Document:

Exhibit 10.1

 

FOURTH AMENDMENT TO THE AMENDED AND RESTATED
LOAN AND SECURITY AGREEMENT

 

THIS FOURTH AMENDMENT to the Amended and Restated
Loan and Security Agreement (this “Amendment”) is made effective as of January 19, 2022 (the “Fourth Amendment
Date”) and made by and among WESTERN ALLIANCE BANK, an Arizona corporation (“Bank”) and CYTOSORBENTS
CORPORATION, a Delaware corporation and CYTOSORBENTS MEDICAL, INC.,
a Delaware corporation (individually and collectively, jointly and severally “Borrower”).

 

WHEREAS, Bank and Borrower have entered into that
certain Amended and Restated Loan and Security Agreement, dated as of March 29, 2018 (as amended, supplemented, restated or otherwise
modified from time to time, the “Loan Agreement”) pursuant to which Bank has provided to Borrower certain loans in
accordance with the terms and conditions thereof; and

 

WHEREAS, Bank and Borrower desire to amend certain
provisions of the Loan Agreement as provided herein and subject to the terms and conditions set forth herein.

 

NOW, THEREFORE, in consideration of the promises,
covenants and agreements contained herein, and other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged,
Bank and Borrower hereby agree as follows:

 

		1.	Capitalized terms used herein but not otherwise defined shall
have the respective meanings given to them in the Loan Agreement.

 

		2.	Section 1.1 of the Loan Agreement is hereby amended by amending
and restating the following definitions therein as follows:

 

“Amortization Date” means (i)
January 1, 2024, if the I/O Extension Event does not occur, and (ii) July 1, 2024, if the I/O Extension Event occurs.

 

“Effective Interest Rate” means,
with respect to the Term Loan, the per annum rate of interest (based on a year of three hundred sixty (360) days) equal to the lesser
of (a) Eight percent (8.00%) and (b) the sum of (i) Index Rate on the last Business Day of the month that immediately precedes the month
in which the interest will accrue, plus (ii) One and Twenty-Five Hundredths percent (1.25%).

 

“Maturity Date” is December 1, 2025.

 

“Required Reserves Test” means that on the date
of its determination, Borrower shall have sufficient cash reserves (including the proceeds of the Term C Loans) to meet all of its projected
expenses in accordance with its then applicable annual operating budget and financial projections delivered and accepted by Bank in accordance
with Section 6.3 hereof (including, but not limited to, interest expenses and any applicable principal repayment expenses) for the then
immediately following 12 month period, as reasonably determined by the Bank based on evidence reasonably acceptable to the Bank.

 

“Third Draw Period” means the period commencing
on the Fourth Amendment Date and ending on the earlier of (i) December 31, 2022 and (ii) the occurrence of an Event of Default; provided
further that no Term C Loan as would cause the aggregate principal amount of Term C Loans to exceed Five Million Dollars ($5,000,000.00)
shall be made during the Third Draw Period unless on the Funding Date of such Term C Loan, the Required Reserves Test is met and on or
before the Funding Date of such Term C Loan (but no earlier than ten (10) days prior to the Funding Date), the Seventy Five Percent Test
is met.

 

     

     

    

 

“I/O Extension Event” is the meeting by Borrower,
of both the Required Reserves Test and the Seventy Five Percent Test as of November 30, 2023 as determined by Bank after receipt of the
financial statements for November 2023 from Borrower that Borrower is obligated to provide under Section 6.3 of this Agreement.

 

		3.	Section 1.1 of the Loan Agreement is hereby further amended
by adding the following definition thereto in alphabetical order:

 

“Fourth Amendment Date” is January 19, 2022.

 

		4.	Section 2.2(a) of the Loan Agreement is hereby amended and restated
as follows:

 

(a)       Availability.

 

(i)       Subject
to the terms and conditions of this Agreement, on the Closing Date, Bank shall make a term loan to Borrower in the amount of Ten Million
Dollars ($10,000,000) (the “Term A Loan”). After repayment, the Term A Loan may not be re-borrowed. The parties hereby acknowledge
that the Term A Loans have been made previously, the outstanding amount of the Term A Loans immediately prior to the Third Amendment Date
was $ 8,888,888.89 and the Term A Loans were fully repaid on the Third Amendment Date.

