Quarterlytics / Healthcare / Medical - Devices / Anika Therapeutics, Inc.

Anika Therapeutics, Inc.

anik · NASDAQ Healthcare
Claim this profile
Ticker anik
Exchange NASDAQ
Sector Healthcare
Industry Medical - Devices
Employees 288
← All annual reports
FY2023 Annual Report · Anika Therapeutics, Inc.
Sign in to download
Loading PDF…
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 10-K

(Mark One)
☒

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

For the fiscal year ended December 31, 2023

☐

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

For the transition period from                          to                  

Commission File Number 001-14027

Anika Therapeutics, Inc.
(Exact Name of Registrant as Specified in Its Charter)

Delaware
(State or Other Jurisdiction of Incorporation or Organization)

04-3145961
(IRS Employer Identification No.)

32 Wiggins Avenue, Bedford, Massachusetts 01730
(Address of Principal Executive Offices) (Zip Code)

(781) 457-9000
(Registrant’s Telephone Number, Including Area Code)

Securities registered pursuant to Section 12(b) of the Act:

Title of Each Class
Common Stock, par value $0.01 per share

Trading Symbol
ANIK

Name of Each Exchange on Which Registered
NASDAQ Global Select Market

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No ☒

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15 (d) of the Securities Exchange Act of 1934
during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing
requirements for the past 90 days. Yes ☒  No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted to Rule 405 of Regulation
S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No
☐

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

Large accelerated filer ☐

Accelerated filer ☒

Non-accelerated filer ☐ Smaller reporting company ☐ Emerging growth company ☐

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

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of internal control
over  financial  reporting  under  Section  404(b)  of  the  Sarbanes-Oxley  Act  (15  U.S.C.  7262(b))  by  the  registered  public  accounting  firm  that  prepared  or
issued its audit report. ☒

If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the
filing reflect the correction of an error to previously issued financial statements. ☐

Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received
by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐

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

The  aggregate  market  value  of  voting  common  stock  held  by  non-affiliates  of  the  registrant  as  of  June  30,  2023,  the  last  day  of  the  registrant’s  most
recently completed second fiscal quarter, was $370,427,535 computed by reference to the closing price of common stock on such date. The registrant does
not have any non-voting stock outstanding.

At March 6, 2024, there were 14,849,942 shares of the registrant’s common stock outstanding.

Documents Incorporated By Reference

Portions of the registrant’s proxy statement for its 2024 annual meeting of stockholders are incorporated by reference in Part III of this Annual Report on
Form 10-K.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ANIKA THERAPEUTICS, INC.
TABLE OF CONTENTS

Cautionary Note Regarding Forward-Looking Statements

Business
Risk Factors
Unresolved Staff Comments
Cybersecurity
Properties
Legal Proceedings
Mine Safety Disclosures

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities
[Reserved]
Management’s Discussion and Analysis of Financial Condition and Results of Operations
Quantitative and Qualitative Disclosures About Market Risk
Financial Statements and Supplementary Data
Changes in and Disagreements with Accountants on Accounting and Financial Disclosures
Controls and Procedures
Other information 
Disclosure Regarding Foreign Jurisdictions that Prevent Inspections

Part I

Part II

Item 1.
Item 1A.
Item 1B.
Item 1C.
Item 2.
Item 3.
Item 4.

Item 5.
Item 6.
Item 7.
Item 7A.
Item 8.
Item 9.
Item 9A.
Item 9B.
Item 9C.

Part III

Item 10.
Item 11.
Item 12.
Item 13.
Item 14.

Directors, Executive Officers and Corporate Governance
Executive Compensation
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters
Certain Relationships and Related Transactions, and Director Independence
Principal Accountant Fees and Services

Part IV

Item 15.
Item 16.

Exhibits and Financial Statement Schedules
Form 10-K Summary

Signatures

Page

4

7
22
37
37
38
38
38

39
40
40
54
55
82
82
85
85

86
86
86
86
86

87
89
90

References in this Annual Report on Form 10-K to “we,” “us,” “our,” “our company,” and other similar references refer to Anika Therapeutics, Inc. and its
subsidiaries unless the context otherwise indicates.

ACTIFLIP, ANIKA, ANIKA THERAPEUTICS, ANIKAVISC, ARTHROSURFACE, ATLAS, CINGAL, DRAW TIGHT, GLENOJET, HYAFF, HYVISC,
INTEGRITY,  MONOVISC,  ORTHOVISC,  OVO,  OVOMOTION,  PARCUS  MEDICAL,  PF  WAVE,  REVOMOTION,  SPEEDSPIRAL,  SYND-EZ,
TACTOSET, WAVEKAHUNA, WRISTMOTION, and X-TWIST are our trademarks that appear in this Annual Report on Form 10-K. For convenience,
these trademarks may appear in this Annual Report on Form 10-K without ® and ™ symbols, but that practice does not mean that we will not assert, to the
fullest extent under applicable law, our rights to the trademarks. This Annual Report on Form 10-K also contains trademarks and trade names that are the
property of other companies and licensed to us.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
FORM 10-K
ANIKA THERAPEUTICS, INC.
For Fiscal Year Ended December 31, 2023

CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS

This Annual Report on Form 10-K contains "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933 and
Section 21E of the Securities Exchange Act of 1934 concerning our business, consolidated financial condition, and results of operations. The Securities and
Exchange Commission, or SEC, encourages companies to disclose forward-looking statements so that investors can better understand a company’s future
prospects  and  make  informed  investment  decisions.  Forward-looking  statements  are  subject  to  risks  and  uncertainties,  many  of  which  are  outside  our
control,  which  could  cause  actual  results  to  differ  materially  from  these  statements.  Therefore,  you  should  not  rely  on  any  of  these  forward-looking
statements.  Forward-looking  statements  can  be  identified  by  such  words  as  "will,"  "likely,"  "may,"  "believe,"  "expect,"  "anticipate,"  "intend,"  "seek,"
"designed," "develop," "would," "future," "can," "could," and other expressions that are predictions of or indicate future events and trends and that do not
relate  to  historical  matters.  All  statements  other  than  statements  of  historical  facts  included  in  this  Annual  Report  regarding  our  strategies,  prospects,
financial  condition,  operations,  costs,  plans,  and  objectives  are  forward-looking  statements.  Examples  of  forward-looking  statements  include,  among
others,  statements  regarding  expected  future  operating  results,  expectations  regarding  the  timing  and  receipt  of  regulatory  results,  anticipated  levels  of
capital expenditures, and expectations of the effect on our financial condition of claims, litigation, and governmental and regulatory proceedings.

Please  refer  to  "Item  1A.  Risk  Factors"  for  important  factors  that  we  believe  could  cause  actual  results  to  differ  materially  from  those  in  our
forward-looking  statements.  Any  forward-looking  statement  made  by  us  in  this  Annual  Report  on  Form  10-K  is  based  only  on  information  currently
available to us and speaks only as of the date on which it is made. We undertake no obligation to publicly update any forward-looking statement, whether
written or oral, that may be made from time to time, whether as a result of new information, future developments, or otherwise.

