consolidated statement of operations and comprehensive loss. Property and Equipment Property and equipment are recorded at cost less accumulated depreciation. Depreciation of property and equipment is provided for by the straight-line method over the estimated useful lives of the related assets. Leasehold improvements are amortized over the lesser of their economic useful lives or the term of the related leases. Gains and losses on depreciable assets retired or sold are recognized in the statements of operations in the year of disposal. Repairs and maintenance expenditures are expensed as incurred. Patents Legal costs incurred to establish patents are capitalized. When patents are issued, capitalized costs are amortized on the straight-line method over the related patent term. In the event a patent is abandoned, the net book value of the patent is written off. Impairment or Disposal of Long-Lived Assets The Company assesses the impairment of patents and other long-lived assets under accounting standards for the impairment or disposal of long-lived assets whenever events or changes in circumstances indicate that the carrying value may not be recoverable. For long-lived assets to be held and used, the Company recognizes an impairment loss only if its carrying amount is not recoverable through its undiscounted cash flows and measures the impairment loss based on the difference between the carrying amount and fair value. During the year ended December 31, 2022, the Company wrote-off patent costs of approximately $636,000 related to the impairment of certain issued patents and pending patent applications in certain specific jurisdictions, the abandonment of certain patent defense costs that are no longer being pursued and the abandonment of certain pending patent application costs in the ordinary course of business. Revenue Recognition Product Sales: Grant Revenue: Research and Development All research and development costs, payments to laboratories, research consultants and costs related to clinical trials and studies are expensed when incurred. Advertising Expenses Advertising costs are charged to activities when incurred. Advertising expense amounted to approximately $582,000, $615,000 and $285,000 in 2022, 2021 and 2020, respectively, and is included in selling, general, and administrative expenses in the consolidated statements of operations and comprehensive loss. Income Taxes Income taxes are accounted for under the asset and liability method prescribed by accounting standards for accounting for income taxes. Deferred income taxes are recorded for temporary differences between financial statement carrying amounts and the tax basis of assets and liabilities. Deferred tax assets and liabilities reflect the tax rates expected to be in effect for the years in which the differences are expected to reverse. A valuation allowance is provided if it is more likely than not that some or all of the deferred tax asset will not be realized. Under Section 382 of the Internal Revenue Code, the net operating losses generated prior to the previously completed reverse merger may be limited due to the change in ownership. Additionally, net operating losses generated subsequent to the reverse merger may be limited in the event of changes in ownership. In 2017, the Tax Cuts and Jobs Act reduced the U.S. federal corporate tax rate from 35% to 21%. See Note 9 for the impact of the tax rate change on deferred tax assets and liabilities. The Company follows the accounting standards associated with uncertain tax provisions. The Company had no unrecognized tax benefits as of December 31, 2022 or 2021. The Company files tax returns in the U.S. federal and state jurisdictions. The Company utilizes the Technology Business Tax Certificate Transfer Program to sell a portion of its New Jersey Net Operating Loss tax carryforwards and Research and Development credits to an industrial company. CytoSorbents Europe GmbH, CytoSorbents Switzerland GmbH, CytoSorbents Poland Sp. z.o.o., CytoSorbents UK Limited, CytoSorbents Medical UK Limited and CytoSorbents France file an annual corporate tax return, a VAT return and a trade tax return in Germany, Switzerland, Poland, France and the United Kingdom, respectively. Use of Estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets, liabilities at the date of the balance sheet, and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from these estimates. The valuation of options granted, allowance for doubtful accounts and recoverability of patents are significant estimates in these consolidated financial statements. Concentration of Credit Risk The Company maintains cash balances, at times, with financial institutions in excess of amounts insured by the Federal Deposit Insurance Corporation. Management monitors the soundness of these institutions in an effort to minimize its collection risk of these balances. A significant portion of the Company’s revenues are from product sales in Germany. Substantially all of the Company’s grant and other income are from grant agencies in the United States. (See Note 3 for further information relating to the Company’s revenue.) As of December 31, 2022, two distributors accounted for approximately 27% of outstanding grants and accounts receivables. As of December 31, 2021, one distributor accounted for approximately 12% of outstanding grants and accounts receivables. For the years ended December 31, 2022, 2021 and 2020, no agency, distributor/strategic partners or direct customer represented more than 10% of the Company’s total revenue. Financial Instruments The carrying values of cash and cash equivalents, accounts receivable, accounts payable and accrued expenses and other current liabilities approximate their fair values due to their short-term nature. Net Loss per Common Share Basic net loss per share is computed by dividing loss attributable to common stockholders by the weighted average number of common shares outstanding during the period. Diluted net loss per common share is computed using the treasury stock method on the basis of the weighted-average number of shares of common stock plus the dilutive effect of potential common shares outstanding during the period. Dilutive potential common shares include outstanding warrants, stock options and restricted shares. The computation of diluted net loss per share does not assume conversion, exercise or contingent exercise of securities that would have an anti-dilutive effect on earnings (see Note 12). Stock-Based Compensation The Company accounts for its stock-based compensation under the recognition requirements of accounting standards for accounting for stock-based compensation for employees and directors whereby each option granted is valued at fair market value on the date of grant. Under these accounting standards, the fair value of each option is estimated on the date of grant using the Black-Scholes option pricing model. The Company also follows the guidance of accounting standards for accounting for equity instruments that are issued to non-employees for acquiring, or in conjunction with selling, goods or services for equity instruments issued to consultants. Shipping and Handling Costs The cost of shipping product to customers and distributors is typically borne by the customer or distributor. The Company records shipping and handling costs in cost of revenue. Total freight costs amounted to approximately $297,000, $276,000 and $560,000 for the years ended December 31, 2022, 2021 and 2020, respectively. Effect of Recent Accounting Pronouncements In November 2021, the Financial Accounting Standards Board (the “FASB”), issued Accounting Standards Update No. 2021-10 entitled, “Government Assistance (Topic 832) Disclosures by Business Entities about Government Assistance” (the “ASU”). This ASU will require enhanced disclosures related to the Company’s contracts with the U.S. government. The ASU is effective for annual periods beginning after December 15, 2021. The Company implemented the provisions of this ASU during 2022. In June 2016, the FASB, issued ASU No. 2016-13 entitled, “Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments”. This ASU provides guidance on the calculation of credit losses, which includes the allowance for doubtful accounts on trade accounts receivable. The updated guidance is effective for public entities for fiscal years beginning after December 15, 2022. The Company is evaluating the impact of the updated guidance but does not believe that this will have a significant impact on its financial statements.

REVENUE

REVENUE	12 Months Ended
	Dec. 31, 2022
REVENUE
REVENUE	3. REVENUE: The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2022: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 787,201 ​ $ 181,750 ​ $ — ​ $ 968,951 Germany ​ 12,566,437 ​ ​ — ​ ​ — ​ ​ 12,566,437 All other countries ​ 4,705,580 ​ ​ 11,118,942 ​ ​ — ​ ​ 15,824,522 Total product revenue ​ 18,059,218 ​ ​ 11,300,692 ​ ​ — ​ ​ 29,359,910 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ ​ — ​ ​ 5,328,899 ​ ​ 5,328,899 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 18,059,218 ​ $ 11,300,692 ​ $ 5,328,899 ​ $ 34,688,809 ​ The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2021: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 189,167 ​ $ 1,500,700 ​ $ — ​ $ 1,689,867 Germany ​ 21,006,432 ​ ​ — ​ ​ — ​ ​ 21,006,432 All other countries ​ 5,846,256 ​ ​ 11,566,012 ​ ​ — ​ ​ 17,412,268 Total product revenue ​ 27,041,855 ​ ​ 13,066,712 ​ ​ — ​ ​ 40,108,567 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ ​ — ​ ​ 3,056,960 ​ ​ 3,056,960 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 27,041,855 ​ $ 13,066,712 ​ $ 3,056,960 ​ $ 43,165,527 ​ The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2020: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 1,148,300 ​ $ 192,900 ​ $ — ​ $ 1,341,200 Germany ​ ​ 20,257,410 ​ ​ — ​ ​ — ​ ​ 20,257,410 All other countries ​ 5,275,619 ​ 12,578,273 ​ — ​ 17,853,892 Total product revenue ​ 26,681,329 ​ 12,771,173 ​ — ​ 39,452,502 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ — ​ 1,552,099 ​ 1,552,099 ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 26,681,329 ​ $ 12,771,173 ​ $ 1,552,099 ​ $ 41,004,601 ​ The Company has two primary revenue streams: (1) sales of the CytoSorb device and related device accessories and (2) grant income from contracts with various agencies of the United States government. Both of these revenue streams are within the scope of this accounting pronouncement. The following is a brief description of each revenue stream. CytoSorb Sales The Company sells its CytoSorb device using both its own sales force (direct sales) and through the use of distributors and/or strategic partners. The majority of sales of the device are outside the U.S., as CytoSorb is not yet approved for commercial sale in the United States. However, in April 2020, the Company was granted Emergency Use Authorization (“EUA”) of CytoSorb for use in critically-ill patients infected with COVID-19 by the FDA. Direct sales outside the United States relate to sales to hospitals located in Germany, Switzerland, Austria, Belgium, Luxembourg, Poland, the Netherlands, Sweden, Denmark, Norway and the United Kingdom. Direct sales are fulfilled from the Company’s office in Berlin, Germany. There are no formal sales contracts with any direct customers relating to product price or minimum purchase requirements. However, there are agreements in place with certain direct customers that provide for either free of charge product or rebate credits based upon achieving minimum purchase levels. The Company records the value of these items earned as a reduction of revenue. These customers submit purchase orders and the order is fulfilled and shipped directly to the customer. Prices to all direct customers are based on a standard price list based on the packaged quantity (6 packs vs. 12 packs). Distributor and strategic partner sales make up the remaining product sales. These distributors are located in various countries throughout the world. The Company has a formal written contract with each distributor/strategic partner. These contracts have terms ranging from 1 Most distributor’s/strategic partner’s contracts have minimum annual purchase requirements in order to maintain exclusivity in their respective territories. There is no additional consideration or monetary penalty that would be required to be paid to CytoSorbents if a distributor does not meet the minimum purchase commitments included in the contract, however, at the discretion of the Company, the distributor may lose its exclusive rights in the territory if such commitments are not met. Government Grants The Company has been the recipient of numerous grant contracts from various agencies of the U.S. government. The purpose of these grant contracts is to perform various research and development activities. The type of research required is outlined in each contract. These contracts fall into one of the following categories: 1. Fixed price – the Company invoices the contract amount in equal installments over the term of the contract without regard to the timing of the costs incurred related to this contract. If billings on fixed price contracts exceed the costs incurred, revenue will be deferred to the extent of the excess billings. 2. Cost reimbursement – the Company submits monthly invoices during the term of the contract for the amount of direct costs incurred during that month plus an agreed percentage that relates to allowable overhead and general and administrative expenses. Cumulative amounts invoiced may not exceed the maximum amount of funding stipulated in the contract. 3. Cost plus – this type of contract is similar to a cost reimbursement contract but this type also allows for the Company to additionally invoice for a fee amount that is included in the contract. 4. Performance based - the Company submits invoices only upon the achievement of the milestones listed in the contract. The amount to be invoiced for each milestone is documented in the contract. These government contracts have terms ranging from three months to four years. The Company may apply for an extension of the term of the contract in order to complete its research and development activities but would not receive additional funding during the extension period in excess of the original contract. See Note 2 regarding the accounting policies related to these contracts. In summary, the contracts the Company has with customers are the distributor/strategic partner contracts related to CytoSorb product sales, agreements with direct customers related to free-of-charge product and credit rebates based upon achieving minimum purchase levels, and contracts with various government agencies related to the Company’s grants. The Company does not currently incur any outside/third-party incremental costs to obtain any of these contracts. The Company does incur internal costs, primarily salary related costs, to obtain the contracts related to the government grants. Company employees spend time reviewing the program requirements and developing the budget and related proposal to submit to the grantor agency. There may additionally be travel expenditures involved with meeting with government agency officials during the negotiation of the contract. These internal costs are expensed as incurred. The following table provides information about receivables and contract liabilities from contracts with customers: ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2022 December 31, 2021 Contract receivables, which are included in grants and accounts receivable ​ $ 3,822,452 ​ $ 3,000,708 Contract liabilities, which are included in accrued expenses and other current liabilities ​ $ 1,694,906 ​ $ 2,251,177 ​ Contract receivables represent balances due from product sales to distributors amounting to $2,944,031 and $2,265,159 at December 31, 2022 and 2021, respectively, and billed and unbilled amounts due on government contracts amounting to $878,421 and $735,549 at December 31, 2022 and 2021, respectively. Contract liabilities represent the value of free of charge goods and credit rebates earned in accordance with the terms of certain direct customer agreements, which amounted to $178,134 and $303,824 at December 31, 2022 and 2021, respectively, and deferred grant revenue related to the billing on fixed price government contracts in excess of costs incurred, which amounted to $1,516,772 and $1,947,343 at December 31, 2022 and 2021, respectively.

PROPERTY AND EQUIPMENT, NET

PROPERTY AND EQUIPMENT, NET	12 Months Ended
	Dec. 31, 2022
PROPERTY AND EQUIPMENT, NET
PROPERTY AND EQUIPMENT, NET	4. PROPERTY AND EQUIPMENT, NET: Property and equipment - net, consist of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Depreciation/ ​ ​ ​ ​ ​ ​ ​ ​ Amortization December 31, 2022 2021 Period ​ ​ ​ ​ ​ ​ ​ ​ ​ Furniture and fixtures ​ $ 1,306,267 ​ $ 1,424,476 7 years Equipment and computers ​ 5,131,934 ​ 5,863,673 3 to 7 years Leasehold improvements ​ 6,201,523 ​ 2,623,356 Lesser of term of lease or estimated useful life ​ ​ 12,639,724 ​ 9,911,505 Less accumulated depreciation and amortization ​ 1,896,692 ​ 4,760,619 Property and Equipment, Net ​ $ 10,743,032 ​ $ 5,150,886 ​ Depreciation expense for the years ended December 31, 2022, 2021 and 2020 amounted to $688,565, $571,156 and $553,946 respectively.

OTHER ASSETS

OTHER ASSETS	12 Months Ended
	Dec. 31, 2022
OTHER ASSETS
OTHER ASSETS	5. OTHER ASSETS: Other assets consist of the following: ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2022 2021 ​ ​ ​ ​ ​ ​ ​ Patent applications pending ​ $ 2,466,341 ​ $ 2,717,701 Patents issued ​ ​ 2,773,191 ​ ​ 2,641,603 Less accumulated amortization of patents issued ​ (848,999) ​ (657,320) Patents, net ​ 4,390,533 ​ 4,701,984 Security deposits ​ 46,914 ​ 256,591 Total ​ $ 4,437,447 ​ $ 4,958,575 ​ Amortization expense amounted to $194,056, $160,422 and $106,842 for the years ended December 31, 2022, 2021 and 2020, respectively. Amortization expense for the next five years will be approximately $201,000 for the year ending December 31, 2023; approximately $201,000 for the year ending December 31, 2024; approximately $201,000 for the year ending December 31, 2025; approximately $200,000 for the year ending December 31, 2026 and approximately $196,000 for the year ending December 31, 2027.