 

(ii)       Subject
to the terms and conditions of this Agreement, during the Second Draw Period, Bank shall make a term loan to Borrower in the amount of
Five Million Dollars ($5,000,000) (the “Term B Loans”). After repayment, the Term B Loan may not be re-borrowed. The parties
hereby acknowledge that the Term B Loans have been made previously, the outstanding amount of the Term B Loans immediately prior to the
Third Amendment Date was $4,444,444.45 and the Term B Loans were fully repaid on the Third Amendment Date.

 

(iii)       Subject
to the terms and conditions of this Agreement, during the Third Draw Period, Bank shall make term loans to Borrower in the aggregate amount
of Fifteen Million Dollars ($15,000,000) (the “Term C Loans”, and together with the Term A Loans and the Term B Loans, the
 “Term Loans,” and each individually, a “Term Loan”). At the option of Borrower, the Term C Loans may be drawn
in three tranches of Five Million Dollars ($5,000,000.00) each. After repayment, the Term C Loans may not be re-borrowed.

 

		5.	Section 2.5 of the Loan Agreement is hereby amended by deleting
the text “ and” at the end of Section 2.5(g), replacing the text “.” at the end of Section 2.5(h) with “;
and” and adding the following Section 2.5(i) thereto:

 

(i)       A fully earned
and non-refundable fourth amendment fee equal to Eighteen Thousand Seven Hundred Fifty Dollars ($18,750.00) which shall be due and payable
on the Fourth Amendment Date.

 

		6.	Section 6.13 of the Loan Agreement is hereby amended and restated
in its entirety as follows:

 

6.13       Financial
Covenant.

 

(a)       Following
the funding of any Term C Loans hereunder after the funding of which the aggregate principal amount of Term C Loans funded shall be in
excess of in excess of Five Million Dollars ($5,000,000.00), but subject to the provisions of Section 6.13(b) below, the Borrower must
satisfy the Seventy Five Percent Test each month, as determined by the Bank on the date of the receipt of the monthly financial statements
by the Bank in accordance with Section 6.3 hereof.

 

(b)       If,
after the applicable Funding Date of the Term C Loan the aggregate principal amount of Term C Loans funded are in excess of Five Million
Dollars ($5,000,000.00), the aggregate cash reserves of Borrower (held in accounts maintained with the Bank or in such accounts as are
subject to one or more account control agreements with the Bank in form and substance satisfactory to Bank) for any given month, as determined
by the Bank based on evidence reasonably acceptable to the Bank, exceed One Hundred Twenty Five percent (125%) of the then outstanding
aggregate outstanding principal amount of the Term Loans, Borrower shall not be required to comply with the provisions of Section 6.13(a)
for such month.

 

     

     

    

 

		7.	Limitation of Amendment.

 

		a.	The amendments and the consents set forth above are effective for the purposes set forth herein and
                                                                               shall be limited precisely as written and shall not be deemed to (a) be a consent to any amendment, waiver or modification of any
                                                                               other term or condition of any Loan Document, or (b) otherwise prejudice any right, remedy or obligation which the Bank or Borrower
                                                                               may now have or may have in the future under or in connection with any Loan Document, as amended hereby.

 

		b.	This Amendment shall be construed in connection with and as
part of the Loan Documents and all terms, conditions, representations, warranties, covenants and agreements set forth in the Loan Documents,
except as herein amended, are hereby ratified and confirmed and shall remain in full force and effect.