4

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The risk factors detailed in Item 1A entitled “Risk Factors” in this Annual Report on Form 10-K are the risks that we believe are material to our
investors and a reader should carefully consider them. Those risks are not all of the risks we face and other factors not presently known to us or that we
currently believe are immaterial may also affect our business if they occur. The following is a summary of the risk factors detailed in Item 1A:

RISK FACTOR SUMMARY

●

●

●

●

Our financial performance depends on sales growth and increasing demand for our legacy and acquired product portfolios, and we may not be
able to successfully manage the recent, and future, expansion of our operations.

Substantial competition could materially affect our financial performance.

Our business may be adversely affected if consolidation in the healthcare industry leads to demand for price concessions or if we are excluded
from being a supplier by a group purchasing organization or similar entity.

A significant portion of our Osteoarthritis, or OA Pain Management revenues are derived from a small number of customers, the loss of which
could materially adversely affect our business, financial condition and results of operations.

● We experience quarterly sales volume variation, which makes our future results difficult to predict and makes period-to-period comparisons

potentially not meaningful.

● We rely on a small number of suppliers for certain key raw materials and a small number of suppliers for a number of other materials required
for the manufacturing and delivery of our products, and disruption could materially adversely affect our business, financial condition, and
results of operations.

●

●

Our manufacturing processes involve inherent risks, and disruption could materially adversely affect our business, financial condition, and
results of operations.

Failure to comply with current or future national, international, federal or state laws and regulations, regulatory guidance and industry standards
relating to data protection, privacy and information security, including restrictive European regulations, could lead to government enforcement
actions (which could include civil or criminal penalties), private litigation, and/or adverse publicity and could negatively affect our operating
results and business.

● We are increasingly dependent on sophisticated information technology and if we fail to effectively maintain or protect our information systems

or data, including from data breaches, our business could be adversely affected.

● We may require additional capital in the future. We cannot give any assurance that such capital will be available at all or on terms acceptable to

us, and if it is available, additional capital raised by us could dilute your ownership interest or the value of your shares.

●

Our license agreements with Mitek provide substantial control of Monovisc and Orthovisc in the United States to Mitek, and Mitek’s actions
could have a material impact on our business, financial condition and results of operations.

● We may not succeed in our integration and buildout of our direct sales channel in the United States, and our failure to do so could negatively

impact our business and financial results.

● We are dependent upon marketing and distribution partners and the failure to maintain strategic alliances on acceptable terms will have a

material adverse effect on our business, financial condition, and results of operations.

●

Sales of our products are largely dependent upon third-party health insurance coverage and reimbursement and our performance may be harmed
by health care cost containment initiatives or decisions of individual third-party payers.

● We are facing a longer than expected pathway to commercialize our Cingal product in the United States, and we may face other unforeseen

difficulties in achieving regulatory approval for Cingal, which could affect our business and financial results.

●

●

●

●

●

Failure to obtain, or any delay in obtaining, U.S. Food and Drug Administration, or FDA, or other U.S. and foreign governmental clearances or
approvals for our products may have a material adverse effect on our business, financial condition and results of operations.

Once obtained, we cannot guarantee that the FDA or international product clearances or approvals will not be withdrawn or that relevant
agencies will not require other corrective action, and any withdrawal or corrective action could materially affect our business and financial
results.

Our operations and products are subject to extensive regulation, compliance with which is costly and time consuming, and our failure to comply
may result in substantial penalties, including recalls of our products.

Any changes in the FDA or international regulations related to product approval or approval renewal, including those currently under
consideration by the FDA or those that apply retroactively, could adversely affect our competitive position and materially affect our business
and financial results.

Notices of inspectional observations or deficiencies from the FDA or other regulatory bodies require us to undertake corrective and preventive
actions or other actions to address the FDA’s or other regulatory bodies’ concerns. These actions could be expensive and time-consuming to
complete and could impose an additional burden on us.

● We may rely on third parties to support certain aspects of our clinical trials. If these third parties do not successfully carry out their contractual
duties or meet expected deadlines, we may not be able to obtain regulatory clearance or approval or commercialize our products, and our
business could be substantially harmed.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
● We may have difficulty managing our growth.

● We may not generate the expected benefits of our acquisitions, and the ongoing integration of those acquisitions could disrupt our ongoing

business, distract our management and increase our expenses.

5

 
 
 
 
 
● We expect to continue to actively explore inorganic growth as a part of our future growth strategy, which exposes us to a variety of risks that

could adversely affect our business operations.

●

As our international sales and operations grow, we could become increasingly subject to additional economic, political, and other risks that
could harm our business.

● We may be unable to adequately protect our intellectual property rights, which could have a material impact on our business and future financial

results.

●

●

Our stock price may be highly volatile, and we cannot assure you that market making in our common stock will continue.

Our charter documents contain anti-takeover provisions that may prevent or delay an acquisition of our company.

● We have been, and may continue to be, subject to the actions of activist stockholders, which could cause us to incur substantial costs, divert

management’s and the board’s attention and resources, and have an adverse effect on our business and stock price.

This  section  contains  forward-looking  statements.  You  should  refer  to  the  explanation  of  the  qualifications  and  limitations  on  forward-looking

statements beginning on page 4.

6

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 1. BUSINESS

Overview

PART I

Founded  in  1992,  Anika  Therapeutics,  Inc.  is  a  global  joint  preservation  company  that  creates  and  delivers  meaningful  advancements  in  early
intervention orthopedic care. Based on our collaborations with clinicians to understand what they need most to treat their patients, we develop minimally
invasive  products  that  restore  active  living  for  people  around  the  world.  We  are  committed  to  leading  in  high  opportunity  spaces  within  orthopedics,
including osteoarthritis, or OA pain management, regenerative solutions, sports medicine and Arthrosurface joint solutions (previously Bone Preserving
Joint Solutions).

We  have  over  thirty  years  of  global  expertise  developing,  manufacturing  and  commercializing  products  based  on  our  hyaluronic  acid,  or  HA,
technology platform. HA is a naturally occurring polymer found throughout the body that is vital for proper joint health and tissue function. Our proprietary
technologies for modifying the HA molecule allow product properties to be tailored specifically to multiple uses, including enabling longer residence time
to support OA pain management and creating a solid form of HA called Hyaff, which is the platform for some of our regenerative solutions portfolio.

In  early  2020,  we  expanded  our  overall  technology  platform,  product  portfolio,  and  significantly  increased  our  commercial  infrastructure,
especially  in  the  United  States,  through  our  strategic  acquisitions  of  Parcus  Medical,  LLC,  or  Parcus  Medical,  a  sports  medicine  and  instrumentation
solutions provider, and Arthrosurface, Inc., or Arthrosurface, a company specializing in bone preserving partial and total joint replacement solutions. These
acquisitions have ignited the transformation of our company by augmenting our HA-based OA pain management and regenerative products with a broad
suite of products and capabilities focused on early intervention joint preservation primarily in upper and lower extremities such as shoulder, foot/ankle,
knee and hand/wrist.

