RISK
FACTORS
An
investment in our securities, including our common stock, common warrants, and pre-funded warrants, involves a high degree
of risk. You should carefully consider the risks described below and all of the other information contained in this prospectus
and incorporated by reference into this prospectus, including our Annual Report on Form 10-K for the year ended December 31, 2016,
as amended, our Quarterly Report on Form 10-Q for the period ended March 31, 2017 and our financial statements and related notes,
before investing in our securities. If any of the possible events described in those sections or below actually occur, our business,
business prospects, cash flow, results of operations or financial condition could be harmed. In this case, the trading price of
our common stock could decline, and you might lose all or part of your investment.
The
following is a discussion of the risk factors that we believe are material to us at this time. These risks and uncertainties are
not the only ones facing us and there may be additional matters that we are unaware of or that we currently consider immaterial.
All of these could adversely affect our business, business prospects, results of operations, financial condition and cash flows.
RISKS
RELATING TO OUR BUSINESS
There
are substantial doubts about our ability to continue as a going concern due to our operating history of net losses, negative working
capital and insufficient cash flows, and lack of liquidity to pay our current obligations and if we are unable to continue our
business, our shares may have little or no value.
Our
ability to become a profitable operating company is dependent upon our ability to generate revenues and/or obtain financing adequate
to support our cost structure. We do not currently have enough cash on hand to meet our obligations over the next twelve months,
and we cannot provide our stockholders any assurance that we will be able to raise sufficient funding from the generation of revenue,
the sale of our common stock, or through financing to sustain us over the next twelve months.
For
the fiscal year ended December 31, 2016 and quarter ended March 31, 2017, we had an operating loss of $6.4 million and operating
income of $3.7 million, respectively. As of March 31, 2017, we had cash and cash equivalents of $7.1 million and current liabilities
of $13.0 million. From September 30, 2016 through December 31, 2016, we provided working capital by extending our payables primarily
by not making timely payments on current obligations and debt incurred prior to the sale of our CSO business, entering into payment
plans, negotiating termination agreements on commitments that were not useful to our current business and not paying certain severance
obligations to terminated employees. We completed four public offerings and a private placement of warrants from December 22,
2016 through February 8, 2017, which resulted in aggregate gross proceeds to us of approximately $14.1 million. Of that amount,
we used approximately $1.3 million to make the first principal payment on that certain Non-Negotiable Subordinated Secured Promissory
Note, dated as of October 31, 2014, as amended, or the RedPath Note, on December 31, 2016 (which RedPath Note has since been acquired
by an investor, exchanged with the Company for the Exchanged Notes and converted into common stock) and approximately $1.0 million
on February 27, 2017 to satisfy severance obligations due to five former senior executives. The proceeds from the public offerings
and private placement have improved our overall cash position. However, we remain in default of certain of our current obligations
and certain vendors have threatened litigation against us. The Company must also fund its operating deficit until a sustainable
level of revenue is achieved. These factors have raised substantial doubts about our ability to continue as a going concern. We
may need to attempt to raise additional equity capital by selling shares of common stock or other dilutive or non-dilutive means,
if necessary. However, the doubts raised, relating to our ability to continue as a going concern, may make investing in our securities
an unattractive investment for potential investors. These factors, among others, may make it difficult to raise any additional
capital.
Our
molecular diagnostics business has limited revenue, and we expect to incur net losses for the foreseeable future and may never
achieve or sustain profitability.
In
2014, we acquired RedPath and certain assets from Asuragen. As a result, we now offer PancraGEN®, ThyGenX®, and ThyraMIR
®
and to a limited extent, BarreGEN
®
. The revenue generated from our molecular diagnostics business
was $13.1 million and $3.5 million for the fiscal year ended December 31, 2016 and our quarter ended March 31, 2017, respectively.
For the fiscal year ended December 31, 2016, our molecular diagnostics business had an operating loss of approximately $6.4 million.
For our quarter ended March 31, 2017, our molecular diagnostics business had operating income from continuing operations of approximately
$3.7 million. However, without the reversal of contingent consideration liabilities of $5.8 million during the quarter ended March
31, 2017, we would have had an operating loss of $2.1 million. Although we expect the revenue generated from our molecular diagnostics
business to grow in the future, there can be no assurance that we will achieve revenue sufficient to offset expenses. Over the
next several years, we expect to continue to devote resources to increase adoption of, and reimbursement for, our molecular diagnostic
tests and to develop and acquire additional diagnostic solutions. However, our business may never achieve or sustain profitability,
and our failure to achieve and sustain profitability in the future could have a material adverse effect on our business, financial
condition and results of operations.
We
may not be able to fund the remaining obligations of our previously sold CSO business, which could have a material adverse effect
on our business and results of operations.
As
a result of an Asset Purchase Agreement, dated as of October 30, 2015, by and between us and the CSO Acquirer (“Asset
Sale”), not all of our CSO obligations were assumed by the CSO Acquirer. These obligations consist of up to $2.6
million, in aggregate, of accounts payable, costs relating to the closeout of the portion of the CSO business that principally
related to the provision of services for multiple non-competing brands for different clients, or the ERT Unit, which the CSO Acquirer
did not acquire in the Asset Sale, and termination of various vendor contracts that had been associated with the CSO business.
As such, we continue to pay some of these obligations, but may not be able to satisfy all of these remaining obligations. If we
are unable to satisfy all our remaining CSO obligations, our business and results of operations could be materially and adversely
affected.
Our
profitability will be impaired by our obligations to make royalty and milestone payments to Asuragen.
In
connection with our acquisition of certain assets of Asuragen in 2014, we are obligated to make certain royalty and milestone
payments. Under the Asuragen License Agreement, we owed $500,000, all of which was paid in installments throughout 2016 and paid
in full as of January 13, 2017. We are further obligated to pay royalties on the future net sales of the miR
Inform
®
pancreas platform for a period of ten years following a qualifying sale, on the future net sales of the miR
Inform
®
thyroid platform through August 13, 2024 and on certain other thyroid diagnostics tests for a period of ten years following a
qualifying sale.
Even
if we are able to successfully launch the above referenced diagnostic tests, our profitability will be impaired by our obligations
to make royalty and milestone payments to Asuragen. Although we believe, under such circumstances, that the increase in revenue
will exceed the corresponding royalty and milestone payments, our obligations to Asuragen could have a material adverse effect
on our business, financial condition and results of operations if we are unable to manage our operating costs and expenses at
profitable levels.
Our
inability to finance our business on acceptable terms in the future may limit our ability to develop and commercialize new molecular
diagnostic solutions and technologies and grow our business, and potentially force us to seek bankruptcy protection.
We
expect capital expenditures and operating expenses to increase over the next several years as we expand our infrastructure and
commercial operations. As of March 31, 2017, we had cash and cash equivalents of $7.1 million, net accounts receivable of $2.3
million, current assets of $10.7 million and current liabilities of $13.0 million. While the Company has made significant reductions
in indebtedness, the Company is not yet cash flow positive from operations. Accordingly, due to the Company’s operating
deficit and obligations, we may need to finance our business in the future through collaborations, equity offerings, debt financings,
licensing arrangements or other dilutive or non-dilutive means. Additional funding may not be available to us on acceptable terms,
or at all. If we raise funds by issuing additional equity securities, dilution to our stockholders could result. Further, our
ability to raise additional financing through equity offerings in the future may be more difficult and costly since we have lost
our eligibility until November 2017 to use our registration statement on Form S-3 (File No. 333-207263) declared effective by
the SEC on October 9, 2015 because we failed to file a timely Form 8-K. In addition, we granted each institutional investor who
participated in the Second Registered Direct Offering, the right, for a period of 15 months following January 6, 2017,
or until April 6, 2018, to participate in any public or private offering by us of equity securities, subject to certain exceptions,
up to such investor’s pro rata portion of 50% of the securities being offered, or the Participation Right. If we fail to
comply with the applicable provisions of the Participation Right or do not receive waivers from such investors, we may not be
able to raise funds through another equity offering. The incurrence of additional indebtedness or the issuance of certain equity
securities could result in increased fixed payment obligations and could also result in restrictive covenants, such as limitations
on our ability to incur additional debt or issue additional equity, limitations on our ability to acquire or license intellectual
property rights, and other operating restrictions that could adversely affect our ability to conduct our business.
Our
financial results currently depend solely on sales of our molecular diagnostic tests, and we will need to generate sufficient
revenue from these and other molecular diagnostic solutions that we develop or acquire to grow our business.
The
majority of our revenue currently is derived from the sale of our molecular diagnostic tests, which we initially launched commercially
in the second half of 2014. We have several additional molecular diagnostics tests and complimentary service extensions that we
have recently launched or are in late stage development, but there can be no assurance that we will be able to successfully commercialize
or sufficiently grow those tests. If we are unable to increase sales of our molecular diagnostic tests, expand reimbursement for
these tests, or successfully develop and commercialize other molecular diagnostic tests, our revenue and our ability to achieve
and sustain profitability would be impaired, and this could have a material adverse effect on our business, financial condition
and results of operations.
We
have a limited operating history as a molecular diagnostics company, which may make it difficult for you to evaluate the success
of our business to date and to assess our future viability.
We
were originally incorporated in New Jersey in 1986 and began commercial operations in 1987. In connection with our initial public
offering, we re-incorporated in Delaware in 1998. From 1987 until the Asset Sale described below, our operations focused primarily
on our CSO business, which was the personal promotion of pharmaceutical customers’ products through outsourced sales teams.
We now conduct our molecular diagnostics business through our wholly owned subsidiaries, Interpace LLC, which was formed in Delaware
in 2013, and Interpace Diagnostics Corporation, which was formed in Delaware in 2007. We began our own commercial sales of our
molecular diagnostic tests in late 2014. Consequently, any evaluations about our future success, performance or viability may
not be as accurate as they could be if we had a longer operating history.
Recent
changes in our senior management team and the lack of shared experience among the current members of our senior management team
could negatively affect our results of operations and our business may be harmed.
Effective
as of December 22, 2015, our President and Chief Executive Officer resigned and also resigned as a member of our Board of Directors
(the “Board”). Our Board appointed Jack E. Stover, previously Chairman of our Audit Committee, as Interim President
and Chief Executive Officer, and subsequently, effective June 21, 2016, Mr. Stover was appointed President and Chief Executive
Officer. Additionally, in light of the departure of our previous Chief Financial Officer, James Early was appointed as Chief Financial
Officer effective as of October 11, 2016. Mr. Early also serves as our principal accounting officer. From August 29, 2016 until
October 11, 2016, Mr. Early was engaged by us as a consultant to perform the role of interim chief financial officer.
As
a result of these changes, we may experience disruption or have difficulty in maintaining or developing our business during this
transition. Further, our senior management team has limited experience working together as a group. This lack of shared experience
could negatively impact our senior management team’s ability to quickly and efficiently respond to problems and effectively
manage our business. If our management team is not able to work together as a group, our results of operations may suffer and
our business may be harmed.
The
loss of members of our senior management team or our inability to attract and retain key personnel could adversely affect our
business.
As
a small company with 63 employees, the success of our business depends largely on the skills, experience and performance of members
of our senior management team and others in key management positions. The efforts of these persons will be critical to us as we
continue to grow our molecular diagnostics business and develop and/or acquire additional molecular diagnostic tests. If we were
to lose one or more of these key employees, we may experience difficulties in competing effectively, developing our technologies
and implementing our business strategy. In addition, our commercial laboratory operations depend on our ability to attract and
retain highly skilled scientists, including licensed clinical laboratory scientists. We may not be able to attract or retain qualified
scientists and technicians in the future due to the competition for qualified personnel, and we may have to pay higher salaries
to attract and retain qualified personnel. We may also be at a disadvantage in recruiting and retaining key personnel as our small
size, limited resources, limited liquidity, work force reductions in late 2015 and recent changes in our senior management team
may be viewed as providing a less stable environment, with fewer opportunities than would be the case at one of our larger competitors.
If we are not able to attract and retain the necessary personnel to accomplish our business objectives, we may experience constraints
that could adversely affect our ability to support our clinical laboratory and commercialization.