ACCRUED EXPENSES AND OTHER CURR

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	12 Months Ended
	Dec. 31, 2022
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	6. ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES: Accrued expenses and other current liabilities consist of the following: ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2022 2021 Accrued salaries and commissions ​ $ 2,862,930 ​ $ 3,270,715 Deferred revenue ​ ​ 1,516,772 ​ ​ 1,947,353 Clinical studies ​ 1,115,123 ​ 1,767,826 Accrued accounts payable ​ 850,630 ​ 1,044,088 Professional fees ​ 622,353 ​ 314,068 Accrued royalties ​ ​ 592,398 ​ ​ 769,262 Customer rebates ​ 166,065 ​ 214,119 Travel and entertainment ​ ​ 99,316 ​ ​ 88,850 Board of Director fees ​ 97,426 ​ 71,381 Sales, payroll and income taxes payable ​ ​ 21,871 ​ ​ 785,818 Interest ​ 5,556 ​ — Congresses ​ — ​ ​ 40,861 ​ ​ $ 7,950,440 ​ $ 10,314,341 ​

LONG-TERM DEBT

LONG-TERM DEBT	12 Months Ended
	Dec. 31, 2022
LONG-TERM DEBT
LONG-TERM DEBT	7. LONG-TERM DEBT: On June 30, 2016, the Company and its wholly owned subsidiary, CytoSorbents Medical, Inc. (together, the “Borrower”), entered into a Loan and Security Agreement with Bridge Bank, a division of Western Alliance Bank, (the “Bank”), pursuant to which the Company borrowed $10 million in two equal tranches of $5 million (the “Original Term Loans”). On March 29, 2018, the Original Term Loans were refinanced with the Bank pursuant to an Amended and Restated Loan and Security Agreement by and between the Bank and the Borrower (the “Amended and Restated Loan and Security Agreement”), under which the Bank agreed to loan the Borrower up to an aggregate of $15 million to be disbursed in two tranches (1) one tranche of $10 million (the “Term A Loan”), which was funded on the Closing Date and used to refinance the Original Term Loans, and (2) a second tranche of $5 million which may be disbursed at the Borrower’s sole request prior to March 31, 2019 provided certain conditions are met (the “Term B Loan” and together with the Term A Loan, the “Term Loans”). On July 31, 2019, the Borrower entered into the First Amendment to the Amended and Restated Loan and Security Agreement (the “First Amendment”) with the Bank, which amended certain provisions of the Amended and Restated Loan and Security Agreement and the 2018 Success Fee Letter (the “2018 Letter”). In connection with the execution of the First Amendment, the draw period for the Term B Loan was extended to August 15, 2019 and the Company drew down the full $5.0 million Term B Loan on the Settlement Date, bringing the total outstanding debt to $15 million at July 31, 2019. The proceeds of Term Loans were used for general business requirements in accordance with the Amended and Restated Loan and Security Agreement. On December 4, 2020 (the “Third Amendment Closing Date”), the Company closed on the Third Amendment (the “Third Amendment”) of its Amended Loan and Security Agreement with Bridge Bank. Under the terms of the Amendment, the Company repaid the outstanding principal balance of its existing $15 million term loans and simultaneously received a commitment from Bridge Bank to provide a new term loan of $15 million, if needed. On January 19, 2022 (the “Fourth Amendment Closing Date”), the Company closed on the Fourth Amendment (the “Fourth Amendment”) of its Amended Loan and Security Agreement with Bridge Bank. Under the terms of the Amendment, the Company received a commitment from Bridge Bank to provide a new term loan of up to $15 million, if needed and entered into the Fourth Amendment Success Fee Letter (the “2022 Success Fee Letter”). On December 28, 2022 (the “Fifth Amendment Date”), the Company entered into the Fifth Amendment of its Amended Loan and Security Agreement with Bridge Bank. The Fifth Amendment extends the draw period under the Fourth Amendment to the earlier of (i) March 1, 2023 and (ii) the occurrence of an Event of Default. On March 9, 2023, the Company entered into the Sixth Amendment of its Amended Loan and Security Agreement. The Sixth Amendment further extends the draw period to March 24, 2023. The Fourth Amendment provides a tranche of term loans (the “Term C Loans”) in the aggregate amount of $15 million, which are available for the Company to draw down at its sole discretion in three tranches of $5 million each at any time during the period commencing on the Fourth Amendment Date and ending on the earlier of (i) December 31, 2022 and (ii) the occurrence of an Event of Default (as defined in the Amended Loan and Security Agreement). The Term C Loans shall bear interest at the Index Rate (defined in the Amendment as the greater of 3.25% or the Prime Rate as published by the Wall Street Journal on the last business date of the month immediately preceding the month in which the interest will accrue) plus 1.25%. Pursuant to the Fourth Amendment, interest on the Term C Loans is subject to an interest rate cap of 8.00%. On December 27, 2022, the Company drew down the first $5 million tranche of the Term C loans available under the terms of the Fourth Amendment. Under the terms of the Fourth Amendment, commencing on February 1, 2023, the Company is required to make monthly payments of interest only through December 2023. The interest-only period will be further extended through June 2024 provided the Company has met both the required reserves test and the seventy-five percent test, as set forth in the Fourth Amendment, as of November 30, 2023. Commencing on January 1, 2024, if the Company does not meet both the required reserves test and the seventy-five percent test, the Company shall make equal monthly payments of principal of $208,333, together with accrued and unpaid interest. Commencing on July 1, 2024, if the Company meets both the required reserves test and the seventy-five percent test, the Company shall make equal monthly payments of principal of $277,778, together with accrued and unpaid interest. In either event, all unpaid principal and accrued and unpaid interest shall be due and payable in full on December 1, 2025. On the Fourth Amendment Closing Date, the Company was required to pay a non-refundable closing fee of approximately $18,750, which was amortized as a monthly charge to interest expense. On the Third Amendment Closing Date, the Company paid a non-refundable closing fee of $75,000, which was amortized as a charge to interest expense. In addition, the Amended and Restated Loan and Security Agreement requires the Company to pay a non-refundable final fee equal to 2.5% of the principal amount of the Term Loan funded upon the earlier of the (i) the maturity date or (ii) termination of the Term Loans via acceleration or prepayment. The Company’s and CytoSorbents Medical, Inc.’s obligations under the Amended and Restated Loan and Security Agreement are joint and severable and are secured by a first priority security interest in favor of the Bank with respect to the Company’s Shares (as defined in the Amended and Restated Loan and Security Agreement) and the Borrower’s Collateral (as defined in the Amended and Restated Loan and Security Agreement, which definition excludes the Borrower’s intellectual property and other customary exceptions). 2018 Success Fee Letter: Pursuant to the amended 2018 Letter, the Borrower shall pay to the Bank a success fee in the amount equal to 6.37% of the funded amount of the Term B Loan (as defined in the Restated Loan and Security Agreement) (the “Success Fee”) upon the first occurrence of any of the following events: (a) a sale or other disposition by the Borrower of all or substantially all of its assets; (b) a merger or consolidation of the Borrower into or with another person or entity, where the holders of the Borrower’s outstanding voting equity securities as of immediately prior to such merger or consolidation hold less than a majority of the issued and outstanding voting equity securities of the successor or surviving person or entity as of immediately following the consummation of such merger or consolidation; (c) a transaction or a series of related transactions in which any “person” or “group” (within the meaning of Section 13(d) and 14(d)(2) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”) becomes the “beneficial owner” (as defined in Rule 13d-3 under the Exchange Act), directly or indirectly, of a sufficient number of shares of all classes of stock then outstanding of the Borrower ordinarily entitled to vote in the election of directors, empowering such “person” or “group” to elect a majority of the Board of Directors of the Borrower, who did not have such power before such transaction; or (d) the closing price per share for the Company’s common stock on the Nasdaq Capital Market being the greater of (i) 70% or more over $7.05, the closing price of the Company’s common stock on March 29, 2018 (after giving effect to any stock splits or consolidations effected after the date thereof) for five 2022 Success Fee Letter: Pursuant to the 2022 Success Fee Letter, the Borrower will pay to the Bank a success fee equal to (i) 1% of $5 million if the Company draws down the first tranche of the Term C Loan and is payable only if the Company’s stock price equals or exceeds $8 for five five five Long-term debt consists of the following as of December 31, 2022: ​ ​ ​ ​ Principal amount $ 5,000,000 Less Current maturities ​ — Long-term debt net of current maturities ​ $ 5,000,000 ​ Principal payments of long-term debt are due as follows during the years ending December 31: ​ ​ ​ ​ 2023 $ — 2024 ​ 2,500,000 2025 ​ 2,500,000 Total ​ $ 5,000,000 ​

LEASES

LEASES	12 Months Ended
	Dec. 31, 2022
LEASES
LEASES	8. LEASES: The Company leases its operating facilities in both the United States and Germany under operating lease agreements. In March 2021, CytoSorbents Medical Inc. entered into a lease agreement for a new operating facility at 305 College Road East, Princeton, New Jersey, which contains office, laboratory, manufacturing and warehouse space. The lease commenced on June 1, 2021. The Early Term commenced on June 1, 2021 and lasted until September 30, 2021. The lease also contains two five-year renewal options; however, the Company has determined that it is not likely that they will exercise these options. Commencing on September 30, 2021, the remaining lease term will last for 15.5 years. The lease requires monthly rental payments of $25,208 for the Initial Early Term, $88,254 for the Early Term and initial monthly payments of approximately $111,171 in the first year of the remaining term. Following the first year of the remaining term, the annual base rent will increase by approximately 2.75% annually over the remaining term. The lease also contains six months of rent abatement (months 1, 2, 3, 25, 26 and 27 of the remaining lease term). In addition to the base rent, payments of operating expenses and real estate taxes will be required. These payments are to be based on actual amounts incurred during 2021 multiplied by the Company’s share of the total building space (92.3%). The landlord will also provide an allowance of approximately $1,455,000 related to certain building improvements as outlined in the lease. In April 2021, the Company provided the landlord with a letter of credit in the amount of approximately $1,467,000 as security. The Company has determined that this lease should be treated as an operating lease in accordance with the provisions of Accounting Standards Codification (“ASC”) 842. On April 1, 2021, the Company recorded a Right-of-Use asset and related lease liability In April 2021, the Company entered into a Twentieth Amendment to Lease with the landlord at the existing Monmouth Junction facility which became effective May 31, 2021. This amendment extended the term of the lease for the Company’s previous facility to May 31, 2022. The Company’s base rent was approximately $35,000 per month. In addition, the Company was obligated to pay monthly operating expenses of approximately $30,000 per month. Under the terms of this amendment, the Company vacated a portion of the space as of May 31, 2022. The Company continued to lease the remaining space until December 31, 2022, at which time the lease terminated and the Company vacated the space. The Company’s base rent for the remaining space was approximately $20,000 per month. Monthly operating expenses were approximately $11,000 per month. In addition, the Company agreed to increase its security deposit by approximately $54,000 to a total of $150,000. At the end of the lease term, the entire security deposit was paid to the landlord for the purpose of making any needed repairs to the vacated premises, and the Company has no further obligation to pay for repairs to the vacated premises. Effective April 1, 2021, the Company adjusted its incremental borrowing rate to the incremental borrowing rate used in the College Road lease and recalculated the right of use asset and lease liability under the amended terms of this lease. In addition, the Company also adjusted the incremental borrowing rate and related right of use asset and lease liability on the existing Germany office lease effective April 1, 2021. In September 2021, the Company extended its two operating leases for its office facility in Germany. These leases require combined base rent payments amounting to approximately $12,100 per month. The initial lease term of both leases ends August 31, 2026. In addition, the Company is obligated to monthly operating expenses of approximately $3,000 per month. Both leases have a five-year option to renew that would extend the lease term to August 31, 2031. There are no provisions in the leases to increase the base rent during the renewal period. There were no lease incentives and no initial direct costs were incurred related to these leases. In January 2021, CytoSorbents Europe GmbH entered into a lease for 1,068 square meters of additional warehouse space. The lease commenced on April 1, 2021 and requires monthly payments of base rent of $7,784 and other costs of approximately $239 and has a term of five years. The lease also has an option to extend the lease term for an additional five-year period through March 31, 2031. The Company has determined that this lease should be treated as an operating lease in accordance with the provisions of ASC 842. On April 1, 2020, the Company recorded a Right-of-Use asset and related lease liability Right-of-Use Asset and Lease Liability: The Company’s consolidated balance sheets reflect the value of the right-of-use asset and related lease liability. This value was calculated based on the present value of the remaining base rent lease payments. The remaining lease payments include all expected renewals for all periods as the Company has determined that it is probable that the renewal options will be exercised under each of the lease agreements. The discount rate used was the Company’s incremental borrowing rate, which is 9.8%, as the Company could not determine the rate implicit in the lease. As a result, the value of the right-of-use asset and related lease liability is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, ​ 2022 2021 Right-of-use asset ​ $ 12,603,901 ​ $ 13,423,472 ​ ​ ​ ​ ​ ​ ​ Total lease liability ​ $ 13,250,944 ​ $ 13,821,509 Less current portion ​ (108,939) ​ ​ (570,566) Lease liability, net of current portion ​ $ 13,142,005 ​ $ 13,250,943 ​ The maturities of the lease liabilities are as follows as of December 31, 2022: ​ ​ ​ ​ ​ 2023 $ 1,266,346 2024 ​ 1,656,678 2025 ​ 1,695,677 2026 ​ 1,735,747 2027 ​ 1,776,920 Thereafter ​ 17,232,300 Total lease payments ​ ​ 25,363,668 Present value discount ​ ​ 12,112,724 Total ​ $ 13,250,944 ​ For the years ended December 31, 2022, 2021 and 2020, operating cash flows paid in connection with operating leases amounted to approximately $2,935,000, $1,968,000 and $937,000, respectively. As of December 31, 2022 and 2021, the weighted average remaining lease term was 12.4 years and 14.3 years, respectively.

INCOME TAXES

INCOME TAXES	12 Months Ended
	Dec. 31, 2022
INCOME TAXES
INCOME TAXES	9. INCOME TAXES: The Company accounts for income taxes under FASB ASC 740 (“ASC 740”). Deferred income tax assets and liabilities are determined based upon differences between financial reporting and tax bases of assets and liabilities, which are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. The Company’s consolidated loss before income taxes for the years ended December 31, 2022, 2021 and 2020 is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 Domestic ​ $ (21,155,203) ​ $ (18,829,797) ​ $ (5,682,628) Foreign ​ (12,749,965) ​ (6,464,854) ​ (3,281,634) Total ​ $ (33,905,168) ​ $ (25,294,651) ​ $ (8,964,262) ​ The benefit from income taxes consists of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 State Tax, including sale of New Jersey losses & credits ​ $ 1,092,585 ​ $ 736,003 ​ $ 1,127,074 Foreign tax provision ​ — ​ — ​ — ​ ​ $ 1,092,585 ​ $ 736,003 ​ $ 1,127,074 ​ The Company has deemed any foreign earnings will be indefinitely reinvested. Currently, foreign operations have resulted in an accumulated deficit. The Company will continue to analyze their stance if their circumstances change in the future. As of December 31, 2022, the Company had federal net operating loss (“NOL”) carryforwards of approximately $87.4 million, state NOL carry forwards of approximately $5.5 million, and foreign NOL carry forwards of approximately $42.7 million, which may be available to offset future taxable income, if any. The federal NOL carryforwards of $47.8 million, if not utilized, will expire between 2022 and 2037. The federal NOL carryforwards of $39.6 million generated since 2018 are subject to an 80% limitation on taxable income, do not expire and will carry forward indefinitely. The state NOL carryforwards of $5.5 million, if not utilized, will begin to expire in 2042. As of December 31, 2022, the Company had Federal and state research and development tax credit carryforwards of approximately $3.7 million and $0.3 million, respectively, available to reduce future tax liabilities, which will begin to expire at various dates starting in 2023. The NOL carry forwards are subject to review and possible adjustment by the Internal Revenue Service and state tax authorities. The NOLs may become subject to an annual limitation in the event of certain cumulative changes in the ownership interest of significant shareholders over a three-year period in excess of 50%, as defined under Section 382 of the Internal Revenue Code of 1986, as amended, as well as similar state tax provisions. In addition to the new provisions enacted under the Tax Cuts and Jobs Act, this could limit the amount of NOLs that the Company can utilize annually to offset future taxable income or tax liabilities. The amount of the annual limitation, if any, will generally be determined based on the value of the Company immediately prior to the ownership change. Subsequent ownership changes may further affect the limitation in future years. We record tax benefits related to uncertain tax positions taken or expected to be taken on a tax return when such benefits meet a more likely than not threshold. We recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. Currently, the Company is not accounting for any uncertain tax positions. U.S. Tax Reform Due to The Tax Cuts and Jobs Act of 2017 (TCJA) there was a change in the deductibility of research and experimental expenditures that took effect for taxable periods that begin after December 31, 2021. Prior to January 1, 2022, the Company expensed research and experimental expenditures under §174(a) in the year that books recognized the expense. The Company has adopted §174(b) for taxable years 2022 and beyond. Domestic and foreign research and experimental expenditures will be capitalized and amortized over a period no less than 60 months and 180 months, respectively. Sale of Net Operating Losses (NOLs) The Company may be eligible, from time to time, to receive cash from the sale of its New Jersey Net Operating Losses and R&D tax credits under the State of New Jersey Technology Business Tax Certificate Transfer Program. The Company will receive a net cash amount of approximately $1,093,000 from the approved sale of the 2021 state NOL and research and development credits in the first half of 2023. The principal components of the Company’s deferred tax assets and liabilities are as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 Deferred tax assets: ​ ​ ​ Net operating loss carry forward ​ $ 31,570,846 ​ $ 27,190,654 ​ $ 22,301,154 Stock options ​ 500,975 ​ 1,203,272 ​ 305,982 Research and development credit carryforward ​ 3,982,147 ​ 2,687,591 ​ 2,194,211 Accruals and others ​ 24,121 ​ 232,665 ​ 135,330 Lease liability ​ 3,724,840 ​ 3,997,114 ​ 289,287 §174(b) research and development ​ 3,331,625 ​ — ​ — Gross deferred tax assets ​ 43,134,554 ​ 35,311,296 ​ 25,225,964 Less valuation allowance ​ (39,303,451) ​ (31,242,130) ​ (24,794,474) ​ ​ 3,831,103 ​ 4,069,166 ​ 431,490 Deferred tax liability: ​ ​ ​ Fixed assets ​ (288,145) ​ (183,941) ​ (431,490) Right of Use Asset ​ (3,542,958) ​ (3,885,225) ​ — Net deferred tax assets ​ $ — ​ $ — ​ $ — ​ In assessing the realization of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers the scheduled reversal of deferred tax liabilities, projected future taxable income and tax planning strategies in making this assessment. Based on this assessment, management has established a full valuation allowance against all of the deferred tax assets for each period because it is more likely than not that all of the deferred tax assets will not be realized. The increases in valuation allowance for the years ended December 31, 2022, 2021 and 2020 were $8,061,321, $6,447,656, and $1,936,732, respectively. A reconciliation of income tax (expense) benefit at the statutory federal income tax rate and income taxes as reflected in the financial statements is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 Federal statutory rate 21.0 % 21.0 % 21.0 % State taxes, net of federal benefit (2.8) (2.0) (9.5) ​ Foreign rate differential 3.4 2.3 3.3 ​ Permanent items (1.5) (6.5) (2.0) ​ Rate change and true-up 0.6 11.8 17.0 ​ Change in valuation allowance (22.8) (25.5) (21.6) ​ R&D credit 2.1 1.7 4.4 ​ Sale of state R&D credit and NOL 3.2 — — ​ Effective income tax rate 3.2 % 2.8 % 12.6 % ​