Note: Illustration of available treatments does not reflect Anika’s full product portfolio

7

 
 
 
 
 
 
 
 
 
 
 
Strategy

Beginning  in  2020,  we  launched  our  transformational  strategy  to  diversify  our  revenue  in  the  global  joint  preservation  markets,  expanding  our
addressable  global  market  from  the  over  $1  billion  global  OA  pain  management  market  to  the  over  $8  billion  global  joint  preservation  market  (which
includes faster growing regenerative medicine, sports medicine and extremities segments). This multi-year journey, which accelerated with the acquisitions
of Arthrosurface and Parcus Medical, through which we entered into the sports medicine and bone preserving joint technology markets with a hybrid direct
sales model that also expanded the commercial capabilities for our regenerative solutions portfolio, leverages our existing leadership position and expertise
in  the  HA-based  OA  pain  management  market,  and  has  included  strengthening  our  team  and  infrastructure  with  investments  in  people,  systems  and
processes. The combination of Anika with Arthrosurface and Parcus Medical enhances the value to the clinician and their patient through a unique product
portfolio  suited  to  early  intervention  orthopedics  that  leverages  HA’s  regenerative  attributes  for  natural,  faster  healing.  In  the  upcoming  years,  we  will
continue to invest in our research and development pipeline and strengthen our commercial capabilities to position our product portfolio for the needs of
clinicians that practice in ambulatory surgical centers, or ASCs, and hospitals, as well as expand into new geographic areas to drive accelerated growth and
profitability. As our pipeline evolves, we intend to expand our HA expertise by selectively developing and offering solutions for joint preservation and
regenerative solutions targeted at procedures that are performed in the ASCs and to focus on completing clinical development for key products we sell
outside the United States, (i.e. Cingal and Hyalofast), to gain approval for entry into the large U.S. market.

As we look forward, our business is positioned to capture value within our target markets in joint preservation. We believe our future success will

be driven by our:

● Over  30  years  of  experience  in  HA-based  regenerative  solutions  and  early  intervention  orthopedics  combined  under  new  seasoned
leadership with a strong financial foundation for future investment in meaningful solutions for our customers and their patients;

● Utilizing HA-based technology and manufacturing expertise to provide new and differentiated solutions in next generation OA Pain

Management and regenerative solutions markets;

●

●

Robust network of stakeholders in our target markets to identify evolving unmet patient treatment needs;

Prioritized investment in differentiated pipeline of regenerative solutions, bone preserving implants and sports medicine solutions;

● Global commercial expertise, which we will leverage to drive growth across our product portfolio, including an intentional site of care

focus in ASCs in the United States and continued international expansion;

● Opportunity to pursue strategic inorganic growth opportunities, including potential partnerships and smaller acquisitions, technology

licensing, and leveraging our strong financial foundation and operational capabilities; and

●

Energized and experienced team focused on strong values, talent, and culture.

8

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Products

OA Pain Management

Our OA Pain Management product family consists of:

● Monovisc and Orthovisc, our single- and multi-injection, HA-based viscosupplement product offerings indicated to provide pain relief
from OA conditions solely for use in the knee. Our OA Pain Management products are generally administered to patients in an office
setting. In the United States, Monovisc and Orthovisc are marketed exclusively by DePuy Synthes Mitek Sports Medicine, part of the
Johnson & Johnson Medical Companies, or Mitek. In December 2011, we entered into a fifteen-year licensing agreement with Mitek
to exclusively market Monovisc in the United States through December 2026. In December 2003, we entered into a ten-year licensing
agreement to exclusively market Orthovisc in the United States. Mitek extended this agreement for additional five-year terms in 2007,
2012,  2017  and  most  recently  in  August  2022.  The  current  agreement  expires  in  December  2028  unless  extended  at  the  option  of
Mitek.  The  Monovisc  and  Orthovisc  products  have  been  the  market  leaders,  based  on  combined  overall  revenue  in  the
viscosupplement  market,  since  2018.  Internationally,  we  market  our  OA  Pain  Management  products  directly  through  a  worldwide
network of commercial distributors.

●

Cingal, our novel, next-generation, non-opioid, single-injection OA Pain Management product consisting of our proprietary cross-
linked HA material combined with a fast-acting steroid, designed to provide both short- and long-term pain relief. Cingal is CE marked
and for several years has been sold outside the United States directly in over 35 countries through our network of distributors. In the
United States, Cingal is a pipeline product in which we are awaiting feedback from the FDA on proposed non-clinical next steps for
U.S. regulatory approval; for additional information please see the section captioned “Item 1. Business—Research and Development.”

Joint Preservation and Restoration

Our Joint Preservation and Restoration product family, consists of: 

● Regenerative Solutions. Our portfolio of orthopedic regenerative solutions leveraging our proprietary technologies based on HA and
Hyaff,  which  is  a  solid  form  of  HA.  These  products  include:  Tactoset  Injectable  Bone  Substitute,  an  HA-enhanced  injectable  bone
repair therapy designed to treat insufficiency fractures and for augmenting hardware fixation, such as suture anchors; Integrity Implant
System,  or  Integrity,  an  HA-based  scaffold  with  bone  and  tendon  fixation  components  and  arthroscopic  delivery  instruments  that  is
designed to protect an injured tendon and promote healing in rotator cuff repair and other tendon procedures and received clearance by
the  FDA  in  August  2023  for  commercial  use  in  the  United  States  and  initiated  limited  market  release  in  November  2023;  and
Hyalofast, a biodegradable support for human bone marrow mesenchymal stem cells used for cartilage regeneration and as an adjunct
for microfracture surgery. Tactoset and Integrity are commercialized principally in the United States, whereas Hyalofast is currently
available outside the United States in over 30 countries within Europe, South America, Asia, and certain other international markets. In
the United States, Hyalofast is a pipeline product under a pivotal Investigational Device Exemption, or IDE, clinical trial and is not
available  for  commercial  sale.  For  additional  information,  please  see  the  section  captioned  “Item  1.  Business—Research  and
Development.”

● Sports Medicine. Our line of soft tissue repair solutions is used by surgeons to repair and reconstruct damaged ligaments and tendons
resulting  from  sports  injuries,  trauma  and  disease.  These  more  traditional  sports  medicine  solutions  include  screws,  sutures,  suture
anchors, grafts and other surgical systems that facilitate surgical procedures on the shoulder, knee, hip, upper and lower extremities,
and other soft tissues. Our X-Twist Fixation System using PEEK (Polyetheretherketone) material, was fully launched in early 2023 for
broad market use in the United States and certain international markets, is a platform of knotless and knotted suture anchors designed
for soft tissue repairs in the shoulder and other extremities. X-Twist Biocomposite, the bioabsorbable version of the X-Twist fixation
system, received FDA clearance in August 2023 and launched in early 2024.