We
depend on a few payors for a significant portion of our revenue, and if one or more significant payors stops providing reimbursement
or decreases the amount of reimbursement for our molecular diagnostic tests, our revenue could decline.
Due
to the age of our typical patients, the majority of our gastrointestinal patients are Medicare based while the majority of our
endocrine patients are covered by commercial insurance carriers. Accordingly, our success in adding and obtaining commercial carriers
has been more significant for our thyroid assays.
Revenue
for tests performed on patients covered by Medicare was approximately 41% of our total net revenue for the fiscal year ended December
31, 2016 and 41% of total net revenue for the quarter ended March 31, 2017. The percentage of our revenue derived from significant
payors is expected to fluctuate from period to period as our revenue increases, as additional payors provide reimbursement for
our molecular diagnostic tests or if one or more payors were to stop reimbursing for our molecular diagnostic tests or change
their reimbursed amounts.
Since
September 2012, Novitas Solutions has been the regional MAC that handles claims processing for Medicare services with jurisdiction
for PancraGEN
®
, ThyGenX
®
, ThyraMIR
®
and BarreGEN
®
. On a five-year
rotational basis, Medicare requests bids for its regional MAC services. Any future changes in the MAC processing or coding for
Medicare claims for our molecular diagnostic tests could result in a change in the coverage or reimbursement rates for such molecular
diagnostic tests, or the loss of coverage.
Our
PancraGEN
®
and ThyGenX
®
tests are reimbursed by Medicare based on applicable CPT codes. PancraGEN
®
is currently reimbursed by Medicare at $3,038 per test, ThyGenX
®
is currently reimbursed by Medicare
at $1,054 a test and ThyraMIR
®
is currently reimbursed by Medicare at $2,110. Presently, our BarreGEN
®
assay is not reimbursed at all. Any future reduction from the current rate would have a material adverse effect on business
and results of operations.
Although
we have entered into contracts with certain third-party payors which establish in-network allowable rates of reimbursement for
our molecular diagnostic tests, payors may suspend or discontinue reimbursement at any time, may require or increase co-payments
from patients, or may reduce the reimbursement rates paid to us. Any such actions could have a negative effect on our revenue.
If
payors do not provide reimbursement, rescind or modify their reimbursement policies or delay payments for our tests, or if we
are unable to successfully negotiate additional reimbursement contracts, our commercial success could be compromised.
Physicians
may generally not order our tests unless payors reimburse a substantial portion of the test price. There is typically uncertainty
concerning third-party reimbursement of any test incorporating new molecular diagnostic technology. Reimbursement by a payor may
depend on a number of factors, including a payor’s determination that tests such as our molecular diagnostic tests are:
(a) not experimental or investigational; (b) pre-authorized and appropriate for the patient; (c) cost-effective; (d) supported
by peer-reviewed publications; and (e) included in clinical practice guidelines. Since each payor generally makes its own decision
as to whether to establish a policy or enter into a contract to reimburse our tests, seeking these approvals is a time-consuming
and costly process. Although we have contracted rates of reimbursement with certain payors, which establishes in-network allowable
rates of reimbursement for our PancraGEN
®
, ThyGenX
®
, and ThyraMIR
®
tests, payors
may suspend or discontinue reimbursement at any time, may require or increase co-payments from patients, or may reduce the reimbursement
rates paid to us. Any such actions could have a negative effect on our revenue.
We
have contracted rates of reimbursement with payors for our PancraGEN
®
, ThyGenX
®
and ThyraMIR
®
tests. Without a contracted rate for reimbursement, claims may be denied upon submission, and we may need to
appeal the claims. The appeals process is time consuming and expensive, and may not result in payment. We expect to continue to
focus resources on increasing adoption of and coverage and reimbursement for our molecular diagnostic tests. We cannot, however,
predict whether, under what circumstances, or at what payment levels payors will reimburse us for our molecular diagnostic tests,
if at all. In addition, the launch of our molecular diagnostic tests, PancraGEN
®
, ThyGenX
®
,
ThyraMIR
®
and BarreGEN
®
and any other new products we may acquire or develop in the future may
require that we expend substantial time and resources in order to obtain and retain reimbursement. Also, payor consolidation is
underway and creates uncertainty as to whether coverage and contracts with existing payors will remain in effect. Finally, commercial
payors may tie their allowable rates to Medicare rates, and should Medicare reduce their rates, we may be negatively impacted.
If we fail to establish broad adoption of and reimbursement for our molecular diagnostic tests, or if we are unable to maintain
existing reimbursement from payors, our ability to generate revenue could be harmed and this could have a material adverse effect
on our business, financial condition and results of operations.
We
may experience limits on our revenue if physicians decide not to order our molecular diagnostic tests.
If
we are unable to create or maintain demand for our molecular diagnostic tests in sufficient volume, we may not become profitable.
To generate demand, we will need to continue to educate physicians and the medical community on the value and benefits of our
molecular diagnostic tests in order to change clinical practices through published papers, presentations at scientific conferences
and one-on-one education by our internal sales force. In addition, our ability to obtain and maintain adequate reimbursement from
third-party payors will be critical to generating revenue.
In
many cases, practice guidelines in the United States have recommended therapies or surgery to determine if a patient’s condition
is malignant or benign. Accordingly, physicians may be reluctant to order a diagnostic test that may suggest surgery is unnecessary.
In addition, our molecular diagnostic tests are performed at our laboratories rather than by a pathologist in a local laboratory,
so pathologists may be reluctant to support our molecular diagnostic tests. In addition, guidelines for the diagnosis and treatment
may change to recommend another type of treatment protocol, and these changes may result in medical practitioners deciding not
to use our molecular diagnostic tests. These facts may make physicians reluctant to convert to using our molecular diagnostic
tests, which could limit our ability to generate revenue and achieve profitability, which could have a material adverse effect
on our business, financial condition and results of operations.
We
may experience limits on our revenue if patients decide not to use our molecular diagnostic tests.
Some
patients may decide not to use our molecular diagnostic tests due to price, all or part of which may be payable directly by the
patient if the patient’s insurer denies reimbursement in full or in part. Many insurers seek to shift more of the cost of
healthcare to patients in the form of higher co-payments or premiums. In addition, the current economic environment in the United
States has and may continue to result in the loss of healthcare coverage. Implementation of provisions of PPACA (also known as
the Affordable Care Act) also resulted in the loss of health insurance, and increases in premiums and reductions in coverage,
for some patients. These events may result in patients delaying or forgoing medical checkups or treatment due to their inability
to pay for our test, which could have an adverse effect on our revenue. In addition, the President of the United States has announced
that he favors repealing PPACA in 2017, and leaders of the Republication-controlled federal legislature also have expressed a
desire to repeal PPACA. The scope and timing of any legislation to repeal, amend, replace, or reform PPACA is uncertain, but if
such legislation were to become law, it could have a significant impact on the U.S. healthcare system. We do have a Patient Assistance
Program that allows eligible patients to apply for assistance in covering a portion of their out of pocket obligation; however,
there is no guarantee that this Program will be sufficient to influence patients to use our molecular diagnostic tests.
If
our internal sales force is less successful than anticipated, our business expansion plans could suffer and our ability to generate
revenues could be diminished. In addition, we have limited history selling our molecular diagnostics tests on a direct basis and
our limited history makes forecasting difficult.
If
our internal sales force is not successful, or new additions to our sales team fail to gain traction among our customers, we may
not be able to increase market awareness and sales of our molecular diagnostic tests. If we fail to establish our molecular diagnostic
tests in the marketplace, it could have a negative effect on our ability to sell subsequent molecular diagnostic tests or other
products or services and hinder the desired expansion of our business. We have growing, however limited, historical experience
forecasting the direct sales of our molecular diagnostics products. Our ability to process quantities that meet customer demand
is dependent upon our ability to forecast accurately and plan production accordingly.
Due
to how we recognize revenue, our quarterly operating results are likely to fluctuate.
We
recognize a significant portion of our revenue when the following four revenue recognition criteria are met: persuasive evidence
of an arrangement exists; services have been rendered; the selling price is fixed or determinable; and collectability is reasonably
assured. We have little visibility as to when we will receive payment, and we must appeal negative payment decisions, which delays
collections. For molecular diagnostic tests performed where we have an agreed upon reimbursement rate or we are able to make a
reasonable estimate of reimbursement at the time delivery is complete, such as in the case of Medicare and certain other payors,
we recognize the related revenue upon delivery of a patient report to the prescribing physician based on the established billing
rate less contractual and other adjustments to arrive at the net amount that we expect to collect. We determine the net amount
we expect to collect based on a per payor, per contract or agreement basis. In situations where we are not able to make a reasonable
estimate of reimbursement, we recognize revenue upon the earlier of receipt of third-party notification of payment or when cash
is received. Upon ultimate collection, the amount received from Medicare and other payors where reimbursement was estimated is
compared to previous estimates and the contractual allowance is adjusted accordingly. These factors will likely result in fluctuations
in our quarterly revenue. Should we recognize revenue from payors on an accrual basis and later determine the judgments underlying
estimated reimbursement change, or were incorrect at the time we accrued such revenue, our financial results could be negatively
impacted in future quarters. As a result, comparing our operating results on a period-to-period basis may vary. You should not
rely on our past results as an indication of our future performance. In addition, these fluctuations in revenue may make it difficult
for us, research analysts and investors to accurately forecast our revenue and operating results. If our revenue or operating
results fall below consensus expectations, the price of our common stock would likely decline.
We
rely on sole suppliers for many of the materials used in our molecular diagnostic tests, and we may not be able to find replacements
or transition to alternative suppliers in a timely manner.
We
rely on sole suppliers for many materials that we use to perform our molecular diagnostic tests, including Asuragen for our thyroid
tests pursuant to our supply agreement with them. We also purchase reagents used in our molecular diagnostic tests from sole-source
suppliers. While we have developed alternate sourcing strategies for many of these materials and vendors, we cannot be certain
whether these strategies will be effective or the alternative sources will be available in a timely manner. We do not currently
have alternative sources for certain supplies and materials, although we believe that alternative sources are available. If these
suppliers can no longer provide us with the materials we need to perform our molecular diagnostic tests, if the materials do not
meet our quality specifications, or if we cannot obtain acceptable substitute materials, an interruption in molecular diagnostic
test processing could occur. Any such interruption may directly impact our revenue and cause us to incur higher costs.
We
may experience problems in scaling our operations, or delays or reagent and supply shortages that could limit the growth of our
revenue.
If
we encounter difficulties in scaling our operations as a result of, among other things, quality control and quality assurance
issues, availability of reagents and raw material supplies, or sufficient credit worthiness to acquire sufficient reagents and
supplies, we will likely experience reduced sales of our molecular diagnostic tests, increased repair or re-engineering costs,
and defects and increased expenses due to switching to alternate suppliers, any of which would reduce our revenues and gross margins.
Although
we attempt to match our capabilities to estimates of marketplace demand, to the extent demand materially varies from our estimates,
we may experience constraints in our operations and delivery capacity, which could adversely impact revenue in a given fiscal
period. Should our need for raw materials and reagents used in our molecular diagnostic tests fluctuate, we could incur additional
costs associated with either expediting or postponing delivery of those materials or reagents.
If
we are unable to support demand for our molecular diagnostic tests or any of our future tests or solutions, our business could
suffer.
As
demand for our molecular diagnostic tests grows, we will need to continue to scale our testing capacity and processing technology,
expand customer service, billing and systems processes and enhance our internal quality assurance program. We will also need additional
certified laboratory scientists and other scientific and technical personnel to process higher volumes of our molecular diagnostic
tests. We cannot assure you that increases in scale, related improvements and quality assurance will be implemented successfully
or that appropriate personnel will be available. Failure to implement necessary procedures, transition to new processes or hire
the necessary or appropriately trained personnel could result in higher costs of processing tests or inability to meet demand.
There can be no assurance that we will be able to perform our testing on a timely basis at a level consistent with demand, or
that our efforts to scale our operations will not negatively affect the quality of test results. If we encounter difficulty meeting
market demand or quality standards, our reputation could be harmed and our future prospects and our business could suffer, causing
a material adverse effect on our business, financial condition and results of operations.
