Cytosorbents (CTSO) 10-K 14 Mar 24 2023 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2023	Mar. 03, 2024	Jun. 30, 2023
Document and Entity Information
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
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
Document Financial Statement Error Correction [Flag]	true
Document Financial Statement Restatement Recovery Analysis [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 143,849,000
Entity Common Stock, Shares Outstanding		54,293,555
Entity Central Index Key	0001175151
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
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, 2023	Dec. 31, 2022
Current Assets:
Cash and cash equivalents	$ 14,131,137	$ 22,144,567
Grants and accounts receivable, net of allowances of $49,663 and $76,041 at December 31, 2023 and 2022, respectively	6,057,072	5,664,941
Inventories	3,680,129	3,461,586
Prepaid expenses and other current assets	1,834,485	2,488,597
Total current assets	25,702,823	33,759,691
Property and equipment - net	10,056,354	10,743,032
Restricted cash	1,483,958	1,687,459
Right-of-use asset	12,058,896	12,603,901
Other assets	3,958,603	4,437,447
Total Assets	53,260,634	63,231,530
Current Liabilities:
Accounts payable	3,802,170	1,655,173
Accrued expenses and other current liabilities	7,870,149	7,950,440
Lease liability - current portion	373,636	108,939
Current maturities of long-term debt	2,500,000
Total current liabilities	14,545,955	9,714,552
Lease liability, net of current portion	12,896,659	13,142,005
Long-term debt, net of current maturities	2,542,857	5,000,000
Total Liabilities	29,985,471	27,856,557
Commitments and Contingencies (Note 10)
Stockholders' Equity:
Preferred Stock, Par Value $0.001, 5,000,000 shares authorized; no shares issued and outstanding at December 31, 2023 and 2022
Common Stock, Par Value $0.001, 100,000,000 shares authorized; 54,240,265 and 43,635,715 shares issued and outstanding at December 31, 2023 and 2022, respectively	54,240	43,635
Additional paid-in capital	305,196,874	287,000,021
Accumulated other comprehensive income	529,321	2,329,195
Accumulated deficit	(282,505,272)	(253,997,878)
Total Stockholders' Equity	23,275,163	35,374,973
Total Liabilities and Stockholders' Equity	$ 53,260,634	$ 63,231,530

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
CONSOLIDATED BALANCE SHEETS
Grants and accounts receivable, net of allowance for doubtful accounts	$ 49,663	$ 76,041
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	54,240,265	43,635,715
Common Stock, shares outstanding	54,240,265	43,635,715

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenue:
Total revenue	$ 36,349,379	$ 34,688,809	$ 43,165,527
Cost of revenue	13,957,356	13,955,752	11,047,350
Gross profit	22,392,023	20,733,057	32,118,177
Operating expenses:
Research and development	15,728,915	15,118,907	16,380,930
Legal, financial and other consulting	4,272,296	2,847,899	2,731,515
Selling, general and administrative	33,600,065	34,288,130	35,750,477
Total operating expenses	53,601,276	52,254,936	54,862,922
Loss from operations	(31,209,253)	(31,521,879)	(22,744,745)
Other income (expense):
Interest income (expense), net	(157,891)	132,597	28,007
Gain (loss) on foreign currency transactions	1,949,257	(2,448,583)	(2,577,913)
Miscellaneous income (expense)	96,754	(67,303)
Total other income (expense), net	1,888,120	(2,383,289)	(2,549,906)
Loss before benefit from income taxes	(29,321,133)	(33,905,168)	(25,294,651)
Benefit from income taxes	813,739	1,092,585	736,003
Net loss attributable to common stockholders	$ (28,507,394)	$ (32,812,583)	$ (24,558,648)
Basic net loss per common share	$ (0.64)	$ (0.75)	$ (0.57)
Diluted net loss per common share	$ (0.64)	$ (0.75)	$ (0.57)
Weighted average number of shares of common stock outstanding, basic	44,656,391	43,573,215	43,359,186
Weighted average number of shares of common stock outstanding, diluted	44,656,391	43,573,215	43,359,186
Comprehensive loss:
Net loss	$ (28,507,394)	$ (32,812,583)	$ (24,558,648)
Other comprehensive income (loss):
Foreign currency translation adjustment	(1,799,874)	1,803,610	2,259,663
Comprehensive loss	(30,307,268)	(31,008,973)	(22,298,985)
Total product sales
Revenue:
Total revenue	31,084,953	29,359,910	40,108,567
CytoSorb sales
Revenue:
Total revenue	31,015,268	28,572,709	39,996,700
Other product sales
Revenue:
Total revenue	69,685	787,201	111,867
Grant income
Revenue:
Total revenue	$ 5,264,426	$ 5,328,899	$ 3,056,960

CONSOLIDATED STATEMENTS OF CHAN

CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY - USD ($)	Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit	Total
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
Proceeds from the exercise of stock options for cash	$ 139	805,060			805,199
Proceeds from the exercise of stock options for cash (in shares)	139,102
Cashless exercise of stock options	$ 10	(2,842)			(2,832)
Cashless exercise of stock options (in shares)	10,724
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
Other comprehensive 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 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
Stock-based compensation - employees, consultants and directors		3,329,307			3,329,307
Proceeds from the exercise of stock options for cash	$ 85	218,193			218,278
Proceeds from the exercise of stock options for cash (in shares)	84,905
Issuance of common stock offerings, net of fees incurred	$ 10,390	14,245,544			$ 14,255,934
Issuance of common stock offerings, net of fees incurred (in shares)	10,389,554				0
Issuance of restricted stock options	$ 130	403,809			$ 403,939
Issuance of restricted stock options (in shares)	130,091
Other comprehensive loss, foreign currency translation adjustment			(1,799,874)		(1,799,874)
Net loss				(28,507,394)	(28,507,394)
Balance at Dec. 31, 2023	$ 54,240	$ 305,196,874	$ 529,321	$ (282,505,272)	$ 23,275,163
Balance (in shares) at Dec. 31, 2023	54,240,265

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net loss	$ (28,507,394)	$ (32,812,583)	$ (24,558,648)
Adjustments to reconcile net loss to net cash used in operating activities:
Accrued final fee	42,857
Non-cash compensation	371,397	376,574	2,183,317
Depreciation and amortization	1,462,436	882,621	731,578
Amortization of right-of-use asset	564,356	249,008	398,035
Bad debt expense (recovery)	14,434	(8,354)	(512)
Loss on disposal of fixed assets		132,303
Impairment of patents	655,685	635,606
Foreign currency transaction (gains) losses	(1,949,256)	2,448,583	2,577,913
Stock-based compensation	3,329,307	3,423,517	4,020,819
Changes in operating assets and liabilities:
Grants and accounts receivable	(245,616)	(1,288,422)	420,578
Inventories	(121,039)	945,352	(2,350,547)
Prepaid expenses and other current assets	1,104,167	(22,187)	280,915
Other assets	(50)	52,678	(135,857)
Accounts payable and accrued expenses	1,623,580	(3,248,978)	2,426,810
Net cash used in operating activities	(21,655,136)	(28,234,282)	(14,005,599)
Cash flows from investing activities:
Purchases of property and equipment	(538,115)	(6,087,365)	(3,641,248)
Patent costs	(398,121)	(368,211)	(640,013)
Net cash used in investing activities	(936,236)	(6,455,576)	(4,281,261)
Cash flows from financing activities:
Proceeds from long-term debt		5,000,000
Equity contributions - net of fees incurred	14,255,932	(40,358)	(90,000)
Proceeds from exercise of stock options	218,278		805,199
Net cash provided by financing activities	14,474,210	4,959,642	715,199
Effect of exchange rates on cash	(99,769)	(262,924)	(24,774)
Net change in cash, cash equivalents and restricted cash	(8,216,931)	(29,993,140)	(17,596,435)
Cash, cash equivalents and restricted cash at beginning of year	23,832,026	53,825,166	71,421,601
Cash, cash equivalents and restricted cash at end of year	15,615,095	23,832,026	53,825,166
Supplemental disclosure of cash flow information:
Cash paid during the year for interest	376,668
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	$ 403,939	$ 380,091	$ 928,417

BASIS OF PRESENTATION

BASIS OF PRESENTATION	12 Months Ended
	Dec. 31, 2023
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, 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 and CytoSorbents India Private Limited, wholly-owned subsidiaries of CytoSorbents Medical, Inc. These entities are collectively referred to as the “Company”. As of December 31, 2023, the Company’s total cash and cash equivalents were approximately $15.6 million, including approximately $14.1 million in cash and cash equivalents and approximately $1.5 million in restricted cash, which is not expected to fund the Company’s operations beyond the next twelve months from the issuance of these consolidated financial statements. This matter raises substantial doubt about the Company’s ability to continue as a going concern. As a result, the accompanying consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. The Company is actively pursuing financing sources, including less or non-dilutive debt financing, royalty financing, strategic or direct investments, equity financing, and/or combinations thereof. There can be no assurance that management will be successful in these endeavors.