● Arthrosurface Joint Solutions. Our portfolio of more than 150 bone preserving joint solutions, including partial joint replacement, joint
resurfacing, and minimally invasive and bone sparing implants, is designed to treat upper and lower extremity orthopedic conditions as
well  as  knee  and  hip  conditions  caused  by  arthritic  disease,  trauma  and  injury.  These  products  span  multiple  joints  including
OVOMotion with Inlay Glenoid for the shoulder, WristMotion wrist arthroplasty system, as well as foot and ankle, and knee products
generally  intended  to  restore  a  patient’s  natural  anatomy  and  movement.  Our  recently  launched  RevoMotion  Reverse  Shoulder
Arthroplasty  System,  is  a  differentiated  reverse  shoulder  implant  system  addressing  the  largest  portion  of  the  shoulder  replacement
market.  These  products  often  are  used  to  treat  patients  with  OA  progression  beyond  where  our  OA  Pain  Management  products  can
allow the patients to retain an active lifestyle when early surgical intervention becomes preferable.

9

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
We  currently  commercialize  our  Joint  Preservation  and  Restoration  products  in  the  United  States  by  selling  to  hospitals  and  ASCs,  through  an

independent network of sales representatives and distributors, and utilize our distributor network for sales in certain international markets.

Non-Orthopedic 

Our Non-Orthopedic product family consists of legacy HA-based products that are marketed principally for non-orthopedic applications. These
products include: Hyvisc, our high molecular weight injectable HA veterinary product for the treatment of joint dysfunction in horses due to non-infectious
synovitis associated with equine OA; Hyalobarrier, an anti-adhesion barrier indicated for use after abdominal-pelvic surgeries; Hyalomatrix, used for the
treatment of complex wounds such as burns and ulcers, as well as products used in connection with the treatment of ears, nose and throat disorders, and
ophthalmic products, including injectable, high molecular weight HA products such as Anikavisc and Nuvisc, used as viscoelastic agents in ophthalmic
surgical procedures such as cataract extraction and intraocular lens implantation. These Non-Orthopedic products are sold through commercial sales and
marketing partners around the world.

Sales Channels

A  majority  of  our  products  are  used  by  clinicians  and  surgeons  in  one  of  three  environments:  office-based  procedures  usually  focused  on
injections, hospital operating rooms and ASCs, which are clinics outside of a normal hospital setting that are often at least partially physician-owned. These
medical care delivery environments typically require different commercial approaches and have distinct call points, which requires diversity in our sales
approach. For instance, our OA Pain Management product family and certain products in our Non-Orthopedic category are almost entirely utilized in an
office-based setting while our Joint Preservation and Restoration and certain of our Non-Orthopedic products are almost exclusively consumed in hospital
operating rooms or ASCs.

As a result of these distinctions, we employ multiple sales models in the United States to ensure that we are meeting the needs of our customers
and  other  healthcare  system  stakeholders.  For  many  years,  we  have  maintained  a  mutually  beneficial  commercial  partnership  with  Mitek,  which  sells
Monovisc  and  Orthovisc  in  the  United  States.  For  this  arrangement  with  Mitek,  we  sell  the  Monovisc  and  Orthovisc  products  that  we  manufacture  to
Mitek, and we also receive from Mitek a royalty on their end user sales of these products in the United States. We have U.S. commercial partnerships for
other products in our OA Pain Management and Non-Orthopedic product families. Under these commercial partnerships, we sell our products directly to
our partners, who perform downstream sales and marketing activities to customers and end-users. In addition to a transfer price, we may also structure our
arrangements to receive a royalty on end user sales.

With our expanded commercial infrastructure as a result of the Parcus Medical and Arthrosurface acquisitions, we sell our Joint Preservation and
Restoration  family  directly  to  clinicians,  including  hospitals  and  ASCs,  through  a  hybrid  approach  with  our  Anika  sales  team  and  large  network  of
independent third-party distributors. Following the acquisitions, we integrated our U.S. commercial organization, including cross training our sales team to
sell  the  consolidated  Joint  Preservation  and  Restoration  product  portfolio.  Within  this  framework,  we  employ  selling  models  that  seek  to  maximize  the
benefit  for  our  company  and  customers,  including  in  certain  instances,  contracts  with  group  purchasing  organizations  and  certain  fixed-price  delivery
models.

Outside of the United States, we market and sell our products using a worldwide network of commercial partners to provide a solid foundation for
future  revenue  growth  and  territorial  expansion.  Our  relationships  with  these  partners  are  generally  structured  such  that  we  sell  our  products  to  these
partners directly while they, with global support from our team, perform the in-country sales and marketing activities to drive growth and adoption of our
products  locally.  We  expect  to  generally  maintain  this  model  for  the  foreseeable  future,  while  also  selectively  evaluating  other  options  and  being
opportunistic about adopting other sales models, including direct sales, in certain jurisdictions.

We believe that our overall sales approach provides our business with a strong base to drive revenue growth as we continue to grow and scale our
commercial infrastructure. We will continue to focus on expanding our own commercial capabilities, including with respect to market access, innovative
sales and delivery models, and improved logistics management.

Manufacturing

We manufacture all of our HA-based products, including all our OA Pain Management products and certain additional products, at our facility in
Bedford,  Massachusetts,  where  we  have  developed  significant  manufacturing  expertise  around  procedures  such  as  homogenized  mixing  and  filling  of
highly viscous liquids and manipulation of solid HA into scaffolds or other presentations. We manufacture much of our sports medicine soft tissue repair
products at our facility in Sarasota, Florida and we manufacture our bone preserving joint products and certain elements of our soft tissue repair portfolio
utilizing third-party contract manufacturing organizations.

10

 
 
 
 
 
 
 
 
 
 
 
 
 
The raw materials necessary to manufacture our products are generally available from multiple sources. However, we rely on a small number of
suppliers for certain key raw materials and other components, parts and disposables required for the manufacturing and delivery of these products, Any
prolonged interruption of operations or significant reduction in the capacity or performance capability of any of our manufacturing facilities, or with any of
our key suppliers, could have a material adverse effect on our operations.

Research and Development

Our  research  and  development  efforts  consist  of  the  development  of  new  medical  applications  that  address  true  unmet  needs  that  leverage  our
technology platforms, including new implant designs, the development of intellectual property with respect to our technology platforms and new products,
the management of clinical trials for certain product candidates, the preparation and processing of applications for regulatory clearances and approvals, and
process development and scale-up manufacturing activities for our existing and new product development initiatives. For 2023, 2022, and 2021, research
and development expenses were $32.7 million, $28.2 million and $27.3 million, respectively. The increase in 2023 was primarily due to costs to ensure
compliance  with  growing  regulatory  requirements  globally,  such  as  EU  MDR,  as  well  as  new  product  development  in  our  research  and  development
pipeline,  led  by  Integrity,  which  received  FDA  clearance  in  August  2023  and  was  launched  with  first  surgeries  in  rotator  cuff  repair  and  other  tendon
procedures in November 2023. We anticipate that we will continue to commit resources to research and development activities, primarily for new product
development, regulatory compliance, scale-up manufacturing activities, and pre-clinical and clinical activities.

Our  new  product  development  efforts  focus  on  products  in  four  large  and  growing  orthopedic  markets  to  drive  long-term  growth:  OA  pain
management, regenerative solutions, sports medicine soft tissue repair and Arthrosurface joint solutions. In order to better inform and target our research
and development investment, we routinely interact with key external stakeholders, including clinicians, to encompass customer and patient insights in our
development process that help ensure we bring needed solutions to the market. As we move forward, we plan to continue to invest in novel and meaningful
new products for our target markets based on our core capabilities, including further expanding our regenerative HA technology platform.