If
we are unable to compete successfully, we may be unable to increase or sustain our revenue or achieve profitability.
We
compete with physicians and the medical community who may use less sophisticated methods to diagnose gastrointestinal and endocrine
cancers. In many cases, practice guidelines in the United States have recommended therapies or surgery to determine if a patient’s
condition is malignant or benign. As a result, we believe that we will need to continue to educate physicians and the medical
community on the value and benefits of our molecular diagnostic tests in order to continue to positively impact clinical practices.
In addition, we face competition from other companies that offer diagnostic tests. Specifically, in regard to our thyroid diagnostic
tests, Veracyte has thyroid nodule cancer diagnostic tests that compete with our ThyGenX
®
and ThyraMIR
®
tests, which are currently on the market, and Veracyte may be developing additional tests aimed at FNAs for thyroid cancer.
Quest currently offers a diagnostic test similar to the earlier version of our ThyGenX
®
test, and CBL is offering
a diagnostic test that analyzes genetic alterations using next-generation sequencing. Other competitors for our thyroid assays
include Rosetta Genomics, Accelerate Diagnostics, Inc., Cancer Genetics, Inc., Genomic Health Inc., NeoGenomics Inc. and Trovagene,
Inc. While we do not believe we currently have direct competition for PancraGEN
®
in the gastrointestinal market,
there is the potential for indirect competition as well as direct competition due to the limited penetration we currently have
of this market.
It
is also possible that we face future competition from Laboratory Developed Tests (“LDTs”) developed by commercial
laboratories such as Quest and/or other diagnostic companies developing new molecular diagnostic tests or technologies. Furthermore,
we may be subject to competition as a result of the new, unforeseen technologies that can be developed by our competitors in the
gastrointestinal and endocrine cancer molecular diagnostic tests space.
To
compete successfully, we must be able to demonstrate, among other things, that our test results are accurate and cost effective,
and we must secure a meaningful level of reimbursement for our tests. Since our molecular diagnostics business began in 2014,
many of our potential competitors have stronger brand recognition and greater financial capabilities than we do. Others may develop
a test with a lower price than ours that could be viewed by physicians and payors as functionally equivalent to our molecular
diagnostic tests, or offer a test at prices designed to promote market penetration, which could force us to lower the price of
our molecular diagnostic tests and affect our ability to achieve and maintain profitability. If we are unable to compete successfully
against current and future competitors, we may be unable to increase market acceptance of our molecular diagnostic tests and overall
sales, which could prevent us from increasing our revenue or achieving profitability and cause the market price of our common
stock to decline. As we add new molecular diagnostic tests and services, we will face many of these same competitive risks for
these new tests and services.
Developing
new molecular diagnostic tests involves a lengthy and complex process, and we may not be able to commercialize on a timely basis,
or at all, other molecular diagnostic tests we are developing.
Developing
new molecular diagnostic tests and solutions require us to devote considerable resources to research and development. We may face
challenges obtaining sufficient numbers of samples to validate a newly acquired or developed molecular diagnostic test. In order
to develop and commercialize new tests, we typically need to:
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expend
significant funds to conduct substantial research and development;
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conduct
successful analytical and clinical studies;
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scale
our laboratory processes to accommodate new molecular diagnostic tests; and
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build
the commercial infrastructure to market and sell new tests.
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Typically,
few research and development projects result in commercial products, and success in early clinical studies often is not replicated
in later studies. At any point, we may abandon development of a test or we may be required to expend considerable resources repeating
clinical studies, which would adversely affect the timing for generating revenue from such test. If a clinical validation study
fails to demonstrate the prospectively defined endpoints of the study or if we fail to sufficiently demonstrate analytical validity,
we might choose to abandon the development of the molecular diagnostic test, which could harm our business. In addition, competitors
may develop and commercialize new competing tests faster than us or at a lower cost, which could have a material adverse effect
on our business, financial condition and results of operations.
Unfavorable
results of legal proceedings could have a material adverse effect on our business, financial condition and results of operations.
We
are and may become subject to various legal proceedings and claims that arise in or outside the ordinary course of business. The
results of legal proceedings cannot be predicted with certainty. Regardless of merit, litigation may be both time-consuming and
disruptive to our operations and cause significant expense and diversion of management attention. If we do not prevail in the
legal proceedings, we may be faced with significant monetary damages or injunctive relief against us that could have a material
adverse effect on our business, financial condition and results of operations.
If
we are unable to develop or acquire molecular diagnostic tests to keep pace with rapid technological, medical and scientific change,
our operating results and competitive position could be affected.
Recently,
there have been numerous advances in technologies relating to diagnostics, particularly diagnostics that are based on genomic
information. These advances require us to continuously develop our technology and to work to develop new solutions to keep pace
with evolving standards of care. Our solutions could become obsolete unless we continually innovate and expand our product offerings
to include new clinical applications. If we are unable to develop or acquire new molecular diagnostic tests or to demonstrate
the applicability of our molecular diagnostic tests for other diseases, our sales could decline and our competitive position could
be harmed.
If
the U.S. Food and Drug Administration were to begin to enforce regulation of our molecular diagnostic tests, we could incur substantial
costs and delays associated with trying to obtain pre-market clearance or approval and costs associated with complying with post-market
requirements.
Clinical
laboratory tests like our molecular diagnostic tests are regulated under CLIA as well as by applicable State laws. Most LDTs are
currently not subject to the FDA’s, regulation (although reagents, instruments, software or components provided by third
parties and used to perform LDTs may be subject to regulation). In October 2014, the FDA issued two draft guidance documents:
“Framework for Regulatory Oversight of Laboratory Developed Tests”, which provides an overview of how the FDA would
regulate LDTs through a risk-based approach, and “FDA Notification and Medical Device Reporting for Laboratory Developed
Tests”, which provides guidance on how the FDA intends to collect information on existing LDTs, including adverse event
reports. Pursuant to the Framework for Regulatory Oversight draft guidance, LDT manufacturers will be subject to medical device
registration, listing, and adverse event reporting requirements. LDT manufacturers will be required to either submit a pre-market
application and receive the FDA’s approval before an LDT may be marketed or submit a pre-market notification in advance
of marketing. The Framework for Regulatory Oversight draft guidance states that within six months after the guidance documents
are finalized, all laboratories will be required to give notice to the FDA and provide basic information concerning the nature
of the LDTs offered.
On
November 18, 2016, however, the FDA announced that it would not release the final guidance at this time and instead would continue
to work with stakeholders, the new administration and Congress to determine the right approach. On January 13, 2017, the FDA released
a discussion paper on LDTs outlining a possible risk-based approach for FDA and CMS oversight of LDTs. According to the 2017 discussion
paper, previously marketed LDTs would not be expected to comply with most or all FDA oversight requirements (grandfathering),
except for adverse event and malfunction reporting. In addition, certain new and significantly modified LDTs would not be expected
to comply with pre-market review unless the agency determines certain tests could lead to patient harm. Since LDTs currently on
the market would be grandfathered in, pre-market review of new and significantly modified LDTs could be phased-in over a four
year period, as opposed to the nine years proposed in the Framework for Regulatory Oversight draft guidance. In addition, tests
introduced after the effective date, but before their phase-in date, could continue to be offered during pre-market review.
The
discussion paper notes that FDA will focus on analytical and clinical validity as the basis for marketing authorization. The FDA
anticipates laboratories that already conduct proper validation should not be expected to experience new costs for validating
their tests to support marketing authorization and laboratories that conduct appropriate evaluations would not have to collect
additional data to demonstrate analytical validity for FDA clearance or approval. The evidence of the analytical and clinical
validity of all LDTs will be made publically available. LDTs are encouraged to submit prospective change protocols in their pre-market
submission that outline specific types of anticipated changes, the procedures that will be followed to implement them and the
criteria that will be met prior to implementation.
Despite
the FDA decision not to release the guidance at this time, it can choose to release the guidance at any time in the future. If
the guidance is released and pre-market review is required, our business could be negatively impacted as a result of commercial
delay that may be caused by the new requirements. The cost of conducting clinical trials and otherwise developing data and information
to support pre-market applications may be significant. If we are required to submit applications for our currently-marketed tests,
we may be required to conduct additional studies, which may be time-consuming and costly and could result in our currently-marketed
tests being withdrawn from the market. Continued compliance with the FDA’s regulations would increase the cost of conducting
our business, and subject us to heightened regulation by the FDA and penalties for failure to comply with these requirements.
Failure to comply with applicable regulatory requirements can result in enforcement action by the FDA, such as fines, product
suspensions, warning letters, recalls, injunctions and other civil and criminal sanctions. There are other regulatory and legislative
proposals that would increase general FDA oversight of clinical laboratories and LDTs. The outcome and ultimate impact of such
proposals on the business is difficult to predict at this time. We are monitoring developments and anticipate that our products
will be able to comply with requirements that are ultimately imposed by the FDA. In the meantime, we maintain our CLIA accreditation,
which permits the use of LDTs for diagnostics purposes.
If
we fail to comply with Federal, State and foreign laboratory licensing requirements, we could lose the ability to perform our
tests or experience disruptions to our business.
We
are subject to CLIA, a Federal law that regulates clinical laboratories that perform testing on specimens derived from humans
for the purpose of providing information for the diagnosis, prevention or treatment of disease. CLIA regulations mandate specific
standards in the areas of personnel qualifications, administration, and participation in proficiency testing, patient test management
and quality assurance. CLIA certification is also required in order for us to be eligible to bill Federal and State healthcare
programs, as well as many private third-party payors, for our molecular diagnostic tests. To renew these certifications, we are
subject to survey and inspection every two years. Moreover, CLIA inspectors may make random inspections of our clinical reference
laboratories. We are also required to maintain State licenses to conduct testing in our New Haven, Connecticut and Pittsburgh,
Pennsylvania laboratories. Connecticut and Pennsylvania laws require that we maintain a license and establishes standards for
the day-to-day operation of our clinical reference laboratory in New Haven, Connecticut and Pittsburgh, Pennsylvania. In addition,
our Pittsburgh and New Haven laboratories are required to be licensed on a test-specific basis by California, Florida, Maryland,
New York and Rhode Island. California, Florida, Maryland, New York and Rhode Island laws also mandate proficiency testing for
laboratories licensed under the laws of each respective State regardless of whether such laboratories are located in California,
Florida, Maryland, New York or Rhode Island. In 2016, we received final approval for our ThyGenX
®
and ThyraMIR
®
assays in New York State. If we were unable to obtain or lose our CLIA certificate for our laboratories, whether
as a result of revocation, suspension or limitation, we would no longer be able to perform our molecular diagnostic tests, which
could have a material adverse effect on our business, financial condition and results of operations. If we were to lose our licenses
issued by New York or by other States where we are required to hold licenses, we would not be able to test specimens from those
States. New molecular diagnostic tests we may develop may be subject to new approvals by governmental bodies such as New York
State, and we may not be able to offer our new molecular diagnostic tests to patients in such jurisdictions until such approvals
are received.
Recent
legislation reforming the U.S. healthcare system may have a material adverse effect on our financial condition and operations.
PPACA
makes changes that are expected to significantly impact the pharmaceutical, medical device and clinical laboratory industries.
Beginning in 2013, each medical device manufacturer must pay a sales tax in an amount equal to 2.3% of the price for which such
manufacturer sells its medical devices that are listed with the FDA. The FDA’s final guidance on LDTs may require our molecular
diagnostic tests to be regulated as medical devices. However, consistent with the FDA’s policy of exercising enforcement
discretion for LDTs, our molecular diagnostic tests are not currently listed as medical devices with the FDA. In December 2015,
the Consolidated Appropriations Act was adopted, which included a two-year moratorium on the medical device excise tax. The moratorium
will end on December 31, 2017, and we cannot assure that the tax will not be extended to services such as ours in the future if
our tests were to be regulated as devices. However, in January 2017, Congress introduced the Medical Device Access and Innovation
Protection Act, which could repeal the medical device tax.