PRINCIPAL BUSINESS ACTIVITY AND

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	12 Months Ended
	Dec. 31, 2023
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, a wholly-owned subsidiary of CytoSorbents Europe, GmbH. In October 2022, the Company formed CytoSorbents France SAS, a wholly-owned subsidiary of CytoSorbents Europe, GmbH, to provide marketing and direct sales services in France. In May 2023, the Company formed CytoSorbents India Private Limited to provide marketing and direct sales services in India. 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 510(k) or premarket approval) consistent with the FDA’s mission to protect and promote public health. In July 2021, the Company received full approval of its Investigative Device Exemption (“IDE”) to conduct the pivotal STAR-T (Safe and Timely Antithrombotic Removal – Ticagrelor) double-blind randomized control trial (“RCT”) for up to 120 patients in the United States to support FDA marketing approval. In July 2023, the Company announced that enrollment in the STAR-T trial has completed, and in August 2023, the Company announced completion of the STAR-T trial, following the last scheduled patient follow-up. In December 2023, the Company announced that the independent Data Safety Monitoring Board (the “DSMB”) performed a final review of the full unblinded data on all 140 patients in the STAR-T trial and concluded there were no issues with device safety, meeting the primary safety endpoint of the study. The Company has also performed the initial data analysis on the primary effectiveness endpoint of STAR-T trial. Based on this analysis, the study did not meet the primary effectiveness endpoint in the overall patient population that underwent different types of cardiac surgeries. However, the study did demonstrate evidence of reduced bleeding complications in patients in the pre-specified isolated coronary artery bypass graft (“CABG”) surgery population, representing more than 90% of the overall study population. The Company expects to complete the analysis of the full trial results during the first quarter of 2024. Pending this final analysis, the Company believes the safety and effectiveness data from STAR-T will support the regulatory submission of DrugSorb-ATR to the U.S. FDA and Health Canada. 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 will 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 three-year preferred supplier agreement with Asklepios, making CytoSorb available without restrictions to all of the approximately 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 September 2023, the distribution agreement with Nikkiso expired, and the Company indicated that it would not seek renewal of the agreement. The Company is actively working with a new supplier to provide a stand-alone hemoperfusion pump. 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. The launch of this program is expected to occur in 2024. 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, as of December 31, 2023, is protected by 19 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 2024 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 and CytoSorbents India Private Limited, wholly-owned subsidiaries 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 $1,949,000, $(2,449,000) and $(2,578,000) for the years ended December 31, 2023, 2022 and 2021, 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, ​ ​ ​ 2023 ​ 2022 Cash and cash equivalents ​ $ 14,131,137 ​ $ 22,144,567 Restricted cash ​ 1,483,958 ​ 1,687,459 Total cash, cash equivalents and restricted cash ​ $ 15,615,095 ​ $ 23,832,026 ​ Restricted Cash The Company’s total restricted cash in the amount of $1,483,958 and $1,687,459 as of December 31, 2023 and 2022, respectively, consisted of cash of $1,467,459 for each year 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 $16,499 and $220,000 as of December 31, 2023 and 2022, respectively, that the Company is obligated to maintain as collateral for the credit limit on the Company’s credit card account. Accounts Receivable and Allowance for Credit Losses Trade accounts receivable consist of amounts due from direct customers, distributors and agencies of the U.S. government and are presented at net realizable value. At each balance sheet date, the Company estimates an expected allowance for credit losses inherent in the Company’s accounts receivable portfolio based on historical experience, specific allowances for known troubled accounts, and other available evidence. In addition, also at each reporting date, this estimate is updated to reflect any changes in credit risk since the receivable was initially recorded. This estimate is calculated on a pooled basis where similar risk characteristics exist. The Company has identified the following portfolio segments: direct customers, distributors/strategic partners and the U.S. government. A fixed reserve percentage for each pool is derived from a review of the Company’s historical losses in relation to the total pool. This estimate is adjusted quarterly for management’s assessment of current conditions, reasonable and supportable forecasts regarding future events, and any other factors deemed relevant by the Company. The Company believes historical loss information is a reasonable starting point in which to calculate the expected allowance for credit losses as the Company’s portfolio segments have remained constant over the Company’s historical evaluation period. The Company writes off receivables when there is information that indicates the debtor is facing significant financial difficulty and there is no possibility of recovery. If any recoveries are made from any accounts previously written off, they are recognized as an offset to credit loss expense in the year of recovery. The total amount of write-offs was immaterial to the financial statements as a whole for the year ended December 31, 2023. The allowance for credit losses reflects accounts receivable balances that are written off when management determines they are uncollectible. The allowance for credit losses is measured on a collective (pool) basis when similar risk characteristics exist, and measures the allowance for credit losses using the following methods: Direct Customers—The Company measures expected credit losses on direct customer receivables using an aging methodology. The risk of loss for direct customer receivables is low based on the Company’s historical experience. The estimate of expected credit losses considers historical credit loss information that is adjusted for current conditions and supportable forecasts. Distributors/Strategic Partners—The Company measures expected credit losses on distributor receivables using an individual reserve methodology. The risk of loss in this portfolio is low based on the Company’s historical experience. The estimate of expected credit losses considers the past payment history of each distributor. U.S. Government- These receivables are related to the Company’s government grants. The Company measures expected credit losses on these receivables using an individual reserve methodology. The risk of loss in this portfolio is very low based on the Company’s historical experience, as these receivables are supported by approved grant award contracts. 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, 2023 and 2022, the Company’s inventory was comprised of finished goods, which amounted to $2,155,457 and $1,567,871, respectively, work in process which amounted to $838,871 and $1,280,368, respectively, and raw materials which amounted to $685,801 and $613,347, 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. Donated devices are removed from inventory and charged to selling, general and administrative expenses. 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 years ended December 31, 2023 and 2022, the Company wrote-off patent costs of approximately $656,000 and $636,000, respectively, related to the impairment of certain issued patents and pending patent applications in certain specific jurisdictions and the abandonment of certain pending patent application costs in the ordinary course of business. This charge is included in legal, financial and other consulting in the consolidated statements of operations and comprehensive loss. Revenue Recognition Revenue is recognized when the Company ships its products to its direct customers and distributors/strategic partners. Revenue is recognized on its grant awards with agencies of U.S. government in accordance with the terms of the award contract. See Note 3 for a description of the types of government contracts. The amount of revenue recognized reflects the consideration the Company expects to be entitled to receive in exchange for the products shipped or the services provided under their grant contracts. To achieve this core principle, the Company applies the following five steps: 1. Identify Contracts with Customers - The Company’s contracts with its direct customers are generally in the form of a purchase order. The Company has formal written contracts with each of its distributors/strategic partners that define their respective territories and minimum purchase commitments which must be met in order to maintain exclusivity in their territory. Distributors/strategic partner customers also submit purchase orders with each order that define the terms of shipment and transaction price. The Company has a contract for each grant award with various agencies of the U.S. government. 2. Identify Performance Obligations - The performance obligations in contracts with direct customers and distributors/strategic partners are for the shipment of the CytoSorb device and related accessory parts. The performance obligations for government contracts are dependent on the contract type, however, these are generally based on the costs incurred related to each government contract. 3. Determine Transaction Price - The price charged is based on the Company’s price list for the CytoSorb device and related accessory parts for both direct customers and distributor/strategic partners. The Company does not permit returns for product sales. The Company also provides for certain rebates and discounts to direct customers for sales of its product that are earned based upon sales volume. These amounts, which are earned based on calendar year sales volume, are recorded as a reduction of sales as earned. The transaction prices for government contracts are dependent on the type of contract and are outlined in each contract. 4. Allocate Transaction Price to Performance Obligations - The transaction price for the performance obligation is based on the purchase orders received for both direct customers and on the type of contract and are outlined in each contract. The transaction prices for government contract performance obligations are dependent on the type of contract and are generally based on costs incurred. 5. Recognize Revenue as Performance Obligations are Satisfied - The Company satisfies its performance obligation to direct customers and distributors/strategic partners generally upon shipment of the products. The Company satisfies its performance obligations on government contracts generally upon incurring costs on each contract. The Company records deferred revenue related to fixed price government contracts to the extent that billings exceed costs incurred. 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 $253,000, $582,000 and $615,000 in 2023, 2022 and 2021, 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 is accounting for an uncertain tax position of approximate $2.1 million for the year ended December 31, 2023. The Company had no unrecognized tax benefits as of December 31, 2022. 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 SAS 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 credit losses 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. Beginning in April of 2023, the Company joined the IntraFi network, and established an Insured CashSweep (“ICS”) account whereby all cash that was previously held in the Company’s money market account at Bridge Bank is swept daily in increments of less than $250,000 and deposited in a number of IntraFi’s 4,000 member banks. This arrangement provides FDIC insurance coverage for all of the cash balances previously held in the money market account, which represents all of the cash and cash equivalents held at Bridge Bank. This arrangement excludes the restricted cash balances. 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, 2023, one distributor accounted for approximately 19% of outstanding grants and accounts receivables. As of December 31, 2022, two distributors accounted for approximately 27% of outstanding grants and accounts receivables. For the years ended December 31, 2023, 2022 and 2021, no agency, distributor/strategic partner 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. Warrants The Company accounts for warrants as either equity-classified or liability-classified instruments based on an assessment of the warrant’s specific terms and applicable authoritative guidance in ASC 480 and ASC 815 “Derivatives and Hedging” (“ASC 815”). The assessment considers whether the warrants are freestanding financial instruments pursuant to ASC 480, meet the definition of a liability pursuant to ASC 480, and whether the warrants meet all of the requirements for equity classification under ASC 815, including whether the warrants are indexed to the Company’s own ordinary shares and whether the warrant holders could potentially require “net cash settlement” in a circumstance outside of the Company’s control, among other conditions for equity classification. This assessment, which requires the use of professional judgment, is conducted at the time of warrant issuance and as of each subsequent quarterly period end date while the warrants are outstanding. For issued or modified warrants that meet all of the criteria for equity classification, the warrants are required to be recorded as a component of equity at the time of issuance. For issued or modified warrants that do not meet all the criteria for equity classification, the warrants are required to be recorded as liabilities at their initial fair value on the date of issuance, and each balance sheet date thereafter. Changes in the estimated fair value of the warrants are recognized as a non-cash gain or loss on the statements of operations. As the warrants issued upon the closing of the Company’s December 13, 2023 Offering meet the criteria for equity classification under ASC 815, the warrants are classified as equity as of December 31, 2023. 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 $464,000, $297,000 and $276,000 for the years ended December 31, 2023, 2022 and 2021, respectively. Effect of Recent Accounting Pronouncements 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 implemented the update

REVENUE

REVENUE	12 Months Ended
	Dec. 31, 2023
REVENUE
REVENUE	3. REVENUE: The following table disaggregates the Company’s revenue by customer type and geographic area for the year ended December 31, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 66,773 ​ $ — ​ $ — ​ $ 66,773 Germany ​ 12,964,806 ​ ​ — ​ ​ — ​ ​ 12,964,806 All other countries ​ 5,956,042 ​ 12,097,332 ​ — ​ 18,053,374 Total product revenue ​ 18,987,621 ​ 12,097,332 ​ — ​ 31,084,953 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ — ​ 5,264,426 ​ 5,264,426 ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 18,987,621 ​ $ 12,097,332 ​ $ 5,264,426 ​ $ 36,349,379 ​ 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 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. 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 one 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, 2023 December 31, 2022 Contract receivables, which are included in grants and accounts receivable ​ $ 3,846,271 ​ $ 3,822,452 Contract liabilities, which are included in accrued expenses and other current liabilities ​ $ 1,577,141 ​ $ 1,694,906 ​ Contract receivables represent balances due from product sales to distributors amounting to $3,270,724 and $2,944,031 at December 31, 2023 and 2022, respectively, and billed and unbilled amounts due on government contracts amounting to $575,547 and $878,421 at December 31, 2023 and 2022, respectively. Contract receivable amounted to $3,000,708 as of January 1, 2022. 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 $196,322 and $178,134 at December 31, 2023 and 2022, respectively, and deferred grant revenue related to the billing on fixed price government contracts in excess of costs incurred, which amounted to $1,376,819 and $1,516,772 at December 31, 2023 and 2022, respectively. Contract liabilities amounted to $2,251,177 as of January 1, 2022.

PROPERTY AND EQUIPMENT, NET

PROPERTY AND EQUIPMENT, NET	12 Months Ended
	Dec. 31, 2023
PROPERTY AND EQUIPMENT, NET
PROPERTY AND EQUIPMENT, NET	4. PROPERTY AND EQUIPMENT, NET: Property and equipment - net, consist of the following as of December 31,: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Depreciation/ ​ ​ December 31 ​ Amortization ​ 2023 2022 Period ​ ​ ​ ​ ​ ​ ​ ​ ​ Furniture and fixtures ​ $ 1,462,778 ​ $ 1,306,267 7 years Equipment and computers ​ 5,404,743 ​ 5,131,934 3 to 7 years Leasehold improvements ​ 6,224,863 ​ 6,201,523 Lesser of term of lease or estimated useful life ​ ​ 13,092,384 ​ 12,639,724 Less accumulated depreciation and amortization ​ 3,036,030 ​ 1,896,692 Property and Equipment, Net ​ $ 10,056,354 ​ $ 10,743,032 ​ Depreciation expense for the years ended December 31, 2023, 2022 and 2021 amounted to $1,239,600, $688,565 and $571,156 respectively.

OTHER ASSETS

OTHER ASSETS	12 Months Ended
	Dec. 31, 2023
OTHER ASSETS
OTHER ASSETS	5. OTHER ASSETS: Other assets consist of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31 ​ 2023 2022 ​ ​ ​ ​ ​ ​ ​ Patent applications pending ​ $ 1,945,532 ​ $ 2,466,341 Patents issued ​ ​ 2,982,253 ​ ​ 2,773,191 Less accumulated amortization of patents issued ​ (1,021,233) ​ (848,999) Patents, net ​ 3,906,552 ​ 4,390,533 Security deposits ​ 52,051 ​ 46,914 Total ​ $ 3,958,603 ​ $ 4,437,447 ​ Amortization expense amounted to $222,836, $194,056, and $160,422 for the years ended December 31, 2023, 2022 and 2021, respectively. Amortization expense for the next five years will be approximately $218,000 for the year ending December 31, 2024; approximately $218,000 for the year ending December 31, 2025; approximately $217,000 for the year ending December 31, 2026; approximately $212,000 for the year ending December 31, 2027 and approximately $212,000 for the year ending December 31, 2028.

ACCRUED EXPENSES AND OTHER CURR

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	12 Months Ended
	Dec. 31, 2023
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 ​ 2023 2022 Accrued salaries and commissions ​ $ 3,344,080 ​ $ 2,862,930 Deferred revenue ​ ​ 1,380,821 ​ ​ 1,516,772 Clinical studies ​ 956,432 ​ 1,115,123 Accrued accounts payable ​ 497,627 ​ 850,630 Professional fees ​ 686,908 ​ 622,353 Accrued royalties ​ ​ 513,338 ​ ​ 592,398 Customer rebates ​ 181,284 ​ 166,065 Travel and entertainment ​ ​ 134,182 ​ ​ 99,316 Board of Director fees ​ 84,610 ​ 97,426 Sales, payroll and income taxes payable ​ ​ 56,423 ​ ​ 21,871 Interest ​ 34,444 ​ 5,556 Total ​ $ 7,870,149 ​ $ 7,950,440 ​

LONG-TERM DEBT

LONG-TERM DEBT	12 Months Ended
	Dec. 31, 2023
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. Therefore, no further draws are available as of the date of this filing. 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. The Company did not meet the required reserves test as of November 30, 2023, and accordingly, commencing on January 1, 2024, the Company is required to make equal monthly payments of principal of $208,333, together with accrued and unpaid interest, through December 1, 2025 at which time the loan balance will be paid in full. 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. This final fee is being accrued and charged to interest expense over the term of the loan. For the year ended December 31, 2023, the Company recorded interest expense of approximately $43,000 related to the final fee. The Term Loans are evidenced by a secured promissory note issued to the Bank by the Company. If the Company elects to prepay the Term Loans pursuant to the terms of the Amended and Restated Loan and Security Agreement, it will owe a prepayment fee to the Bank, as follows: (1) for a prepayment made on or after the funding date of a Term Loan through and including the first anniversary of such funding date, an amount equal to 2.0% of the principal amount of such Term Loan prepaid; (2) for a prepayment made after the first anniversary of the funding date of a Term Loan through and including the second anniversary of such funding date, an amount equal to 1.5% of the principal amount of such Term Loan prepaid; and (3) for a prepayment made after the second anniversary of the funding date of a Term Loan, an amount equal to 1.0% of the principal amount of such Term Loan prepaid. 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, 2023: ​ ​ ​ ​ Principal amount $ 5,000,000 Accrued final fee ​ ​ 42,857 Subtotal ​ 5,042,857 Less Current maturities ​ 2,500,000 Long-term debt net of current maturities ​ $ 2,542,857 ​ Principal payments of long-term debt are due as follows during the years ending December 31: ​ ​ ​ ​ 2024 $ 2,500,000 2025 ​ 2,500,000 Total ​ $ 5,000,000 ​

LEASES

LEASES	12 Months Ended
	Dec. 31, 2023
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 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, ​ 2023 2022 Right-of-use asset ​ $ 12,058,896 ​ $ 12,603,901 ​ ​ ​ ​ ​ ​ ​ Total lease liability ​ $ 13,270,295 ​ $ 13,250,944 Less current portion ​ (373,636) ​ ​ (108,939) Lease liability, net of current portion ​ $ 12,896,659 ​ $ 13,142,005 ​ The maturities of the lease liabilities are as follows as of December 31, 2023: ​ ​ ​ ​ ​ 2024 $ 1,656,678 2025 ​ 1,695,677 2026 ​ 1,735,747 2027 ​ 1,776,920 2028 ​ 1,819,224 Thereafter ​ 15,413,075 Total lease payments ​ ​ 24,097,321 Present value discount ​ ​ (10,827,026) Total ​ $ 13,270,295 ​ For the years ended December 31, 2023, 2022 and 2021, operating cash flows paid in connection with operating leases amounted to approximately $2,403,000, $2,935,000 and $1,968,000, respectively. As of December 31, 2023 and 2022, the weighted average remaining lease term was 12.7 years and 12.4 years, respectively.