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	12 Months Ended
	Dec. 31, 2022
COMMITMENTS AND CONTINGENCIES
COMMITMENTS AND CONTINGENCIES	10. COMMITMENTS AND CONTINGENCIES: Payroll Tax Examination In December 2021, the Company was notified that its European subsidiary, CytoSorbents Europe GmbH, would be subject to an audit of their payroll tax and social cost filings for the four-year period from 2018 through 2021. The Company has determined that payroll taxes and social costs were not paid on certain employee expense reimbursements as is required by German tax rules. Accordingly, the Company accrued approximately $598,000 as an estimate of this liability as of December 31, 2021. In January 2023, the Company received an assessment from the German tax authorities for the payroll tax audit of approximately $90,000. In addition, it was determined that the Company would owe additional social security and VAT taxes related to this matter of approximately $83,000. Accordingly, the Company has adjusted its accrual related to this payroll tax audit to approximately $173,000 as of December 31, 2022. This liability is included in accrued expenses and other current liabilities in the consolidated balance sheet as of December 31, 2022. The expense related this examination is included in selling, general and administrative expenses on the consolidated statements of operations and comprehensive loss. Employment Agreements On July 30, 2019, CytoSorbents Corporation entered into amended and restated executive employment agreements with its principal executives, Dr. Phillip P. Chan, Chief Executive Officer, Vincent Capponi, President and Chief Operating Officer, and Kathleen P. Bloch, Chief Financial Officer. Each of the agreements has an initial term of three years and was retroactively effective as of January 1, 2019. On April 12, 2020, CytoSorbents Corporation entered into an executive employment agreement with Dr. Efthymios Deliargyris, who began employment as Chief Medical Officer on May 1, 2020, with an initial term that expired on December 31, 2021. After the expiration of the initial terms, the employment agreements will automatically renew for additional terms of one year unless either party provides written notice of non-renewal at least 60 days prior to a renewal.In January 2022, these employment agreements automatically renewed for an additional 1 year. The foregoing employment agreements each provide for base salary and other customary benefits which include participation in group insurance plans, paid time off and reimbursement of certain business-related expenses, including travel and continuing educational expenses, as well as bonus and/or equity awards at the discretion of the Board of Directors. In addition, the agreements provide for certain termination benefits in the event of termination without “Cause” or voluntary termination of employment for “Good Reason”, as defined in each agreement. The agreements also provide for certain benefits in the event of a “Change of Control” of the Company, as defined in each agreement. On September 30, 2022, Ms. Bloch notified the Company of her intention to retire effective March 31, 2023. A search has been initiated for Ms. Bloch’s replacement. Ms. Bloch and the Company expect to enter into a consulting arrangement under which Ms. Bloch will continue to provide services to the Company in a limited capacity following the effective date of her retirement. Litigation The Company is, from time to time, subject to claims and litigation arising in the ordinary course of business. The Company intends to defend vigorously against any future claims and litigation. The Company is not currently a party to any legal proceedings. Royalty Agreement Pursuant to an agreement dated August 11, 2003, an existing investor agreed to make a $4 million equity investment in the Company. These amounts were received by the Company in 2003. In connection with this agreement the Company granted the investor a perpetual royalty of 3% on all gross revenues received by the Company from the sale of its CytoSorb device which such rights were assigned to an existing investor in 2017. For the years ended December 31, 2022, 2021 and 2020, the Company recorded royalty expenses of approximately $849,000, $1,193,000, and $1,172,000, respectively. These expenses are included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive loss. On August 1, 2022, the Company entered into the Marketing Agreement with Fresenius, which expands the Company’s strategic partnership with Fresenius by establishing a multi-stage global collaboration to combat life-threatening diseases in critical care. The Marketing Agreement has an initial term of three years, with an automatic renewal for an additional two years at the end of such initial term, subject to earlier termination by either of the parties (the “Term”) To help support the increased marketing and promotional efforts of the expanded collaboration, the Company has agreed to subsidize a portion of the marketing costs through royalty payments to Fresenius. Initially, the Marketing Agreement provides for royalty payments equal to 0.9% of the Company’s net sales of CytoSorb products made during the Term (excluding net sales in the United States). This initial royalty rate was determined based on certain assumptions regarding the percentage of the Company’s sale of CytoSorb products that are used with the Fresenius critical care platforms in the intensive care unit outside of the United States but is subject to adjustment if the Company determines that the underlying assumptions have changed significantly. For the year ended December 31, 2022, the Company did not record any expense related to this agreement as Fresenius did not commence any marketing activities as defined by the agreement. License Agreement In an agreement dated September 1, 2006, the Company entered into a license agreement which provides the Company the exclusive right to use its patented technology and proprietary know how relating to adsorbent polymers for a period of 18 years. Under the terms of the agreement, the Company has agreed to pay license fees of 2.5% to 5% on the sale of certain of its products if and when those products are sold commercially for a term not greater than 18 years commencing with the date of the agreement. For the years ended December 31, 2022, 2021 and 2020 per the terms of the license agreement, the Company recorded licensing expenses of approximately $1,416,000, $1,988,000 and $1,954,000, respectively. These expenses are included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive loss.

STOCKHOLDERS' EQUITY

STOCKHOLDERS' EQUITY	12 Months Ended
	Dec. 31, 2022
STOCKHOLDERS' EQUITY
STOCKHOLDERS' EQUITY	11. STOCKHOLDERS’ EQUITY: Preferred Stock In June 2019, the Company amended and restated its certificate of incorporation. The amended and restated certificate of incorporation authorizes the issuance of up to 5,000,000 shares of “blank check” preferred stock, with such designation rights and preferences as may be determined from time to time by the Board of Directors. Common Stock In June 2019, the Company amended and restated its certificate of incorporation. The amended and restated certificate of incorporation increased the number of shares of common stock authorized for issuance from 50,000,000 shares to 100,000,000 shares. Shelf Registration On July 14, 2021, the Company filed a registration statement on Form S-3 with the SEC, which was amended on July 20, 2021 and declared effective by the SEC on July 27, 2021 (as amended, the “2021 Shelf”). The 2021 Shelf enables the Company to offer and sell, in one or more offerings, any combination of common stock, preferred stock, senior or subordinated debt securities, warrants and units, up to a total dollar amount of $150 million. Open Market Sale Agreement with Jefferies LLC On December 30, 2021, the Company entered into an Open Market Sale Agreement (the “Sale Agreement”) with Jefferies LLC (the “Agent”), pursuant to which the Company could sell, from time to time, at its option, shares of the Company’s common stock having an aggregate offering price of up to $25 million through the Agent, as the Company’s sales agent. All shares of the Company’s common stock offered and sold, or to be offered and sold under the Sale Agreement, would have been issued and sold pursuant to the Company’s 2021 Shelf by methods deemed to be an “at the market offering” as defined in Rule 415(a)(4) promulgated under the Securities Act of 1933, as amended, in block transactions or if specified by the Company, in privately negotiated transactions. Subject to the terms of the Sales Agreement, the Agent is required to use their commercially reasonable efforts consistent with their normal sales and trading practices to sell the shares of the Company’s common stock from time to time, based upon the Company’s instructions (including any price, time or size limits or other customary parameters or conditions the Company may impose). The Company is required to pay the Agent a commission of up to 3.0% of the gross proceeds from the sale of the shares of the Company’s common stock sold thereunder, if any. There were no sales pursuant to the Amended Sale Agreement during the years ended December 31, 2022 and 2021, respectively. In addition, during the year ended December 31, 2021, the Company paid approximately $90,000 related to the Amended Sale Agreement. Stock Option Plans As of December 31, 2022, the Company had two Long Term Incentive Plans (the “2014 Plan” and the “2006 Plan”) to attract, retain, and provide incentives to employees, officers, directors, and consultants. The Plans generally provide for the granting of stock, stock options, stock appreciation rights, restricted shares, or any combination of the foregoing to eligible participants. A total of 13,400,000 and 2,400,000 shares of common stock are reserved for issuance under the 2014 Plan and the 2006 Plan, respectively. As of December 31, 2022, there were shares remaining to purchase approximately 3,713,000 and 258,000 units of common stock reserved under the 2014 Plan and the 2006 Plan, respectively. The 2014 and 2006 Plans as well as grants issued outside of the Plan are administered by the Compensation Committee of the Board of Directors (the “Compensation Committee”). The Compensation Committee is authorized to select from among eligible employees, directors, advisors and consultants those individuals to whom incentives are to be granted and to determine the number of shares to be subject to, and the terms and conditions of the options. The Compensation Committee is also authorized to prescribe, amend and rescind terms relating to options granted under the Plans. Generally, the interpretation and construction of any provision of the Plans or any options granted hereunder is within the discretion of the Compensation Committee. The 2014 Plan provides that options may or may not be Incentive Stock Options (“ISOs”) within the meaning of Section 422 of the Internal Revenue Code. Only employees of the Company are eligible to receive ISOs, while employees and non-employee directors, advisors and consultants are eligible to receive options, which are not ISOs, i.e., “Non-Qualified Options.” Because the Company has not obtained shareholder approval of the 2006 Plan, all options granted thereunder to date are “Non-Qualified Options” and until such shareholder approval is obtained, all future options issued under the 2006 Plan will also be “Non-Qualified Options.” In December 2014, the Company’s received shareholder approval authorizing the Board of Directors to implement the form, terms and provisions of the 2014 Plan. Accordingly, any options issued to employees under the 2014 Plan will be ISOs within the meaning of Section 422 of the Internal Revenue Code. Stock-Based Compensation Total share-based employee, director, and consultant compensation for the years ended December 31, 2022, 2021 and 2020 amounted to approximately $3,424,000, $4,021,000, and $3,514,000, respectively. These amounts are included in selling, general, and administrative expenses on the consolidated statements of operations and comprehensive loss. The summary of the stock option activity for the years ended December 31, 2022, 2021 and 2020 is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Weighted ​ Average ​ ​ ​ ​ Average ​ Remaining ​ ​ ​ ​ Exercise ​ Contractual ​ Shares per Share Life (Years) ​ ​ ​ ​ ​ ​ ​ ​ Outstanding January 1, 2020 4,218,189 ​ $ 6.16 7.0 Granted 1,579,106 ​ $ 6.37 9.0 Forfeited (34,644) ​ $ 7.50 — Expired (226,440) ​ $ 5.60 — Exercised (371,007) ​ $ 4.46 — Outstanding, December 31, 2020 5,165,204 ​ $ 6.36 7.26 Granted 2,051,980 ​ $ 8.78 9.30 Forfeited (138,037) ​ $ 6.73 — Expired (21,756) ​ $ 7.46 — Exercised (171,413) ​ $ 5.73 — Outstanding, December 31, 2021 6,885,978 ​ $ 7.09 ​ 7.15 Granted 2,721,205 ​ $ 1.99 9.60 Forfeited (1,270,155) ​ $ 8.65 — Expired (227,204) ​ $ 7.71 — Exercised — ​ $ — — Outstanding, December 31, 2022 8,109,824 ​ $ 5.11 6.91 ​ The fair value of each stock option was estimated using the Black-Scholes pricing model which takes the following factors into account. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Current Price ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of the ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Underlying ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Stock and its ​ ​ ​ ​ ​ ​ ​ ​ Grant Date ​ Expected Life ​ Expected ​ ​ ​ ​ ​ Risk Free ​ ​ Exercise Price ​ of the Stock ​ Volatility ​ ​ Expected ​ ​ Interest Rate Year - Ended Range Option Range ​ Dividends ​ Range December 31, 2020 ​ $ 5.00 - $10.58 per share ​ 6 years ​ 61.7% to 69.8 % ​ 0 % ​ 0.28% to 0.96 % December 31, 2021 ​ $ 4.26 - $11.39 per share ​ 6 years ​ 58.2% to 60.7 % ​ 0 % ​ 0.47% to 1.39 % December 31, 2022 ​ $ 1.11 - $3.91 per share ​ 6 years ​ 59.3% to 67.9 % ​ 0 % ​ 1.52% to 4.20 % ​ In addition, the Company recognizes forfeitures as they occur. The intrinsic value is calculated at the difference between the market value as of December 31, 2022 of $1.55 and the exercise price of the shares. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Options Outstanding ​ ​ Number ​ Weighted ​ Weighted ​ ​ ​ Range of ​ Outstanding at ​ Average ​ Average ​ Aggregate Exercise ​ December 31, ​ Exercise ​ Remaining ​ Intrinsic Price 2022 Price Life (Years) Value $1.11 - $13.20 8,109,824 ​ $ 5.11 ​ 6.91 ​ $ 7,280 ​ ​ ​ ​ ​ ​ ​ ​ Options Exercisable Number ​ Weighted ​ ​ Exercisable at ​ Average ​ Aggregate December 31, ​ Exercise ​ Intrinsic 2022 Price Value 4,623,085 ​ $ 6.32 ​ $ 1,250 ​ The summary of the status of the Company’s non-vested options for the year ended December 31, 2022, is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value ​ ​ ​ ​ ​ ​ Non-vested, January 1, 2022 2,994,846 ​ $ 4.68 Granted 2,721,205 ​ ​ 1.99 Forfeited (1,270,155) ​ ​ 8.65 Vested (959,157) ​ ​ 3.65 Non-vested, December 31, 2022 3,486,739 ​ $ 2.10 ​ As of December 31, 2022, the Company had approximately $4,745,000 of total unrecognized compensation cost related to stock options which will, on average, be amortized over 43 months. Awards of Stock Options: On August 10, 2022, the Board of Directors granted options to purchase 1,163,800 shares of common stock to the Company’s employees which will be awarded based upon each employee’s 2022 individual performance evaluation. Once awarded, these options will vest one quarter on February 15, 2023, one quarter on February 15, 2024, one quarter on February 15, 2025 and one quarter on February 15, 2026. The grant date fair value of these unvested options amounted to approximately $1,381,000. The Company has recorded approximately $180,440 in stock option expense related to these options for the year ended December 31, 2022. On August 10, 2022, the Board of Directors granted options to purchase 772,905 shares of common stock to the Company’s employees. These options will vest one eighth on the six-month anniversary of the grant date, one eighth on the first anniversary of the grant date, one quarter on second anniversary of the grant date, one quarter on third anniversary of the grant date and one quarter on fourth anniversary of the grant date. The grant date fair value of these unvested options amounted to approximately $917,000. The Company has recorded approximately $89,662 in stock option expense related to these options for the year ended December 31, 2022. On August 10, 2022, the Board of Directors granted options to purchase 113,850 shares of common stock to members of the Company’s Board of Directors. These options will vest one quarter on the grant date, one quarter on September 30, 2022, one quarter on December 31, 2022, and one quarter on March 31, 2023. The grant date fair value of these unvested options amounted to approximately $135,000. The Company has recorded approximately $101,336 in stock option expense related to these options for the year ended December 31, 2022. On August 10, 2022, the Board of Directors granted options to purchase 473,750 shares of common stock to certain senior managers of the Company. These options will vest one quarter on the grant date, one quarter on the first anniversary of the grant date, one quarter on second anniversary of the grant date, one quarter on third anniversary of the grant date. The grant date fair value of these unvested options amounted to approximately $562,000. The Company has recorded approximately $160,944 in stock option expense related to these options for the year ended December 31, 2022. On August 10, 2022, the Board of Directors granted options to purchase 1,365,000 shares of common stock to certain senior managers of the Company which will only vest upon the achievement of certain specific, predetermined milestones related to the Company’s long-term performance goals. The grant date fair value of these unvested options amounted to approximately $1,620,000. As of December 31, 2022, none of these milestones has been met. Accordingly, no charge for these options has been recorded in the consolidated statements of operations and comprehensive loss for the year ended December 31, 2022. On April 12, 2021, the Board of Directors granted options to purchase 1,323,400 shares of common stock to the Company’s employees which will vest upon the achievement of certain specific, predetermined milestones related to the Company’s 2021 operations. Once awarded, these options will vest in four equal tranches, the first tranche vesting on the date of the award. The grant date fair value of these unvested options amounted to approximately $7,042,000. On March 1, 2022, Board of Directors determined that the Company met approximately 19% of these milestones, and accordingly, the Company has recorded $314,000, and $273,000 in stock option expense related to these options for the years ended December 31, 2022, and 2021, respectively. On February 28, 2020, the Board of Directors granted options to purchase 1,114,325 shares of common stock to the Company’s employees which will vest upon the achievement of certain specific, predetermined milestones related to the Company’s 2020 operations. The grant date fair value of these unvested options amounted to approximately $3,883,000. On April 12, 2021, Board of Directors determined that the Company met approximately 88% of these milestones, and accordingly, the Company has recorded $951,000 and $1,070,000 in stock option expense related to these options for the years ended December 31, 2022, and 2021, respectively. Change in Control-Based Awards of Restricted Stock Units: The Board of Directors has granted restricted stock units to members of the Board of Directors, to the Company’s executive officers, and to employees of the Company. These restricted stock units will only vest upon a Change in Control of the Company, as defined in the Company’s 2014 Long-Term Incentive Plan. The following table is a summary of these restricted stock units: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Board of Executive Other ​ ​ ​ ​ ​ Directors ​ Management Employees Total ​ Intrinsic Value December 31, 2019 277,200 604,500 1,205,050 2,086,750 $ 8,033,988 Granted 2020 — 120,000 265,700 385,700 ​ ​ Forfeited 2020 — — (25,250) (25,250) ​ ​ December 31, 2020 277,200 724,500 1,445,500 2,447,200 ​ $ 19,504,184 Granted 2021 ​ — ​ — ​ 396,000 ​ 396,000 ​ ​ ​ Forfeited 2021 ​ — ​ — ​ (132,000) ​ (132,000) ​ ​ ​ December 31, 2021 ​ 277,200 ​ 724,500 ​ 1,709,500 ​ 2,711,200 ​ $ 11,359,928 Granted 2022 69,300 55,000 373,750 ​ 498,050 ​ ​ Forfeited 2022 — — (318,750) ​ (318,750) ​ ​ December 31, 2022 346,500 779,500 1,764,500 ​ 2,890,500 ​ $ 4,480,275 ​ Due to the uncertainty over whether these restricted stock units will vest, which will only happen upon a Change in Control, no charge for these restricted stock units has been recorded in the consolidated statement of operations and comprehensive loss through the year ended December 31, 2022. Performance-Based Awards of Restricted Stock Units: Pursuant to a review of the compensation of the senior management of the Company and management’s performance in 2020, on February 28, 2020, the Board of Directors granted 168,100 restricted stock units to certain senior managers of the Company. These awards were valued at approximately $1,014,000 at the date of issuance, based upon the market price of the Company’s common stock at the date of the grant, and vest one third on the date of the grant, one third on the first anniversary of the date of the grant, and one Pursuant to a review of the compensation of the senior management of the Company and management’s performance in 2021, on April 12, 2021, the Board of Directors granted 235,765 restricted stock units to certain senior managers of the Company. These awards were valued at approximately $2,120,000 at the date of issuance, based upon the market price of the Company’s common stock at the date of the grant, and vest one one one On August 10, 2022, certain named executive officers and senior managers were granted 288,500 restricted stock units. These awards were valued at approximately $563,000 at the date of issuance, based upon the market price of the Company’s common stock at the date of the grant, and vested (or will vest) one one one Additionally, in 2021 and 2020 certain employees were offered 91,750 restricted stock units as a condition of their employment. These awards were valued at approximately $713,868 at the date of issuance. 46,750 of these restricted stock units vest upon the earlier of a Change in Control or one one one The following table outlines the restricted stock unit activity for the year ended December 31, 2022: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value Non-vested, January 1, 2022 304,962 ​ $ 8.08 Granted ​ 288,500 ​ $ 1.95 Forfeited (45,000) ​ $ 8.35 Vested ​ (236,370) ​ $ 5.38 Non-vested, December 31, 2022 ​ 312,092 ​ $ 4.42 ​ Warrants: As of December 31, 2022, the Company had no warrants outstanding.