Our development focus for OA Pain Management will continue to be on bringing Cingal, our next-generation, non-opioid, single-injection HA-
based OA pain product combined with a fast-acting steroid, to the U.S. market. In 2022, we completed a third Phase III clinical trial for Cingal, which
achieved its primary endpoint. We have been actively engaging with the U.S. Food and Drug Administration, or the FDA, on next steps for U.S. regulatory
approval. In parallel, we are exploring the potential to advance Cingal through commercial partnerships in the U.S. and select Asian markets. These efforts
will inform next steps, including if and how to proceed with another clinical trial in the United States.

Development for our Joint Preservation and Restoration product family is focused in several key areas. We are developing novel solutions and line
extensions  across  our  regenerative  solutions,  sports  medicine  soft  tissue  repair  and  Arthrosurface  joint  solutions  product  families,  largely  targeting  the
faster-growing extremities segments such as the shoulder. These include enhancements to existing regenerative solutions such as our fast-growing Tactoset
Injectable  Bone  Substitute,  which  received  an  additional  510(k)  clearance  in  2021  for  hardware  augmentation,  along  with  new  soft  tissue  fixation  and
extremities  products  like  our  X-Twist  Fixation  System  that  received  510(k)  clearance  from  the  FDA  in  2022  and  our  RevoMotion  reverse  shoulder
arthroplasty system, which received 510(k) clearance in 2021, as well as our Integrity Implant System, a regenerative HA-based patch product targeted at
rotator cuff repair that received 510(k) clearance in August 2023 and is now in limited market release. We also launched our X-Twist Biocomposite, the
bioabsorbable  version  of  the  X-Twist  Fixation  System,  in  early  2024.  In  addition,  we  made  significant  progress  in  2023  on  our  clinical  trial  to  support
approval in the United States for Hyalofast, our single stage, off the shelf, cartilage repair therapy, currently sold only outside the United States. We have
fully  enrolled  the  200  patients  targeted  in  the  trial.  This  pivotal  trial  has  a  two-year  follow-up  protocol  expected  to  be  achieved  in  early  2025  before
regulatory submission is completed.  We are targeting to file the first module as part of a modular PMA in 2024 which is the first step in seeking FDA
approval for Hyalofast in the U.S. The final module of the PMA will be filed in 2025 once the clinical data becomes available to be submitted to the FDA.

Intellectual Property

We  seek  patent  and  trademark  protection  for  our  key  technologies,  products  and  product  improvements,  both  in  the  U.S.  and  in  select  foreign
countries.  When  determined  appropriate,  we  enforce  and  plan  to  enforce  and  defend  our  patent  and  trademark  rights.  While  we  rely  on  our  patent  and
trademark portfolio to provide us with competitive advantages as it relates to our existing and future product lines, it is not our sole source of protection.
We also rely upon trade secrets and continuing technological innovations to develop and maintain our competitive position.

11

 
 
 
 
 
 
 
 
 
 
 
Competition

We compete with many companies including large pharmaceutical firms and large and specialized medical device companies across our product
lines. For our OA Pain Management products, our principal competitors include Sanofi Genzyme, Zimmer Biomet, Inc., Bioventus Inc., Avanos Medical,
Inc., and Ferring Pharmaceuticals, as well as other companies that are commercializing or developing competitive products. Our key competitors for our
Joint Preservation and Restoration products include Arthrex, Inc., the DePuy Synthes Companies of Johnson & Johnson, Smith & Nephew PLC., Stryker
Corporation, and Zimmer Biomet, Inc., as well as certain smaller organizations that focus on subsets of the larger industry, such as Catalyst OrthoScience,
Enovis  Corporation  and  Shoulder  Innovations.  Many  of  the  larger  companies  have  substantially  greater  financial  resources,  larger  research  and
development  staffs,  more  extensive  marketing  and  manufacturing  organizations,  and  more  experience  in  regulatory  processes  than  we  have.  We  also
compete  with  academic  institutions,  government  agencies,  and  other  research  organizations  that  may  be  involved  in  the  research  and  development  and
commercialization  of  products.  Many  of  our  competitors  also  compete  against  us  in  securing  relationships  with  collaborators  for  their  research  and
development and commercialization programs.

We compete with other market participants primarily on the efficacy of our products, our products’ reputation for safety, and the breadth of our
overall  product  portfolio.  Other  factors  that  impact  competition  in  our  industry  are  the  timing  and  scope  of  regulatory  approvals,  the  availability  of
manufacturing supplies, raw materials and finished product supply, marketing and sales capability, reimbursement coverage, product pricing, and patent
protection. Some of the principal factors that may affect our ability to compete in our target markets include:

●

●

●

●

●

●

●

The quality and breadth of our continued development of our product portfolio;

Our ability to complete successful clinical studies and obtain FDA marketing and foreign regulatory clearances/approvals;

Our  ability  to  successfully  source  raw  materials  and  components  from  suppliers  at  price  points  that  are  in-line  with  our  financial
objectives, as well as deliver them on schedule to meet the needs of our operational and commercial organizations;

Our ability to continue to strengthen our commercial infrastructure, integrate our sales channels and execute our sales strategies;

The execution by our key partners of their commercial strategies for our products and our ability to manage our relationships with those
key partners;

Our ability to recruit and retain skilled employees; and

The availability of capital resources to fund strategic activities related to the significant expansion of our business or product portfolio,
including through acquisitions of third parties or certain assets.

We are aware of several companies that are developing and/or marketing competitive products. In some cases, competitors have already obtained
product approvals, submitted applications for approval, or commenced human clinical studies, either in the United States or in certain foreign countries. All
our  products  face  substantial  competition.  There  is  a  risk  that  we  will  be  unable  to  compete  effectively  against  our  current  or  future  competitors.
Additionally, legislation and regulation aimed at curbing rising healthcare costs has resulted in a consolidation trend in the healthcare industry to create
larger companies, including hospitals, with greater market power. In turn, this has led to greater and more intense competition in the provision of products
and services to market participants. Important market makers, like group purchasing organizations and integrated delivery networks, have increased their
negotiating  leverage,  and  if  these  market  makers  demand  significant  price  concessions  or  if  we  are  excluded  as  a  supplier  by  these  market  makers,  our
product revenue could be adversely impacted.

12

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Governmental Regulation

The clinical development, manufacturing, and marketing of our products are subject to governmental regulation in the United States, the European
Union, and other territories worldwide, including pursuant to the Federal Food, Drug, and Cosmetic Act, or FDCA, in the United States. Medical products
regulated  by  the  FDA  and  other  regulatory  authorities  are  generally  classified  as  drugs,  biologics,  or  medical  devices,  and  the  current  classification
standards for our current or future products may be altered over time due to new regulations or augmented interpretation of data or current regulations.