Other
significant measures contained in PPACA include, for example, coordination and promotion of research on comparative clinical effectiveness
of different technologies and procedures, initiatives to revise Medicare payment methodologies, such as bundling of payments across
the continuum of care by providers and physicians, and initiatives to promote quality indicators in payment methodologies. PPACA
also includes significant new fraud and abuse measures, including required disclosures of financial arrangements with physician
customers, lower thresholds for violations and increasing potential penalties for such violations. In addition, PPACA establishes
an Independent Payment Advisory Board, or IPAB, to reduce the per capita rate of growth in Medicare spending. The IPAB has broad
discretion to propose policies to reduce expenditures, which may have a negative effect on payment rates for services. The IPAB
proposals may affect payments for clinical laboratory services beginning in 2016 and for hospital services beginning in 2020.
We are monitoring the effect of PPACA to determine the trends and any potential changes that may be necessitated by the legislation,
any of which may potentially affect our business.
Following
the 2016 U.S. general election, a single party now leads the executive branch and holds majorities in both the U.S. Senate and
House of Representatives. The President of the United States has announced that he favors repealing PPACA in 2017, and leaders
of the Republication-controlled federal legislature also have expressed a desire to repeal PPACA. The scope and timing of any
legislation to repeal, amend, replace, or reform PPACA is uncertain, but if such legislation were to become law, it could have
a significant impact on the U.S. healthcare system.
On
January 20, 2017, the new administration signed an executive order directing federal agencies to exercise existing authorities
to reduce burdens associated with PPACA pending further action by Congress. On the same day, the White House issued a regulatory
freeze memo under which rules and guidance published but not yet effective must be frozen for 60 days pending review; rules and
guidance submitted for publication but not yet published must be withdrawn; and rules and guidance not yet submitted for publication
must not be submitted without further direction from the Administration. Since then, further executive orders and statements from
the White House and Congress have addressed potential regulatory changes that could affect us and our customers. Changes to, or
repeal of, PPACA may continue to affect coverage, reimbursement, and utilization of laboratory services, as well as administrative
requirements, in ways that are currently unpredictable.
In
addition to PPACA, the effect of which cannot presently be fully quantified, various healthcare reform proposals have emerged
from Federal and State governments. For example, in February 2012, Congress passed the Middle Class Tax Relief and Job Creation
Act of 2012, which reduced the clinical laboratory payment rates on the Medicare CLFS by 2% in 2013. In addition, a further reduction
of 2% was implemented under the Budget Control Act of 2011, which is to be in effect for dates of service on or after April 1,
2013 until fiscal year 2024. Reductions resulting from the Congressional sequester are applied to total claim payments made; however,
they do not currently result in a rebasing of the negotiated or established Medicare or Medicaid reimbursement rates.
State
legislation on reimbursement applies to Medicaid reimbursement and Managed Medicaid reimbursement rates within that State. Some
States have passed or proposed legislation that would revise reimbursement methodology for clinical laboratory payment rates under
those Medicaid programs. We cannot predict whether future healthcare initiatives will be implemented at the Federal or State level
or in countries outside of the United States in which we may do business, or the effect any future legislation or regulation will
have on us. The taxes imposed by Federal legislation, cost reduction measures and the expansion in the role of the U.S. government
in the healthcare industry may result in decreased revenue, lower reimbursement by payors for our tests or reduced medical procedure
volumes, all of which may adversely affect our business, financial condition and results of operations.
Ongoing
calls for deficit reduction at the Federal government level and reforms to programs such as the Medicare program to pay for such
reductions may affect the pharmaceutical, medical device and clinical laboratory industries. In particular, recommendations by
the Simpson-Bowles Commission called for the combination of Medicare Part A (hospital insurance) and Part B (physician and ancillary
service insurance) into a single co-insurance and co-payment structure. Currently, clinical laboratory services are excluded from
the Medicare Part B co-insurance and co-payment as preventative services. Combining Parts A and B may require clinical laboratories
to collect co-payments from patients, which may increase our costs and reduce the amount ultimately collected.
In
2013, CMS announced plans to bundle payments for clinical laboratory tests together with other services performed during hospital
outpatient visits under the Hospital Outpatient Prospective Payment System. CMS exempted molecular diagnostic tests from this
packaging provision at that time. It is possible that this exemption could be removed by CMS in future rule making, which might
result in lower reimbursement for tests performed in this setting.
In
April 2014, the President signed PAMA, which included a substantial new payment system for clinical laboratory tests under the
CLFS. PAMA removed CMS’s authority to adjust the CLFS based and established a new method for setting CLFS rates. Implementation
of this new method for setting CLFS rates began in 2016. Under PAMA, laboratories that have more than $12,500 in Medicare revenues
from laboratory services and that receive more than 50 percent of their Medicare revenues from laboratory services would report
private payor data from January 1, 2016 through June 30, 2016, to CMS between January 1, 2017 and March 31, 2017. CMS will post
the new Medicare CLFS rates (based on weighted median private payor rates) in November 2016 and the new rates will be effective
beginning on January 1, 2018. Any reductions to payment rates resulting from the new methodology are limited to 10% per test per
year in each of the years 2017 through 2019 and to 15% per test per year in each of the years 2020 through 2022. CMS has issued
draft regulations regarding these changes. Further rule-making from CMS will define the time period and data elements evaluated
on an annual basis to set reimbursement rates for tests like ours.
Complying
with numerous statutes and regulations pertaining to our molecular diagnostics business is an expensive and time-consuming process,
and any failure to comply could result in substantial penalties.
We
are subject to regulation by both the Federal government and the States in which we conduct our molecular diagnostics business,
including:
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The
Food, Drug and Cosmetic Act, as supplemented by various other statutes;
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The
Prescription Drug Marketing Act of 1987, the amendments thereto, and the regulations promulgated thereunder and contained
in 21 C.F.R. Parts 203 and 205;
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CLIA
and State licensing requirements;
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Manufacturing
and promotion laws;
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Medicare
billing and payment regulations applicable to clinical laboratories;
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The
Federal Anti-Kickback Statute, which prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration,
directly or indirectly, in exchange for or to induce either the referral of an individual, or the furnishing, arranging for,
or recommending of an item or service that is reimbursable, in whole or in part, by a Federal healthcare program;
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The
Federal Stark physician self-referral law (and state equivalents), which prohibits a physician from making a referral for
certain designated health services covered by the Medicare program, including laboratory and pathology services, if the physician
or an immediate family member has a financial relationship with the entity providing the designated health services, unless
the financial relationship falls within an applicable exception to the prohibition;
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HIPAA,
which established comprehensive federal standards with respect to the privacy and security of protected health information
and requirements for the use of certain standardized electronic transactions, and amendments made in 2013 to HIPAA under the
Health Information Technology for Economic and Clinical Health Act, which strengthen and expand HIPAA privacy and security
compliance requirements, increase penalties for violators, extend enforcement authority to state attorneys general, and impose
requirements for breach notification;
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The
Federal Civil Monetary Penalties Law, which prohibits, among other things, the offering or transfer of remuneration to a Medicare
or state healthcare program beneficiary if the person knows or should know it is likely to influence the beneficiary’s
selection of a particular provider, practitioner, or supplier of services reimbursable by Medicare or a state healthcare program,
unless an exception applies;
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The
Federal False Claims Act, which imposes liability on any person or entity that, among other things, knowingly presents, or
causes to be presented, a false or fraudulent claim for payment to the federal government;
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Other
Federal and State fraud and abuse laws, prohibitions on self-referral, fee-splitting restrictions, prohibitions on the provision
of products at no or discounted cost to induce physician or patient adoption, and false claims acts, which may extend to services
reimbursable by any third-party payor, including private insurers;
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The
prohibition on reassignment of Medicare claims, which, subject to certain exceptions, precludes the reassignment of Medicare
claims to any other party;
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The
rules regarding billing for diagnostic tests reimbursable by the Medicare program, which prohibit a physician or other supplier
from marking up the price of the technical component or professional component of a diagnostic test ordered by the physician
or other supplier and supervised or performed by a physician who does not “share a practice” with the billing
physician or supplier; and
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State
laws that prohibit other specified practices related to billing such as billing physicians for testing that they order, waiving
coinsurance, co-payments, deductibles, and other amounts owed by patients, and billing a State Medicaid program at a price
that is higher than what is charged to other payors.
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We
have implemented policies and procedures designed to comply with these laws and regulations. We periodically conduct internal
reviews of our compliance with these laws. Our compliance is also subject to governmental review. The growth of our business may
increase the potential of violating these laws, regulations or our internal policies and procedures. The risk of our being found
in violation of these or other laws and regulations is further increased by the fact that many have not been fully interpreted
by the regulatory authorities or the courts, and their provisions are open to a variety of interpretations. Violations of Federal
or State regulations may incur investigation or enforcement action by the FDA, Department of Justice, State agencies, or other
legal authorities, and may result in substantial civil, criminal, or other sanctions. Any action brought against us for violation
of these or other laws or regulations, even if we successfully defend against it, could cause us to incur significant legal expenses
and divert our management’s attention from the operation of our business. If our operations are found to be in violation
of any of these laws and regulations, we may be subject to civil and criminal penalties, damages and fines, we could be required
to refund payments received by us, we could face possible exclusion from Medicare, Medicaid and other Federal or State healthcare
programs and we could even be required to cease our operations. Any of the foregoing consequences could have a material adverse
effect on our business, financial condition and results of operations.
A
failure to comply with Federal and State laws and regulations pertaining to our payment practices could result in substantial
penalties.
We
retain healthcare practitioners as key opinion leaders providing consultation in various aspects of our business. These arrangements,
like any arrangement that includes compensation to a healthcare provider, may trigger Federal or State anti-kickback and Stark
Law liability. Our arrangements are designed to meet available safe harbors and exceptions provided in the anti-kickback laws
and Stark Laws, respectively. However, there are no guarantees that the Federal or State governments will find that these arrangements
are designed properly or that they do not trigger liability under Federal and State laws. Under existing laws, all arrangements
must have a legitimate purpose and compensation must be fair market value. These terms require some subjective analysis and there
is limited available case law or guidance for the application of these laws to the CLIA laboratory industry. Safe harbors in the
anti-kickback laws do not necessarily equate to exceptions in the Stark Law, and there is no guarantee that the government will
agree with our payment practices with respect to the relationships between our laboratories and the healthcare providers. A failure
to comply with Federal and State laws and regulations pertaining to our payment practices could result in substantial penalties
and adversely affect our business, financial condition and results of operations.
If
we use hazardous materials in a manner that causes contamination or injury, we could be liable for resulting damages.
We
are subject to Federal, State and local laws, rules and regulations governing the use, discharge, storage, handling and disposal
of biological material, chemicals and waste. We cannot eliminate the risk of accidental contamination or injury to employees or
third parties from the use, storage, handling or disposal of these materials. In the event of contamination or injury, we could
be held liable for any resulting damages, remediation costs and any related penalties or fines, and any liability could exceed
our resources or any applicable insurance coverage we may have. The cost of compliance with these laws and regulations may become
significant, and our failure to comply may result in substantial fines or other consequences, and either could have a significant
impact on our operating results.
Security
breaches, loss of data and other disruptions to us or our third-party service providers could compromise sensitive information
related to our business or prevent us from accessing critical information and expose us to liability, which could adversely affect
our business and our reputation.
Our
business requires that we and our third-party service providers collect and store sensitive data, including legally protected
health information, personally identifiable information about patients, credit card information, and our proprietary business
and financial information. We face a number of risks relative to our protection of, and our service providers’ protection
of, this critical information, including loss of access, inappropriate disclosure and inappropriate access, as well as risks associated
with our ability to identify and audit such events. The secure processing, storage, maintenance and transmission of this critical
information are vital to our operations and business strategy, and we devote significant resources to protecting such information.