 

		8.	To induce the Bank to enter into this Amendment, Borrower hereby
represents and warrants to the Bank as follows:

 

		a.	Immediately after giving effect to this Amendment (a) the representations
and warranties contained in the Loan Documents are true, accurate and complete in all material respects as of the date hereof (except
to the extent such representations and warranties relate to an earlier date, in which case they are true and correct in all material
respects as of such date), and (b) no Event of Default has occurred and is continuing;

 

		b.	Borrower has the power and due authority to execute and deliver
this Amendment and to perform its obligations under the Loan Agreement, as amended by this Amendment;

 

		c.	The organizational documents of Borrower delivered to the Bank
on the Effective Date, and updated pursuant to subsequent deliveries by the Borrower to the Bank, if any, remain true, accurate and complete
and have not been amended, supplemented or restated and are and continue to be in full force and effect;

 

		d.	The execution and delivery by Borrower of this Amendment and
the performance by Borrower of its obligations under the Loan Agreement, as amended by this Amendment, will not constitute an event of
default under any material agreement with a Person binding on Borrower, or a breach of any provision contained in the Articles of Incorporation
or Bylaws of Borrower; and

 

		e.	This Amendment has been duly executed and delivered by Borrower
and is the binding obligation of Borrower, enforceable against Borrower in accordance with its terms, except as such enforceability may
be limited by bankruptcy, insolvency, reorganization, liquidation, moratorium or other similar laws of general application and by general
equitable principles.

 

		9.	Except as expressly set forth herein, the Loan Agreement shall
continue in full force and effect without alteration or amendment. This Amendment and the Loan Documents represent the entire agreement
about this subject matter and supersede prior negotiations or agreements.

 

		10.	This Amendment shall be deemed effective as of the Amendment
Date upon (i) the due execution and delivery to the Bank of this Amendment by each party hereto, and (ii) the payment by Borrower to
the Bank of the fourth amendment fee of Eighteen Thousand Seven Hundred Fifty Dollars ($18,750.00) in accordance with the provisions
of Section 2.5(i) of the Loan Agreement.

 

     

     

    

 

 

		11.	This Amendment may be executed in any number of counterparts,
each of which shall be deemed an original, and all of which, taken together, shall constitute one and the same instrument.

 

		12.	This Amendment and the rights and obligations of the parties
hereto shall be governed by and construed in accordance with the laws of the State of California.

 

 

[Balance of Page Intentionally Left Blank]

 

     

     

    

  

IN WITNESS WHEREOF, the parties hereto have
caused this Fourth Amendment to the Amend and Restated Loan and Security Agreement to be executed as of the date first set forth above.

 

 

	 	CytoSorbents Corporation, a Delaware corporation
	 	 
	 	By:	/s/ Kathleen P. Bloch
	 	Name:	Kathleen P. Bloch
	 	Title:	Chief Financial Officer
	 	 	 
	 	 	 
	 	CytoSorbents Medical, Inc., a Delaware corporation
	 	 
	 	By:	/s/ Kathleen P. Bloch
	 	Name:	Kathleen P. Bloch
	 	Title:	Chief Financial Officer
	 	 	 
	 	 	 
	 	Western Alliance Bank, an Arizona corporation
	 	 
	 	By:	/s/ Christian Ebert
	 	Name:	Christian Ebert
	 	Title:	Vice PresidentExhibit 10.2

 

Success Fee Letter

 

CytoSorbents Corporation

7 Deer Park Drive

Suite K

Monmouth Junction, NJ 08852

January 19, 2022

 

Bridge Bank, a division of Western Alliance Bank

4370 La Jolla Village Drive

Suite 305

San Diego, CA 92122

Attn: Bill Wickline

 

Ladies and Gentlemen:

 

Reference is herein made to
that certain Amended and Restated Loan and Security Agreement (the “Loan Agreement”), dated as of even date herewith, by and
between Western Alliance Bank, an Arizona corporation (“Bank”), and CytoSorbents Corporation, a Delaware corporation and CytoSorbents
Medical, Inc., a Delaware corporation (individually and collectively, jointly and severally “Borrower”). CytoSorbents Corporation
may be referred to herein as “Parent.” Capitalized terms used but not otherwise defined herein shall have the respective meanings
given to them in the Loan Agreement. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged
by Borrower hereby agrees to pay to the Bank, (i) an amount equal to 1.00% of the of the First Tranche Term C Loans (as defined herein)
(the “First Tranche Success Fee”) promptly upon the occurrence of the First Tranche Liquidity Event (as defined herein), (ii)
an amount equal to 1.50% of the Second Tranche Term C Loans (as defined herein) (the “Second Tranche Success Fee”) promptly
upon the occurrence of the Second Tranche Liquidity Event (as defined herein) and (iii) an amount equal to 2.00% of the Third Tranche
Term C Loans (as defined herein) (the “Third Tranche Success Fee”) (each of the First Tranche Success Fee, Second Tranche
Success Fee and Third Tranche Success Fee, a “Success Fee”) promptly upon the occurrence of the Third Tranche Liquidity Event
(as defined herein), in each case in accordance with the payment instructions that the Bank may provide to Borrower following the receipt
of the applicable Liquidity Event Notice.