NET LOSS PER SHARE

NET LOSS PER SHARE	12 Months Ended
	Dec. 31, 2022
NET LOSS PER SHARE
NET LOSS PER SHARE	12. NET LOSS PER SHARE: Basic net loss per share and diluted net loss per share for the years ended December 31, 2022, 2021 and 2020 have been computed by dividing the net loss attributable to common shareholders for each respective period by the weighted average number of shares outstanding during that period. All outstanding warrants and options and restricted stock awards representing approximately 11,312,000, 9,902,000 and 7,786,000 incremental shares at December 31, 2022, 2021 and 2020, respectively, have been excluded from the computation of diluted net loss per share as they are anti-dilutive.

RETIREMENT PLAN

RETIREMENT PLAN	12 Months Ended
	Dec. 31, 2022
RETIREMENT PLAN
RETIREMENT PLAN	13. RETIREMENT PLAN: In June 2014, the Company formed the CytoSorbents 401(k) Plan. The plan is a defined contribution plan as described in section 401(k) of the Internal Revenue Code (“IRC”) covering substantially all full-time employees. Employees are eligible to participate in the plan on the first day of the calendar quarter following three

QUARTERLY FINANCIAL RESULTS (UN

QUARTERLY FINANCIAL RESULTS (UNAUDITED)	12 Months Ended
	Dec. 31, 2022
QUARTERLY FINANCIAL RESULTS (UNAUDITED)
QUARTERLY FINANCIAL RESULTS (UNAUDITED)	14. QUARTERLY FINANCIAL RESULTS (UNAUDITED): Summarized quarterly data for 2022, 2021 and 2020 are as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ For the Quarters Ended ​ March 31 June 30 September 30 December 31 2022: ​ ​ ​ ​ Total revenue ​ $ 8,691,424 ​ 8,495,558 ​ 8,111,353 ​ 9,390,474 Gross margin ​ 6,413,788 ​ 4,944,856 ​ 3,617,377 ​ 5,757,036 Loss from operations ​ (7,791,135) ​ (8,357,050) ​ (9,017,338) ​ (6,356,356) Net loss attributable to common stockholders ​ (8,966,398) ​ (10,879,222) ​ (12,200,837) ​ (766,128) Net loss per share, basic and diluted ​ ​ (0.21) ​ (0.25) ​ (0.28) ​ (0.02) ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 10,598,847 $ 12,024,069 $ 9,760,416 $ 10,782,195 Gross margin ​ 7,847,403 ​ 9,313,852 ​ 7,297,470 ​ 7,659,452 Loss from operations ​ (2,852,191) ​ (4,924,733) ​ (5,406,000) ​ (9,561,821) Net loss attributable to common stockholders ​ (4,167,821) ​ (4,677,530) ​ (6,406,285) ​ (9,307,012) Net loss per share, basic and diluted ​ (0.10) ​ (0.11) ​ (0.15) ​ (0.25) ​ ​ ​ ​ ​ ​ ​ ​ ​ 2020: ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 8,707,310 $ 9,794,903 $ 10,546,612 $ 11,955,776 Gross margin ​ 6,322,468 ​ 6,545,136 ​ 7,656,230 ​ 9,428,358 Loss from operations ​ (2,478,754) ​ (3,297,667) ​ (1,959,652) ​ (2,634,264) Net loss attributable to common stockholders ​ (3,452,779) ​ (2,866,956) ​ (839,729) ​ (677,724) Net loss per share, basic and diluted ​ (0.10) ​ (0.08) ​ (0.02) ​ 0.00 ​