INCOME TAXES

INCOME TAXES	12 Months Ended
	Dec. 31, 2023
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, 2023, 2022 and 2021 is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 Domestic ​ $ (21,475,931) ​ $ (21,155,203) ​ $ (18,829,797) Foreign ​ (7,843,202) ​ (12,749,965) ​ (6,464,854) Total ​ $ (29,319,133) ​ $ (33,905,168) ​ $ (25,294,651) ​ The benefit from income taxes consists of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 State Tax, including sale of New Jersey losses & credits ​ $ 813,739 ​ $ 1,092,585 ​ $ 736,003 Foreign tax provision ​ — ​ — ​ — ​ ​ $ 813,739 ​ $ 1,092,585 ​ $ 736,003 ​ 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, 2023, the Company had federal net operating loss (“NOL”) carryforwards of approximately $97.2 million, state NOL carry forwards of approximately $17.6 million, and foreign NOL carry forwards of approximately $50.6 million, which may be available to offset future taxable income, if any. The federal NOL carryforwards of $47.7 million, if not utilized, will expire between 2023 and 2038. The federal NOL carryforwards of $49.5 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 $17.6 million, if not utilized, will begin to expire in 2042. As of December 31, 2023, the Company had Federal and state research and development tax credit carryforwards of approximately $2.1 million and $0.2 million, respectively, available to reduce future tax liabilities, which will begin to expire at various dates starting in 2026. 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 accounting for $2.1 million relating to uncertain tax positions for the year ended December 31, 2023. 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 $816,000 from the approved sale of the 2022 state NOL and research and development credits in the first half of 2024. The principal components of the Company’s deferred tax assets and liabilities are as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 ​ 2022 ​ 2021 Deferred tax assets: ​ ​ ​ Net operating loss carry forward ​ $ 36,836,007 ​ $ 31,570,846 ​ $ 27,190,654 Stock options ​ 418,776 ​ 500,975 ​ 1,203,272 Research and development credit carryforward ​ 2,310,639 ​ 3,982,147 ​ 2,687,591 Accruals and others ​ 248,673 ​ 24,121 ​ 232,665 Lease liability ​ 3,730,280 ​ 3,724,840 ​ 3,997,114 §174(b) research and development ​ 5,495,850 ​ 3,331,625 ​ — Gross deferred tax assets ​ 49,040,225 ​ 43,134,554 ​ 35,311,296 Less valuation allowance ​ (45,334,554) ​ (39,303,451) ​ (31,242,130) ​ ​ 3,705,671 ​ 3,831,103 ​ ​ 4,069,166 Deferred tax liability: ​ ​ ​ Fixed assets ​ (315,915) ​ (288,145) ​ (183,941) Right of Use Asset ​ (3,389,756) ​ (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, 2023, 2022 and 2021 were $6,031,103, $8,061,321, and $6,447,656, 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, ​ ​ 2023 2022 2021 Federal statutory rate 21.0 % 21.0 % 21.0 % State taxes, net of federal benefit 5.2 (2.8) (2.0) ​ Foreign rate differential 2.3 3.4 2.3 ​ Permanent items (2.0) (1.5) (6.5) ​ Rate change and true-up (0.7) 0.6 11.8 ​ Uncertain tax positions ​ (7.2) ​ — ​ — ​ Change in valuation allowance (20.6) (22.8) (25.5) ​ R&D credit 1.9 2.1 1.7 ​ Sale of state R&D credit and NOL 2.8 3.2 — ​ Other ​ 0.1 ​ — ​ — ​ Effective income tax rate 2.8 % 3.2 % 2.8 % ​ A reconciliation of the unrecognized tax benefit balances is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 Balance at beginning of the year ​ $ — ​ $ — ​ $ — Increase for tax positions of prior years ​ 1,842,332 ​ — ​ — Increase for tax positions in current year ​ 270,901 ​ — ​ — Decrease for tax positions due to payment or settlement ​ — ​ — ​ — Decrease for tax positions due to limitation expirations ​ — ​ — ​ — ​ ​ $ 2,113,233 ​ $ — ​ $ — ​ The total amount of unrecognized tax benefits that could affect our effective tax rate, if recognized, was $2.1 million and $0 as of December 31, 2023 and 2022, respectively. The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and New Jersey. With few exceptions, we are no longer subject to U.S. federal, state and local, or non-U.S. income tax examinations by tax authorities for years before 2018, although NOL carryforwards and tax credit carryforwards from any year are subject to examination and adjustment for at least three years following the year in which they are fully utilized. As of December 31, 2023, no significant adjustments have been proposed relative to our tax positions. Although the outcome and timing of such events are highly uncertain, it is reasonably possible that the balance of gross unrecognized tax benefits will not change during the next 12 months. However, changes in the occurrence, expected outcomes and timing of those events could cause the Company’s current estimate to materially change in the future. For year ended December 31, 2023, there are no interest and penalties relating to our uncertain tax positions.