Although we take measures to protect sensitive information from unauthorized access or disclosure, our information technology
and infrastructure may be vulnerable to attacks by hackers or viruses or otherwise breached due to employee error, malfeasance
or other activities. While we have not experienced any such attack or breach, if such event would occur and cause interruptions
in our operations, our networks would be compromised and the information we store on those networks could be accessed by unauthorized
parties, publicly disclosed, lost or stolen. Unauthorized access, loss or dissemination could disrupt our operations, including
our ability to process tests, provide test results, bill payors or patients, process claims, provide customer assistance services,
conduct research and development activities, collect, process and prepare company financial information, provide information about
our solution and other patient and physician education and outreach efforts through our website, manage the administrative aspects
of our business and damage our reputation, any of which could adversely affect our business. In addition, the interpretation and
application of consumer, health-related and data protection laws in the United States are often uncertain, contradictory and in
flux. It is possible that these laws may be interpreted and applied in a manner that is inconsistent with our practices. Complying
with these various laws could cause us to incur substantial costs or require us to change our business practices, systems and
compliance procedures in a manner adverse to our business.
If
we are sued for product liability or errors and omissions liability, we could face substantial liabilities that exceed our resources.
The
marketing, sale and use of our molecular diagnostic tests could lead to product liability claims if someone were to allege that
the molecular diagnostic test failed to perform as it was designed. We may also be subject to liability for errors in the results
we provide to physicians or for a misunderstanding of, or inappropriate reliance upon, the information we provide. A product liability
or errors and omissions liability claim could result in substantial damages and be costly and time consuming for us to defend.
Although we maintain product liability and errors and omissions insurance, we cannot be certain that our insurance would fully
protect us from the financial impact of defending against these types of claims or any judgments, fines or settlement costs arising
out of such claims. Any product liability or errors and omissions liability claim brought against us, with or without merit, could
increase our insurance rates or prevent us from securing insurance coverage in the future. Additionally, any product liability
lawsuit could cause injury to our reputation or cause us to suspend sales of our products and solutions. The occurrence of any
of these events could have a material adverse effect on our business, financial condition and results of operations.
We
may need to increase the size of our organization, and we may experience difficulties in managing this growth.
We
are a small company with approximately 63 employees. Future growth will impose significant added responsibilities on members of
management, including the need to identify, attract, retain, motivate and integrate highly skilled personnel. We may increase
the number of employees in the future depending on the progress and growth of our business Our future financial performance and
our ability to sell our existing molecular diagnostic tests and develop and commercialize new molecular diagnostic tests and to
compete effectively will depend, in part, on our ability to manage any future growth effectively. To that end, we must be able
to:
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manage
our clinical studies effectively;
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integrate
additional management, administrative, laboratory and regulatory personnel;
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maintain
sufficient administrative, accounting management and laboratory information systems and internal accounting controls; and
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hire
and train additional qualified personnel.
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may not be able to accomplish these tasks, and our failure to accomplish any of them could harm our financial results. We may
need to reduce the size of our organization in order to become profitable and we may experience difficulties in managing these
reductions.
Billing
for our diagnostic tests is complex, and we must dedicate substantial time and resources to the billing process to be paid for
our molecular diagnostic tests.
Billing
for clinical laboratory testing services is complex, time consuming and expensive. Depending on the billing arrangement and applicable
law, we bill various payors, including Medicare, insurance companies and patients, all of which have different billing requirements.
To the extent laws or contracts require us to bill patient co-payments or co-insurance, we must also comply with these requirements.
We may also face increased risk in our collection efforts, including write-offs of doubtful accounts and long collection cycles,
which could have a material adverse effect on our business, results of operations and financial condition. Among others, the following
factors make the billing process complex:
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differences
between the list price for our molecular diagnostic tests and the reimbursement rates of payors;
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compliance
with complex Federal and State regulations related to billing Medicare;
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disputes
among payors as to which party is responsible for payment;
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differences
in coverage among payors and the effect of patient co-payments or co-insurance;
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differences
in information and billing requirements among payors;
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incorrect
or missing billing information; and
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the
resources required to manage the billing and claims appeals process.
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As
we grow and introduce new tests, we will need to add new codes to our billing process as well as our financial reporting systems.
Failure or delays in effecting these changes in external billing and internal systems and processes could negatively affect our
revenue and cash flow. Additionally, our billing activities require us to implement compliance procedures and oversight, train
and monitor our employees or contractors, challenge coverage and payment denials, assist patients in appealing claims, and undertake
internal audits to evaluate compliance with applicable laws and regulations as well as internal compliance policies and procedures.
Payors also conduct external audits to evaluate payments, which add further complexity to the billing process. These billing complexities,
and the related uncertainty in obtaining payment for our diagnostic solution, could negatively affect our revenue and cash flow,
our ability to achieve profitability, and the consistency and comparability of our results of operations.
We
rely on a third party to process and transmit claims to payors, and any delay in either could have an adverse effect on
our revenue.
We
rely on a third-party provider to provide overall processing of claims and to transmit the actual claims to payors
based on the specific payor billing format. If claims for our molecular diagnostic tests are not submitted to payors on a timely
basis, or if we are required to switch to a different provider to handle claim submissions, we may experience delays in our ability
to process these claims and receipt of payments from payors, which could have a material adverse effect on our business, financial
condition and results of operations.
Enacted
healthcare reform legislation may increase our costs, impair our ability to adjust our pricing to match any such increased costs,
and therefore could materially and adversely affect our business, financial condition and results of operations.
PPACA
entails sweeping healthcare reforms with staggered effective dates from 2010 through 2018, although certain of these effective
dates have been delayed by action of the current administration. While some guidance has been issued under PPACA over the past
several years, many provisions in PPACA require the issuance of additional guidance from the U.S. Department of Labor, the Internal
Revenue Service, the U.S. Department of Health & Human Services, and State governments. This reform includes, but is not limited
to: the implementation of a small business tax credit; required changes in the design of our healthcare policy including providing
insurance coverage to part-time workers working on average thirty (30) or more hours per week; “grandfathering” provisions
for existing policies; “pay or play” requirements; a “Cadillac plan” excise tax; and specifically required
“essential benefits,” that must be included in “qualified plans,” which benefits include coverage for
laboratory tests.
Effective
January 1, 2014, each State was required to participate in the PPACA marketplace and make health insurance coverage available
for purchase by eligible individuals through a website. While these websites were subject to significant administrative issues
leading up to their inception dates (and, in some cases, thereafter), it is currently estimated that in excess of 11 million individuals
nationwide had enrolled in health insurance coverage through these exchanges as of the end of 2015. It is unclear, however, how
many of these individuals are becoming insured after previously not having health insurance coverage, versus maintaining their
plans purchased on the exchanges in 2014 or switching from other health insurance plans.
PPACA
also requires “Applicable Manufacturers” to disclose to the Secretary of the Department of Health & Human Services
drug sample distributions and certain payments or transfers of value to covered recipients (physicians and teaching hospitals)
on an annual basis. “Applicable Manufacturers” and “Applicable Group Purchasing Organizations” must also
disclose certain physician ownership or investment interests. The data submitted will ultimately be made available on a public
website. Based upon the structure of our relationship with our clients, we may be included in the definition of “Applicable
Manufacturer” for purposes of the disclosure requirements or may provide services that include the transfer of drug samples
and/or other items of value to covered recipients. As such, we may be required to disclose or provide information that is subject
to disclosure. There may be certain risks and penalties associated with the failure to properly make such disclosures, including
but not limited to the specific civil liabilities set forth in PPACA, which allows for a maximum civil monetary penalty per “Applicable
Manufacturer” of $1,150,000 per year. There may be additional risks and claims made by third parties derived from an improper
disclosure that are difficult to ascertain at this time.
In
June 2012, the United States Supreme Court upheld the constitutionality of key provisions of PPACA. PPACA contains numerous other
initiatives that impact the pharmaceutical industry. These include, among other things:
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increasing
existing price rebates in Federally funded healthcare programs;
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expanding
rebates, or other pharmaceutical company discounts, into new programs;
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imposing
a new non-deductible excise tax on sales of certain prescription pharmaceutical products by prescription drug manufacturers
and importers;
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increasing
requirements on employer-sponsored health insurance plans, generally, and imposing taxes on certain high-cost employer-sponsored
plans;
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creating
an independent commission to propose changes to Medicare with a particular focus on the cost of biopharmaceuticals in Medicare
Part D; and
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increasing
oversight by the FDA of pharmaceutical research and development processes and commercialization activities.
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While
PPACA may increase the number of patients who have insurance coverage, its cost containment measures could also adversely affect
reimbursement for any of our molecular diagnostic tests. Cost control initiatives also could decrease the price that we receive
for any molecular diagnostic tests we may develop in the future. If our molecular diagnostic tests are not considered cost-effective
or if we are unable to generate adequate third-party reimbursement for the users of our molecular diagnostic tests, then we may
be unable to maintain revenue streams sufficient to realize our targeted return on investment for our molecular diagnostic tests.
We
are currently unable to determine the long-term, direct or indirect impact of such legislation on our business. Since the effect
of many of the provisions of PPACA may not be determinable for a number of years, we do not expect PPACA to have a material adverse
impact on our near term results of operations. However, healthcare reform as mandated and implemented under PPACA and any future
Federal or State mandated healthcare reform could materially and adversely affect our business, financial condition and operations
by increasing our operating costs, including our costs of providing health insurance to our employees, decreasing our revenue,
impeding our ability to attract and retain customers, requiring changes to our business model, or causing us to lose certain current
competitive advantages.
However,
following the 2016 U.S. general election, a single party now leads the executive branch and holds majorities in both the U.S.
Senate and House of Representatives. The President of the United States has announced that he favors repealing PPACA in 2017,
and leaders of the Republication-controlled federal legislature also have expressed a desire to repeal PPACA. The scope and timing
of any legislation to repeal, amend, replace, or reform PPACA is uncertain, but if such legislation were to become law, it could
have a significant impact on the U.S. healthcare system.
On
January 20, 2017, the new administration signed an executive order directing federal agencies to exercise existing authorities
to reduce burdens associated with PPACA pending further action by Congress. On the same day, the White House issued a regulatory
freeze memo under which rules and guidance published but not yet effective must be frozen for 60 days pending review; rules and
guidance submitted for publication but not yet published must be withdrawn; and rules and guidance not yet submitted for publication
must not be submitted without further direction from the Administration. Since then, further executive orders and statements from
the White House and Congress have addressed potential regulatory changes that could affect us and our customers. Changes to, or
repeal of, PPACA may continue to affect coverage, reimbursement, and utilization of laboratory services, as well as administrative
requirements, in ways that are currently unpredictable.
Changes
in governmental regulation could negatively impact our business operations and increase our costs.
The
pharmaceutical, biotechnology and healthcare industries are subject to a high degree of governmental regulation. Significant changes
in these regulations affecting our business could result in the imposition of additional restrictions on our business, additional
costs to us in providing our molecular diagnostic tests to our customers or otherwise negatively impact our business operations.
Changes in governmental regulations mandating price controls and limitations on patient access to our products could also reduce,
eliminate or otherwise negatively impact our sales.
If
we do not increase our revenues and successfully manage the size of our operations, our business, financial condition and results
of operations could be materially and adversely affected.
The
majority of our operating expenses are personnel-related costs such as employee compensation and benefits, reagents and disposable
supplies as well as the cost of infrastructure to support our operations, including facility space and equipment. We continuously
review our personnel to determine whether we are fully utilizing their services. If we believe we are not in a position to fully
utilize our personnel, we may make further reductions to our workforce. If we are unable to achieve revenue growth in the future
or fail to adjust our cost infrastructure to the appropriate level to support our revenues, our business, financial condition
and results of operations could be materially and adversely affected.
We
may acquire businesses or assets or make investments in other companies or molecular diagnostic technologies that could harm our
operating results, dilute our stockholders’ ownership, increase our debt or cause us to incur significant expense.