PRINCIPAL BUSINESS ACTIVITY A_2

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	12 Months Ended
	Dec. 31, 2022
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Nature of Business	Nature of Business The Company is a leader in the treatment of life-threatening conditions in intensive care and cardiac surgery using blood purification. The Company, through its subsidiary CytoSorbents Medical, Inc. (formerly known as CytoSorbents, Inc.), is engaged in the research, development and commercialization of medical devices with its blood purification technology platform which incorporates a proprietary adsorbent, porous polymer technology. The Company, through its wholly owned European subsidiary, CytoSorbents Europe GmbH, conducts sales and marketing related operations for the CytoSorb device. In March 2016, the Company formed CytoSorbents Switzerland GmbH, a wholly owned subsidiary of CytoSorbents Europe GmbH. This subsidiary, which began operations during the second quarter of 2016, provides marketing and direct sales services in Switzerland. In November 2018, the Company formed CytoSorbents Poland Sp. z.o.o., a wholly owned subsidiary of CytoSorbents Europe GmbH. This subsidiary, which began operations during the first quarter of 2019, provides marketing and direct sales services in Poland. In the third quarter of 2019, the Company formed CytoSorbents UK Limited, a wholly owned subsidiary of CytoSorbents Medical, Inc., which is responsible for the management of the Company’s clinical trial activities in the United Kingdom. In March 2022, the Company formed CytoSorbents Medical UK Limited to provide marketing and direct sales services in the United Kingdom and the Republic of Ireland. In October 2022, the Company formed CytoSorbents France SAS to provide marketing and direct sales services in France. CytoSorb, the Company’s flagship product, was approved in the European Union (“EU”) in March 2011 and is currently being marketed and distributed in more than 75 countries around the world, as an effective extracorporeal cytokine absorber, designed to reduce the “cytokine storm” or “cytokine release syndrome” seen in critical illnesses that may result in massive inflammation, organ failure, and patient death. In May 2018, the Company received a label extension for CytoSorb covering use of the device for the removal of bilirubin and myoglobin which allows for the use of the device in the treatment of liver failure and trauma, respectively. CytoSorb is also being used during and after cardiac surgery to remove inflammatory mediators that can lead to post-operative complications, including multiple organ failure. In January 2020, CytoSorb received EU CE Mark label expansion to include the removal of ticagrelor during cardiopulmonary bypass in patients undergoing cardiothoracic surgery. In May 2020, CytoSorb also received EU CE Mark label expansion to include rivaroxaban removal for the same indication. In April 2020, CytoSorb received United States Food and Drug Administration (“FDA”) Emergency Use Authorization (“EUA”) of CytoSorb for use in adult critically-ill COVID-19 patients with imminent or confirmed respiratory failure. The CytoSorb device has neither been cleared nor approved for the indication to treat patients with COVID-19 infection. The EUA will be effective until a declaration is made that the circumstances justifying the EUA have terminated or until revoked by the FDA. In April 2020, the Company also announced that the FDA had granted Breakthrough Designation for its DrugSorb-ATR Antithrombotic Removal System for the removal of ticagrelor in a cardiopulmonary bypass circuit during emergent and urgent cardiothoracic surgery. The Breakthrough Devices Program provides for more effective treatment of life-threatening or irreversibly debilitating disease or conditions, in this case the need to reverse the effects of ticagrelor in emergent or urgent cardiac surgery that can otherwise cause a high risk of serious or life-threatening bleeding. Through Breakthrough Designation, the FDA intends to work with CytoSorbents to expedite the development, assessment, and regulatory review of CytoSorbents’ technology for the removal of ticagrelor, while maintaining statutory standards of regulatory approval (e.g., 510(k), de novo In August 2021, the Company announced that it was granted a second Breakthrough Device designation for its DrugSorb-ATR Antithrombotic Removal System by the FDA. This Breakthrough Device designation covers the removal of the Direct Oral Anticoagulants (DOACs) apixaban and rivaroxaban in a cardiopulmonary bypass circuit to reduce the likelihood of serious perioperative bleeding during urgent cardiothoracic surgery. In October 2021, the Company also received full FDA approval of an IDE application to conduct a double-blind, randomized, controlled clinical study for up to 120 patients entitled, “Safe and Timely Antithrombotic Removal – Direct Oral Anticoagulants (STAR-D),” in the United States to support FDA marketing approval. If FDA marketing approval is obtained for either the removal of ticagrelor or direct oral anticoagulants indications, the device would be marketed as DrugSorb-ATR in the United States. The DrugSorb-ATR Antithrombotic Removal System is based on the same polymer technology as CytoSorb. In May 2022, the Company announced that the Company entered into a 3-year preferred supplier agreement with Asklepios, making CytoSorb available without restrictions to all of the approximate 170 healthcare facilities across 14 states throughout Germany at which Asklepios operates. This includes Asklepios Klinik St. Georg in Hamburg, Germany, which pioneered the use of CytoSorb to remove antithrombotic drugs during cardiothoracic surgery, and is well-known for their seminal publication on CytoSorb use for this application during emergency cardiac surgery in patients at high risk of bleeding. In June 2022, the Company announced that, following a successful pilot program in three countries, the Company signed an expanded non-exclusive agreement with Nikkiso Europe GmbH (“Nikkiso”) to distribute Nikkiso’s PureADJUST stand-alone hemoperfusion pump and accessories in a total of 14 countries. In addition to securing the rights to sell Nikkiso’s stand-alone pump and accessories in Germany, Austria, and Luxembourg, the Company entered into an expanded multi-country reseller agreement with Nikkiso covering the following countries: Belgium, Bosnia and Herzegovina, Croatia, Finland, France, Iceland, Lichtenstein, Poland, Serbia, Slovenia and Switzerland. The Company will also be able to provide field support services in these countries. In August 2022, the Company entered into a Marketing Agreement (the “Marketing Agreement”) with Fresenius Medical Care Deutschland GmbH (“Fresenius”), which expands the Company’s strategic partnership with Fresenius by establishing a multi-stage global collaboration to combat life-threatening diseases in critical care. The Marketing Agreement provides for the combined marketing and promotion of CytoSorb with Fresenius’ critical care products by Fresenius’ marketing organization worldwide, excluding the United States. The Marketing Agreement has an initial term of three years, with an automatic renewal for an additional two years at the end of such initial term, subject to earlier termination by either of the parties (the “Term”). Compared to the prior co-marketing agreement between the parties, the Marketing Agreement intends to increase the commitments from both parties and to ensure an ongoing and consistent level of marketing and promotional activity specifically focused around CytoSorb, where Fresenius will actively market and promote CytoSorb as the featured blood purification therapy for removal of cytokines, bilirubin, and myoglobin on its critical care platforms. Specifically, the Marketing Agreement provides that various Fresenius-led in-person, virtual, social media, and web-based marketing programs and events will feature the CytoSorb therapy and highlight the cooperation between the two companies in the field of critical care during the Term. To help support the increased marketing and promotional efforts of the expanded collaboration, CytoSorbents has agreed to subsidize a portion of the marketing costs through a royalty payment to Fresenius Medical Care based on CytoSorb sales in the intensive care unit on Fresenius Medical Care platforms, excluding the United States. In addition to strengthening and expanding the global marketing of CytoSorb, the Company and Fresenius also plan to work together to bring new innovative solutions to the market. The Marketing Agreement also includes the certification of compatibility of CytoSorb for usage on Fresenius’ current critical care platforms. Certain initial activities have been completed with the formal launch of this program expected to occur sometime in 2023. The technology is based upon biocompatible, highly porous polymer sorbent beads that can actively remove toxic substances from blood and other bodily fluids by pore capture and surface adsorption. The Company has numerous products under development based upon this unique blood purification technology, which is protected by 18 issued U.S. patents and multiple international patents, with applications pending both in the U.S. and internationally, including HemoDefend, ContrastSorb, DrugSorb, DrugSorb-ATR and others. These patents and patent applications are directed to various compositions and methods of use related to the Company’s blood purification technologies and are expected to expire between 2023 and 2038, absent any patent term extensions. Management believes that any near-term expiring patents will not have a significant impact on the Company’s ongoing business.
Stock Market Listing	Stock Market Listing On December 17, 2014 the Company’s common stock was approved for listing on The Nasdaq Capital Market (“Nasdaq”), and it began trading on Nasdaq on December 23, 2014 under the symbol “CTSO”. Previously, the Company’s common stock traded in the over-the-counter-market on the OTC Bulletin Board.
Basis of Consolidation and Foreign Currency Translation	Basis of Consolidation and Foreign Currency Translation The consolidated financial statements include the accounts of CytoSorbents Corporation and its wholly owned subsidiaries, CytoSorbents Medical, Inc. and CytoSorbents Europe GmbH. In addition, the consolidated financial statements include CytoSorbents Switzerland GmbH, CytoSorbents Poland Sp. z.o.o., CytoSorbents Medical UK Limited and CytoSorbents France SAS, wholly owned subsidiaries of CytoSorbents Europe GmbH, and CytoSorbents UK Limited, a wholly owned subsidiary of CytoSorbents Medical, Inc. All significant intercompany transactions and balances have been eliminated in consolidation. Translation gains and losses resulting from the process of remeasuring into the United States of America dollar, the foreign currency financial statements of the European subsidiary, for which the United States of America dollar is the functional currency, are included in operations. Foreign currency transaction gain (loss) included in net loss amounted to approximately $(2,448,000), $(2,578,000) and $2,607,000 for the years ended December 31, 2022, 2021 and 2020, respectively. The Company translates assets and liabilities of the European subsidiary, whose functional currency is their local currency, at the exchange rate in effect at the balance sheet date. The Company translates revenue and expenses at the daily average exchange rates. The Company includes accumulated net translation adjustments in accumulated other comprehensive income (loss) as a component of stockholders’ equity. ​
Cash, Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid instruments purchased with an original maturity of three months or less to be cash equivalents. The following table provides a reconciliation of cash and cash equivalents and restricted cash and cash equivalents to amounts shown in the consolidated balance sheets and consolidated statements of cash flows: ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, ​ ​ ​ 2022 ​ 2021 Cash and cash equivalents ​ $ 22,144,567 ​ $ 52,137,707 Restricted cash ​ 1,687,459 ​ 1,687,459 Total cash, cash equivalents and restricted cash ​ $ 23,832,026 ​ $ 53,825,166 ​
Restricted Cash	Restricted Cash The Company’s total restricted cash in the amount of $1,687,459 consists of cash of $1,467,459 that the Company is obligated to maintain as collateral for the outstanding letter of credit with Bridge Bank that was provided to the landlord of the College Road facility as security and cash of $220,000 that the Company is obligated to maintain as collateral for the credit limit on the Company’s credit card account.
Grants and Accounts Receivable	Grants and Accounts Receivable Grants receivable represent amounts due from U.S. government agencies and are included in grants and accounts Receivable in the accompanying consolidated balance sheets. Accounts receivable are unsecured, non-interest-bearing customer obligations due under normal trade terms. The Company sells its devices to various hospitals and distributors. The Company performs ongoing credit evaluations of customers’ financial condition. Management reviews accounts receivable periodically to determine collectability. Balances that are determined to be uncollectible are reserved in the allowance for doubtful accounts.
Inventories	Inventories Inventories are valued at the lower of cost or net realizable value. Cost is determined using a first-in first-out (“FIFO”) basis. At December 31, 2022 and 2021, the Company’s inventory was comprised of finished goods, which amounted to $1,567,871 and $3,084,606, respectively, work in process which amounted to $1,280,368 and $1,322,736, respectively, and raw materials which amounted to $613,347 and $358,756, respectively. Devices used in clinical trials or for research and development purposes are removed from inventory and charged to research and development expenses at the time of their use. In September 2022, the Company experienced an equipment failure of a refrigeration unit at its new College Road manufacturing facility. This equipment stored various items of work-in-process inventory. The Company determined all the items that were stored in this unit were required to be scrapped. The value of this inventory was approximately $599,000. Accordingly, this inventory was written off and was included in cost of goods sold at the time of the loss in September 2022. The Company filed a claim with its insurance carrier related to this loss. In December 2022, the claim was approved in the amount of approximately $299,000 and, accordingly, has been recorded as a reduction to cost of goods sold in the accompanying consolidated statement of operations and comprehensive loss.
Property and Equipment	Property and Equipment Property and equipment are recorded at cost less accumulated depreciation. Depreciation of property and equipment is provided for by the straight-line method over the estimated useful lives of the related assets. Leasehold improvements are amortized over the lesser of their economic useful lives or the term of the related leases. Gains and losses on depreciable assets retired or sold are recognized in the statements of operations in the year of disposal. Repairs and maintenance expenditures are expensed as incurred.
Patents	Patents Legal costs incurred to establish patents are capitalized. When patents are issued, capitalized costs are amortized on the straight-line method over the related patent term. In the event a patent is abandoned, the net book value of the patent is written off.
Impairment or Disposal of Long-Lived Assets	Impairment or Disposal of Long-Lived Assets The Company assesses the impairment of patents and other long-lived assets under accounting standards for the impairment or disposal of long-lived assets whenever events or changes in circumstances indicate that the carrying value may not be recoverable. For long-lived assets to be held and used, the Company recognizes an impairment loss only if its carrying amount is not recoverable through its undiscounted cash flows and measures the impairment loss based on the difference between the carrying amount and fair value. During the year ended December 31, 2022, the Company wrote-off patent costs of approximately $636,000 related to the impairment of certain issued patents and pending patent applications in certain specific jurisdictions, the abandonment of certain patent defense costs that are no longer being pursued and the abandonment of certain pending patent application costs in the ordinary course of business.
Revenue Recognition	Revenue Recognition Product Sales: Grant Revenue:
Research and Development	Research and Development All research and development costs, payments to laboratories, research consultants and costs related to clinical trials and studies are expensed when incurred.
Advertising Expenses	Advertising Expenses Advertising costs are charged to activities when incurred. Advertising expense amounted to approximately $582,000, $615,000 and $285,000 in 2022, 2021 and 2020, respectively, and is included in selling, general, and administrative expenses in the consolidated statements of operations and comprehensive loss.
Income Taxes	Income Taxes Income taxes are accounted for under the asset and liability method prescribed by accounting standards for accounting for income taxes. Deferred income taxes are recorded for temporary differences between financial statement carrying amounts and the tax basis of assets and liabilities. Deferred tax assets and liabilities reflect the tax rates expected to be in effect for the years in which the differences are expected to reverse. A valuation allowance is provided if it is more likely than not that some or all of the deferred tax asset will not be realized. Under Section 382 of the Internal Revenue Code, the net operating losses generated prior to the previously completed reverse merger may be limited due to the change in ownership. Additionally, net operating losses generated subsequent to the reverse merger may be limited in the event of changes in ownership. In 2017, the Tax Cuts and Jobs Act reduced the U.S. federal corporate tax rate from 35% to 21%. See Note 9 for the impact of the tax rate change on deferred tax assets and liabilities. The Company follows the accounting standards associated with uncertain tax provisions. The Company had no unrecognized tax benefits as of December 31, 2022 or 2021. The Company files tax returns in the U.S. federal and state jurisdictions. The Company utilizes the Technology Business Tax Certificate Transfer Program to sell a portion of its New Jersey Net Operating Loss tax carryforwards and Research and Development credits to an industrial company. CytoSorbents Europe GmbH, CytoSorbents Switzerland GmbH, CytoSorbents Poland Sp. z.o.o., CytoSorbents UK Limited, CytoSorbents Medical UK Limited and CytoSorbents France file an annual corporate tax return, a VAT return and a trade tax return in Germany, Switzerland, Poland, France and the United Kingdom, respectively.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets, liabilities at the date of the balance sheet, and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from these estimates. The valuation of options granted, allowance for doubtful accounts and recoverability of patents are significant estimates in these consolidated financial statements.
Concentration of Credit Risk	Concentration of Credit Risk The Company maintains cash balances, at times, with financial institutions in excess of amounts insured by the Federal Deposit Insurance Corporation. Management monitors the soundness of these institutions in an effort to minimize its collection risk of these balances. A significant portion of the Company’s revenues are from product sales in Germany. Substantially all of the Company’s grant and other income are from grant agencies in the United States. (See Note 3 for further information relating to the Company’s revenue.) As of December 31, 2022, two distributors accounted for approximately 27% of outstanding grants and accounts receivables. As of December 31, 2021, one distributor accounted for approximately 12% of outstanding grants and accounts receivables. For the years ended December 31, 2022, 2021 and 2020, no agency, distributor/strategic partners or direct customer represented more than 10% of the Company’s total revenue.
Financial Instruments	Financial Instruments The carrying values of cash and cash equivalents, accounts receivable, accounts payable and accrued expenses and other current liabilities approximate their fair values due to their short-term nature.
Net Loss per Common Share	Net Loss per Common Share Basic net loss per share is computed by dividing loss attributable to common stockholders by the weighted average number of common shares outstanding during the period. Diluted net loss per common share is computed using the treasury stock method on the basis of the weighted-average number of shares of common stock plus the dilutive effect of potential common shares outstanding during the period. Dilutive potential common shares include outstanding warrants, stock options and restricted shares. The computation of diluted net loss per share does not assume conversion, exercise or contingent exercise of securities that would have an anti-dilutive effect on earnings (see Note 12).
Stock-Based Compensation	Stock-Based Compensation The Company accounts for its stock-based compensation under the recognition requirements of accounting standards for accounting for stock-based compensation for employees and directors whereby each option granted is valued at fair market value on the date of grant. Under these accounting standards, the fair value of each option is estimated on the date of grant using the Black-Scholes option pricing model. The Company also follows the guidance of accounting standards for accounting for equity instruments that are issued to non-employees for acquiring, or in conjunction with selling, goods or services for equity instruments issued to consultants.
Shipping and Handling Costs	Shipping and Handling Costs The cost of shipping product to customers and distributors is typically borne by the customer or distributor. The Company records shipping and handling costs in cost of revenue. Total freight costs amounted to approximately $297,000, $276,000 and $560,000 for the years ended December 31, 2022, 2021 and 2020, respectively.
Effect of Recent Accounting Pronouncements	Effect of Recent Accounting Pronouncements In November 2021, the Financial Accounting Standards Board (the “FASB”), issued Accounting Standards Update No. 2021-10 entitled, “Government Assistance (Topic 832) Disclosures by Business Entities about Government Assistance” (the “ASU”). This ASU will require enhanced disclosures related to the Company’s contracts with the U.S. government. The ASU is effective for annual periods beginning after December 15, 2021. The Company implemented the provisions of this ASU during 2022.

PRINCIPAL BUSINESS ACTIVITY A_3

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)	12 Months Ended
	Dec. 31, 2022
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Schedule of reconciliation of cash and cash equivalents and restricted cash and cash equivalents	​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, ​ ​ ​ 2022 ​ 2021 Cash and cash equivalents ​ $ 22,144,567 ​ $ 52,137,707 Restricted cash ​ 1,687,459 ​ 1,687,459 Total cash, cash equivalents and restricted cash ​ $ 23,832,026 ​ $ 53,825,166 ​

REVENUE (Tables)

REVENUE (Tables)	12 Months Ended
	Dec. 31, 2022
REVENUE
Schedule of disaggregation of Revenue	The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2022: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 787,201 ​ $ 181,750 ​ $ — ​ $ 968,951 Germany ​ 12,566,437 ​ ​ — ​ ​ — ​ ​ 12,566,437 All other countries ​ 4,705,580 ​ ​ 11,118,942 ​ ​ — ​ ​ 15,824,522 Total product revenue ​ 18,059,218 ​ ​ 11,300,692 ​ ​ — ​ ​ 29,359,910 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ ​ — ​ ​ 5,328,899 ​ ​ 5,328,899 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 18,059,218 ​ $ 11,300,692 ​ $ 5,328,899 ​ $ 34,688,809 ​ The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2021: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 189,167 ​ $ 1,500,700 ​ $ — ​ $ 1,689,867 Germany ​ 21,006,432 ​ ​ — ​ ​ — ​ ​ 21,006,432 All other countries ​ 5,846,256 ​ ​ 11,566,012 ​ ​ — ​ ​ 17,412,268 Total product revenue ​ 27,041,855 ​ ​ 13,066,712 ​ ​ — ​ ​ 40,108,567 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ ​ — ​ ​ 3,056,960 ​ ​ 3,056,960 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 27,041,855 ​ $ 13,066,712 ​ $ 3,056,960 ​ $ 43,165,527 ​ The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2020: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 1,148,300 ​ $ 192,900 ​ $ — ​ $ 1,341,200 Germany ​ ​ 20,257,410 ​ ​ — ​ ​ — ​ ​ 20,257,410 All other countries ​ 5,275,619 ​ 12,578,273 ​ — ​ 17,853,892 Total product revenue ​ 26,681,329 ​ 12,771,173 ​ — ​ 39,452,502 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ — ​ 1,552,099 ​ 1,552,099 ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 26,681,329 ​ $ 12,771,173 ​ $ 1,552,099 ​ $ 41,004,601 ​
Schedule of receivables and contract liabilities from contracts with customers	​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2022 December 31, 2021 Contract receivables, which are included in grants and accounts receivable ​ $ 3,822,452 ​ $ 3,000,708 Contract liabilities, which are included in accrued expenses and other current liabilities ​ $ 1,694,906 ​ $ 2,251,177 ​

PROPERTY AND EQUIPMENT, NET (Ta

PROPERTY AND EQUIPMENT, NET (Tables)	12 Months Ended
	Dec. 31, 2022
PROPERTY AND EQUIPMENT, NET
Schedule of Property and Equipment, Net	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Depreciation/ ​ ​ ​ ​ ​ ​ ​ ​ Amortization December 31, 2022 2021 Period ​ ​ ​ ​ ​ ​ ​ ​ ​ Furniture and fixtures ​ $ 1,306,267 ​ $ 1,424,476 7 years Equipment and computers ​ 5,131,934 ​ 5,863,673 3 to 7 years Leasehold improvements ​ 6,201,523 ​ 2,623,356 Lesser of term of lease or estimated useful life ​ ​ 12,639,724 ​ 9,911,505 Less accumulated depreciation and amortization ​ 1,896,692 ​ 4,760,619 Property and Equipment, Net ​ $ 10,743,032 ​ $ 5,150,886 ​

OTHER ASSETS (Tables)

OTHER ASSETS (Tables)	12 Months Ended
	Dec. 31, 2022
OTHER ASSETS
Schedule of Other Assets	​ ​ ​ ​ ​ ​ ​ ​ December 31, 2022 2021 ​ ​ ​ ​ ​ ​ ​ Patent applications pending ​ $ 2,466,341 ​ $ 2,717,701 Patents issued ​ ​ 2,773,191 ​ ​ 2,641,603 Less accumulated amortization of patents issued ​ (848,999) ​ (657,320) Patents, net ​ 4,390,533 ​ 4,701,984 Security deposits ​ 46,914 ​ 256,591 Total ​ $ 4,437,447 ​ $ 4,958,575 ​

ACCRUED EXPENSES AND OTHER CU_2

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	12 Months Ended
	Dec. 31, 2022
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Schedule of accrued expenses and other current liabilities	​ ​ ​ ​ ​ ​ ​ ​ December 31, 2022 2021 Accrued salaries and commissions ​ $ 2,862,930 ​ $ 3,270,715 Deferred revenue ​ ​ 1,516,772 ​ ​ 1,947,353 Clinical studies ​ 1,115,123 ​ 1,767,826 Accrued accounts payable ​ 850,630 ​ 1,044,088 Professional fees ​ 622,353 ​ 314,068 Accrued royalties ​ ​ 592,398 ​ ​ 769,262 Customer rebates ​ 166,065 ​ 214,119 Travel and entertainment ​ ​ 99,316 ​ ​ 88,850 Board of Director fees ​ 97,426 ​ 71,381 Sales, payroll and income taxes payable ​ ​ 21,871 ​ ​ 785,818 Interest ​ 5,556 ​ — Congresses ​ — ​ ​ 40,861 ​ ​ $ 7,950,440 ​ $ 10,314,341