Regulation of Medical Devices

Medical devices intended for human use are classified into three categories (Class I, II or III) based on the controls deemed reasonably necessary
by  the  FDA  to  assure  their  safety  and  effectiveness.  Class  I  and  II  devices  are  subject  to  the  510(k)  premarket  notification  process  in  order  to  be
commercially distributed, unless exempt Class III devices must obtain FDA approval of their premarket approval applications, or PMAs, in order to be
commercially distributed.

Some of our current products are subject to premarket notification and clearance under section 510(k) of the FDCA. To obtain 510(k) clearance, a
company  must  submit  to  the  FDA  a  premarket  notification,  or  510(k),  demonstrating  that  the  proposed  device  is  “substantially  equivalent”  to  a  legally
marketed device, known as a “predicate device.” A device is substantially equivalent if, with respect to the predicate device, it has the same intended use
and has either (i) the same technological characteristics, or (ii) different technological characteristics, but the information provided in the 510(k) submission
demonstrates that the device does not raise new questions of safety and effectiveness and is at least as safe and effective as the predicate device.

The FDA aims to review and issue a determination on a 510(k) submission within 90 calendar days. As a practical matter, 510(k) clearance often

takes longer. The FDA may require additional information, including clinical data, to make a determination regarding substantial equivalence.

If  the  FDA  agrees  that  the  device  is  substantially  equivalent,  it  will  grant  510(k)  clearance  to  commercially  market  the  device.  If  the  FDA
determines that the device is ”not substantially equivalent” to a predicate device, the device is automatically designated as a Class III device. The device
sponsor must then fulfill more rigorous PMA requirements or may be able to request a risk-based classification determination for the device in accordance
with the ‘‘de novo’’ process, which is a route to market for novel medical devices that are low to moderate risk and are not substantially equivalent to a
predicate device.

After  a  device  receives  510(k)  clearance,  any  modification  that  could  significantly  affect  its  safety  or  effectiveness,  or  that  would  constitute  a
major change or modification in its intended use, will require a new 510(k) clearance or, depending on the modification, PMA approval. The determination
as to whether a modification could significantly affect the device’s safety or effectiveness is initially left to the manufacturer using available FDA guidance.
Many minor modifications are accomplished by a ‘‘letter to file’’, in which the manufacturer documents the rationale for the change and why a new 510(k)
submission is not required. However, the FDA may review such letters to file to evaluate the regulatory status of the modified device at any time and may
require the manufacturer to cease marketing and recall the modified device until 510(k) clearance or PMA approval is obtained.

Some of our devices are Class III devices that require PMA approval before they can be marketed. In a PMA, the manufacturer must demonstrate
that  the  device  is  reasonably  safe  and  effective,  and  the  PMA  must  be  supported  by  extensive  data,  including  data  from  preclinical  studies  and  clinical
trials. The PMA must also contain a full description of the device and its components, a full description of the methods, facilities and controls used for
manufacturing, and proposed labeling. If the FDA accepts the application for review, it has 180 days under the FDCA to complete its review of a PMA,
although in practice, the FDA’s review often takes significantly longer, and can take up to several years. An advisory committee of experts from outside the
FDA may be convened to review and evaluate the application and provide recommendations to the FDA as to the approvability of the device. The FDA
may or may not accept the advisory committee’s recommendation. In addition, the FDA will generally conduct a pre-approval inspection of the applicant or
its third-party manufacturers’ or suppliers’ manufacturing facility or facilities to ensure compliance with the QSR.

The  FDA  will  approve  the  new  device  for  commercial  distribution  if  it  determines  that  the  data  and  information  in  the  PMA  constitute  valid
scientific evidence and that there is reasonable assurance that the device is safe and effective for its intended use(s). Certain changes to an approved device
that affect the safety or effectiveness of the device, require submission of a PMA supplement or in some cases a new PMA.

Regulation of a Drug

In order to be marketed, new drugs require FDA approval of a New Drug Application, or NDA. Satisfaction of the FDA approval requirements for
drugs typically takes several years and the actual time required may vary substantially based on the type, complexity and novelty of the product. None of
our products are currently approved under an NDA.

13

 
 
 
 
 
 
 
 
 
 
 
 
 
 
The steps for obtaining FDA approval of an NDA to market a drug in the United States include:

●

●

●

●

●

●

●

completion of preclinical laboratory tests, animal studies and formulation studies under the FDA’s Good Laboratory Practices
regulations;         

submission to the FDA of an Investigational New Drug Application, or IND, for human clinical testing, which must become effective
before human clinical trials may begin and Institutional Review Board, or IRB, approval at each clinical site before the trials may be
initiated;        

performance of adequate and well-controlled clinical trials in accordance with Good Clinical Practices to establish the safety and
efficacy of the product for each indication;         

submission to the FDA of a user fee (unless a fee waiver applies) and an NDA, which contains detailed information about the Chemistry,
Manufacturing and Control, or CMC, for the product, reports of the outcomes and full data sets of the preclinical testing and clinical
trials, and proposed labeling and packaging for the product;         

satisfactory review of the contents of the NDA by the FDA, including the satisfactory resolution of any questions raised during the
review;

satisfactory completion of an FDA advisory committee review, if applicable;         

satisfactory completion of an FDA inspection of the manufacturing facility or facilities at which the product is produced to assess
compliance with current Good Manufacturing Practices, or cGMP, regulations, to assure that the facilities, methods and controls are
adequate to ensure the product’s identity, strength, quality and purity; and      

●

FDA approval of the NDA including agreement on post-marketing commitments, if applicable.    

After the NDA submission is accepted for filing, the FDA reviews the NDA to determine, among other things, whether the proposed product is
safe and effective for its intended use, and has an acceptable purity profile. A drug-drug combination product must meet the FDA’s fixed combination rule
and thus demonstrate the contribution of each component to the therapeutic effect.

If  the  FDA  determines  the  application,  the  manufacturing  process  or  manufacturing  facilities  are  not  acceptable,  it  will  either  not  approve  the
NDA or issue a complete response letter in which it will outline the deficiencies in the NDA. If a complete response letter is issued, the applicant may
either resubmit the NDA to address all deficiencies identified in the letter, withdraw the application, or request a hearing. Notwithstanding the submission
of any requested additional information, the FDA ultimately may decide that the NDA does not satisfy the regulatory criteria for approval.

The FDA seeks to review standard NDAs in 10 months and priority NDAs in six months, whereupon a review decision is to be made. The FDA does not
always meet its goal dates for standard and priority NDAs and its review goals are subject to change from time to time. 