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	12 Months Ended
	Dec. 31, 2023
COMMITMENTS AND CONTINGENCIES
COMMITMENTS AND CONTINGENCIES	10. COMMITMENTS AND CONTINGENCIES: 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. 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 2023, these employment agreements automatically renewed for an additional one 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. Effective March 31, 2023, Ms. Bloch retired from her role as Chief Financial Officer of the Company. Ms. Bloch’s employment agreement expired on March 31, 2023, upon her retirement from the Company. In connection with Ms. Bloch’s retirement, the Company and Ms. Bloch entered into a Consulting Agreement, dated as of March 31, 2023 (the “Consulting Agreement”), pursuant to which Ms. Bloch will serve as a consultant to the Company and as the Company’s Interim Chief Financial Officer. On September 18, 2023, the Company entered into a new Employment Agreement with Ms. Kathleen P. Bloch pursuant to which Ms. Bloch will continue to serve as the Company’s Chief Financial Officer. Ms. Bloch’s service under the Employment Agreement has replaced and terminated the Consulting Agreement disclosed above. The Employment Agreement provides 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 agreement provides for certain termination benefits in the event of termination without “Cause” or voluntary termination of employment for “Good Reason”, as defined in each agreement. Unless terminated sooner by either the Company or Ms. Bloch, the Employment Agreement will remain in effect until December 31, 2025, and thereafter, as mutually agreed between the Company and Ms. Bloch. On July 19, 2023, the Company announced the appointment of Alexander D’Amico as Chief Financial Officer effective August 7, 2023. The Company entered into an executive employment agreement with Mr. D’Amico with an initial term commencing on August 7, 2023 and expiring on December 31, 2025. On August 28, 2023, the Company and Mr. D’Amico mutually agreed to terminate Mr. D’Amico’s employment with the Company. Mr. D’Amico and the Company entered into a Mutual Termination and Release Agreement (the “Termination and Release Agreement”), pursuant to which the Company and Mr. D’Amico have mutually agreed to terminate the Employment Agreement in its entirety. In addition, under the Termination and Release Agreement, the Company and Mr. D’Amico have agreed to customary and mutual non-disparagement and release provisions, payment of specific accrued expenses, and no severance payments or vesting of equity. 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 has settled a litigation matter. As part of the settlement agreement, the Company paid a total of $280,000 in November 2023 to settle this matter in return for a release of all claims against the Company. The expense related to this settlement is included in legal financial and other consulting expenses on the consolidated statements of operations and comprehensive loss for the year ended December 31, 2023. On March 5, 2024, Danielle Greene, a former employee, filed a complaint against us in the Superior Court of New Jersey, Law Division, Mercer County, alleging breach of the New Jersey Conscientious Employee Protection Act ("CEPA"). The complaint specifically alleges that we violated the provisions of the CEPA by allegedly terminating Ms. Greene in retaliation for complaining about certain business practices. We dispute these allegations and intend to vigorously defend against them, but there can be no assurance as to the outcome of the litigation. 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, 2023, 2022 and 2021, the Company recorded royalty expenses of approximately $923,000, $849,000, and $1,193,000, 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 years ended December 31, 2023 and 2022, the Company did not record any expense related to this agreement as the launch of this program is expected to occur in 2024. 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, 2023, 2022 and 2021 per the terms of the license agreement, the Company recorded licensing expenses of approximately $1,233,000, $1,416,000 and $1,988,000, 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, 2023
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. December 13, 2023 Offering On December 13, 2023, the Company closed on a registered direct offering for the sale, directly to investors, of 7,733,090 registered shares of common stock and warrants to purchase up to 2,706,561 shares of common stock (the “Offering”). Each share of common stock and accompanying warrant to purchase up to 0.35 shares of common stock, were sold together for a combined purchase price of $1.33, for an aggregate purchase price of approximately $10,285,000. After deducting transaction fees and expenses payable by the Company in connection with the Offering, the Company received net proceeds of approximately $9,785,000, excluding any proceeds that may be received upon the exercise of the warrants. Each warrant is immediately cash exercisable at an exercise price of $2.00 per share and will expire on the fifth anniversary of the issue date. The Company’s executive officers, directors, and certain non-executive officer employees of the Company also participated in the Offering with a combined investment of $435,000. 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 year ended December 31, 2022. During the year ended December 31, 2023, the Company sold 2,656,464 shares pursuant to the Sale Agreement, at an average selling price of $1.76 per share, generating net proceeds of approximately $4,532,000. In addition, during the years ended December 31, 2023 and 2022, the Company paid approximately $61,000 and $45,000, respectively, in expenses related to the Sale Agreement. Stock Option Plans As of December 31, 2023, 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, 2023, there were approximately 647,000 and 320,000 shares of common stock remaining for issuance under the 2014 Plan and the 2006 Plan, respectively. The 2014 and 2006 Plans as well as grants issued outside of the Plans 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 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, 2023, 2022 and 2021 amounted to approximately $3,329,000, $3,424,000, and $4,021,000, 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, 2023, 2022 and 2021 is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Weighted ​ Average ​ ​ ​ ​ Average ​ Remaining ​ ​ ​ ​ Exercise ​ Contractual ​ Shares per Share Life (Years) ​ ​ ​ ​ ​ ​ ​ ​ Outstanding January 1, 2021 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 4,086,205 ​ $ 1.97 9.61 Forfeited (1,270,155) ​ $ 8.65 — Expired (227,204) ​ $ 7.71 — Exercised — ​ $ — — Outstanding, December 31, 2022 9,474,824 ​ $ 4.66 ​ 7.36 Granted 2,601,880 ​ $ 3.43 9.52 Forfeited (974,555) ​ $ 2.96 — Expired (467,332) ​ $ 5.61 — Exercised (86,643) ​ $ 2.59 — Outstanding, December 31, 2023 10,548,174 ​ $ 4.49 7.01 ​ During the third quarter of 2023, management identified a misstatement related to the number of granted options within the option roll forward activity disclosure for the year ended December 31, 2022. The options granted were properly disclosed within the stock-based compensation footnote however; the number was incorrectly omitted from the tabular disclosure. The Company assessed the materiality of these misstatements on prior period financial statements in accordance with U.S. Securities and Exchange Commission Staff Accounting Bulletin No. 99, Materiality, codified in ASC 250, Presentation of Financial Statements, and concluded that this misstatement was not material to any prior annual or interim period. As such, the Company has revised the 2022 options granted and the options outstanding amounts as of December 31, 2022 to include the 1,365,000 options granted and disclosed. The fair value of each stock option was estimated using the Black-Scholes pricing model which takes the following factors into account. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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, 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 % December 31, 2023 ​ $ 1.17 - $3.71 per share ​ 6 years ​ 70.4% to 75.6 % ​ 0 % ​ 3.50% to 4.76 % ​ 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, 2023 of $1.11 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 2023 Price Life (Years) Value $1.17 - $13.20 10,548,174 ​ $ 4.49 ​ 7.01 ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ Options Exercisable Number ​ Weighted ​ ​ Exercisable at ​ Average ​ Aggregate December 31, ​ Exercise ​ Intrinsic 2023 Price Value 5,342,438 ​ $ 5.97 ​ $ — ​ The summary of the status of the Company’s non-vested options for the year ended December 31, 2023, is as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value ​ ​ ​ ​ ​ ​ Non-vested, January 1, 2023 4,851,739 ​ $ 1.84 Granted 2,601,880 ​ ​ 2.35 Forfeited (974,555) ​ ​ 1.95 Vested (1,273,328) ​ ​ 2.59 Non-vested, December 31, 2023 5,205,736 ​ $ 1.89 ​ As of December 31, 2023, the Company had approximately $4,868,000 of total unrecognized compensation cost related to stock options which will, on average, be amortized over 42 months. Awards of Stock Options: On July 7, 2023, the Board of Directors granted options to purchase 1,138,750 shares of common stock to the Company’s employees which will be awarded based upon each employee’s 2023 individual performance evaluation. Once awarded, these options will vest one quarter on the first anniversary of the grant date, one quarter on the second anniversary of the grant date, one quarter on the 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 $2,665,000. The Company has recorded approximately $260,000 in stock option expense related to these options for the year ended December 31, 2023. On July 7, 2023, the Board of Directors granted options to purchase 56,130 shares of common stock to certain of the Company’s employees. These options will vest in full on the first anniversary of the grant date. The grant date fair value of these unvested options amounted to approximately $178,000. The Company has recorded approximately $59,000 in stock option expense related to these options for the year ended December 31, 2023. On July 7, 2023, the Board of Directors granted options to purchase 100,000 shares of common stock to members of the Company’s Board of Directors. These options will vest in full on the first anniversary of the grant date. The grant date fair value of these unvested options amounted to approximately $234,000. The Company has recorded approximately $113,000 in stock option expense related to these options for the year ended December 31, 2023. On July 7, 2023, the Board of Directors granted options to purchase 20,000 shares of common stock to a named executive officer of the Company. These options will vest in full on the first anniversary of the grant date. The grant date fair value of these unvested options amounted to approximately $47,000. The Company has recorded approximately $23,000 in stock option expense related to these options for the year ended December 31, 2023. On July 7, 2023, the Board of Directors granted options to purchase 424,000 shares of common stock to certain senior managers of the Company. These options will vest one half 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 $992,000. The Company has recorded approximately $285,000 in stock option expense related to these options for the year ended December 31, 2023. On July 7, 2023, the Board of Directors granted options to purchase 182,000 shares of common stock to the named executive officers and certain senior managers of the Company. These options were awarded as a one-time award to each executive officer or senior manager in order to account for lost wages resulting from the salary freezes implemented by the Company over the preceding two years and to account for recent inflation. These options will vest one half on the first anniversary of the grant date, one half on second anniversary of the grant date. The grant date fair value of these unvested options amounted to approximately $426,000. The Company has recorded approximately $104,000 in stock option expense related to these options for the year ended December 31, 2023. On July 7, 2023, the Board of Directors granted options to purchase 115,000 shares of common stock to a senior manager of the Company. These options will vest only upon the achievement of certain milestones pursuant to the terms of the Company’s existing 2022-2025 performance pool in place for the Company’s management team. The grant date fair value of these unvested options amounted to approximately $320,000. As of December 31, 2023, 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, 2023. On July 10, 2023, in connection with his appointment as Chief Financial Officer, Mr. Alexander D’Amico was awarded options to purchase 70,000 shares of common stock which will vest as follows: 25,000 options upon the six-month anniversary of the date of grant and 15,000 options upon each of the first, second and third anniversaries of the date of grant. Mr. D’Amico was also granted options to purchase 215,000 shares of common stock that will vest only upon the achievement of certain milestones pursuant to the terms of the Company’s existing 2022-2025 performance pool in place for the Company’s management team. All of these options were forfeited upon the termination of Mr. D’Amico’s employment agreement. See Note 10. 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 $311,000, and $180,000 in stock option expense related to these options for the years ended December 31, 2023, and 2022, respectively. 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 $201,000, and $90,000 in stock option expense related to these options for the years ended December 31, 2023, and 2022, respectively. 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 $34,000, and $101,000 in stock option expense related to these options for the years ended December 31, 2023, and 2022, respectively. 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 $107,000, and $161,000 in stock option expense related to these options for the years ended December 31, 2023, and 2022, respectively. 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, 2023, 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 years ended December 31, 2023, and 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 were designed to vest upon the achievement of certain specific, predetermined milestones related to the Company’s 2021 operations. Once awarded, these options were designed to 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 $320,000, and $314,000 in stock option expense related to these options for the years ended December 31, 2023, and 2022, respectively. During the years ended December 31, 2023, 2022, and 2021, 281,000, 196,900 and 281,880 options were awarded to newly hired employees, respectively, in connection with their employment agreements. 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 the outstanding balance of these restricted stock units at the end of each of the past three calendar years:: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Board of Executive Other ​ ​ ​ ​ ​ Directors ​ Management Employees Total ​ Intrinsic Value 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 Granted 2023 — 150,000 244,000 ​ 394,000 ​ ​ Forfeited 2023 — (150,000) (311,000) ​ (461,000) ​ ​ December 31, 2023 346,500 779,500 1,697,500 ​ 2,823,500 ​ $ 3,134,085 ​ 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 statements of operations and comprehensive loss through the year ended December 31, 2023. 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 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 On July 7, 2023, certain named executive officers and senior managers were granted 250,000 restricted stock units. These awards were valued at approximately $883,000 at the date of issuance, based upon the market price of the Company’s common stock at the date of the grant, and will vest two-third on the first anniversary of date of the grant, and one-third on the second anniversary of the date of the grant. For the years ended December 31, 2023 and 2022, the Company recorded expense of approximately $213,000 and $0, respectively, related to these restricted stock unit awards. On September 18, 2023, a named executive officer was granted 45,000 restricted stock units. This award was valued at approximately $89,000 at the date of issuance, based upon the market price of the Company’s common stock at the date of the grant, and vested (will vest) two-thirds on the date of the grant, one-third on the first anniversary of the date of the grant, and one-third on the second anniversary of the date of the grant. For the years ended December 31, 2023 and 2022, the Company recorded expense of approximately $55,000 and $0, respectively, related to these restricted stock unit awards. On January 23, 2023, an employee was awarded 30,000 restricted stock units, as a condition of her employment. These awards were valued at $64,200 at the date of issuance. Also in 2023, 2,500 restricted stock units were forfeited. The remaining unvested restricted stock awards will vest based upon a change of control or over the next two to four years, whichever occurs first. For the year ended December 31, 2023 and 2022, the Company recorded (income) expense of approximately $80,000 and $(16,000), respectively, related to these restricted stock unit awards. On July 10, 2023, in connection with his appointment as Chief Financial Officer, Mr. D’Amico was awarded 45,000 restricted stock units which were scheduled to vest one half on the first anniversary of the grant date and one half on the second anniversary of the grant date. These restricted stock units were valued at approximately $157,000 at the date of issuance, based upon the market price of the Company’s common stock at the date of the grant. Additionally, on July 10, 2023, Mr. D’Amico was awarded 15,000 restricted stock units which were scheduled to vest either upon a Change of Control or will cliff vest on the second anniversary of the date of the grant, subject to Mr. D’Amico’s continued service with the Company as of the applicable vesting date. Upon Mr. D’Amico’s resignation effective August 28, 2023, all 60,000 of his restricted stock units were forfeited. 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, 2023 312,092 ​ $ 4.42 Granted ​ 385,000 ​ $ 3.23 Forfeited (62,500) ​ $ 3.57 Vested ​ (204,087) ​ $ 4.79 Non-vested, December 31, 2023 ​ 430,505 ​ $ 3.31 ​ Warrants: As of December 31, 2023, the Company had 2,706,561 warrants outstanding related to the Company’s December 13, 2023 Offering. These warrants are immediately cash exercisable at an exercise price of $2.00 per share and expire on December 13, 2028.

NET LOSS PER SHARE

NET LOSS PER SHARE	12 Months Ended
	Dec. 31, 2023
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, 2023, 2022 and 2021 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 16,819,000, 11,312,000 and 9,902,000 incremental shares at December 31, 2023, 2022 and 2021, 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, 2023
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, 2023
QUARTERLY FINANCIAL RESULTS (UNAUDITED)
QUARTERLY FINANCIAL RESULTS (UNAUDITED)	14. QUARTERLY FINANCIAL RESULTS (UNAUDITED): Summarized quarterly data for 2023, 2022 and 2021 are as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ For the Quarters Ended ​ March 31 June 30 September 30 December 31 2023: ​ ​ ​ ​ Total revenue ​ $ 9,449,496 $ 9,420,821 $ 8,810,847 $ 8,668,215 Gross margin ​ 5,455,327 ​ 6,018,550 ​ 5,606,866 ​ 5,311,280 Loss from operations ​ (7,891,596) ​ (6,559,237) ​ (7,350,198) ​ (9,408,222) Net loss attributable to common stockholders ​ (7,325,883) ​ (6,153,084) ​ (9,193,520) ​ (5,834,907) Net loss per share, basic and diluted ​ ​ (0.17) ​ (0.14) ​ (0.21) ​ (0.12) ​ ​ ​ ​ ​ ​ ​ ​ ​ 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) ​