LONG-TERM DEBT (Tables)

LONG-TERM DEBT (Tables)	12 Months Ended
	Dec. 31, 2022
LONG-TERM DEBT
Schedule of Long-term debt	Long-term debt consists of the following as of December 31, 2022: ​ ​ ​ ​ Principal amount $ 5,000,000 Less Current maturities ​ — Long-term debt net of current maturities ​ $ 5,000,000 ​
Schedule of Principal payments of long-term debt	Principal payments of long-term debt are due as follows during the years ending December 31: ​ ​ ​ ​ 2023 $ — 2024 ​ 2,500,000 2025 ​ 2,500,000 Total ​ $ 5,000,000

LEASES (Tables)

LEASES (Tables)	12 Months Ended
	Dec. 31, 2022
LEASES
Schedule of right-of- use asset and related lease liability	​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, ​ 2022 2021 Right-of-use asset ​ $ 12,603,901 ​ $ 13,423,472 ​ ​ ​ ​ ​ ​ ​ Total lease liability ​ $ 13,250,944 ​ $ 13,821,509 Less current portion ​ (108,939) ​ ​ (570,566) Lease liability, net of current portion ​ $ 13,142,005 ​ $ 13,250,943 ​
Schedule of maturities of the lease liabilities	The maturities of the lease liabilities are as follows as of December 31, 2022: ​ ​ ​ ​ ​ 2023 $ 1,266,346 2024 ​ 1,656,678 2025 ​ 1,695,677 2026 ​ 1,735,747 2027 ​ 1,776,920 Thereafter ​ 17,232,300 Total lease payments ​ ​ 25,363,668 Present value discount ​ ​ 12,112,724 Total ​ $ 13,250,944 ​

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
	Dec. 31, 2022
INCOME TAXES
Schedule of Income before Income Tax, Domestic and Foreign	The Company’s consolidated loss before income taxes for the years ended December 31, 2022, 2021 and 2020 is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 Domestic ​ $ (21,155,203) ​ $ (18,829,797) ​ $ (5,682,628) Foreign ​ (12,749,965) ​ (6,464,854) ​ (3,281,634) Total ​ $ (33,905,168) ​ $ (25,294,651) ​ $ (8,964,262) ​
Schedule of Components of Income Tax Expense (Benefit)	The benefit from income taxes consists of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 State Tax, including sale of New Jersey losses & credits ​ $ 1,092,585 ​ $ 736,003 ​ $ 1,127,074 Foreign tax provision ​ — ​ — ​ — ​ ​ $ 1,092,585 ​ $ 736,003 ​ $ 1,127,074 ​
Schedule of Deferred Tax Assets and Liabilities	The principal components of the Company’s deferred tax assets and liabilities are as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 Deferred tax assets: ​ ​ ​ Net operating loss carry forward ​ $ 31,570,846 ​ $ 27,190,654 ​ $ 22,301,154 Stock options ​ 500,975 ​ 1,203,272 ​ 305,982 Research and development credit carryforward ​ 3,982,147 ​ 2,687,591 ​ 2,194,211 Accruals and others ​ 24,121 ​ 232,665 ​ 135,330 Lease liability ​ 3,724,840 ​ 3,997,114 ​ 289,287 §174(b) research and development ​ 3,331,625 ​ — ​ — Gross deferred tax assets ​ 43,134,554 ​ 35,311,296 ​ 25,225,964 Less valuation allowance ​ (39,303,451) ​ (31,242,130) ​ (24,794,474) ​ ​ 3,831,103 ​ 4,069,166 ​ 431,490 Deferred tax liability: ​ ​ ​ Fixed assets ​ (288,145) ​ (183,941) ​ (431,490) Right of Use Asset ​ (3,542,958) ​ (3,885,225) ​ — Net deferred tax assets ​ $ — ​ $ — ​ $ — ​
Schedule of Effective Income Tax Rate Reconciliation	A reconciliation of income tax (expense) benefit at the statutory federal income tax rate and income taxes as reflected in the financial statements is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ 2022 2021 2020 Federal statutory rate 21.0 % 21.0 % 21.0 % State taxes, net of federal benefit (2.8) (2.0) (9.5) ​ Foreign rate differential 3.4 2.3 3.3 ​ Permanent items (1.5) (6.5) (2.0) ​ Rate change and true-up 0.6 11.8 17.0 ​ Change in valuation allowance (22.8) (25.5) (21.6) ​ R&D credit 2.1 1.7 4.4 ​ Sale of state R&D credit and NOL 3.2 — — ​ Effective income tax rate 3.2 % 2.8 % 12.6 %

STOCKHOLDERS' EQUITY (Tables)

STOCKHOLDERS' EQUITY (Tables)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
STOCKHOLDERS' EQUITY
Schedule of stock options activity		​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Weighted ​ Average ​ ​ ​ ​ Average ​ Remaining ​ ​ ​ ​ Exercise ​ Contractual ​ Shares per Share Life (Years) ​ ​ ​ ​ ​ ​ ​ ​ Outstanding January 1, 2020 4,218,189 ​ $ 6.16 7.0 Granted 1,579,106 ​ $ 6.37 9.0 Forfeited (34,644) ​ $ 7.50 — Expired (226,440) ​ $ 5.60 — Exercised (371,007) ​ $ 4.46 — Outstanding, December 31, 2020 5,165,204 ​ $ 6.36 7.26 Granted 2,051,980 ​ $ 8.78 9.30 Forfeited (138,037) ​ $ 6.73 — Expired (21,756) ​ $ 7.46 — Exercised (171,413) ​ $ 5.73 — Outstanding, December 31, 2021 6,885,978 ​ $ 7.09 ​ 7.15 Granted 2,721,205 ​ $ 1.99 9.60 Forfeited (1,270,155) ​ $ 8.65 — Expired (227,204) ​ $ 7.71 — Exercised — ​ $ — — Outstanding, December 31, 2022 8,109,824 ​ $ 5.11 6.91 ​
Schedule of fair value of each stock option estimated using the Black-Scholes pricing model		​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Current Price ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of the ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Underlying ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Stock and its ​ ​ ​ ​ ​ ​ ​ ​ Grant Date ​ Expected Life ​ Expected ​ ​ ​ ​ ​ Risk Free ​ ​ Exercise Price ​ of the Stock ​ Volatility ​ ​ Expected ​ ​ Interest Rate Year - Ended Range Option Range ​ Dividends ​ Range December 31, 2020 ​ $ 5.00 - $10.58 per share ​ 6 years ​ 61.7% to 69.8 % ​ 0 % ​ 0.28% to 0.96 % December 31, 2021 ​ $ 4.26 - $11.39 per share ​ 6 years ​ 58.2% to 60.7 % ​ 0 % ​ 0.47% to 1.39 % December 31, 2022 ​ $ 1.11 - $3.91 per share ​ 6 years ​ 59.3% to 67.9 % ​ 0 % ​ 1.52% to 4.20 % ​
Schedule of intrinsic value		​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Options Outstanding ​ ​ Number ​ Weighted ​ Weighted ​ ​ ​ Range of ​ Outstanding at ​ Average ​ Average ​ Aggregate Exercise ​ December 31, ​ Exercise ​ Remaining ​ Intrinsic Price 2022 Price Life (Years) Value $1.11 - $13.20 8,109,824 ​ $ 5.11 ​ 6.91 ​ $ 7,280 ​ ​ ​ ​ ​ ​ ​ ​ Options Exercisable Number ​ Weighted ​ ​ Exercisable at ​ Average ​ Aggregate December 31, ​ Exercise ​ Intrinsic 2022 Price Value 4,623,085 ​ $ 6.32 ​ $ 1,250 ​
Schedule of Company's non-vested options	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value ​ ​ ​ ​ ​ ​ Non-vested, January 1, 2022 2,994,846 ​ $ 4.68 Granted 2,721,205 ​ ​ 1.99 Forfeited (1,270,155) ​ ​ 8.65 Vested (959,157) ​ ​ 3.65 Non-vested, December 31, 2022 3,486,739 ​ $ 2.10 ​
Schedule of restricted stock unit		​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Board of Executive Other ​ ​ ​ ​ ​ Directors ​ Management Employees Total ​ Intrinsic Value December 31, 2019 277,200 604,500 1,205,050 2,086,750 $ 8,033,988 Granted 2020 — 120,000 265,700 385,700 ​ ​ Forfeited 2020 — — (25,250) (25,250) ​ ​ December 31, 2020 277,200 724,500 1,445,500 2,447,200 ​ $ 19,504,184 Granted 2021 ​ — ​ — ​ 396,000 ​ 396,000 ​ ​ ​ Forfeited 2021 ​ — ​ — ​ (132,000) ​ (132,000) ​ ​ ​ December 31, 2021 ​ 277,200 ​ 724,500 ​ 1,709,500 ​ 2,711,200 ​ $ 11,359,928 Granted 2022 69,300 55,000 373,750 ​ 498,050 ​ ​ Forfeited 2022 — — (318,750) ​ (318,750) ​ ​ December 31, 2022 346,500 779,500 1,764,500 ​ 2,890,500 ​ $ 4,480,275 ​
Schedule of the restricted stock unit activity		​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value Non-vested, January 1, 2022 304,962 ​ $ 8.08 Granted ​ 288,500 ​ $ 1.95 Forfeited (45,000) ​ $ 8.35 Vested ​ (236,370) ​ $ 5.38 Non-vested, December 31, 2022 ​ 312,092 ​ $ 4.42 ​

QUARTERLY FINANCIAL RESULTS (_2

QUARTERLY FINANCIAL RESULTS (UNAUDITED) (Tables)	12 Months Ended
	Dec. 31, 2022
QUARTERLY FINANCIAL RESULTS (UNAUDITED)
Summarized quarterly information	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ For the Quarters Ended ​ March 31 June 30 September 30 December 31 2022: ​ ​ ​ ​ Total revenue ​ $ 8,691,424 ​ 8,495,558 ​ 8,111,353 ​ 9,390,474 Gross margin ​ 6,413,788 ​ 4,944,856 ​ 3,617,377 ​ 5,757,036 Loss from operations ​ (7,791,135) ​ (8,357,050) ​ (9,017,338) ​ (6,356,356) Net loss attributable to common stockholders ​ (8,966,398) ​ (10,879,222) ​ (12,200,837) ​ (766,128) Net loss per share, basic and diluted ​ ​ (0.21) ​ (0.25) ​ (0.28) ​ (0.02) ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 10,598,847 $ 12,024,069 $ 9,760,416 $ 10,782,195 Gross margin ​ 7,847,403 ​ 9,313,852 ​ 7,297,470 ​ 7,659,452 Loss from operations ​ (2,852,191) ​ (4,924,733) ​ (5,406,000) ​ (9,561,821) Net loss attributable to common stockholders ​ (4,167,821) ​ (4,677,530) ​ (6,406,285) ​ (9,307,012) Net loss per share, basic and diluted ​ (0.10) ​ (0.11) ​ (0.15) ​ (0.25) ​ ​ ​ ​ ​ ​ ​ ​ ​ 2020: ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 8,707,310 $ 9,794,903 $ 10,546,612 $ 11,955,776 Gross margin ​ 6,322,468 ​ 6,545,136 ​ 7,656,230 ​ 9,428,358 Loss from operations ​ (2,478,754) ​ (3,297,667) ​ (1,959,652) ​ (2,634,264) Net loss attributable to common stockholders ​ (3,452,779) ​ (2,866,956) ​ (839,729) ​ (677,724) Net loss per share, basic and diluted ​ (0.10) ​ (0.08) ​ (0.02) ​ 0.00

BASIS OF PRESENTATION (Details)

BASIS OF PRESENTATION (Details) $ in Millions	Dec. 31, 2022 USD ($)
BASIS OF PRESENTATION
Cash, cash equivalents and restricted cash	$ 23.8

PRINCIPAL BUSINESS ACTIVITY A_4

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Details)	12 Months Ended
	Dec. 31, 2022 USD ($) patent country	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2018	Dec. 31, 2017	Sep. 30, 2022 USD ($)
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Number of countries where the entity's flagship product is marketed and distributed | country	75
Number of patents | patent	18
Foreign currency transaction gain (loss)	$ (2,448,000)	$ (2,578,000)	$ 2,607,000
Restricted cash	1,687,459	1,687,459
Inventory - finished goods	1,567,871	3,084,606
Inventory - work in process	1,280,368	1,322,736
Inventory - raw materials	613,347	358,756
Inventory						$ 599,000
wrote-off patent costs	636,000
Advertising expenses	$ 582,000	$ 615,000	$ 285,000
Federal statutory rate	0.21%	0.21%	0.21%
Unrecognized tax benefits	$ 0	$ 0
Concentration risk	27%
Cost of revenue	$ 13,955,752	11,047,350	$ 11,052,409
Federal
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Federal statutory rate				21%	35%
Letter of credit
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Cash collateral	1,467,459
Credit Card
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Cash collateral	220,000
Cargo and Freight
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Cost of revenue	297,000	$ 276,000	$ 560,000
Insurance settlement receivable for loss on inventory recorded as a reduction to cost of goods sold	$ 299,000
Accounts Receivable | One Distributor/strategic partner
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Concentration risk	12%
Sales Revenue, Net
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Concentration risk	10%	10%	10%

PRINCIPAL BUSINESS ACTIVITY A_5

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Cash and cash equivalents	$ 22,144,567	$ 52,137,707
Restricted cash	1,687,459	1,687,459
Total cash, cash equivalents and restricted cash	$ 23,832,026	$ 53,825,166	$ 71,421,601	$ 12,232,418

REVENUE - Revenue by customer t

REVENUE - Revenue by customer type and geographic area (Details) - USD ($)	3 Months Ended												12 Months Ended
	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Product sales:
Total revenue	$ 9,390,474	$ 8,111,353	$ 8,495,558	$ 8,691,424	$ 10,782,195	$ 9,760,416	$ 12,024,069	$ 10,598,847	$ 11,955,776	$ 10,546,612	$ 9,794,903	$ 8,707,310	$ 34,688,809	$ 43,165,527	$ 41,004,601
Total product sales
Product sales:
Total revenue													29,359,910	40,108,567	39,452,502
Grant income
Product sales:
Total revenue													5,328,899	3,056,960	1,552,099
United States | Total product sales
Product sales:
Total revenue													968,951	1,689,867	1,341,200
United States | Grant income
Product sales:
Total revenue													5,328,899	3,056,960	1,552,099
Germany | Total product sales
Product sales:
Total revenue													12,566,437	21,006,432	20,257,410
All other countries | Total product sales
Product sales:
Total revenue													15,824,522	17,412,268	17,853,892
Direct
Product sales:
Total revenue													18,059,218	27,041,855	26,681,329
Direct | Total product sales
Product sales:
Total revenue													18,059,218	27,041,855	26,681,329
Direct | United States | Total product sales
Product sales:
Total revenue													787,201	189,167	1,148,300
Direct | United States | Grant income
Product sales:
Total revenue													0	0	0
Direct | Germany | Total product sales
Product sales:
Total revenue													12,566,437	21,006,432	20,257,410
Direct | All other countries | Total product sales
Product sales:
Total revenue													4,705,580	5,846,256	5,275,619
Distributors/Strategic Partners
Product sales:
Total revenue													11,300,692	13,066,712	12,771,173
Distributors/Strategic Partners | Total product sales
Product sales:
Total revenue													11,300,692	13,066,712	12,771,173
Distributors/Strategic Partners | United States | Total product sales
Product sales:
Total revenue													181,750	1,500,700	192,900
Distributors/Strategic Partners | United States | Grant income
Product sales:
Total revenue													0	0	0
Distributors/Strategic Partners | Germany | Total product sales
Product sales:
Total revenue													0	0	0
Distributors/Strategic Partners | All other countries | Total product sales
Product sales:
Total revenue													11,118,942	11,566,012	12,578,273
United States Government Agencies
Product sales:
Total revenue													5,328,899	3,056,960	1,552,099
United States Government Agencies | Total product sales
Product sales:
Total revenue													0	0	0
United States Government Agencies | United States | Total product sales
Product sales:
Total revenue													0	0	0
United States Government Agencies | United States | Grant income
Product sales:
Total revenue													5,328,899	3,056,960	1,552,099
United States Government Agencies | Germany | Total product sales
Product sales:
Total revenue													0	0	0
United States Government Agencies | All other countries | Total product sales
Product sales:
Total revenue													$ 0	$ 0	$ 0