Clinical Trials

Clinical trials are typically required to support a PMA and an NDA and are sometimes required to support a 510(k) submission. All clinical trials
must be approved by and conducted under the oversight of an IRB for each clinical site. Clinical investigators must obtain informed consent from all study
subjects. After a trial begins, we, the FDA or the IRB could suspend or terminate a clinical trial at any time for various reasons, including a belief that the
risks  to  study  subjects  outweigh  the  anticipated  benefits.  Information  about  certain  clinical  studies  must  be  submitted  with  specific  timeframes  to  the
National Institutes of Health for public dissemination at www.clinicaltrials.gov. All clinical investigations of devices to determine safety and effectiveness
must  be  conducted  in  accordance  with  the  FDA’s  investigational  device  exemption,  or  IDE,  regulations  which  govern  investigational  device  labeling,
prohibit promotion of the investigational device, and specify an array of recordkeeping, reporting and monitoring responsibilities of study sponsors and
study investigators. If the device presents a ‘‘significant risk’’ as defined by the FDA, to human health, the FDA requires the device sponsor to submit an
IDE application to the FDA, which must be approved prior to commencing human clinical trials. A significant risk device is one that presents a potential
for serious risk to the health, safety or welfare of a patient and either is implanted, purported or represented to be used in supporting or sustaining human
life, is for a use that is substantially important in diagnosing, curing, mitigating or treating disease or otherwise preventing impairment of human health, or
otherwise presents a potential for serious risk to a subject. A clinical trial may begin 30 days after receipt of the IDE by the FDA unless the FDA notifies
the company that the investigation may not begin.

14

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If an IDE application is approved by the FDA and one or more IRBs, human clinical trials may begin at a specific number of investigational sites
with  a  specific  number  of  patients,  as  approved  by  the  FDA.  If  the  device  is  considered  a  ‘‘non-significant  risk’’  IDE  submission  to  the  FDA  is  not
required. Instead, only approval from the IRB overseeing the investigation at each clinical trial site is required.  

For a new drug, an IND application must be submitted prior to the initiation of the clinical study and contain information on animal pharmacology

and toxicology studies, manufacturing, and clinical protocols and investigator information.

Some preclinical testing may continue after the IND application is submitted. The IND must become effective before human clinical trials may
begin. An IND will automatically become effective 30 days after receipt by the FDA, unless before that time the FDA raises concerns or questions about
issues such as the conduct of the trials and/or supporting preclinical data as outlined in the IND application and places the trial on clinical hold. In that case,
the IND sponsor and the FDA must resolve any outstanding FDA concerns or questions before clinical trials can proceed.

For purposes of NDA approval, human clinical trials are typically conducted in three sequential phases that may overlap:

●

●

●

Phase  1—The  investigational  product  is  initially  introduced  into  healthy  human  subjects  and  tested  for  safety.  In  the  case  of  some
products  for  severe  or  life-threatening  diseases,  especially  when  the  product  may  be  too  inherently  toxic  to  ethically  administer  to
healthy  volunteers,  the  initial  human  testing  is  often  conducted  in  patients.  These  trials  may  also  provide  early  evidence  of  their
effectiveness.

Phase  2—These  trials  are  conducted  in  a  limited  number  of  patients  in  the  target  population  to  identify  possible  adverse  effects  and
safety risks, to preliminarily evaluate the efficacy of the product for specific targeted diseases and to determine dosage tolerance and
optimal dosage.

Phase 3—Phase 3 trials are undertaken to provide statistically significant evidence of clinical efficacy and to further evaluate dosage,
potency,  and  safety  in  an  expanded  patient  population  at  multiple  clinical  trial  sites.  They  are  performed  after  preliminary  evidence
suggesting  effectiveness  of  the  product  has  been  obtained  and  are  intended  to  establish  the  overall  benefit-risk  relationship  of  the
investigational product, and to provide an adequate basis for product approval and physician labeling.

Typically, if a product is intended to treat a chronic disease, safety and efficacy data must be gathered over an extended period, which can range

from six months to three years or more.

During all phases of clinical development, the FDA requires extensive monitoring and auditing of all clinical activities, clinical data, and clinical

trial investigators. Annual progress reports detailing the results of the clinical trials and reports of serious adverse events must be submitted to the FDA.

Post-Approval Requirements

Products manufactured or distributed pursuant to FDA clearances or approvals are subject to continuing regulation by the FDA, including, among
other things, requirements relating to monitoring, record-keeping, advertising and promotion, reporting of adverse experiences, and limitations on industry-
sponsored scientific and educational activities.  

15

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
FDA  regulations  require  that  PMA  and  NDA  approved  products  be  manufactured  in  specific  facilities  and  all  devices  and  drugs  must  be
manufactured  in  accordance  with  the  QSR  and  cGMP  regulations,  respectively.  Manufacturers  and  other  entities  involved  in  the  manufacture  and
distribution  of  cleared  or  approved  devices  or  drugs  are  required  to  register  their  establishments  and  list  their  products  with  the  FDA  and  certain  state
agencies.  Manufacturers  are  subject  to  periodic  announced  and  unannounced  inspections  by  the  FDA  and  certain  state  agencies  for  compliance  with
regulatory requirements. The discovery of violative conditions, including failure to conform to the QSR and cGMP regulations, could result in enforcement
actions.

Products may be promoted only for the cleared or approved indications and in accordance with the provisions of the label. The FDA does not
regulate behavior of physicians in their choice of treatments and physicians may legally prescribe available products for uses that are not described in the
product’s labeling and that differ from those approved or cleared by the FDA. However, the FDA does restrict an applicant’s communications about off-
label use of its products. The FDA and other agencies actively enforce the laws prohibiting the marketing and promotion of off-label uses, and a company
that is found to have improperly marketed or promoted off-label use may be subject to significant liability, including criminal and civil penalties under the
FDCA and False Claims Act, exclusion from participation in federal healthcare programs, and mandatory compliance programs.

The FDA also may require post-marketing testing and surveillance to monitor the effects of a marketed product. Discovery of previously unknown
problems  with  a  product  or  the  failure  to  comply  with  applicable  FDA  requirements  can  have  negative  consequences,  including  adverse  publicity,
restrictions  on  a  product,  and  judicial  or  administrative  enforcement.  The  FDA  has  broad  regulatory  compliance  and  enforcement  powers.  If  the  FDA
determines that we failed to comply with applicable regulatory requirements, it can take a variety of compliance or enforcement actions, including, without
limitation, issuing a Form FDA 483 notice of inspectional observations or a warning letter or untitled letter, imposing civil money penalties, suspending or
delaying issuance of clearances or approvals or refusing to grant clearances or approve pending premarket applications, requiring or requesting product
recall,  imposing  a  total  or  partial  shutdown  of  production,  withdrawal  of  approvals  or  clearances  already  granted,  pursuing  product  seizures,  consent
decrees or other injunctive relief, or criminal prosecution through the Department of Justice. The FDA can also require us to repair, replace, or refund the
cost of devices that we manufactured or distributed. Outside the United States, regulatory agencies may exert a range of similar powers.

EU Regulation

In the European Union, medical devices must be CE marked in order to be marketed. CE marking a device involves working with a notified body
(or in some cases, for the lowest risk class devices, the manufacturer can self-certify) to demonstrate that the device meets all applicable general safety and
performance requirements of the EU medical devices legislation, including that the manufacturer’s Quality Management System is compliant with such
requirements. The EU’s Medical Devices Directive, or MDD, has been replaced by the EU Medical Devices Regulation (Regulation (EU) No 2017/745), or
EU MDR, and which became effective on May 26, 2021. Medical devices lawfully placed on the market pursuant to a certification issued under the MDD
may continue to be marketed during a transitional period.  The timing for this transition has been extended from no later than May 26, 2024 to December
2027 or December 2028, depending on device classification, provided certain conditions are met with regard to compliance with the EU MDR, including
compliance  with  the  requirements  under  the  EU  MDR  in  respect  of  post-market  surveillance,  vigilance  and  registration  and  that  an  agreement  for
conformity assessment under the EU MDR for the device by a notified body under the EU MDR has been enacted to be filed by May 26, 2024. The EU
MDR will generally require increased levels of clinical data as compared to MDD requirements, and all product technical data must comply to the latest
standards regardless of when the product was initially developed.