PRINCIPAL BUSINESS ACTIVITY A_2

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	12 Months Ended
	Dec. 31, 2023
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, a wholly-owned subsidiary of CytoSorbents Europe, GmbH. In October 2022, the Company formed CytoSorbents France SAS, a wholly-owned subsidiary of CytoSorbents Europe, GmbH, to provide marketing and direct sales services in France. In May 2023, the Company formed CytoSorbents India Private Limited to provide marketing and direct sales services in India. 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 510(k) or premarket approval) consistent with the FDA’s mission to protect and promote public health. In July 2021, the Company received full approval of its Investigative Device Exemption (“IDE”) to conduct the pivotal STAR-T (Safe and Timely Antithrombotic Removal – Ticagrelor) double-blind randomized control trial (“RCT”) for up to 120 patients in the United States to support FDA marketing approval. In July 2023, the Company announced that enrollment in the STAR-T trial has completed, and in August 2023, the Company announced completion of the STAR-T trial, following the last scheduled patient follow-up. In December 2023, the Company announced that the independent Data Safety Monitoring Board (the “DSMB”) performed a final review of the full unblinded data on all 140 patients in the STAR-T trial and concluded there were no issues with device safety, meeting the primary safety endpoint of the study. The Company has also performed the initial data analysis on the primary effectiveness endpoint of STAR-T trial. Based on this analysis, the study did not meet the primary effectiveness endpoint in the overall patient population that underwent different types of cardiac surgeries. However, the study did demonstrate evidence of reduced bleeding complications in patients in the pre-specified isolated coronary artery bypass graft (“CABG”) surgery population, representing more than 90% of the overall study population. The Company expects to complete the analysis of the full trial results during the first quarter of 2024. Pending this final analysis, the Company believes the safety and effectiveness data from STAR-T will support the regulatory submission of DrugSorb-ATR to the U.S. FDA and Health Canada. 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 will 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 three-year preferred supplier agreement with Asklepios, making CytoSorb available without restrictions to all of the approximately 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 September 2023, the distribution agreement with Nikkiso expired, and the Company indicated that it would not seek renewal of the agreement. The Company is actively working with a new supplier to provide a stand-alone hemoperfusion pump. 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. The launch of this program is expected to occur in 2024. 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, as of December 31, 2023, is protected by 19 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 2024 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 and CytoSorbents India Private Limited, wholly-owned subsidiaries 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 $1,949,000, $(2,449,000) and $(2,578,000) for the years ended December 31, 2023, 2022 and 2021, 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	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, ​ ​ ​ 2023 ​ 2022 Cash and cash equivalents ​ $ 14,131,137 ​ $ 22,144,567 Restricted cash ​ 1,483,958 ​ 1,687,459 Total cash, cash equivalents and restricted cash ​ $ 15,615,095 ​ $ 23,832,026 ​
Restricted Cash	Restricted Cash The Company’s total restricted cash in the amount of $1,483,958 and $1,687,459 as of December 31, 2023 and 2022, respectively, consisted of cash of $1,467,459 for each year 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 $16,499 and $220,000 as of December 31, 2023 and 2022, respectively, that the Company is obligated to maintain as collateral for the credit limit on the Company’s credit card account.
Accounts Receivable and Allowance for Credit Losses	Accounts Receivable and Allowance for Credit Losses Trade accounts receivable consist of amounts due from direct customers, distributors and agencies of the U.S. government and are presented at net realizable value. At each balance sheet date, the Company estimates an expected allowance for credit losses inherent in the Company’s accounts receivable portfolio based on historical experience, specific allowances for known troubled accounts, and other available evidence. In addition, also at each reporting date, this estimate is updated to reflect any changes in credit risk since the receivable was initially recorded. This estimate is calculated on a pooled basis where similar risk characteristics exist. The Company has identified the following portfolio segments: direct customers, distributors/strategic partners and the U.S. government. A fixed reserve percentage for each pool is derived from a review of the Company’s historical losses in relation to the total pool. This estimate is adjusted quarterly for management’s assessment of current conditions, reasonable and supportable forecasts regarding future events, and any other factors deemed relevant by the Company. The Company believes historical loss information is a reasonable starting point in which to calculate the expected allowance for credit losses as the Company’s portfolio segments have remained constant over the Company’s historical evaluation period. The Company writes off receivables when there is information that indicates the debtor is facing significant financial difficulty and there is no possibility of recovery. If any recoveries are made from any accounts previously written off, they are recognized as an offset to credit loss expense in the year of recovery. The total amount of write-offs was immaterial to the financial statements as a whole for the year ended December 31, 2023. The allowance for credit losses reflects accounts receivable balances that are written off when management determines they are uncollectible. The allowance for credit losses is measured on a collective (pool) basis when similar risk characteristics exist, and measures the allowance for credit losses using the following methods: Direct Customers—The Company measures expected credit losses on direct customer receivables using an aging methodology. The risk of loss for direct customer receivables is low based on the Company’s historical experience. The estimate of expected credit losses considers historical credit loss information that is adjusted for current conditions and supportable forecasts. Distributors/Strategic Partners—The Company measures expected credit losses on distributor receivables using an individual reserve methodology. The risk of loss in this portfolio is low based on the Company’s historical experience. The estimate of expected credit losses considers the past payment history of each distributor. U.S. Government- These receivables are related to the Company’s government grants. The Company measures expected credit losses on these receivables using an individual reserve methodology. The risk of loss in this portfolio is very low based on the Company’s historical experience, as these receivables are supported by approved grant award contracts.
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, 2023 and 2022, the Company’s inventory was comprised of finished goods, which amounted to $2,155,457 and $1,567,871, respectively, work in process which amounted to $838,871 and $1,280,368, respectively, and raw materials which amounted to $685,801 and $613,347, 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. Donated devices are removed from inventory and charged to selling, general and administrative expenses.
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 years ended December 31, 2023 and 2022, the Company wrote-off patent costs of approximately $656,000 and $636,000, respectively, related to the impairment of certain issued patents and pending patent applications in certain specific jurisdictions and the abandonment of certain pending patent application costs in the ordinary course of business. This charge is included in legal, financial and other consulting in the consolidated statements of operations and comprehensive loss.
Revenue Recognition	Revenue Recognition Revenue is recognized when the Company ships its products to its direct customers and distributors/strategic partners. Revenue is recognized on its grant awards with agencies of U.S. government in accordance with the terms of the award contract. See Note 3 for a description of the types of government contracts. The amount of revenue recognized reflects the consideration the Company expects to be entitled to receive in exchange for the products shipped or the services provided under their grant contracts. To achieve this core principle, the Company applies the following five steps: 1. Identify Contracts with Customers - The Company’s contracts with its direct customers are generally in the form of a purchase order. The Company has formal written contracts with each of its distributors/strategic partners that define their respective territories and minimum purchase commitments which must be met in order to maintain exclusivity in their territory. Distributors/strategic partner customers also submit purchase orders with each order that define the terms of shipment and transaction price. The Company has a contract for each grant award with various agencies of the U.S. government. 2. Identify Performance Obligations - The performance obligations in contracts with direct customers and distributors/strategic partners are for the shipment of the CytoSorb device and related accessory parts. The performance obligations for government contracts are dependent on the contract type, however, these are generally based on the costs incurred related to each government contract. 3. Determine Transaction Price - The price charged is based on the Company’s price list for the CytoSorb device and related accessory parts for both direct customers and distributor/strategic partners. The Company does not permit returns for product sales. The Company also provides for certain rebates and discounts to direct customers for sales of its product that are earned based upon sales volume. These amounts, which are earned based on calendar year sales volume, are recorded as a reduction of sales as earned. The transaction prices for government contracts are dependent on the type of contract and are outlined in each contract. 4. Allocate Transaction Price to Performance Obligations - The transaction price for the performance obligation is based on the purchase orders received for both direct customers and on the type of contract and are outlined in each contract. The transaction prices for government contract performance obligations are dependent on the type of contract and are generally based on costs incurred. 5. Recognize Revenue as Performance Obligations are Satisfied - The Company satisfies its performance obligation to direct customers and distributors/strategic partners generally upon shipment of the products. The Company satisfies its performance obligations on government contracts generally upon incurring costs on each contract. The Company records deferred revenue related to fixed price government contracts to the extent that billings exceed costs incurred.
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 $253,000, $582,000 and $615,000 in 2023, 2022 and 2021, 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 is accounting for an uncertain tax position of approximate $2.1 million for the year ended December 31, 2023. The Company had no unrecognized tax benefits as of December 31, 2022. 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 SAS 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 credit losses 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. Beginning in April of 2023, the Company joined the IntraFi network, and established an Insured CashSweep (“ICS”) account whereby all cash that was previously held in the Company’s money market account at Bridge Bank is swept daily in increments of less than $250,000 and deposited in a number of IntraFi’s 4,000 member banks. This arrangement provides FDIC insurance coverage for all of the cash balances previously held in the money market account, which represents all of the cash and cash equivalents held at Bridge Bank. This arrangement excludes the restricted cash balances. 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, 2023, one distributor accounted for approximately 19% of outstanding grants and accounts receivables. As of December 31, 2022, two distributors accounted for approximately 27% of outstanding grants and accounts receivables. For the years ended December 31, 2023, 2022 and 2021, no agency, distributor/strategic partner 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.
Warrants	Warrants The Company accounts for warrants as either equity-classified or liability-classified instruments based on an assessment of the warrant’s specific terms and applicable authoritative guidance in ASC 480 and ASC 815 “Derivatives and Hedging” (“ASC 815”). The assessment considers whether the warrants are freestanding financial instruments pursuant to ASC 480, meet the definition of a liability pursuant to ASC 480, and whether the warrants meet all of the requirements for equity classification under ASC 815, including whether the warrants are indexed to the Company’s own ordinary shares and whether the warrant holders could potentially require “net cash settlement” in a circumstance outside of the Company’s control, among other conditions for equity classification. This assessment, which requires the use of professional judgment, is conducted at the time of warrant issuance and as of each subsequent quarterly period end date while the warrants are outstanding. For issued or modified warrants that meet all of the criteria for equity classification, the warrants are required to be recorded as a component of equity at the time of issuance. For issued or modified warrants that do not meet all the criteria for equity classification, the warrants are required to be recorded as liabilities at their initial fair value on the date of issuance, and each balance sheet date thereafter. Changes in the estimated fair value of the warrants are recognized as a non-cash gain or loss on the statements of operations. As the warrants issued upon the closing of the Company’s December 13, 2023 Offering meet the criteria for equity classification under ASC 815, the warrants are classified as equity as of December 31, 2023.
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 $464,000, $297,000 and $276,000 for the years ended December 31, 2023, 2022 and 2021, respectively.
Effect of Recent Accounting Pronouncements	Effect of Recent Accounting Pronouncements 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 implemented the updated guidance as of January 1, 2023, and this did not have significant impact on its consolidated financial statements. In August 2020, the FASB issued ASU 2020-06, “Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40)” (“ASU 2020-06”). ASU2020-06 simplifies the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. The ASU is part of the FASB’s simplification initiative, which aims to reduce unnecessary complexity in U.S. GAAP. The ASU’s amendments are effective for fiscal years beginning after December 15, 2024, and interim periods within those fiscal years. The Company will adopt the provisions of ASU 2020-06 on January 1, 2024. This is not expected to have a material impact on the Company’s financial statements. In December 2023, the FASB issued ASU No. 2023-09 entitled “Income Taxes (Topic 740): Improvements to Income Tax Disclosures”. This ASU provides guidance related to additional disclosures that will be required related to income taxes. The updated guidance is effective for public entities for fiscal years beginning after December 15, 2024. This ASU will result in additional disclosures in the Company’s consolidated financial statements related to income taxes in 2025.

PRINCIPAL BUSINESS ACTIVITY A_3

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)	12 Months Ended
	Dec. 31, 2023
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, ​ ​ ​ 2023 ​ 2022 Cash and cash equivalents ​ $ 14,131,137 ​ $ 22,144,567 Restricted cash ​ 1,483,958 ​ 1,687,459 Total cash, cash equivalents and restricted cash ​ $ 15,615,095 ​ $ 23,832,026

REVENUE (Tables)

REVENUE (Tables)	12 Months Ended
	Dec. 31, 2023
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, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ United States ​ ​ ​ ​ ​ ​ ​ ​ Distributors/ ​ Government ​ ​ ​ ​ Direct Strategic Partners Agencies Total Product sales: ​ ​ ​ ​ United States ​ $ 66,773 ​ $ — ​ $ — ​ $ 66,773 Germany ​ 12,964,806 ​ ​ — ​ ​ — ​ ​ 12,964,806 All other countries ​ 5,956,042 ​ 12,097,332 ​ — ​ 18,053,374 Total product revenue ​ 18,987,621 ​ 12,097,332 ​ — ​ 31,084,953 Grant income: ​ ​ ​ ​ ​ ​ ​ ​ United States ​ — ​ — ​ 5,264,426 ​ 5,264,426 ​ ​ ​ ​ ​ ​ ​ ​ ​ Total revenue ​ $ 18,987,621 ​ $ 12,097,332 ​ $ 5,264,426 ​ $ 36,349,379 ​ 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
Schedule of receivables and contract liabilities from contracts with customers	​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2023 December 31, 2022 Contract receivables, which are included in grants and accounts receivable ​ $ 3,846,271 ​ $ 3,822,452 Contract liabilities, which are included in accrued expenses and other current liabilities ​ $ 1,577,141 ​ $ 1,694,906

PROPERTY AND EQUIPMENT, NET (Ta

PROPERTY AND EQUIPMENT, NET (Tables)	12 Months Ended
	Dec. 31, 2023
PROPERTY AND EQUIPMENT, NET
Schedule of Property and Equipment, Net	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Depreciation/ ​ ​ December 31 ​ Amortization ​ 2023 2022 Period ​ ​ ​ ​ ​ ​ ​ ​ ​ Furniture and fixtures ​ $ 1,462,778 ​ $ 1,306,267 7 years Equipment and computers ​ 5,404,743 ​ 5,131,934 3 to 7 years Leasehold improvements ​ 6,224,863 ​ 6,201,523 Lesser of term of lease or estimated useful life ​ ​ 13,092,384 ​ 12,639,724 Less accumulated depreciation and amortization ​ 3,036,030 ​ 1,896,692 Property and Equipment, Net ​ $ 10,056,354 ​ $ 10,743,032

OTHER ASSETS (Tables)

OTHER ASSETS (Tables)	12 Months Ended
	Dec. 31, 2023
OTHER ASSETS
Schedule of Other Assets	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31 ​ 2023 2022 ​ ​ ​ ​ ​ ​ ​ Patent applications pending ​ $ 1,945,532 ​ $ 2,466,341 Patents issued ​ ​ 2,982,253 ​ ​ 2,773,191 Less accumulated amortization of patents issued ​ (1,021,233) ​ (848,999) Patents, net ​ 3,906,552 ​ 4,390,533 Security deposits ​ 52,051 ​ 46,914 Total ​ $ 3,958,603 ​ $ 4,437,447

ACCRUED EXPENSES AND OTHER CU_2

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	12 Months Ended
	Dec. 31, 2023
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Schedule of accrued expenses and other current liabilities	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31 ​ 2023 2022 Accrued salaries and commissions ​ $ 3,344,080 ​ $ 2,862,930 Deferred revenue ​ ​ 1,380,821 ​ ​ 1,516,772 Clinical studies ​ 956,432 ​ 1,115,123 Accrued accounts payable ​ 497,627 ​ 850,630 Professional fees ​ 686,908 ​ 622,353 Accrued royalties ​ ​ 513,338 ​ ​ 592,398 Customer rebates ​ 181,284 ​ 166,065 Travel and entertainment ​ ​ 134,182 ​ ​ 99,316 Board of Director fees ​ 84,610 ​ 97,426 Sales, payroll and income taxes payable ​ ​ 56,423 ​ ​ 21,871 Interest ​ 34,444 ​ 5,556 Total ​ $ 7,870,149 ​ $ 7,950,440 ​

LONG-TERM DEBT (Tables)

LONG-TERM DEBT (Tables)	12 Months Ended
	Dec. 31, 2023
LONG-TERM DEBT
Schedule of Long-term debt	Long-term debt consists of the following as of December 31, 2023: ​ ​ ​ ​ Principal amount $ 5,000,000 Accrued final fee ​ ​ 42,857 Subtotal ​ 5,042,857 Less Current maturities ​ 2,500,000 Long-term debt net of current maturities ​ $ 2,542,857
Schedule of Principal payments of long-term debt	Principal payments of long-term debt are due as follows during the years ending December 31: ​ ​ ​ ​ 2024 $ 2,500,000 2025 ​ 2,500,000 Total ​ $ 5,000,000 ​

LEASES (Tables)

LEASES (Tables)	12 Months Ended
	Dec. 31, 2023
LEASES
Schedule of right-of- use asset and related lease liability	​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, ​ 2023 2022 Right-of-use asset ​ $ 12,058,896 ​ $ 12,603,901 ​ ​ ​ ​ ​ ​ ​ Total lease liability ​ $ 13,270,295 ​ $ 13,250,944 Less current portion ​ (373,636) ​ ​ (108,939) Lease liability, net of current portion ​ $ 12,896,659 ​ $ 13,142,005 ​
Schedule of maturities of the lease liabilities	The maturities of the lease liabilities are as follows as of December 31, 2023: ​ ​ ​ ​ ​ 2024 $ 1,656,678 2025 ​ 1,695,677 2026 ​ 1,735,747 2027 ​ 1,776,920 2028 ​ 1,819,224 Thereafter ​ 15,413,075 Total lease payments ​ ​ 24,097,321 Present value discount ​ ​ (10,827,026) Total ​ $ 13,270,295