REVENUE - Receivables and contr

REVENUE - Receivables and contract liabilities (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
REVENUE
Contract receivables, which are included in grants and accounts receivable	$ 3,822,452	$ 3,000,708
Contract liabilities, which are included in accrued expenses and other current liabilities	$ 1,694,906	$ 2,251,177

REVENUE - Additional informatio

REVENUE - Additional information (Details)	12 Months Ended
	Dec. 31, 2022 USD ($) item	Dec. 31, 2021 USD ($)
REVENUE
Number of primary revenue streams | item	2
Term of customer contracts	3 years
Value of free of charge goods and credit rebates	$ 178,134	$ 303,824
Contract liabilities net of Value of free of charge goods and credit rebates	1,516,772	1,947,343
Contract receivables, which are included in grants and accounts receivable	3,822,452	3,000,708
Product sales
REVENUE
Contract receivables, which are included in grants and accounts receivable	2,944,031	2,265,159
Government grants
REVENUE
Contract receivables, which are included in grants and accounts receivable	$ 878,421	$ 735,549
Maximum
REVENUE
Term of customer contracts	5 years
Minimum
REVENUE
Term of customer contracts	1 year

PROPERTY AND EQUIPMENT, NET (De

PROPERTY AND EQUIPMENT, NET (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 12,639,724	$ 9,911,505
Less accumulated depreciation and amortization	1,896,692	4,760,619
Property and equipment, net	10,743,032	5,150,886
Furniture and fixtures
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 1,306,267	1,424,476
Depreciation/Amortization Period	7 years
Equipment and computers
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 5,131,934	5,863,673
Equipment and computers | Maximum
PROPERTY AND EQUIPMENT, NET:
Depreciation/Amortization Period	7 years
Equipment and computers | Minimum
PROPERTY AND EQUIPMENT, NET:
Depreciation/Amortization Period	3 years
Leasehold improvements
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 6,201,523	$ 2,623,356

PROPERTY AND EQUIPMENT, NET - A

PROPERTY AND EQUIPMENT, NET - Additional information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
PROPERTY AND EQUIPMENT, NET
Depreciation expense	$ 688,565	$ 571,156	$ 553,946

OTHER ASSETS (Details)

OTHER ASSETS (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
OTHER ASSETS:
Less accumulated amortization of patents issued	$ (848,999)	$ (657,320)
Patents, net	4,390,533	4,701,984
Security deposits	46,914	256,591
Total	4,437,447	4,958,575
Patent applications pending
OTHER ASSETS:
Patents	2,466,341	2,717,701
Patents issued
OTHER ASSETS:
Patents	$ 2,773,191	$ 2,641,603

OTHER ASSETS - Additional infor

OTHER ASSETS - Additional information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
OTHER ASSETS
2023	$ 201,000
2024	201,000
2025	201,000
2026	200,000
2027	196,000
Amortization expense	$ 194,056	$ 160,422	$ 106,842

ACCRUED EXPENSES AND OTHER CU_3

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Accrued salaries and commissions	$ 2,862,930	$ 3,270,715
Deferred revenue	1,516,772	1,947,353
Clinical studies	1,115,123	1,767,826
Accrued accounts payable	850,630	1,044,088
Professional fees	622,353	314,068
Accrued royalties	592,398	769,262
Customer rebates	166,065	214,119
Travel and entertainment	99,316	88,850
Board of Director fees	97,426	71,381
Sales, payroll and income taxes payable	21,871	785,818
Interest	5,556	0
Congresses	0	40,861
Accrued expenses and other current liabilities	$ 7,950,440	$ 10,314,341

LONG-TERM DEBT - Additional inf

LONG-TERM DEBT - Additional information (Details) - USD ($)							12 Months Ended
	Jul. 01, 2024	Jan. 01, 2024	Dec. 27, 2022	Jan. 19, 2022	Dec. 04, 2020	Jul. 31, 2019	Dec. 31, 2022	Dec. 31, 2020	Mar. 29, 2018	Jun. 30, 2016
LONG-TERM DEBT
Amount drawn down							$ 5,000,000	$ 1,410,900
Non-refundable fee percent							2.50%
Term C Loan | First Tranche
LONG-TERM DEBT
Maximum borrowing capacity							$ 5,000,000
Percentage of success fee							1%
Average selling price							$ 8
Number of days for stock price threshold set in success fee letter							5 days
Term C Loan | Second Tranche
LONG-TERM DEBT
Maximum borrowing capacity							$ 5,000,000
Percentage of success fee							1.50%
Average selling price							$ 10
Number of days for stock price threshold set in success fee letter							5 days
Term C Loan | Third Tranche
LONG-TERM DEBT
Maximum borrowing capacity							$ 5,000,000
Percentage of success fee							2%
Average selling price							$ 12
Number of days for stock price threshold set in success fee letter							5 days
Non refundable Closing Fee
LONG-TERM DEBT
Debt issuance costs				$ 18,750
Western Alliance Bank
LONG-TERM DEBT
Debt instrument , Face amount									$ 15,000,000	$ 10,000,000
Repayments of debt					$ 15,000,000
Western Alliance Bank | Forecast
LONG-TERM DEBT
Equal monthly payments of principal with accrued and unpaid interest payable	$ 277,778	$ 208,333
Western Alliance Bank | Closing Fee
LONG-TERM DEBT
Debt issuance costs					75,000
Western Alliance Bank | New Term Loan
LONG-TERM DEBT
Debt instrument , Face amount				$ 15,000,000	$ 15,000,000					$ 5,000,000
Rate of interest added to reference rate as per debt agreement				1.25%
Western Alliance Bank | Term A Loan | First Tranche
LONG-TERM DEBT
Debt instrument , Face amount									10,000,000
Western Alliance Bank | Term B Loan
LONG-TERM DEBT
Repayments of debt						$ 5,000,000
Long-term debt						$ 15,000,000
Western Alliance Bank | Term B Loan | Second Tranche
LONG-TERM DEBT
Debt instrument , Face amount									$ 5,000,000
Western Alliance Bank | Term C Loan
LONG-TERM DEBT
Maximum borrowing capacity				$ 15,000,000
Current borrowing capacity				$ 5,000,000
Interest rate cap				8%
Western Alliance Bank | Term C Loan | First Tranche
LONG-TERM DEBT
Amount drawn down			$ 5,000,000
Western Alliance Bank | 2018 Success Fee Letter
LONG-TERM DEBT
Percentage of success fee							6.37%
Average selling price							$ 7.05
Number of days for stock price threshold set in success fee letter							5 days
Western Alliance Bank | 2018 Success Fee Letter | Minimum
LONG-TERM DEBT
Percentage of closing price on common stock							26.13%
Western Alliance Bank | 2018 Success Fee Letter | Maximum
LONG-TERM DEBT
Percentage of closing price on common stock							70%

LONG TERM DEBT (Details)

LONG TERM DEBT (Details)	Dec. 31, 2022 USD ($)
LONG-TERM DEBT
Principal amount	$ 5,000,000
Long-term debt net of current maturities	$ 5,000,000

LONG-TERM DEBT - Principal paym

LONG-TERM DEBT - Principal payments (Details)	Dec. 31, 2022 USD ($)
LONG-TERM DEBT
2024	$ 2,500,000
2025	2,500,000
Total	$ 5,000,000

LEASES (Details)

LEASES (Details)		1 Months Ended			12 Months Ended
	Apr. 01, 2021 USD ($)	Sep. 30, 2021 USD ($)	Apr. 30, 2021 USD ($)	Mar. 31, 2021 USD ($) item	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Jan. 31, 2021 m²
LEASES:
Operating lease lability					$ 13,250,944	$ 13,821,509
Right of use asset					$ 12,603,901	13,423,472
Incremental borrowing rate					9.80%
Security deposit					$ 46,914	256,591
Operating lease paid					$ 2,935,000	$ 1,968,000	$ 937,000
Weighted average remaining lease term					12 years 4 months 24 days	14 years 3 months 18 days
Twentieth Amendment To lease
LEASES:
Monthly payments of base rent and other costs			$ 35,000
Additional operating leases rent expense			30,000
Operating lease base rent for remaining space			20,000
Monthly operating expenses			11,000
Security deposit			150,000				$ 54,000
CytoSorbents Medical, Inc
LEASES:
Number of times lease renewal options available | item				2
Renewal term				5 years
Rent abatement term				6 months
CytoSorbents Europe GmbH
LEASES:
Monthly payments of base rent and other costs	$ 7,784
Operating lease lability	594,000
Right of use asset	594,000
Area of Land | m²								1,068
Other costs	$ 239
Lease term	5 years
United States | CytoSorbents Medical, Inc
LEASES:
Remaining lease term				15 years 6 months
Annual rent expense increment rate				2.75%
Percentage of total building space occupied				92.30%
Allowance for building improvement				$ 1,455,000
Operating lease lability	$ 11,600,000
Right of use asset	$ 11,600,000
Incremental borrowing rate	9.80%
United States | Letter of credit | CytoSorbents Medical, Inc
LEASES:
Security amount			$ 1,467,000
United States | Initial early term | CytoSorbents Medical, Inc
LEASES:
Monthly payments of base rent and other costs				25,208
United States | Early term | CytoSorbents Medical, Inc
LEASES:
Monthly payments of base rent and other costs				88,254
United States | Early term | CytoSorbents Medical, Inc
LEASES:
Monthly payments of base rent and other costs				$ 111,171
Germany
LEASES:
Monthly payments of base rent and other costs		$ 12,100
Additional operating leases rent expense		$ 3,000

LEASES - Right-of- use asset an

LEASES - Right-of- use asset and related lease liability (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
LEASES
Right-of-use asset	$ 12,603,901	$ 13,423,472
Total	13,250,944	13,821,509
Less current portion	(108,939)	(570,566)
Lease liability, net of current portion	$ 13,142,005	$ 13,250,943

LEASES - Maturities of the leas

LEASES - Maturities of the lease liabilities (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
LEASES
2023	$ 1,266,346
2024	1,656,678
2025	1,695,677
2026	1,735,747
2027	1,776,920
Thereafter	17,232,300
Total lease payments	25,363,668
Present value discount	12,112,724
Total	$ 13,250,944	$ 13,821,509

INCOME TAXES - Consolidated los

INCOME TAXES - Consolidated loss before income taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES
Domestic	$ (21,155,203)	$ (18,829,797)	$ (5,682,628)
Foreign	(12,749,965)	(6,464,854)	(3,281,634)
Total	$ (33,905,168)	$ (25,294,651)	$ (8,964,262)

INCOME TAXES - The benefit from

INCOME TAXES - The benefit from income taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES
State Tax, including sale of New Jersey losses & credits	$ 1,092,585	$ 736,003	$ 1,127,074
Income Tax Expense (Benefit), Total	$ 1,092,585	$ 736,003	$ 1,127,074

INCOME TAXES - The principal co

INCOME TAXES - The principal components of the Company's deferred tax assets and liabilities (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Net operating loss carry forward	$ 31,570,846	$ 27,190,654	$ 22,301,154
Stock options	500,975	1,203,272	305,982
Research and development credit carryforward	3,982,147	2,687,591	2,194,211
Accruals and others	24,121	232,665	135,330
Lease liability	3,724,840	3,997,114	289,287
174(b) research and development	3,331,625
Gross deferred tax assets	43,134,554	35,311,296	25,225,964
Less valuation allowance	(39,303,451)	(31,242,130)	(24,794,474)
Deferred tax assets, net of valuation allowance	3,831,103	4,069,166	431,490
Deferred tax liability:
Fixed assets	(288,145)	(183,941)	$ (431,490)
Right of Use Asset	$ (3,542,958)	$ (3,885,225)

INCOME TAXES - Reconciliation o

INCOME TAXES - Reconciliation of income tax (expense) benefit (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES
Federal statutory rate	0.21%	0.21%	0.21%
State taxes, net of federal benefit	(0.028%)	(0.02%)	(0.095%)
Foreign rate differential	0.034%	0.023%	0.033%
Permanent items	(0.015%)	(0.065%)	(0.02%)
Rate change and true-up	0.006%	0.118%	0.17%
Change in valuation allowance	(0.228%)	(0.255%)	(0.216%)
R&D credit	0.021%	0.017%	0.044%
Sale of state R&D credit and NOL	0.032%
Effective income tax rate	0.032%	0.028%	0.126%

INCOME TAXES - Additional infor

INCOME TAXES - Additional information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2018
INCOME TAXES
Proceeds from the sale of prior unused net operating loss carryovers	$ 1,093,000
Net operating loss carry forwards	47,800,000
Valuation Allowance, Deferred Tax Asset, Increase, Amount	$ 8,061,321	$ 6,447,656	$ 1,936,732
operating loss carryforwards	80% limitation on taxable income
Federal
INCOME TAXES
Net operating loss carry forwards	$ 87,400,000			$ 39,600,000
Tax credit carryforward, amount	3,700,000
State
INCOME TAXES
Net operating loss carry forwards	5,500,000
Tax credit carryforward, amount	300,000
Foreign Tax
INCOME TAXES
Net operating loss carry forwards	$ 42,700,000

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Details) - USD ($)			1 Months Ended	12 Months Ended
	Jan. 01, 2019	Aug. 11, 2003	Jan. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Jan. 31, 2023
COMMITMENTS AND CONTINGENCIES
Accrued tax liability					$ 598,000
Initial term (in years)	3 years
Automatic renewal period for employment agreements			1 year
Additional automatic renewed period for employment agreements			1 year
Payroll Tax Audit
COMMITMENTS AND CONTINGENCIES
Accrued tax liability				$ 173,000			$ 90,000
Additional Social Security and VAT Taxes
COMMITMENTS AND CONTINGENCIES
Accrued tax liability				83,000
Royalty Agreements
COMMITMENTS AND CONTINGENCIES
Equity investment by an existing investor		$ 4,000,000
Future royalty payment percentage on gross revenue		3%
Royalty cost				849,000	1,193,000	$ 1,172,000
License Agreement [Member]
COMMITMENTS AND CONTINGENCIES
Royalty cost				$ 1,416,000	$ 1,988,000	$ 1,954,000
Term of license agreement				18 years
Royalty rate, lower limit				2.50%
Royalty rate, upper limit				5%

STOCKHOLDERS' EQUITY - Stock op

STOCKHOLDERS' EQUITY - Stock option activity (Details) - $ / shares		12 Months Ended
	Feb. 28, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Shares
Outstanding, beginning of the year		6,885,978	5,165,204	4,218,189
Granted	1,114,325	2,721,205	2,051,980	1,579,106
Forfeited		(1,270,155)	(138,037)	(34,644)
Expired		(227,204)	(21,756)	(226,440)
Exercised			(171,413)	(371,007)
Outstanding, end of the year		8,109,824	6,885,978	5,165,204	4,218,189
Weighted Average Exercise Price per Share
Outstanding, beginning of the year		$ 7.09	$ 6.36	$ 6.16
Granted		1.99	8.78	6.37
Forfeited		8.65	6.73	7.50
Expired		7.71	7.46	5.60
Exercised			5.73	4.46
Outstanding, end of the year		$ 5.11	$ 7.09	$ 6.36	$ 6.16
Weighted Average Remaining Contractual Life (Years)
Outstanding, beginning of the year					7 years
Granted		9 years 7 months 6 days	9 years 3 months 18 days	9 years
Forfeited		0 years	0 years	0 years
Expired		0 years	0 years	0 years
Exercised		0 years	0 years	0 years
Outstanding, end of the year		6 years 10 months 28 days	7 years 1 month 24 days	7 years 3 months 3 days