 

As used herein:

 

“First Tranche Term
C Loans” means the lesser of (i) Five Million Dollars ($5,000,000.00) and (ii) aggregate original principal amount of all of the
Term C Loans made under the Loan Agreement.

 

“First Tranche Liquidity
Event” means the first to occur of any of the following after the Funding Date of the First Tranche Term C Loans: (a) a sale or
other disposition by either Borrower of all or substantially all of its assets; (b) a merger or consolidation of either Borrower into
or with another person or entity, where the holders of such Borrower’s outstanding voting equity securities as of immediately prior
to such merger or consolidation hold less than a majority of the issued and outstanding voting equity securities of the successor or surviving
person or entity as of immediately following the consummation of such merger or consolidation; (c) a transaction or a series of related
transactions in which any “person” or “group” (within the meaning of Section 13(d) and 14(d)(2) of the Securities
Exchange Act of 1934) becomes the “beneficial owner” (as defined in Rule 13d-3 under the Securities Exchange Act of 1934),
directly or indirectly, of a sufficient number of shares of all classes of stock then outstanding of either Borrower ordinarily entitled
to vote in the election of directors, empowering such “person” or “group” to elect a majority of the Board of
Directors of such Borrower, who did not have such power before such transaction; or (d) the closing price per share for Parent’s
common stock on stock exchange where shares of Parent’s common stock are traded at the applicable time being equal to or greater
than $8.00 (after giving effect to any stock splits or consolidations effected after the date hereof) for five successive business days.

 

     

     

    

 

“Second Tranche Term
C Loans” means the lesser of (i) Five Million Dollars ($5,000,000.00) and (ii) the greater of (A) Zero Dollars ($0.00) and (B) the
difference of (1) the aggregate original principal amount of all of the Term C Loans made under the Loan Agreement minus (2) Five Million
Dollars ($5,000,000.00).

 

“Second Tranche Liquidity
Event” means the first to occur of any of the following after the Funding Date of the Second Tranche Term C Loans: (a) a sale or
other disposition by either Borrower of all or substantially all of its assets; (b) a merger or consolidation of either Borrower into
or with another person or entity, where the holders of such Borrower’s outstanding voting equity securities as of immediately prior
to such merger or consolidation hold less than a majority of the issued and outstanding voting equity securities of the successor or surviving
person or entity as of immediately following the consummation of such merger or consolidation; (c) a transaction or a series of related
transactions in which any “person” or “group” (within the meaning of Section 13(d) and 14(d)(2) of the Securities
Exchange Act of 1934) becomes the “beneficial owner” (as defined in Rule 13d-3 under the Securities Exchange Act of 1934),
directly or indirectly, of a sufficient number of shares of all classes of stock then outstanding of either Borrower ordinarily entitled
to vote in the election of directors, empowering such “person” or “group” to elect a majority of the Board of
Directors of such Borrower, who did not have such power before such transaction; or (d) the closing price per share for Parent’s
common stock on stock exchange where shares of Parent’s common stock are traded at the applicable time being equal to or greater
than $10.00 (after giving effect to any stock splits or consolidations effected after the date hereof) for five successive business days.

 

“Third Tranche Term
C Loans” means the lesser of (i) Five Million Dollars ($5,000,000.00) and (ii) the greater of (A) Zero Dollars ($0.00) and (B) the
difference of (1) the aggregate original principal amount of all of the Term C Loans made under the Loan Agreement minus (2) Ten Million
Dollars ($10,000,000.00).