As
part of our strategy, we may pursue acquisitions of synergistic businesses or molecular diagnostic assets. If we make any further
acquisitions, we may not be able to integrate these acquisitions successfully into our existing business, and we could assume
unknown or contingent liabilities. Any future acquisition by us also could result in significant write-offs or the incurrence
of debt and contingent liabilities, any of which could harm our operating results and financial condition. Integration of an acquired
company or business will also likely require management resources that otherwise would be available for ongoing development of
our existing business. We may not identify or complete these transactions in a timely manner, on a cost-effective basis, or at
all, and we may not realize the anticipated benefits of any acquisition. To finance any acquisitions or investments, we may choose
to issue shares of our common stock as consideration, which would dilute the ownership of our stockholders. If the price of our
common stock is low or volatile, we may not be able to acquire other companies for stock. Alternatively, it may be necessary for
us to raise additional funds for these activities through public or private financings. Additional funds may not be available
on terms that are favorable to us, or at all. If these funds are raised through the sale of equity or convertible debt securities,
dilution to our stockholders could result. Consummating an acquisition poses a number of risks including:
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may not be able to accurately estimate the financial impact of an acquisition on our overall business;
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an
acquisition may require us to incur debt or other obligations, incur large and immediate write-offs, issue capital stock potentially
dilutive to our stockholders or spend significant cash, or may negatively affect our operating results and financial condition;
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if
we spend significant funds or incur additional debt or other obligations, our ability to obtain financing for working capital
or other purposes could decline;
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worse
than expected performance of an acquired business may result in the impairment of intangible assets;
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we
may be unable to realize the anticipated benefits and synergies from acquisitions as a result of inherent risks and uncertainties,
including difficulties integrating acquired businesses or retaining key personnel, partners, customers or other key relationships,
and risks that acquired entities may not operate profitably or that acquisitions may not result in improved operating performance;
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we
may fail to successfully manage relationships with customers, distributors and suppliers;
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our
customers may not accept new molecular diagnostic tests from our acquired businesses;
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may fail to effectively coordinate sales and marketing efforts of our acquired businesses;
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we
may fail to combine product offerings and product lines of our acquired businesses timely and efficiently;
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an
acquisition may involve unexpected costs or liabilities, including as a result of pending and future shareholder lawsuits
relating to acquisitions or exercise by stockholders of their statutory appraisal rights, or the effects of purchase accounting
may be different from our expectations;
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an
acquisition may involve significant contingent payments that may adversely affect our future liquidity or capital resources;
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accounting
for contingent payments requires significant judgment and changes to the assumptions used in determining the fair value of
our contingent payments could lead to significant volatility in earnings;
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acquisitions
and subsequent integration of these companies may disrupt our business and distract our management from other responsibilities;
and
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the
costs of an unsuccessful acquisition may adversely affect our financial performance.
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Additional
risks of integration of an acquired business include:
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differing
information technology, internal control, financial reporting and record-keeping systems;
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differences
in accounting policies and procedures;
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unanticipated
additional transaction and integration-related costs;
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facilities
or operations of acquired businesses in remote locations and the inherent risks of operating in unfamiliar legal and regulatory
environments; and
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new
products, including the risk that any underlying intellectual property associated with such products may not have been adequately
protected or that such products may infringe on the proprietary rights of others.
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our information technology and communications systems fail or we experience a significant interruption in their operation, our
reputation, business and results of operations could be materially and adversely affected.
The
efficient operation of our business is dependent on our information technology and communications systems. Increasingly, we are
also dependent upon our ability to electronically interface with our customers. The failure of these systems to operate as anticipated
could disrupt our business and result in decreased revenue and increased overhead costs. In addition, we do not have complete
redundancy for all of our systems and our disaster recovery planning cannot account for all eventualities. Our information technology
and communications systems, including the information technology systems and services that are maintained by third party vendors,
are vulnerable to damage or interruption from natural disasters, fire, terrorist attacks, malicious attacks by computer viruses
or hackers, power loss or failure of computer systems, Internet, telecommunications or data networks. If these systems or services
become unavailable or suffer a security breach, we may expend significant resources to address these problems, and our reputation,
business and results of operations could be materially and adversely affected.
We
have and may continue to experience goodwill and other intangible asset impairment charges.
We
are required to evaluate goodwill and the carrying value of intangibles at least annually, and between annual tests if events
or circumstances warrant such a test. As of December 31, 2016 and March 31, 2017 a substantial portion of our total assets are
comprised of goodwill and other intangible assets. For the year ended December 31, 2015, we recorded a goodwill impairment charge
of $15.7 million pertaining to the acquisition of RedPath in October 2014 and during the third quarter of 2016, we recorded an
impairment charge of $3.4 million related to changes in our development strategy for products acquired from Asuragen.
We
review the recoverability of long-lived assets and finite-lived intangible assets whenever events or changes in circumstances
indicate that the carrying value of such assets may not be recoverable. If the sum of the expected future undiscounted cash flows
is less than the carrying amount of the asset, an impairment loss is recognized by reducing the recorded value of the asset to
its fair value measured by future discounted cash flows. This analysis requires estimates of the amount and timing of projected
cash flows and, where applicable, judgments associated with, among other factors, the appropriate discount rate. Such estimates
are critical in determining whether any impairment charge should be recorded and the amount of such charge if an impairment loss
is deemed to be necessary. During the fourth quarter of 2016, we reviewed the recoverability of long-lived assets and finite-lived
intangible assets and concluded that no further finite-lived intangible assets were impaired.
RISKS
RELATING TO THE ASSET SALE
We
may not be able to fund the remaining obligations of our previously sold CSO business, which could have a material adverse effect
on our business and results of operations.
In
December 2015, we sold substantially all of our CSO business to a third party strategic acquirer, pursuant to an
Asset Purchase Agreement, dated as of October 30, 2015, by and between us and the purchaser of substantially all of our
CSO business (the “CSO Acquirer“), or the Asset Purchase Agreement, for a total cash payment of $28.5 million,
or the Asset Sale, including an initial upfront cash payment of $25.5 million and $3.0 million of a working capital
adjustment. We used a significant portion of the net proceeds received at the closing of the Asset Sale to pay the balance of
the outstanding loan under the Credit Agreement, dated October 31, 2014, by and among us, SWK Funding LLC and the financial
institutions party thereto from time to time as lenders, and related fees. As a result of the Asset Sale, not all of our CSO
obligations were assumed by the CSO Acquirer. These obligations consist of accounts payable, costs relating to the
closeout of the portion of the CSO business that principally related to the provision of services for multiple non-competing
brands for different clients, or the ERT Unit, which the CSO Acquirer did not acquire in the Asset Sale, and
termination of various vendor contracts that had been associated with the CSO business. As such, we continue to negotiate
terms and pay some of these obligations, but may not be able to satisfy all of these remaining obligations. If we are unable
to satisfy all our remaining CSO obligations, our business and results of operations could be materially and adversely
affected. As of June 1, 2017, our current remaining CSO obligations were up to $2.6 million, in aggregate.
The
Asset Purchase Agreement exposes us to contingent liabilities that could have a material adverse effect on our financial condition.
We
have agreed to indemnify the CSO Acquirer for damages resulting from or arising out of any inaccuracy or breach of any
representation, warranty or covenant of ours in the Asset Purchase Agreement against any and all liabilities of ours not assumed
by the CSO Acquirer in the Asset Sale and for certain other matters. Significant indemnification claims by the CSO Acquirer
could have a material adverse effect on our financial condition. We will not be obligated to indemnify the CSO Acquirer
for any breach of certain of the representations and warranties by us under the Asset Purchase Agreement until the aggregate
amount of claims for indemnification exceed $250,000. In the event that claims for indemnification exceed this threshold, we will
be obligated to indemnify the CSO Acquirer for any damages or loss resulting from such breach up to 25% of the total purchase
price paid or due and payable by the CSO Acquirer to us. Claims for indemnification for breaches of covenants made by us
under the Asset Purchase Agreement and for breaches of representations and warranties classified as fundamental representations
or any provision of the Asset Purchase Agreement relating to taxes will not be subject to the deductible or aggregate liability
cap described above. The Asset Purchase Agreement also allows the CSO Acquirer to withhold monies due against an earn-out
payment if indemnification claims are asserted. In addition, under the Asset Purchase Agreement, we will retain all of our debts
and liabilities not assumed by the CSO Acquirer.
RISKS
RELATING TO OUR INTELLECTUAL PROPERTY
If
we breach the Asuragen License Agreement or the CPRIT License Agreement, it could have a material adverse effect on our sales
and commercialization efforts for miR
Inform
®
thyroid and pancreas cancer diagnostic tests and other tests
in development for thyroid cancer, and the sale of diagnostic devices and the performance of certain services relating to thyroid
cancer.
We
currently license certain patents and know-how from Asuragen relating to (i) miR
Inform
®
thyroid and pancreas
cancer diagnostic tests and other tests in development for thyroid cancer, or the Asuragen License Agreement, and (ii) the sale
of diagnostic devices and the performance of certain services relating to thyroid cancer, or the CPRIT License Agreement. Under
the Asuragen License Agreement, we are obligated to pay royalties on the future net sales of the miR
Inform
®
pancreas platform for a period of ten years following a qualifying sale, on the future net sales of the miR
Inform
®
thyroid platform through August 13, 2024 and on certain other thyroid diagnostics tests for a period of ten years following
a qualifying sale. Under the CPRIT License Agreement, we are obligated to pay 5% of net sales on sales of diagnostic devices and
the performance of services relating to thyroid cancer, subject to a maximum deduction of 1.5% for royalties paid to third parties.
Both of the Asuragen License Agreement and the CPRIT License Agreement continue until terminated by (i) mutual agreement of the
parties or (ii) either party in the event of a material breach of the respective agreement by the other party. If we materially
breach or fail to perform any provision under the CPRIT License Agreement, Asuragen will have the right to terminate our license,
and upon the effective date of such termination, our right to practice the licensed patent rights would end. To the extent such
licensed patent rights relate to our molecular diagnostic tests currently on the market, we would expect to exercise all rights
and remedies available to us, including attempting to cure any breach by us, and otherwise seek to preserve our rights under the
patent rights and other technology licensed to us, but we may not be able to do so in a timely manner, at an acceptable cost to
us or at all. Any uncured, material breach under these license agreements could result in our loss of rights to practice the patent
rights licensed to us under these license agreements, and to the extent such patent rights and other technology relate to our
molecular diagnostic tests currently on the market, it could have a material adverse effect on our sales and commercialization
efforts for miR
Inform
® thyroid and pancreas cancer molecular diagnostic tests and other tests in development for thyroid
cancer, and the sale of molecular diagnostic tests and the performance of certain services relating to thyroid cancer.
If
we are unable to protect our intellectual property effectively, our business would be harmed.
We
rely on patent protection as well as trademark, trade secret and other intellectual property rights protection and contractual
restrictions to protect our proprietary technology. If we fail to protect our intellectual property, third parties may be able
to compete more effectively against us and we may incur substantial litigation costs in our attempts to recover or restrict use
of our intellectual property. While we apply for patents covering our products and technologies and uses thereof, we may fail
to apply for patents on important products and technologies in a timely fashion or at all, or we may fail to apply for patents
in relevant jurisdictions. Others could seek to design around our current or future patented technologies. We may not be successful
in defending any challenges made against our patents or patent applications. Any successful third-party challenge to our patents
could result in the unenforceability or invalidity of such patents and increased competition to our business. The outcome of patent
litigation can be uncertain and any attempt by us to enforce our patent rights against others may not be successful, or, if successful,
may take substantial time and result in substantial cost, and may divert our efforts and attention from other aspects of our business.
Monitoring
unauthorized disclosure is difficult, and we do not know whether the steps we have taken to prevent such disclosure are, or will
be, adequate. If we were to enforce a claim that a third-party had illegally obtained and was using our trade secrets, it would
be expensive and time consuming, and the outcome would be unpredictable. Further, competitors could willfully infringe our intellectual
property rights, design around our protected technology or develop their own competitive technologies that arguably fall outside
of our intellectual property rights. Others may independently develop similar or alternative products and technologies or replicate
any of our products and technologies. If our intellectual property does not adequately protect us against competitors’ products
and methods, our competitive position could be adversely affected, as could our business and the results of our operations. To
the extent our intellectual property offers inadequate protection, or is found to be invalid or unenforceable, we would be exposed
to a greater risk of competition. If our intellectual property does not provide adequate coverage of our competitors’ products,
our competitive position could be adversely affected, as could our overall business. Both the patent application process and the
process of managing patent disputes can be time consuming and expensive.
Changes
in U.S. patent law could diminish the value of patents in general, thereby impairing our ability to protect our molecular diagnostic
tests.