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
	Dec. 31, 2023
INCOME TAXES
Schedule of consolidated loss before income taxes	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 Domestic ​ $ (21,475,931) ​ $ (21,155,203) ​ $ (18,829,797) Foreign ​ (7,843,202) ​ (12,749,965) ​ (6,464,854) Total ​ $ (29,319,133) ​ $ (33,905,168) ​ $ (25,294,651)
Schedule of benefit from income taxes	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 State Tax, including sale of New Jersey losses & credits ​ $ 813,739 ​ $ 1,092,585 ​ $ 736,003 Foreign tax provision ​ — ​ — ​ — ​ ​ $ 813,739 ​ $ 1,092,585 ​ $ 736,003
Schedule of deferred tax assets and liabilities	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 ​ 2022 ​ 2021 Deferred tax assets: ​ ​ ​ Net operating loss carry forward ​ $ 36,836,007 ​ $ 31,570,846 ​ $ 27,190,654 Stock options ​ 418,776 ​ 500,975 ​ 1,203,272 Research and development credit carryforward ​ 2,310,639 ​ 3,982,147 ​ 2,687,591 Accruals and others ​ 248,673 ​ 24,121 ​ 232,665 Lease liability ​ 3,730,280 ​ 3,724,840 ​ 3,997,114 §174(b) research and development ​ 5,495,850 ​ 3,331,625 ​ — Gross deferred tax assets ​ 49,040,225 ​ 43,134,554 ​ 35,311,296 Less valuation allowance ​ (45,334,554) ​ (39,303,451) ​ (31,242,130) ​ ​ 3,705,671 ​ 3,831,103 ​ ​ 4,069,166 Deferred tax liability: ​ ​ ​ Fixed assets ​ (315,915) ​ (288,145) ​ (183,941) Right of Use Asset ​ (3,389,756) ​ (3,542,958) ​ (3,885,225) Net deferred tax assets ​ $ — ​ $ — ​ $ —
Schedule of effective income tax rate reconciliation	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 Federal statutory rate 21.0 % 21.0 % 21.0 % State taxes, net of federal benefit 5.2 (2.8) (2.0) ​ Foreign rate differential 2.3 3.4 2.3 ​ Permanent items (2.0) (1.5) (6.5) ​ Rate change and true-up (0.7) 0.6 11.8 ​ Uncertain tax positions ​ (7.2) ​ — ​ — ​ Change in valuation allowance (20.6) (22.8) (25.5) ​ R&D credit 1.9 2.1 1.7 ​ Sale of state R&D credit and NOL 2.8 3.2 — ​ Other ​ 0.1 ​ — ​ — ​ Effective income tax rate 2.8 % 3.2 % 2.8 %
Schedule of reconciliation of the unrecognized tax benefit balances	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year Ended December 31, ​ ​ 2023 2022 2021 Balance at beginning of the year ​ $ — ​ $ — ​ $ — Increase for tax positions of prior years ​ 1,842,332 ​ — ​ — Increase for tax positions in current year ​ 270,901 ​ — ​ — Decrease for tax positions due to payment or settlement ​ — ​ — ​ — Decrease for tax positions due to limitation expirations ​ — ​ — ​ — ​ ​ $ 2,113,233 ​ $ — ​ $ —

STOCKHOLDERS' EQUITY (Tables)

STOCKHOLDERS' EQUITY (Tables)	12 Months Ended
	Dec. 31, 2023
STOCKHOLDERS' EQUITY
Schedule of stock options activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Weighted ​ Average ​ ​ ​ ​ Average ​ Remaining ​ ​ ​ ​ Exercise ​ Contractual ​ Shares per Share Life (Years) ​ ​ ​ ​ ​ ​ ​ ​ Outstanding January 1, 2021 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 4,086,205 ​ $ 1.97 9.61 Forfeited (1,270,155) ​ $ 8.65 — Expired (227,204) ​ $ 7.71 — Exercised — ​ $ — — Outstanding, December 31, 2022 9,474,824 ​ $ 4.66 ​ 7.36 Granted 2,601,880 ​ $ 3.43 9.52 Forfeited (974,555) ​ $ 2.96 — Expired (467,332) ​ $ 5.61 — Exercised (86,643) ​ $ 2.59 — Outstanding, December 31, 2023 10,548,174 ​ $ 4.49 7.01
Schedule of fair value of each stock option estimated using the Black-Scholes pricing model	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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, 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 % December 31, 2023 ​ $ 1.17 - $3.71 per share ​ 6 years ​ 70.4% to 75.6 % ​ 0 % ​ 3.50% to 4.76 %
Schedule of intrinsic value	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Options Outstanding ​ ​ Number ​ Weighted ​ Weighted ​ ​ ​ Range of ​ Outstanding at ​ Average ​ Average ​ Aggregate Exercise ​ December 31, ​ Exercise ​ Remaining ​ Intrinsic Price 2023 Price Life (Years) Value $1.17 - $13.20 10,548,174 ​ $ 4.49 ​ 7.01 ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ Options Exercisable Number ​ Weighted ​ ​ Exercisable at ​ Average ​ Aggregate December 31, ​ Exercise ​ Intrinsic 2023 Price Value 5,342,438 ​ $ 5.97 ​ $ —
Schedule of company's non-vested options	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value ​ ​ ​ ​ ​ ​ Non-vested, January 1, 2023 4,851,739 ​ $ 1.84 Granted 2,601,880 ​ ​ 2.35 Forfeited (974,555) ​ ​ 1.95 Vested (1,273,328) ​ ​ 2.59 Non-vested, December 31, 2023 5,205,736 ​ $ 1.89
Schedule of restricted stock unit	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Board of Executive Other ​ ​ ​ ​ ​ Directors ​ Management Employees Total ​ Intrinsic Value 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 Granted 2023 — 150,000 244,000 ​ 394,000 ​ ​ Forfeited 2023 — (150,000) (311,000) ​ (461,000) ​ ​ December 31, 2023 346,500 779,500 1,697,500 ​ 2,823,500 ​ $ 3,134,085
Schedule of the restricted stock unit activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ Average ​ ​ ​ ​ Grant Date ​ Shares Fair Value Non-vested, January 1, 2023 312,092 ​ $ 4.42 Granted ​ 385,000 ​ $ 3.23 Forfeited (62,500) ​ $ 3.57 Vested ​ (204,087) ​ $ 4.79 Non-vested, December 31, 2023 ​ 430,505 ​ $ 3.31

QUARTERLY FINANCIAL RESULTS (_2

QUARTERLY FINANCIAL RESULTS (UNAUDITED) (Tables)	12 Months Ended
	Dec. 31, 2023
QUARTERLY FINANCIAL RESULTS (UNAUDITED)
Summarized quarterly information	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ For the Quarters Ended ​ March 31 June 30 September 30 December 31 2023: ​ ​ ​ ​ Total revenue ​ $ 9,449,496 $ 9,420,821 $ 8,810,847 $ 8,668,215 Gross margin ​ 5,455,327 ​ 6,018,550 ​ 5,606,866 ​ 5,311,280 Loss from operations ​ (7,891,596) ​ (6,559,237) ​ (7,350,198) ​ (9,408,222) Net loss attributable to common stockholders ​ (7,325,883) ​ (6,153,084) ​ (9,193,520) ​ (5,834,907) Net loss per share, basic and diluted ​ ​ (0.17) ​ (0.14) ​ (0.21) ​ (0.12) ​ ​ ​ ​ ​ ​ ​ ​ ​ 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) ​

BASIS OF PRESENTATION (Details)

BASIS OF PRESENTATION (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
BASIS OF PRESENTATION
Cash and cash equivalents gross value	$ 15,600,000
Cash and cash equivalents	14,131,137	$ 22,144,567
Restricted cash	$ 1,500,000

PRINCIPAL BUSINESS ACTIVITY A_4

PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Details)	1 Months Ended	12 Months Ended
	May 31, 2022 Institution state	Dec. 31, 2023 USD ($) patent country	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2020 USD ($)
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Number of countries where the entity's flagship product is marketed and distributed | country		75
Preferred supplier agreement term	3 years
Number of healthcare facilities | Institution	170
Number of states healthcare facilities across throughout Germany | state	14
Number of patents | patent		19
Foreign currency transaction gain (loss)		$ 1,949,000	$ (2,449,000)	$ (2,578,000)
Restricted cash		1,483,958	1,687,459
Inventory - finished goods		2,155,457	1,567,871
Inventory - work in process		838,871	1,280,368
Inventory - raw materials		685,801	613,347
wrote-off patent costs		656,000	636,000
Advertising expenses		$ 253,000	$ 582,000	$ 615,000
Federal statutory rate		21%	21%	21%
Unrecognized tax benefits		$ 2,113,233	$ 0	$ 0			$ 0
Cost of revenue		13,957,356	13,955,752	11,047,350
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		16,499	220,000
Cargo and Freight
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Cost of revenue		$ 464,000	$ 297,000	$ 276,000
Accounts Receivable | One Distributor/strategic partner
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Concentration risk		19%	27%
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, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
PRINCIPAL BUSINESS ACTIVITY AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Cash and cash equivalents	$ 14,131,137	$ 22,144,567
Restricted cash	1,483,958	1,687,459
Total cash, cash equivalents and restricted cash	$ 15,615,095	$ 23,832,026	$ 53,825,166	$ 71,421,601

REVENUE - Revenue by customer t

REVENUE - Revenue by customer type and geographic area (Details) - USD ($)	3 Months Ended												12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	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, 2023	Dec. 31, 2022	Dec. 31, 2021
Product sales:
Total revenue	$ 8,668,215	$ 8,810,847	$ 9,420,821	$ 9,449,496	$ 9,390,474	$ 8,111,353	$ 8,495,558	$ 8,691,424	$ 10,782,195	$ 9,760,416	$ 12,024,069	$ 10,598,847	$ 36,349,379	$ 34,688,809	$ 43,165,527
Total product sales
Product sales:
Total revenue													31,084,953	29,359,910	40,108,567
Grant income
Product sales:
Total revenue													5,264,426	5,328,899	3,056,960
United States | Total product sales
Product sales:
Total revenue													66,773	968,951	1,689,867
United States | Grant income
Product sales:
Total revenue													5,264,426	5,328,899	3,056,960
Germany | Total product sales
Product sales:
Total revenue													12,964,806	12,566,437	21,006,432
All other countries | Total product sales
Product sales:
Total revenue													18,053,374	15,824,522	17,412,268
Direct
Product sales:
Total revenue													18,987,621	18,059,218	27,041,855
Direct | Total product sales
Product sales:
Total revenue													18,987,621	18,059,218	27,041,855
Direct | United States | Total product sales
Product sales:
Total revenue													66,773	787,201	189,167
Direct | United States | Grant income
Product sales:
Total revenue													0	0	0
Direct | Germany | Total product sales
Product sales:
Total revenue													12,964,806	12,566,437	21,006,432
Direct | All other countries | Total product sales
Product sales:
Total revenue													5,956,042	4,705,580	5,846,256
Distributors/Strategic Partners
Product sales:
Total revenue													12,097,332	11,300,692	13,066,712
Distributors/Strategic Partners | Total product sales
Product sales:
Total revenue													12,097,332	11,300,692	13,066,712
Distributors/Strategic Partners | United States | Total product sales
Product sales:
Total revenue													0	181,750	1,500,700
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													12,097,332	11,118,942	11,566,012
United States Government Agencies
Product sales:
Total revenue													5,264,426	5,328,899	3,056,960
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													5,264,426	5,328,899	3,056,960
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, 2023	Dec. 31, 2022	Jan. 01, 2022
REVENUE
Contract receivables, which are included in grants and accounts receivable	$ 3,846,271	$ 3,822,452	$ 3,000,708
Contract liabilities, which are included in accrued expenses and other current liabilities	$ 1,577,141	$ 1,694,906	$ 2,251,177

REVENUE - Additional informatio

REVENUE - Additional information (Details)	12 Months Ended
	Dec. 31, 2023 USD ($) item	Dec. 31, 2022 USD ($)	Jan. 01, 2022 USD ($)
REVENUE
Number of primary revenue streams | item	2
Term of customer contracts	3 years
Value of free of charge goods and credit rebates	$ 196,322	$ 178,134
Contract liabilities net of value of free of charge goods and credit rebates	1,376,819	1,516,772
Receivables, which are included in grants and accounts receivable	3,846,271	3,822,452	$ 3,000,708
Contract liabilities	1,577,141	1,694,906	$ 2,251,177
Product sales
REVENUE
Receivables, which are included in grants and accounts receivable	3,270,724	2,944,031
Government grants
REVENUE
Receivables, which are included in grants and accounts receivable	$ 575,547	$ 878,421
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 ($)	Dec. 31, 2023	Dec. 31, 2022
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 13,092,384	$ 12,639,724
Less accumulated depreciation and amortization	3,036,030	1,896,692
Property and equipment, net	10,056,354	10,743,032
Furniture and fixtures
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 1,462,778	1,306,267
Depreciation/Amortization Period	7 years
Equipment and computers
PROPERTY AND EQUIPMENT, NET:
Property and equipment, gross	$ 5,404,743	5,131,934
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	$ 6,224,863	$ 6,201,523