 

“Third Tranche Liquidity
Event” means the first to occur of any of the following after the Funding Date of the Third Tranche Term C Loans: (a) a sale or
other disposition by either Borrower of all or substantially all of its assets; (b) a merger or consolidation of either Borrower into
or with another person or entity, where the holders of such Borrower’s outstanding voting equity securities as of immediately prior
to such merger or consolidation hold less than a majority of the issued and outstanding voting equity securities of the successor or surviving
person or entity as of immediately following the consummation of such merger or consolidation; (c) a transaction or a series of related
transactions in which any “person” or “group” (within the meaning of Section 13(d) and 14(d)(2) of the Securities
Exchange Act of 1934) becomes the “beneficial owner” (as defined in Rule 13d-3 under the Securities Exchange Act of 1934),
directly or indirectly, of a sufficient number of shares of all classes of stock then outstanding of either Borrower ordinarily entitled
to vote in the election of directors, empowering such “person” or “group” to elect a majority of the Board of
Directors of such Borrower, who did not have such power before such transaction; or (d) the closing price per share for Parent’s
common stock on stock exchange where shares of Parent’s common stock are traded at the applicable time being equal to or greater
than $12.00 (after giving effect to any stock splits or consolidations effected after the date hereof) for five successive business days.

 

Each of the First Tranche
Liquidity Event, the Second Tranche Liquidity Event and the Third Trance Liquidity Event may be referred to here in as a “Liquidity
Event.”

 

Borrower shall give Bank a
written notice (“Liquidity Event Notice”) not less than ten (10) days’ prior to the closing of each Liquidity Event
(described in clauses (a) through (c) of the definition of the applicable Liquidity Event), and promptly upon the occurrence of each Liquidity
Event described in clause (d) of the definition of the applicable Liquidity Event, at the Bank’s address set forth above (or the
then current address of the Bank as advised by the Bank to Borrower in writing) via certified mail or a reputable courier service. Each
Liquidity Event Notice shall include Borrower’s then current address. Bank, upon receipt of a Liquidity Event Notice, shall deliver
to Borrower at its then current address as set forth in the Liquidity Event Notice, payment instructions for the applicable Success Fee.
If the applicable Success Fee is pursuant to a Liquidity Event described in clause (d) of the definition of the applicable Liquidity Event,
at the Borrower’s election, Parent shall in lieu of paying the applicable Success Fee in cash, issue and sell in exchange for the
applicable Success Fee (and without any further consideration from the Bank) to the Bank such number of registered shares of Parent’s
common stock as would equal the quotient (calculated by rounding up the nearest whole number) obtained by dividing (a) the applicable
Success Fee by (b) the volume weighted average price per share of Parent’s common stock for the same five successive business days
on which the closing price per share of Parent’s common stock caused the applicable Success Fee to become payable.

 

     

     

    

 

The right of Bank to receive
the Success Fees and the obligation of the Borrower to pay the Success Fees hereunder shall terminate on the date that is fifth anniversary
of the funding date of the last Term C Loans made but shall survive the termination of the Loan Agreement and any prepayment of the Term
C Loans.

 

Notwithstanding anything herein
to the contrary, the obligations of Borrower hereunder are in addition to (and not in lieu of) Borrower’s obligations under that
certain Success Fee Letter dated March 29, 2018 from Borrower to Bank (the “Prior Letter”), and the Prior Letter shall continue
be in full force and effect in accordance with its terms.

 

[Signature Page follows]

 

     

     

    

 

	 	Very truly yours,
	 	 
	 	CYTOSORBENTS CORPORATION
	 	 
	 	By:	/s/ Kathleen P. Bloch
	 	Name:	Kathleen P. Bloch
	 	Title:	Chief Financial Officer
	 	 	 
	 	CYTOSORBENTS MEDICAL, INC.
	 	 
	 	By:	/s/ Kathleen P. Bloch
	 	Name:	Kathleen P. Bloch
	 	Title:	Chief Financial Officer

 

 

	ACCEPTED AND AGREED:	 
	 	 
	WESTERN ALLIANCE BANK	 
	 	 	 
	By	/s/ Christian Ebert	 
	Name:	Christian Ebert	 
	Title:	Vice President

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