As
is the case with other molecular diagnostics companies, our success is heavily dependent on intellectual property, particularly
on obtaining and enforcing patents. Obtaining and enforcing patents of molecular diagnostics tests, like our molecular diagnostic
tests in our PancraGEN® and miR
Inform
® platforms, involves both technological and legal complexity, and is therefore
costly, time-consuming and inherently uncertain. From time-to-time the U.S. Supreme Court, other Federal courts, the U.S. Congress
or the United States Patent and Trademark Office, or the USPTO, may change the standards of patentability and any such changes
could have a negative impact on our business. For instance, on October 30, 2008, the Court of Appeals for the Federal Circuit
issued a decision that methods or processes cannot be patented unless they are tied to a machine or involve a physical transformation.
The U.S. Supreme Court later reversed that decision in
Bilski v. Kappos
, finding that the “machine-or-transformation”
test is not the only test for determining patent eligibility. The Court, however, declined to specify how and when processes are
patentable. On March 30, 2012, in the case
Mayo Collaborative Services v. Prometheus Laboratories, Inc.
, the U.S. Supreme
Court reversed the Federal Circuit’s application of
Bilski
and invalidated a patent focused on a process for identifying
a proper dosage for an existing therapeutic because the patent claim embodied a law of nature. On July 30, 2012, the USPTO
released a memorandum entitled “
2012 Interim Procedure for Subject Matter Eligibility Analysis of Process Claims Involving
Laws of Nature
,” with guidelines for determining patentability of diagnostic or other processes in line with the
Mayo
decision. On June 13, 2013, in
Association for Molecular Pathology v. Myriad Genetics
, the Supreme Court held that
a naturally occurring DNA segment is a product of nature and not patent eligible merely because it has been isolated. The Supreme
Court did not address the patentability of any innovative method claims involving the manipulation of isolated genes. On March
4, 2014, the USPTO released a memorandum entitled “
2014 Procedure For Subject Matter Eligibility Analysis Of Claims Reciting
Or Involving Laws Of Nature/Natural Principles, Natural Phenomena, And/Or Natural Products
.” This memorandum provides
guidelines for the USPTO’s new examination procedure for subject matter eligibility under 35 U.S.C. §101 for claims
embracing natural products or natural principles. On June 12, 2015, the Federal Circuit issued a decision in
Ariosa v. Sequenom
holding that a method for detecting a paternally inherited nucleic acid of fetal origin performed on a maternal serum or plasma
sample from a pregnant female were unpatentable as directed to a naturally occurring phenomenon. On July 30, 2015, the USPTO released
a Federal Register Notice entitled, “
July 2015 Update on Subject Matter Eligibility
.” This Notice updated
the USPTO guidelines for the USPTO’s procedure for subject matter eligibility under 35 U.S.C. §101 for claims embracing
natural products or natural principles phenomenon. On May 4, 2016, the USPTO released life science examples that were intended
to be used in conjunction with the USPTO guidance on subject matter eligibility. Although the guidelines and examples do not have
the force of law, patent examiners have been instructed to follow them. What constitutes a law of nature and a sufficient inventive
concept remains uncertain, and it is possible that certain aspects of molecular diagnostics tests would be considered natural
laws and, therefore, ineligible for patent protection. Some aspects of our technology involve processes that may be subject to
this evolving standard and we cannot guarantee that any of our pending or issued claims will be patentable or upheld as valid
as a result of such evolving standards. In addition, patents we own or license that issued before these recent cases may be subject
to challenge in court or before the USPTO in view of these current legal standards. Accordingly, the evolving interpretation and
application of patent laws in the United States governing the eligibility of diagnostics for patent protection may adversely affect
our ability to obtain patents and may facilitate third-party challenges to any owned and licensed patents. Changes in either the
patent laws or in interpretations and application of patent laws may also diminish the value of our existing intellectual property
or intellectual property that we continue to develop. We cannot predict the breadth of claims that may be allowed or enforceable
in our patents or in third-party patents.
We
may be involved in litigation related to intellectual property, which could be time-intensive and costly and may adversely affect
our business, operating results or financial condition.
On
April 18, 2017, we received a letter from Rosetta Genomics Ltd. (“Rosetta”), stating that Rosetta expected to shortly
be granted patents that cover the ThyraMIR® miRNA Gene Expression Classifier marketed and sold by a subsidiary of the Company.
Such patents were subsequently issued on May 16, 2017 as US Patent Nos. 9,650,680 and 9,650,679. In the letter, Rosetta indicated
an interest in discussing the terms of a royalty-bearing license agreement to cover our continuing sale of the ThyraMIR® miRNA
Gene Expression Classifier. Based upon available information, we do not believe the Rosetta patents cover the sale or use of the
ThyraMIR® miRNA Gene Expression Classifier. However, patent litigation is inherently risky, and no assurances can be made
that if Rosetta were to assert its patents against the Company, that the Company would prevail. In the event that Rosetta
were to bring an action against us alleging patent infringement and prevail against us, Rosetta could be entitled to relief, including
preliminary or permanent injunctive relief to prohibit the sale or marketing of our ThyraMIR Gene Expression Classifier, and monetary
damages in the form of lost profits or royalties for our sale of the ThyraMIR® miRNA Gene Expression Classifier, which could
have a material adverse effect on our business, financial condition and results of operations.
It
is possible that we may receive notices of claims of direct or indirect infringement or misappropriation or misuse of other parties’
proprietary rights from time to time and some of these claims may lead to litigation. We cannot assume that we will prevail in
such actions, or that other actions alleging misappropriation or misuse by us of third-party trade secrets, infringement by us
of third-party patents and trademarks or other rights, or the validity of our patents, trademarks or other rights, will not be
asserted or prosecuted against us. We might not have been the first to make the inventions covered by each of our pending patent
applications and we might not have been the first to file patent applications for these inventions. No assurance can be given
that other patent applications will not have priority over our patent applications. If third parties bring these proceedings against
our patents, we could incur significant costs and experience management distraction. Litigation may be necessary for us to enforce
our patents and proprietary rights or to determine the scope, coverage and validity of the proprietary rights of others. Defending
any litigation, and particularly patent litigation, is expensive and time-consuming, and the outcome of any litigation or other
proceeding is inherently uncertain and might not be favorable to us. It is also possible that we might not be able to obtain
licenses to technology that we require on acceptable terms or at all. In addition, if we resort to legal proceedings to enforce
our intellectual property rights or to determine the validity, scope and coverage of the intellectual property or other proprietary
rights of others, the proceedings could be burdensome and expensive, even if we were to prevail. Any litigation that may be necessary
in the future could result in substantial costs and diversion of resources and could have a material adverse effect on our business,
financial condition and operating results.
In
the event of a successful claim of infringement against us, we may be required to pay damages and ongoing royalties, and obtain
one or more licenses from third parties, or be prohibited from selling our products. We may not be able to obtain these licenses
on acceptable terms, if at all. We could incur substantial costs related to royalty payments for licenses obtained from third
parties, which could negatively affect our financial results. An unfavorable outcome of patent litigation may significantly impact
our ability to generate future revenues and impair our ability to continue as a going concern. In addition, our agreements with
some of our customers, suppliers or other entities with whom we do business require us to defend or indemnify these parties to
the extent they become involved in infringement claims, including the types of claims described above. If we are required or agree
to defend or indemnify third parties in connection with any infringement claims, we could incur significant costs and expenses
that could have a material adverse effect on our business, financial condition, and results of operations.
RISKS
RELATING TO OUR CORPORATE STRUCTURE AND OUR COMMON STOCK
We
do not meet one of The Nasdaq Capital Market continued listing requirements and therefore, we risk delisting, which may decrease
our stock price and make it harder for our stockholders to trade our stock.
Our
common stock is currently listed for trading on The Nasdaq Capital Market. As previously disclosed in our Current Report on Form
8-K dated October 5, 2016, Heinrich Dreismann, Ph.D. a member of our Board who was also a member of our Audit Committee
resigned effective as of September 30, 2016. As a result, we are not currently in compliance with NASDAQ Listing Rule 5605(c)(2)(A),
which requires the Audit Committee be comprised of at least three independent members. We intend to appoint an additional independent
director to our Board and to the Audit Committee prior to the end of the applicable cure period which is the sooner of the Company’s
annual meeting of stockholders or October 2, 2017. We were previously not in compliance with the NASDAQ minimum bid price and
stockholder equity requirements. We effected a one-for-ten reverse split of our issued and outstanding common stock on December
28, 2016 and on January 13, 2017, we were notified by NASDAQ that we had regained compliance with the minimum bid price requirement.
On April 10, 2017, we received written notice from NASDAQ that we were in compliance with the NASDAQ stockholder equity requirements.
Our
common stock currently remains listed on The Nasdaq Capital Market under the symbol “IDXG.” There can be no assurance
that we will be able to regain or maintain compliance with the NASDAQ continued listing requirements, or that our common stock
will not be delisted from The Nasdaq Capital Market in the future. If our common stock is delisted by NASDAQ, it could lead to
a number of negative implications, including an adverse effect on the price of our common stock, increased volatility in our common
stock, reduced liquidity in our common stock, the loss of federal preemption of state securities laws and greater difficulty in
obtaining financing. In addition, delisting of our common stock could deter broker-dealers from making a market in or otherwise
seeking or generating interest in our common stock, could result in a loss of current or future coverage by certain sell-side
analysts and might deter certain institutions and persons from investing in our securities at all. Delisting could also cause
a loss of confidence of our customers, collaborators, vendors, suppliers and employees, which could harm our business and future
prospects.
If
our common stock is delisted by NASDAQ in the future, our common stock may be eligible to trade on the OTC Bulletin Board, OTC
QB or another over-the-counter market. Any such alternative would likely result in it being more difficult for us to raise additional
capital through the public or private sale of equity securities and for investors to dispose of, or obtain accurate quotations
as to the market value of, our common stock. In addition, there can be no assurance that our common stock would be eligible for
trading on any such alternative exchange or markets. For these reasons and others, delisting could adversely affect the price
of our securities and our business, financial condition and results of operations.
We
have a substantial number of authorized common and preferred shares available for future issuance that could cause dilution of
our stockholders’ interest, adversely impact the rights of holders of our common stock and cause our stock price to decline.
We
have a total of 100,000,000 shares of common stock and 5,000,000 shares of preferred stock authorized for issuance. As of June
1, 2017, we had 91,211,396 shares of common stock and 5,000,000 shares of preferred stock available for issuance. As of June
1, 2017, we have reserved 660,492 shares of our common stock for issuance upon the exercise of outstanding awards under our
stock incentive plan, of which 184,647 are subject to stockholder approval with respect to their grant and an increase in the
number of shares in the plan, and there are no additional shares available for future grants of awards under our stock incentive
plan. We may seek financing that could result in the issuance of additional shares of our capital stock and/or rights to acquire
additional shares of our capital stock. We may also make acquisitions that result in issuances of additional shares of our capital
stock. Those additional issuances of capital stock could result in substantial dilution of our existing stockholders. Furthermore,
the book value per share of our common stock may be reduced. This reduction would occur if the exercise price of any issued warrants,
the conversion price of any convertible notes or the conversion ratio of any issued preferred stock is lower than the book value
per share of our common stock at the time of such exercise or conversion. Additionally, new investors in any subsequent issuances
of our securities could gain rights, preferences and privileges senior to those of holders of common stock.
Any
weakness in our disclosure controls and procedures and our internal controls could have a material adverse effect on us
.
Our
senior management has identified material weaknesses in our disclosure controls and procedures and our internal controls over
financial reporting. Management is currently addressing these control weaknesses, but we cannot assure you that our corrective
actions will be sufficient or timely and we cannot assure you that additional material weaknesses will not be identified in the
future. Any such failure could adversely affect our ability to report financial results on a timely and accurate basis, which
could have other material effects on our business, reputation, results of operations, financial condition or liquidity. Material
weaknesses in internal controls over financial reporting or disclosure controls and procedures could also cause investors to lose
confidence in our reported financial information which could have an adverse effect on the trading price of our securities.
We
have anti-takeover defenses that could delay or prevent an acquisition and could adversely affect the price of our common stock.