STOCKHOLDERS' EQUITY - Fair val

STOCKHOLDERS' EQUITY - Fair value of stock option (Details) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range	$ 1.55
Exercise price ranging from 5.00 to 10.58
STOCKHOLDERS' EQUITY
Expected Life of the Stock Option			6 years
Expected Dividends			0%
Exercise price ranging from 5.00 to 10.58 | Maximum [Member]
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range			$ 10.58
Current Price of the Underlying Stock and its Expected Volatility Range			69.80%
Risk Free Interest Rate Range			0.96%
Exercise price ranging from 5.00 to 10.58 | Minimum [Member]
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range			$ 5
Current Price of the Underlying Stock and its Expected Volatility Range			61.70%
Risk Free Interest Rate, minimum			0.28%
Exercise price ranging from 4.46 to 11.39
STOCKHOLDERS' EQUITY
Expected Life of the Stock Option		6 years
Expected Dividends		0%
Risk Free Interest Rate, minimum		0.47%
Risk Free Interest Rate Range		1.39%
Exercise price ranging from 4.46 to 11.39 | Maximum [Member]
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range		$ 11.39
Current Price of the Underlying Stock and its Expected Volatility Range		60.70%
Exercise price ranging from 4.46 to 11.39 | Minimum [Member]
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range		$ 4.26
Current Price of the Underlying Stock and its Expected Volatility Range		58.20%
Exercise price ranging from 1.11 to 3.91
STOCKHOLDERS' EQUITY
Expected Life of the Stock Option	6 years
Expected Dividends	0%
Risk Free Interest Rate, minimum	1.52%
Risk Free Interest Rate Range	4.20%
Exercise price ranging from 1.11 to 3.91 | Maximum [Member]
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range	$ 3.91
Current Price of the Underlying Stock and its Expected Volatility Range	67.90%
Exercise price ranging from 1.11 to 3.91 | Minimum [Member]
STOCKHOLDERS' EQUITY
Grant Date Exercise Price Range	$ 1.11
Current Price of the Underlying Stock and its Expected Volatility Range	59.30%

STOCKHOLDERS' EQUITY - Intrinsi

STOCKHOLDERS' EQUITY - Intrinsic value (Details)	12 Months Ended
	Dec. 31, 2022 USD ($) $ / shares shares
Options Outstanding
Aggregate Intrinsic Value | $	$ 3,883,000
Options Exercisable
Number Exercisable at December 31, 2022 | shares	4,623,085
Weighted Average Exercise Price	$ 6.32
Aggregate Intrinsic Value | $	$ 1,250
Exercise Price Range One [Member]
Options Outstanding
Range of Exercise Price, Lower Range Limit	$ 1.11
Range of Exercise Price, Upper Range Limit	$ 13.20
Number Outstanding at December 31, 2022 | shares	8,109,824
Weighted Average Exercise Price	$ 5.11
Weighted Average Remaining Life (Years)	6 years 10 months 28 days
Aggregate Intrinsic Value | $	$ 7,280

STOCKHOLDERS' EQUITY - Non-vest

STOCKHOLDERS' EQUITY - Non-vested options (Details) - $ / shares		12 Months Ended
	Feb. 28, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Shares
Non-vested, January 1, 2022		2,994,846
Granted	1,114,325	2,721,205	2,051,980	1,579,106
Forfeited		(1,270,155)
Vested		(959,157)
Non-vested, December 31, 2022		3,486,739	2,994,846
Weighted Average Grant Date Fair Value
Non-vested, January 1, 2022		$ 4.68
Granted		1.99
Forfeited		8.65
Vested		3.65
Non-vested, December 31, 2022		$ 2.10	$ 4.68

STOCKHOLDERS' EQUITY - Restrict

STOCKHOLDERS' EQUITY - Restricted stock unit (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
STOCKHOLDERS' EQUITY
Restricted Stock Units, Intrinsic Value Beginning Balance	$ 11,359,928	$ 19,504,184	$ 8,033,988
Restricted Stock Units, Intrinsic Value Ending Balance	$ 4,480,275	$ 11,359,928	$ 19,504,184
Restricted stock
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	2,711,200	2,447,200	2,086,750
Restricted Stock Units, Granted	498,050	396,000	385,700
Restricted Stock Units, Forfeited	(318,750)	(132,000)	(25,250)
Restricted Stock Units, Ending Balance	2,890,500	2,711,200	2,447,200
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number	312,092	304,962
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value	$ 4.42	$ 8.08
Restricted stock | Board of directors
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	277,200	277,200	277,200
Restricted Stock Units, Granted	69,300	0	0
Restricted Stock Units, Forfeited	0	0	0
Restricted Stock Units, Ending Balance	346,500	277,200	277,200
Restricted stock | Executive Management
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	724,500	724,500	604,500
Restricted Stock Units, Granted	55,000	0	120,000
Restricted Stock Units, Forfeited	0	0	0
Restricted Stock Units, Ending Balance	779,500	724,500	724,500
Restricted stock | Other Employees
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	1,709,500	1,445,500	1,205,050
Restricted Stock Units, Granted	373,750	396,000	265,700
Restricted Stock Units, Forfeited	(318,750)	(132,000)	(25,250)
Restricted Stock Units, Ending Balance	1,764,500	1,709,500	1,445,500

STOCKHOLDERS' EQUITY - Restri_2

STOCKHOLDERS' EQUITY - Restricted stock unit activity (Details) - Restricted stock	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Shares
Non-vested, January 1, 2022 | shares	304,962
Granted | shares	288,500
Forfeited | shares	(236,370)
Vested | shares	(45,000)
Non-vested, December 31, 2022 | shares	312,092
Weighted Average Grant Date Fair Value
Non-vested, January 1, 2022 | $ / shares	$ 8.08
Granted | $ / shares	1.95
Forfeited | $ / shares	8.35
Vested | $ / shares	5.38
Non-vested, December 31, 2022 | $ / shares	$ 4.42

STOCKHOLDERS' EQUITY - Addition

STOCKHOLDERS' EQUITY - Additional information (Details)

12 Months Ended

Aug. 10, 2022 USD ($) shares

Apr. 01, 2022

Dec. 30, 2021 USD ($)

Apr. 12, 2021 USD ($) shares

Apr. 12, 2021 USN ($) shares

Feb. 28, 2020 USD ($) shares

Jul. 22, 2019

Dec. 31, 2022 USD ($) item $ / shares shares

Dec. 31, 2021 USD ($) shares

Dec. 31, 2020 USD ($) $ / shares shares

Jul. 14, 2021 USD ($)

Dec. 31, 2019 shares

Jun. 30, 2019 shares

May 31, 2019 shares

STOCKHOLDERS' EQUITY

Number of preferred stock authorized | shares

5,000,000

5,000,000

5,000,000

Common Stock, shares authorized | shares

100,000,000

100,000,000

100,000,000

50,000,000

Aggregate registered amount for offerings

$ 150,000,000

Expenses incurred

$ 90,000

Number of option granted | shares

1,114,325

2,721,205

2,051,980

1,579,106

Aggregate Intrinsic Value

$ 3,883,000

Grant date fair value of these unvested options

$ 3,883,000

Stock option expense

$ 1,070,000

Percentage of milestone activity met by the company

19%

88%

88%

Number of long-term incentive plans | item

2

Allocated share-based compensation expense

$ 3,424,000

4,021,000

$ 3,514,000

Grant Date Exercise Price Range | $ / shares

$ 1.55

Total unrecognized compensation cost related to stock options

$ 4,745,000

Amortized period

43 months

Vested | shares

(959,157)

Issuance of restricted stock options

$ 380,091

$ 928,417

$ 657,780

Outstanding | shares

8,109,824

6,885,978

5,165,204

4,218,189

Number of shares to be purchased | shares

0

Employees

STOCKHOLDERS' EQUITY

Number of option granted | shares

1,323,400

1,323,400

Grant date fair value of unvested options

$ 7,042,000

Stock option expense

$ 273,000

Restricted stock

STOCKHOLDERS' EQUITY

Stock issued during period, shares, restricted stock award, gross | shares

91,750

Stock issued during period, value, restricted stock sward, gross

$ 713,868

Vesting period

4 years

Issuance of restricted stock options

$ (16,000)

178,000

Restricted stock | Second 45,000 restricted stock

STOCKHOLDERS' EQUITY

Stock issued during period, shares, restricted stock award, gross | shares

45,000

Restricted stock | Second 46,750 restricted stock

STOCKHOLDERS' EQUITY

Stock issued during period, shares, restricted stock award, gross | shares

46,750

Restricted stock | Second anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

Restricted stock | Third anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

Restricted stock | Fourth anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

Employee stock options

STOCKHOLDERS' EQUITY

Stock option expense

$ 101,336

Employee stock options | Employees

STOCKHOLDERS' EQUITY

Aggregate Intrinsic Value

135,000

Grant date fair value of these unvested options

135,000

Employee one

STOCKHOLDERS' EQUITY

Allocated share-based compensation expense

1,381,000

Number of options granted | shares

1,163,800

Employee two

STOCKHOLDERS' EQUITY

Number of option granted | shares

772,905

Aggregate Intrinsic Value

917,000

Grant date fair value of these unvested options

917,000

Allocated share-based compensation expense

89,662

Board of directors

STOCKHOLDERS' EQUITY

Number of option granted | shares

113,850

Senior manager one

STOCKHOLDERS' EQUITY

Number of option granted | shares

473,750

Aggregate Intrinsic Value

562,000

Grant date fair value of these unvested options

562,000

Stock option expense

160,944

Senior manager two | Employee stock options

STOCKHOLDERS' EQUITY

Number of option granted | shares

1,365,000

Aggregate Intrinsic Value

1,620,000

Grant date fair value of these unvested options

$ 1,620,000

Stock option plan one

STOCKHOLDERS' EQUITY

Common stock reserved for issuance | shares

2,400,000

Outstanding | shares

258,000

2014 Stock Option Plan

STOCKHOLDERS' EQUITY

Common stock reserved for issuance | shares

13,400,000

Outstanding | shares

3,713,000

July 22, 2019 performance-based award | Restricted stock | On the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

1%

February 28 2020 performance based award

STOCKHOLDERS' EQUITY

Stock option expense

$ 951,000

February 28 2020 performance based award | Restricted stock

STOCKHOLDERS' EQUITY

Stock issued during period, shares, restricted stock award, gross | shares

168,100

Stock issued during period, value, restricted stock sward, gross

$ 1,014,000

Issuance of restricted stock options

(65,000)

528,000

February 28 2020 performance based award | Restricted stock | First anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

1%

February 28 2020 performance based award | Restricted stock | Second anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

April 12, 2021 performance based award

STOCKHOLDERS' EQUITY

Stock option expense

314,000

April 12, 2021 performance based award | Restricted stock

STOCKHOLDERS' EQUITY

Stock issued during period, shares, restricted stock award, gross | shares

235,765

235,765

Stock issued during period, value, restricted stock sward, gross

$ 2,120,000

Issuance of restricted stock options

226,000

1,207,000

April 12, 2021 performance based award | Restricted stock | On the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

33.30%

April 12, 2021 performance based award | Restricted stock | First anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

33.30%

April 12, 2021 performance based award | Restricted stock | Second anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

33.30%

33.30%

August 10, 2022 performance based award

STOCKHOLDERS' EQUITY

Stock option expense

180,440

August 10, 2022 performance based award | Restricted stock

STOCKHOLDERS' EQUITY

Stock issued during period, shares, restricted stock award, gross | shares

288,500

Stock issued during period, value, restricted stock sward, gross

$ 563,000

Issuance of restricted stock options

$ 260,000

$ 0

August 10, 2022 performance based award | Restricted stock | On the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

August 10, 2022 performance based award | Restricted stock | First anniversary of the date of the grant

STOCKHOLDERS' EQUITY

Vesting percentage

33.30%

Jefferies LLC and B. Riley FBR, Inc

STOCKHOLDERS' EQUITY

Aggregate offering price

$ 25,000,000

Commission rate (as a percent)

3%

Exercise price ranging from 5.00 to 10.58

STOCKHOLDERS' EQUITY

Expected Life of the Stock Option

6 years

Expected Dividends

0%

Exercise price ranging from 5.00 to 10.58 | Maximum

STOCKHOLDERS' EQUITY

Grant Date Exercise Price Range | $ / shares

$ 10.58

Current Price of the Underlying Stock and its Expected Volatility Range

69.80%

Risk Free Interest Rate Range

0.96%

Exercise price ranging from 5.00 to 10.58 | Minimum

STOCKHOLDERS' EQUITY

Grant Date Exercise Price Range | $ / shares

$ 5

Current Price of the Underlying Stock and its Expected Volatility Range

61.70%

Risk Free Interest Rate, minimum

0.28%

Exercise price ranging from 1.11 to 3.91

STOCKHOLDERS' EQUITY

Expected Life of the Stock Option

6 years

Expected Dividends

0%

Risk Free Interest Rate, minimum

1.52%

Risk Free Interest Rate Range

4.20%

Exercise price ranging from 1.11 to 3.91 | Maximum

STOCKHOLDERS' EQUITY

Grant Date Exercise Price Range | $ / shares

$ 3.91

Current Price of the Underlying Stock and its Expected Volatility Range

67.90%

Exercise price ranging from 1.11 to 3.91 | Minimum

STOCKHOLDERS' EQUITY

Grant Date Exercise Price Range | $ / shares

$ 1.11

Current Price of the Underlying Stock and its Expected Volatility Range

59.30%

STOCKHOLDERS' EQUITY - Warrants

STOCKHOLDERS' EQUITY - Warrants (Details)	Dec. 31, 2022 shares
STOCKHOLDERS' EQUITY
Number of shares to be purchased	0

NET LOSS PER SHARE (Details)

NET LOSS PER SHARE (Details) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Stock options and warrants
NET LOSS PER SHARE
Antidilutive securities excluded from computation of earnings per share	11,312,000	9,902,000	7,786,000

RETIREMENT PLAN (Details)

RETIREMENT PLAN (Details) - USD ($)		1 Months Ended	12 Months Ended
	Jan. 01, 2021	Jun. 30, 2014	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
RETIREMENT PLAN
Term of employment required		3 months
Compensation subject to IRC limitations		100%
Matching contribution, Percent			20%
Compensation for participant contributions			5%
Matching contributions, Amount			$ 442,000	$ 355,000	$ 59,200
Participants contribution up to 3 percent
RETIREMENT PLAN
Matching contribution, Percent	100%
Compensation for participant contributions	3%
Participants contribution over 3% and maximum 5%
RETIREMENT PLAN
Matching contribution, Percent	50%
Minimum | Participants contribution over 3% and maximum 5%
RETIREMENT PLAN
Compensation for participant contributions	3%
Maximum | Participants contribution over 3% and maximum 5%
RETIREMENT PLAN
Compensation for participant contributions	5%

QUARTERLY FINANCIAL RESULTS (_3

QUARTERLY FINANCIAL RESULTS (UNAUDITED) (Details) - USD ($)	3 Months Ended												12 Months Ended
	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
QUARTERLY FINANCIAL RESULTS (UNAUDITED)
Total revenue	$ 9,390,474	$ 8,111,353	$ 8,495,558	$ 8,691,424	$ 10,782,195	$ 9,760,416	$ 12,024,069	$ 10,598,847	$ 11,955,776	$ 10,546,612	$ 9,794,903	$ 8,707,310	$ 34,688,809	$ 43,165,527	$ 41,004,601
Gross margin	5,757,036	3,617,377	4,944,856	6,413,788	7,659,452	7,297,470	9,313,852	7,847,403	9,428,358	7,656,230	6,545,136	6,322,468	20,733,057	32,118,177	29,952,192
Loss from operations	(6,356,356)	(9,017,338)	(8,357,050)	(7,791,135)	(9,561,821)	(5,406,000)	(4,924,733)	(2,852,191)	(2,634,264)	(1,959,652)	(3,297,667)	(2,478,754)	(31,521,879)	(22,744,745)	(10,370,334)
Net loss attributable to common stockholders	$ (766,128)	$ (12,200,837)	$ (10,879,222)	$ (8,966,398)	$ (9,307,012)	$ (6,406,285)	$ (4,677,530)	$ (4,167,821)	$ (677,724)	$ (839,729)	$ (2,866,956)	$ (3,452,779)	$ (32,812,583)	$ (24,558,648)	$ (7,837,188)
Basic net loss per common share	$ (0.02)	$ (0.28)	$ (0.25)	$ (0.21)	$ (0.25)	$ (0.15)	$ (0.11)	$ (0.10)	$ 0	$ (0.02)	$ (0.08)	$ (0.10)	$ (0.75)	$ (0.57)	$ (0.20)
Diluted net loss per common share	$ (0.02)	$ (0.28)	$ (0.25)	$ (0.21)	$ (0.25)	$ (0.15)	$ (0.11)	$ (0.10)	$ 0	$ (0.02)	$ (0.08)	$ (0.10)	$ (0.75)	$ (0.57)	$ (0.20)

REVENUE - Contract with custome

REVENUE - Contract with customer asset And liability (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
REVENUE
Contract liabilities, which are included in expenses and other current liabilities	$ 1,516,772	$ 1,947,353