PROPERTY AND EQUIPMENT, NET - A

PROPERTY AND EQUIPMENT, NET - Additional information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
PROPERTY AND EQUIPMENT, NET
Depreciation expense	$ 1,239,600	$ 688,565	$ 571,156

OTHER ASSETS (Details)

OTHER ASSETS (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
OTHER ASSETS:
Less accumulated amortization of patents issued	$ (1,021,233)	$ (848,999)
Patents, net	3,906,552	4,390,533
Security deposits	52,051	46,914
Total	3,958,603	4,437,447
Patent applications pending
OTHER ASSETS:
Patents	1,945,532	2,466,341
Patents issued
OTHER ASSETS:
Patents	$ 2,982,253	$ 2,773,191

OTHER ASSETS - Additional infor

OTHER ASSETS - Additional information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
OTHER ASSETS
2024	$ 218,000
2025	218,000
2026	217,000
2027	212,000
2028	212,000
Amortization expense	$ 222,836	$ 194,056	$ 160,422

ACCRUED EXPENSES AND OTHER CU_3

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Accrued salaries and commissions	$ 3,344,080	$ 2,862,930
Deferred revenue	1,380,821	1,516,772
Clinical studies	956,432	1,115,123
Accrued accounts payable	497,627	850,630
Professional fees	686,908	622,353
Accrued royalties	513,338	592,398
Customer rebates	181,284	166,065
Travel and entertainment	134,182	99,316
Board of Director fees	84,610	97,426
Sales, payroll and income taxes payable	56,423	21,871
Interest	34,444	5,556
Total	$ 7,870,149	$ 7,950,440

LONG-TERM DEBT - Additional inf

LONG-TERM DEBT - Additional information (Details) - USD ($)						12 Months Ended
	Jan. 01, 2024	Dec. 27, 2022	Jan. 19, 2022	Dec. 04, 2020	Jul. 31, 2019	Dec. 31, 2023	Dec. 31, 2022	Mar. 29, 2018	Jun. 30, 2016
LONG-TERM DEBT
Long-term debt						$ 5,042,857
Amount drawn down							$ 5,000,000
Non-refundable fee percent						2.50%
First Anniversary
LONG-TERM DEBT
Percentage of debt instrument principal amount						2%
Second Anniversary
LONG-TERM DEBT
Percentage of debt instrument principal amount						1.50%
Subsequent to second anniversary
LONG-TERM DEBT
Percentage of debt instrument principal amount						1%
Term C Loan
LONG-TERM DEBT
Interest rate cap						3.25%
Non refundable Final Fee
LONG-TERM DEBT
Debt issuance costs			$ 18,750
2022 Success Fee Letter | 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
2022 Success Fee Letter | 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
2022 Success Fee Letter | 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
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 | Subsequent event
LONG-TERM DEBT
Equal monthly payments of principal with accrued and unpaid interest payable	$ 208,333
Western Alliance Bank | Closing Fee
LONG-TERM DEBT
Debt issuance costs				75,000
Western Alliance Bank | Final Fee
LONG-TERM DEBT
Debt interest costs						$ 43,000
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) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
LONG-TERM DEBT
Principal amount	$ 5,000,000
Accrued final fee	42,857
Subtotal	5,042,857
Less current maturities	2,500,000
Long-term debt net of current maturities	$ 2,542,857	$ 5,000,000

LONG-TERM DEBT - Principal paym

LONG-TERM DEBT - Principal payments (Details)	Dec. 31, 2023 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 ($)	Sep. 30, 2021 USD ($)	Mar. 31, 2021 USD ($) item	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Apr. 30, 2021 USD ($)	Jan. 31, 2021 m²
LEASES:
Operating lease lability				$ 13,270,295	$ 13,250,944
Right of use asset				$ 12,058,896	12,603,901
Incremental borrowing rate				9.80%
Security deposit				$ 52,051	46,914
Operating lease paid				$ 2,403,000	$ 2,935,000	$ 1,968,000
Weighted average remaining lease term				12 years 8 months 12 days	12 years 4 months 24 days
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, 2023	Dec. 31, 2022
LEASES
Right-of-use asset	$ 12,058,896	$ 12,603,901
Total lease liability	13,270,295	13,250,944
Less current portion	(373,636)	(108,939)
Lease liability, net of current portion	$ 12,896,659	$ 13,142,005

LEASES - Maturities of the leas

LEASES - Maturities of the lease liabilities (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022
LEASES
2024	$ 1,656,678
2025	1,695,677
2026	1,735,747
2027	1,776,920
2028	1,819,224
Thereafter	15,413,075
Total lease payments	24,097,321
Present value discount	(10,827,026)
Total lease liability	$ 13,270,295	$ 13,250,944

INCOME TAXES - Consolidated los

INCOME TAXES - Consolidated loss before income taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
INCOME TAXES
Domestic	$ (21,475,931)	$ (21,155,203)	$ (18,829,797)
Foreign	(7,843,202)	(12,749,965)	(6,464,854)
Total	$ (29,319,133)	$ (33,905,168)	$ (25,294,651)

INCOME TAXES - Benefit from inc

INCOME TAXES - Benefit from income taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
INCOME TAXES
State Tax, including sale of New Jersey losses & credits	$ 813,739	$ 1,092,585	$ 736,003
Income Tax Expense (Benefit), Total	$ 813,739	$ 1,092,585	$ 736,003

INCOME TAXES - The principal co

INCOME TAXES - The principal components of the Company's deferred tax assets and liabilities (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Deferred tax assets:
Net operating loss carry forward	$ 36,836,007	$ 31,570,846	$ 27,190,654
Stock options	418,776	500,975	1,203,272
Research and development credit carryforward	2,310,639	3,982,147	2,687,591
Accruals and others	248,673	24,121	232,665
Lease liability	3,730,280	3,724,840	3,997,114
174(b) research and development	5,495,850	3,331,625
Gross deferred tax assets	49,040,225	43,134,554	35,311,296
Less valuation allowance	(45,334,554)	(39,303,451)	(31,242,130)
Deferred tax assets, net of valuation allowance	3,705,671	3,831,103	4,069,166
Deferred tax liability:
Fixed assets	(315,915)	(288,145)	(183,941)
Right of Use Asset	$ (3,389,756)	$ (3,542,958)	$ (3,885,225)

INCOME TAXES - Reconciliation o

INCOME TAXES - Reconciliation of income tax (expense) benefit (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
INCOME TAXES
Federal statutory rate	21%	21%	21%
State taxes, net of federal benefit	5.20%	(2.80%)	(2.00%)
Foreign rate differential	2.30%	3.40%	2.30%
Permanent items	(2.00%)	(1.50%)	(6.50%)
Rate change and true-up	(0.70%)	0.60%	11.80%
Uncertain tax positions	(7.20%)
Change in valuation allowance	(20.60%)	(22.80%)	(25.50%)
R&D credit	1.90%	2.10%	1.70%
Sale of state R&D credit and NOL	2.80%	3.20%
Other	0.10%
Effective income tax rate	2.80%	3.20%	2.80%

INCOME TAXES - Reconciliation_2

INCOME TAXES - Reconciliation of of the unrecognized tax benefit balances (Details)	12 Months Ended
	Dec. 31, 2023 USD ($)
Reconciliation of the unrecognized tax benefit balances
Balance at beginning of the year	$ 0
Increase for tax positions of prior years	1,842,332
Increase for tax positions in current year	270,901
Balance at end of the year	$ 2,113,233

INCOME TAXES - Additional infor

INCOME TAXES - Additional information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	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	$ 816,000
Net operating loss carry forwards	47,700,000
Valuation Allowance, Deferred Tax Asset, Increase, Amount	$ 6,031,103	$ 8,061,321	$ 6,447,656
operating loss carryforwards	80% limitation on taxable
Unrecognized tax benefits	$ 2,113,233	$ 0	$ 0	$ 0
Interest and penalties relating to our uncertain tax positions	0
Federal
INCOME TAXES
Net operating loss carry forwards	97,200,000				$ 49,500,000
Tax credit carryforward, amount	2,100,000
State
INCOME TAXES
Net operating loss carry forwards	17,600,000
Tax credit carryforward, amount	200,000
Foreign Tax
INCOME TAXES
Net operating loss carry forwards	$ 50,600,000

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, 2023	Dec. 31, 2022	Dec. 31, 2021
COMMITMENTS AND CONTINGENCIES
Initial term (in years)	3 years
Automatic renewal period for employment agreements			1 year
Additional automatic renewed period for employment agreements			1 year
Litigation settlement amount for employees				$ 280,000
Percentage of royalty				0.90%
Royalty Agreement
COMMITMENTS AND CONTINGENCIES
Equity investment by an existing investor		$ 4,000,000
Future royalty payment percentage on gross revenue		3%
Royalty cost				$ 923,000	$ 849,000	$ 1,193,000
License Agreement
COMMITMENTS AND CONTINGENCIES
Royalty cost				$ 1,233,000	$ 1,416,000	$ 1,988,000
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
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Shares
Outstanding, beginning of the year	9,474,824	6,885,978	5,165,204
Granted	2,601,880	4,086,205	2,051,980
Forfeited	(974,555)	(1,270,155)	(138,037)
Expired	(467,332)	(227,204)	(21,756)
Exercised	(86,643)		(171,413)
Outstanding, end of the year	10,548,174	9,474,824	6,885,978	5,165,204
Weighted Average Exercise Price per Share
Outstanding, beginning of the year	$ 4.66	$ 7.09	$ 6.36
Granted	3.43	1.97	8.78
Forfeited	2.96	8.65	6.73
Expired	5.61	7.71	7.46
Exercised	2.59		5.73
Outstanding, end of the year	$ 4.49	$ 4.66	$ 7.09	$ 6.36
Weighted Average Remaining Contractual Life (Years)
Outstanding, beginning of the year				7 years 3 months 3 days
Granted	9 years 6 months 7 days	9 years 7 months 9 days	9 years 3 months 18 days
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	7 years 3 days	7 years 4 months 9 days	7 years 1 month 24 days

STOCKHOLDERS' EQUITY - Fair val

STOCKHOLDERS' EQUITY - Fair value of stock option (Details) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
STOCKHOLDERS' EQUITY
Grant date exercise price range	$ 1.11
Exercise price ranging from 4.26 to 11.39
STOCKHOLDERS' EQUITY
Expected life of the stock option			6 years
Expected dividends			0%
Exercise price ranging from 4.26 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%
Risk free interest rate range			1.39%
Exercise price ranging from 4.26 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%
Risk free interest rate, minimum			0.47%
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%
Exercise price ranging from 1.17 to 3.71
STOCKHOLDERS' EQUITY
Expected life of the stock option	6 years
Expected dividends	0%
Risk free interest rate, minimum	3.50%
Risk free interest rate range	4.76%
Exercise price ranging from 1.17 to 3.71 | Maximum [Member]
STOCKHOLDERS' EQUITY
Grant date exercise price range	$ 3.71
Current price of the underlying stock and its expected volatility range	75.60%
Exercise price ranging from 1.17 to 3.71 | Minimum [Member]
STOCKHOLDERS' EQUITY
Grant date exercise price range	$ 1.17
Current price of the underlying stock and its expected volatility range	70.40%

STOCKHOLDERS' EQUITY - Intrinsi

STOCKHOLDERS' EQUITY - Intrinsic value (Details)	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Options Exercisable
Number Exercisable at December 31, 2023 | shares	5,342,438
Weighted Average Exercise Price	$ 5.97
Exercise Price Range One
Options Outstanding
Range of Exercise Price, Lower Range Limit	1.17
Range of Exercise Price, Upper Range Limit	$ 13.20
Number Outstanding at December 31, 2023 | shares	10,548,174
Weighted Average Exercise Price	$ 4.49
Weighted Average Remaining Life (Years)	7 years 3 days

STOCKHOLDERS' EQUITY - Non-vest

STOCKHOLDERS' EQUITY - Non-vested options (Details) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Shares
Non-vested, January 1, 2023	4,851,739
Granted	2,601,880	4,086,205	2,051,980
Forfeited	(974,555)
Vested	(1,273,328)
Non-vested, December 31, 2023	5,205,736	4,851,739
Weighted Average Grant Date Fair Value
Non-vested, January 1, 2023	$ 1.84
Granted	2.35
Forfeited	1.95
Vested	2.59
Non-vested, December 31, 2023	$ 1.89	$ 1.84