Our
certificate of incorporation, as amended, and amended and restated bylaws include provisions, such as providing for three classes
of directors, which may make it more difficult to remove our directors and management and may adversely affect the price of our
common stock. In addition, our certificate of incorporation, as amended, authorizes the issuance of “blank check”
preferred stock, which allows our Board to create one or more classes of preferred stock with rights and preferences greater than
those afforded to the holders of our common stock. This provision could have the effect of delaying, deterring or preventing a
future takeover or a change in control, unless the takeover or change in control is approved by our Board. We are also subject
to laws that may have a similar effect. For example, Section 203 of the General Corporation Law of the State of Delaware prohibits
us from engaging in a business combination with an interested stockholder for a period of three years from the date the person
became an interested stockholder unless certain conditions are met. As a result of the foregoing, it will be difficult for another
company to acquire us and, therefore, could limit the price that possible investors might be willing to pay in the future for
shares of our common stock. In addition, the rights of our common stockholders will be subject to, and may be adversely affected
by, the rights of holders of any class or series of preferred stock that may be issued in the future and in this offering.
We
have not declared any cash dividends on our capital stock and do not intend to declare or pay any cash dividends in the foreseeable
future. Future earnings, if any, will be used to finance the future operation and growth of our business. As a result, capital
appreciation, if any, will be your sole source of gain.
We
have never paid cash dividends on our capital stock. We do not currently anticipate paying cash dividends on our common stock
in the foreseeable future and we may not have sufficient funds legally available to pay dividends. Even if the funds are legally
available for distribution, we may nevertheless decide not to pay any dividends. We presently intend to retain all earnings for
our operations. As a result, capital appreciation, if any, of our common stock will be your sole source of gain for the foreseeable
future.
Our
quarterly and annual operating results may vary, which may cause the price of our common stock to fluctuate.
Our
quarterly and annual operating results may vary as a result of a number of factors, including:
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the
commencement, delay, cancellation or completion of sales and marketing programs;
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regulatory
developments;
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uncertainty
about when sales of our molecular diagnostic tests will be recognized;
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timing
and amount of expenses for implementing new programs and accuracy of estimates of resources required for ongoing programs;
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adoption
of and coverage and reimbursement for our molecular diagnostic tests;
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accounting
for impairment of contingent liabilities which are recorded in operation;
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timing
and integration of any acquisitions; and
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changes
in regulations related to diagnostics, pharmaceutical, biotechnology and healthcare companies.
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We
believe that quarterly, and in certain instances annual, comparisons of our financial results may not necessarily be meaningful
and should not be relied upon as an indication of future performance. Fluctuations in quarterly and annual results could materially
and adversely affect the market price of our common stock in a manner unrelated to our long-term operating performance.
Our
stock price is volatile and could be further affected by events not within our control, and an investment in our common stock
could suffer a decline in value.
During
the first five complete months of 2017, our common stock traded at a low of $1.66 and a high of $14.25. During 2016, our common
stock traded at a low of $0.70 and a high of $19.80. The trading price of our common stock has been and will continue to be subject
to:
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general
volatility in the trading markets;
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significant
fluctuations in our quarterly operating results;
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significant
changes in our cash and cash equivalent reserves;
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announcements
regarding our business or the business of our competitors;
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announcements
regarding our equity offerings;
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strategic
actions by us or our competitors, such as acquisitions or restructurings;
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industry
and/or regulatory developments;
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changes
in revenue mix;
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changes
in revenue and revenue growth rates for us and for the industries in which we operate;
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changes
in accounting standards, policies, guidance, interpretations or principles; and
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statements
or changes in opinions, ratings or earnings estimates made by brokerage firms or industry analysts relating to the markets
in which we operate or expect to operate.
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*The
prices of our common stock listed above have been adjusted to reflect a one-for-ten reverse split on our issued and outstanding
shares of common stock effected on December 28, 2016.
We
may be subject to securities litigation, which is expensive and could divert our management’s attention.
The
market price of our securities may be volatile, and in the past companies that have experienced volatility in the market price
of their securities have been subject to securities class action litigation. We may be the target of this type of litigation in
the future. Securities litigation against us could result in substantial costs and divert our management’s attention from
other business concerns, which could seriously harm our business.
The
indemnification rights provided to our directors, officers and employees may result in substantial expenditures by us and may
discourage lawsuits against its directors, officers, and employees.
Our
certificate of incorporation, as amended, contains provisions permitting us to enter into indemnification agreements with our
directors, officers, and employees. The foregoing indemnification obligations could result in us incurring substantial expenditures
to cover the cost of settlement or damage awards against directors and officers, which we may be unable to recoup. These provisions
and resultant costs may also discourage us from bringing a lawsuit against our directors and officers for breaches of their fiduciary
duties, and may similarly discourage the filing of derivative litigation by our stockholders against our directors and officers
even though such actions, if successful, might otherwise benefit us and our stockholders.
We
are a smaller reporting company and we cannot be certain if the reduced disclosure requirements applicable to smaller reporting
companies will make our common stock less attractive to investors.
We
are currently a “smaller reporting company” as defined in the Exchange Act, and are thus allowed
to provide simplified executive compensation disclosures in our filings, are exempt from the provisions of Section 404(b) of the
Sarbanes-Oxley Act requiring that an independent registered public accounting firm provide an attestation report on the effectiveness
of internal control over financial reporting and have certain other decreased disclosure obligations in our SEC filings. We cannot
predict whether investors will find our common stock less attractive because of our reliance on any of these exemptions. If some
investors find our common stock less attractive as a result, there may be a less active trading market for our common stock and
our stock price may be more volatile.
If
we explore or engage in future business combinations or other transactions, we may be subject to various uncertainties and risks.
From
time-to-time, unrelated third-parties may approach the Company about potential transactions, including business combinations.
To date, we have not entered into any agreements related to any business combination. While we may explore such opportunities
when they arise, we could not pursue any proposed business combination or other transaction unless our Board first has determined
that doing so would be in our and our stockholders’ interest. There can be no assurance that we will negotiate acceptable
terms, enter into binding agreements or successfully consummate any business combination or other transaction with this private
company or any other third parties.
We
cannot currently predict the effects a future, potential business combination or other transaction would have on holders of the
pre-funded warrants or common warrants or any of our other securities. There are various uncertainties and risks relating to our
evaluation and negotiation of possible business combination or other transactions, our ability to consummate such transactions
and the consummation of such transactions, including:
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evaluation
and negotiation of a proposed transaction may distract management from focusing our time and resources on execution of our
operating plan, which could have a material adverse effect on our operating results and business;
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the
process of evaluating proposed transactions may be time consuming and expensive and may result in the loss of business opportunities;
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perceived
uncertainties as to our future direction may result in increased difficulties in retaining key employees and recruiting new
employees, particularly senior management;
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even
if we negotiate a definitive agreement, successful integration or execution of a business combination or other transaction
will be subject to additional risks;
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the
current market price of our common stock may reflect a market assumption that a transaction will occur, and during the period
in which we are considering a transaction, the market price of our common stock could be highly volatile;
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a
failure to complete a transaction could result in a negative perception by our investors generally and could cause a decline
in the market price of our common stock, as well as lead to greater volatility in the market price of our common stock, all
of which could adversely affect our ability to access the equity and financial markets, as well as our ability to explore
and enter into different strategic alternatives;
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expected
benefits may not be successfully achieved;
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such
transactions may increase our operating expenses and cash requirements, cause us to assume or incur indebtedness or contingent
liabilities, make it difficult to retain management and key personnel; and
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dilution
of our existing stockholders if such transaction involves our issuing dilutive securities.
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RISK
RELATED TO THIS OFFERING
There
is no public market for the pre-funded warrants or common warrants being offered in this offering.
There
is no established public trading market for the pre-funded warrants or common warrants being offered in this offering,
and we do not expect a market to develop. In addition, we do not intend to apply to list the pre-funded warrants or common
warrants on any securities exchange or nationally recognized trading system, including the Nasdaq Capital Market. Without
an active market, the liquidity of the pre-funded warrants or common warrants will be limited.
Management
will have broad discretion as to the use of proceeds from this offering and we may use the net proceeds in ways with which you
may disagree.
We
intend to use the net proceeds of this offering for working capital, trade payables, payment of legacy CSO obligations that were
not assumed by the CSO Acquirer and general corporate purposes. Our management will have broad discretion in the application
of the net proceeds from this offering and could spend the proceeds in ways that do not improve our results of operations or enhance
the value of our common stock. Accordingly, you will be relying on the judgment of our management on the use of net proceeds,
and you will not have the opportunity, as part of your investment decision, to assess whether the proceeds are being used appropriately.
Our failure to apply these funds effectively could have a material adverse effect on our business and cause the price of our common
stock to decline.
The
offering price was set by our Board and does not necessarily indicate the actual or market value of our common stock.
Our Board approved the offering price
and other terms of this offering after considering, among other things: the number of shares authorized in our certificate of
incorporation; the current market price of our common stock; trading prices of our common stock over time; the volatility of our
common stock; our current financial condition and the prospects for our future cash flows; the availability of and likely cost
of capital of other potential sources of capital; the characteristics of interested investors and market and economic conditions
at the time of the offering. The offering price is not intended to bear any relationship to the book value of our assets or our
past operations, cash flows, losses, financial condition, net worth or any other established criteria used to value securities.
The offering price may not be indicative of the fair value of the common stock.
If
you purchase the common stock and related common warrants sold in this offering, you will experience immediate substantial
dilution as a result of this offering and future equity issuances.
Because
the price per share of our common stock and related common stock warrant being offered is higher than the book value per
share of our common stock, you will suffer immediate substantial dilution in the net tangible book value of the common stock you
purchase in this offering. See the section entitled “Dilution” of this prospectus for a more detailed discussion of
the dilution you will incur if you purchase common stock and related common warrants in this offering.
The
issuance of additional shares of our common stock in future offerings could be dilutive to stockholders if they do not invest
in future offerings. Moreover, to the extent that we issue options or warrants to purchase, or securities convertible into or
exchangeable for, shares of our common stock in the future and those options, warrants or other securities are exercised, converted
or exchanged, stockholders may experience further dilution.
Holders
of pre-funded warrants or common warrants purchased in this offering will have no rights as common stockholders until such
holders exercise their pre-funded warrants or common warrants and acquire our common stock.
Until
holders of pre-funded warrants or common warrants acquire shares of our common stock upon exercise of the pre-funded warrants
or common warrants, holders of pre-funded warrants or common warrants will have no rights with respect to the shares
of our common stock underlying such pre-funded warrants or common warrants. Upon exercise of the pre-funded warrants
or common warrants, the holders will be entitled to exercise the rights of a common stockholder only as to matters for which
the record date occurs after the exercise date.
Provisions
of the common warrants and pre-funded warrants offered by this prospectus could discourage an acquisition of us by a third
party.
In
addition to the discussion of the provisions of our Certificate of Incorporation, as amended, certain provisions of the common
warrants and pre-funded warrants offered by this prospectus could make it more difficult or expensive for a third party to
acquire us. Such warrants prohibit us from engaging in certain transactions constituting “fundamental transactions”
unless, among other things, the surviving entity assumes our obligations under the warrants. Further, the warrants provide that,
in the event of certain transactions constituting “fundamental transactions,” with some exception, holders of such
warrants will have the right, at their option, to require us to repurchase such warrants at a price described in such warrants.
These and other provisions of the common warrants and pre-funded warrants offered by this prospectus could prevent or deter
a third party from acquiring us even where the acquisition could be beneficial to you.
The
exercise price of the common warrants and pre-funded warrants offered by this prospectus will not be adjusted for certain
dilutive events.
The
exercise price of the common warrants and pre-funded warrants offered by this prospectus is subject to adjustment for certain
events, including, but not limited to, certain issuances and/or distributions of capital stock, options, convertible securities
and other securities. However, the exercise prices will not be adjusted for dilutive issuances of securities considered “excluded
securities” and there may be transactions or occurrences that may adversely affect the market price of our common
stock or the market value of such warrants without resulting in an adjustment of the exercise prices of such warrants.