STOCKHOLDERS' EQUITY - Restrict

STOCKHOLDERS' EQUITY - Restricted stock unit (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
STOCKHOLDERS' EQUITY
Restricted Stock Units, Intrinsic Value Beginning Balance	$ 4,480,275	$ 11,359,928	$ 19,504,184
Restricted Stock Units, Intrinsic Value Ending Balance	$ 3,134,085	$ 4,480,275	$ 11,359,928
Restricted stock
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	2,890,500	2,711,200	2,447,200
Granted	394,000	498,050	396,000
Forfeited	(461,000)	(318,750)	(132,000)
Restricted Stock Units, Ending Balance	2,823,500	2,890,500	2,711,200
Non-vested, January 1, 2023	312,092
Non-vested, December 31, 2023	$ 3.31	$ 4.42
Restricted stock | Board of directors
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	346,500	277,200	277,200
Granted	0	69,300	0
Forfeited	0	0	0
Restricted Stock Units, Ending Balance	346,500	346,500	277,200
Restricted stock | Executive Management
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	779,500	724,500	724,500
Granted	150,000	55,000	0
Forfeited	(150,000)	0	0
Restricted Stock Units, Ending Balance	779,500	779,500	724,500
Restricted stock | Other Employees
STOCKHOLDERS' EQUITY
Restricted Stock Units, Beginning Balance	1,764,500	1,709,500	1,445,500
Granted	244,000	373,750	396,000
Forfeited	(311,000)	(318,750)	(132,000)
Restricted Stock Units, Ending Balance	1,697,500	1,764,500	1,709,500

STOCKHOLDERS' EQUITY - Addition

STOCKHOLDERS' EQUITY - Additional information (Details)												12 Months Ended
	Dec. 13, 2023 USD ($) $ / shares shares	Sep. 18, 2023 USD ($) shares	Aug. 28, 2023 shares	Jul. 10, 2023 USD ($) shares	Jul. 07, 2023 USD ($) shares	Jan. 23, 2023 USD ($) shares	Aug. 10, 2022 USD ($) shares	Apr. 01, 2022	Dec. 30, 2021 USD ($)	Apr. 12, 2021 USD ($) shares	Apr. 12, 2021 USN ($) shares	Dec. 31, 2023 USD ($) item $ / shares shares	Dec. 31, 2023 USN ($) shares	Dec. 31, 2022 USD ($) shares	Dec. 31, 2022 USN ($) shares	Dec. 31, 2021 USD ($) shares	Jul. 14, 2021 USD ($)	Dec. 31, 2020 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				5,000,000
Common stock, shares authorized | shares												100,000,000		100,000,000	100,000,000				100,000,000	50,000,000
Issuance of common stock | shares												0	0
Warrant Exercise Price per Share | $ / shares												$ 2
Aggregate registered amount for offerings																	$ 150,000,000
Number of option granted | shares												2,601,880	2,601,880	4,086,205	4,086,205	2,051,980
Number of long-term incentive plans | item												2
Allocated share-based compensation expense												$ 3,329,000		$ 3,424,000		$ 4,021,000
Stock or unit option plan expense												$ 260,000
Grant date exercise price range | $ / shares												$ 1.11
Total unrecognized compensation cost related to stock options												$ 4,868,000
Amortized period												42 months	42 months
Vested | shares												(1,273,328)	(1,273,328)
Issuance of restricted stock options												$ 403,939		$ 380,091		$ 928,417
Outstanding | shares												10,548,174		9,474,824	9,474,824	6,885,978		5,165,204
Forfeited | shares												974,555	974,555	1,270,155	1,270,155	138,037
Employees
STOCKHOLDERS' EQUITY
Number of option granted | shares										1,323,400	1,323,400
Percentage of milestone activity met by the company								19%
Grant date fair value of unvested options											$ 7,042,000
Stock or unit option plan expense												$ 320,000		$ 314,000
Employee Stock
STOCKHOLDERS' EQUITY
Outstanding | shares												281,000		196,900	196,900	281,880
December 13, 2023 Offering
STOCKHOLDERS' EQUITY
Issuance of common stock | shares	7,733,090
Warrants to purchase shares | shares	2,706,561
Number of common stock purchased by each warrant | shares	0.35
Average selling price | $ / shares	$ 1.33
Net proceeds excluding proceeds received upon exercise of warrants	$ 9,785,000
Warrant Exercise Price per Share | $ / shares	$ 2
Net proceeds from issuance of stock	$ 10,285,000
Common Stock
STOCKHOLDERS' EQUITY
Issuance of common stock | shares												10,389,554	10,389,554
Stock or unit option plan expense												$ 104,000
Issuance of restricted stock options												130		$ 145		$ 107
Common Stock | First anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 426,000
Restricted stock
STOCKHOLDERS' EQUITY
Stock or unit option plan expense												$ 0
Stock issued during period, shares, restricted stock award, gross | shares			60,000			30,000						250,000	250,000
Stock issued during period, value, restricted stock sward, gross						$ 64,200						$ 883,000
RSU Forfeited | shares						2,500						204,087	204,087
Issuance of restricted stock options												$ 80,000		(16,000)
Options to grant (in shares) | shares												385,000	385,000
Employee stock options
STOCKHOLDERS' EQUITY
Stock or unit option plan expense												$ 113,000		101,000
Employee stock options | Employees
STOCKHOLDERS' EQUITY
Aggregate intrinsic value												135,000
Grant date fair value of these unvested options												135,000
Stock or unit option plan expense												34,000
Executive Officer, Director And Non-executive Officer Employees [Member] | December 13, 2023 Offering
STOCKHOLDERS' EQUITY
Net proceeds excluding proceeds received upon exercise of warrants	$ 435,000
Employee one
STOCKHOLDERS' EQUITY
Number of options granted | shares							1,163,800
Allocated share-based compensation expense												1,381,000
Employee Stock
STOCKHOLDERS' EQUITY
Number of options granted | shares					1,138,750
Employee Stock | Second anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 178,000
Employee Stock | Second anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 2,665,000
Employee Stock | Common Stock
STOCKHOLDERS' EQUITY
Number of options granted | shares					56,130
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					$ 59,000							201,000		90,000
Board of directors
STOCKHOLDERS' EQUITY
Number of option granted | shares							113,850
Board of directors | First anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 234,000
Board of directors | Common Stock
STOCKHOLDERS' EQUITY
Number of option granted | shares					100,000
Chief Executive Officer
STOCKHOLDERS' EQUITY
Stock or unit option plan expense												23,000
Options to purchase common stock vested | shares				70,000
Chief Executive Officer | First anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 47,000
Chief Executive Officer | Common Stock
STOCKHOLDERS' EQUITY
Number of options granted | shares					20,000
Senior managers
STOCKHOLDERS' EQUITY
Number of option granted | shares					424,000
Stock or unit option plan expense												285,000
Senior managers | First anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 992,000
Senior managers | Common Stock
STOCKHOLDERS' EQUITY
Number of options granted | shares					182,000
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 or unit option plan expense												107,000		$ 161,000
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 or unit option plan expense													$ 0		$ 0
Existing 2022-2025 performance
STOCKHOLDERS' EQUITY
Number of option granted | shares					115,000
Stock or unit option plan expense												$ 0
Existing 2022-2025 performance | Second anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Unvested options in fair value					$ 320,000
MR. D Amico
STOCKHOLDERS' EQUITY
Number of options granted | shares				25,000
MR. D Amico | First anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Options to grant (in shares) | shares				15,000
MR. D Amico | Common Stock
STOCKHOLDERS' EQUITY
Shares issued other (in shares) | shares				215,000
MR. D Amico | Restricted stock
STOCKHOLDERS' EQUITY
Number of option granted | shares				15,000
Options to purchase common stock vested | shares				45,000
Shares vested and expected vest value				$ 157,000
Revision of prior period adjustment
STOCKHOLDERS' EQUITY
Outstanding | shares														1,365,000	1,365,000
2006 Stock Option Plan
STOCKHOLDERS' EQUITY
Common stock reserved for issuance | shares												2,400,000
Outstanding | shares												320,000
2014 Stock Option Plan
STOCKHOLDERS' EQUITY
Common stock reserved for issuance | shares												13,400,000
Outstanding | shares												647,000
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												$ (245,000)		$ 226,000
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%
April 12, 2021 performance based award | Restricted stock | Second anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Vesting percentage										33.30%	33.30%
August 10, 2022 performance based award
STOCKHOLDERS' EQUITY
Allocated share-based compensation expense												311,000
Stock or unit option plan expense														180,000
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												267,000		260,000
August 10, 2022 performance based award | Restricted stock | First anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Vesting percentage							33.30%
August 10, 2022 performance based award | Restricted stock | Second anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Vesting percentage							33.30%
August 10, 2022 performance based award | Restricted stock | Second anniversary of the date of the grant
STOCKHOLDERS' EQUITY
Vesting percentage							33.30%
July 07, 2023 performance based award | Restricted stock
STOCKHOLDERS' EQUITY
Issuance of restricted stock options												213,000		0
September 18, 2023 performance based award
STOCKHOLDERS' EQUITY
Stock issued during period, shares, restricted stock award, gross | shares		45,000
Stock issued during period, value, restricted stock sward, gross		$ 89,000
September 18, 2023 performance based award | Restricted stock
STOCKHOLDERS' EQUITY
Issuance of restricted stock options												$ 55,000		0
Jefferies LLC and B. Riley FBR, Inc
STOCKHOLDERS' EQUITY
Issuance of common stock | shares												2,656,464	2,656,464
Aggregate offering price									$ 25,000,000
Net proceeds from issuance of stock													$ 4,532,000	$ 45,000
Commission rate (as a percent)												3%
Net proceeds from issuance of stock												$ 61,000
Average selling price | $ / shares												$ 1.76

STOCKHOLDERS' EQUITY - Restri_2

STOCKHOLDERS' EQUITY - Restricted stock unit activity (Details) - Restricted stock - $ / shares		12 Months Ended
	Jan. 23, 2023	Dec. 31, 2023
Shares
Non-vested, January 1, 2023		312,092
Granted		385,000
Vested		(62,500)
Forfeited	(2,500)	(204,087)
Non-vested, December 31, 2023		430,505
Weighted Average Grant Date Fair Value
Non-vested, January 1, 2023		$ 4.42
Granted		3.23
Vested		4.79
Forfeited		3.57
Non-vested, December 31, 2023		$ 3.31

STOCKHOLDERS' EQUITY - Warrants

STOCKHOLDERS' EQUITY - Warrants (Details)	Dec. 31, 2023 $ / shares shares
STOCKHOLDERS' EQUITY
Number of shares to be purchased | shares	2,706,561
Warrant exercise price per share | $ / shares	$ 2

NET LOSS PER SHARE (Details)

NET LOSS PER SHARE (Details) - shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Stock options and warrants
NET LOSS PER SHARE
Antidilutive securities excluded from computation of earnings per share	16,819,000	11,312,000	9,902,000

RETIREMENT PLAN (Details)

RETIREMENT PLAN (Details) - USD ($)		1 Months Ended	12 Months Ended
	Jan. 01, 2021	Jun. 30, 2014	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
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			$ 405,000	$ 442,000	$ 355,000
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, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	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, 2023	Dec. 31, 2022	Dec. 31, 2021
QUARTERLY FINANCIAL RESULTS (UNAUDITED)
Total revenue	$ 8,668,215	$ 8,810,847	$ 9,420,821	$ 9,449,496	$ 9,390,474	$ 8,111,353	$ 8,495,558	$ 8,691,424	$ 10,782,195	$ 9,760,416	$ 12,024,069	$ 10,598,847	$ 36,349,379	$ 34,688,809	$ 43,165,527
Gross margin	5,311,280	5,606,866	6,018,550	5,455,327	5,757,036	3,617,377	4,944,856	6,413,788	7,659,452	7,297,470	9,313,852	7,847,403	22,392,023	20,733,057	32,118,177
Loss from operations	(9,408,222)	(7,350,198)	(6,559,237)	(7,891,596)	(6,356,356)	(9,017,338)	(8,357,050)	(7,791,135)	(9,561,821)	(5,406,000)	(4,924,733)	(2,852,191)	(31,209,253)	(31,521,879)	(22,744,745)
Net loss attributable to common stockholders	$ (5,834,907)	$ (9,193,520)	$ (6,153,084)	$ (7,325,883)	$ (766,128)	$ (12,200,837)	$ (10,879,222)	$ (8,966,398)	$ (9,307,012)	$ (6,406,285)	$ (4,677,530)	$ (4,167,821)	$ (28,507,394)	$ (32,812,583)	$ (24,558,648)
Basic net loss per common share	$ (0.12)	$ (0.21)	$ (0.14)	$ (0.17)	$ (0.02)	$ (0.28)	$ (0.25)	$ (0.21)	$ (0.25)	$ (0.15)	$ (0.11)	$ (0.10)	$ (0.64)	$ (0.75)	$ (0.57)
Diluted net loss per common share	$ (0.12)	$ (0.21)	$ (0.14)	$ (0.17)	$ (0.02)	$ (0.28)	$ (0.25)	$ (0.21)	$ (0.25)	$ (0.15)	$ (0.11)	$ (0.10)	$ (0.64)	$ (0.75)	$ (0.57)

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net Income (Loss)	$ (28,507,394)	$ (32,812,583)	$ (24,558,648)

Insider Trading Arrangements

Insider Trading Arrangements	12 Months Ended
	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false