Drug approval in the European Union follows one of several possible processes: (i) a centralized procedure involving members of the European
Medicines Agency’s Committee for Medicinal Products for Human Use; (ii) a “mutual recognition procedure” in which an individual country's regulatory
agency approves the product followed by “mutual recognition” of this approval by regulatory agencies of other countries; (iii) a decentralized procedure in
which the approval is sought through the regulatory agencies of multiple countries at the same time; or (iv) a national procedure in which the approval is
sought through the regulatory agency of one country.

UK Regulation

The UK formally left the EU on January 31, 2020. The EU and the UK have concluded a trade and cooperation agreement, or TCA, which was
provisionally  applicable  since  January  1,  2021  and  has  been  formally  applicable  since  May  1,  2021.  The  TCA  includes  specific  provisions  concerning
pharmaceuticals, which include the mutual recognition of GMP, inspections of manufacturing facilities for medicinal products and GMP documents issued
but does not provide for wholesale mutual recognition of UK and EU pharmaceutical regulations. At present, Great Britain has implemented EU legislation
on the marketing, promotion and sale of medicinal products through the Human Medicines Regulations 2012 (as amended) (under the Northern Ireland
Protocol, the EU regulatory framework continues to apply in Northern Ireland). The regulatory regime in Great Britain therefore currently aligns with EU
regulations in many ways, however it is possible that these regimes will diverge more significantly in the future now that Great Britain’s regulatory system
is independent from the EU.

16

 
 
 
 
 
 
 
 
 
 
 
In respect of medical devices, since the end of the Brexit transitional period on January 1, 2021, new regulations require medical devices to be
registered  with  the  Medicines  and  Healthcare  products  Regulatory  Agency,  or  MHRA  (the  UK  medicines  and  medical  devices  regulator)  before  being
placed  on  the  Great  Britain  market.  The  MHRA  will  only  register  devices  where  the  manufacturer  or  their  United  Kingdom  Responsible  Person  has  a
registered place of business in the United Kingdom. CE marks issued by EU notified bodies to place medical devices on the market in the EU will remain
valid in the UK up until June 30, 2028 (for CE marks issued under the EU MDD) or June 30, 2030 (for CE marks issued under the EU MDR), following
which a UK Conformity Assessed (“UKCA”) mark will be required to place a device on the Great Britain market. Manufacturers may choose to use the
UKCA  mark  on  a  voluntary  basis  prior  to  such  dates.  UCKA  marking  will,  however,  not  be  recognized  in  the  EU.  The  EU  regulatory  framework  on
medical devices continues to apply in Northern Ireland under the Northern Ireland Protocol and medical devices in Northern Ireland may either carry an
EU  CE  mark  or  a  UK  and  Northern  Ireland  CE  mark  (“CE  UKNI”),  although  devices  bearing  the  CE  UKNI  marking  will  not  be  accepted  on  the  EU
market. 

Other Health Care Laws 

The  delivery  of  our  products  is  subject  to  regulation  by  the  U.S.  Department  of  Health  and  Human  services  and  other  state  and  non-U.S.
government agencies responsible for reimbursement and regulation of health care items and services. U.S. laws and regulations are imposed primarily in
connection with government-funded health care programs, such as Medicare and Medicaid, as well as the government’s interest in regulating the quality
and cost of health care. Other governments also impose regulations in connection with their health care reimbursement programs and the delivery of health
care items and services. 

We are subject to various U.S. federal and state laws pertaining to health care fraud and abuse, including anti-kickback, false claims, self-referrals,
and other health care fraud. In addition, we are subject to U.S. federal and state transparency laws, such as the U.S. Physician Payments Sunshine Act,
which require us to annually disclose certain payments and other transfers of value we make to U.S.-licensed health care practitioners (like physicians,
nurse practitioners, advanced practice registered nurses, and others) and others. Similar laws and regulations pertaining to sales, marketing and advertising
practices exist in the other geographic areas where we operate.

Coverage and Reimbursement

Sales of any medical product depend, in part, on the extent to which such product (or procedures using such product) will be covered by third-
party  payers,  such  as  federal,  state,  and  foreign  government  healthcare  programs,  commercial  insurance  and  managed  healthcare  organizations,  and  the
level of reimbursement for such product or procedure by third-party payers. Decisions regarding the extent of coverage and amount of reimbursement to be
provided are made on a plan-by-plan basis. These third-party payers are increasingly reducing reimbursements for medical products and related procedures.

Factors that payers consider in determining reimbursement are based on whether the product or procedure is:

●

●

●

●

●

a covered benefit under its health plan;

safe, effective and medically necessary;

appropriate for the specific patient;

cost-effective; and

neither experimental nor investigational.

17

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No uniform policy for coverage and reimbursement for medical products or procedures that use medical products exists among third-party payers
in the U.S. Therefore, coverage and reimbursement for products or their procedures can differ significantly from payer to payer. As a result, the coverage
determination process is often a time-consuming and costly process that will require us to provide scientific and clinical support for the use of our products
to  each  payer  separately,  with  no  assurance  that  coverage  and  adequate  reimbursement  will  be  applied  consistently  or  obtained  in  the  first  instance.
Furthermore, rules and regulations regarding reimbursement change frequently, in some cases on short notice, and we believe that changes in these rules
and regulations are likely.

In addition, the U.S. government, state legislatures and foreign governments have continued implementing cost-containment programs, including
price  controls,  restrictions  on  coverage  and  reimbursement  and  requirements  for  substitution  of  generic  products.  Adoption  of  price  controls  and  cost-
containment  measures,  and  adoption  of  more  restrictive  policies  in  jurisdictions  with  existing  controls  and  measures,  could  further  limit  sales  of  any
product. Decreases in third-party reimbursement for any product or procedure that uses our products or a decision by a third-party payer not to cover a
product or related procedure could reduce physician usage and patient demand for the product or procedure and also have a material adverse effect on sales.

Health Care Reform

The Affordable Care Act of 2010, or the ACA, substantially changed the way healthcare is financed by both governmental and private insurers,
and  significantly  affected  the  pharmaceutical  and  medical  device  industry.  The  ACA  contained  a  number  of  provisions,  including  those  governing
enrollment  in  federal  healthcare  programs,  reimbursement  adjustments  and  changes  to  fraud  and  abuse  laws  as  well  as  Medicare  provisions  aimed  at
decreasing  costs,  comparative  effectiveness  research,  an  independent  payment  advisory  board  and  pilot  programs  to  evaluate  alternative  payment
methodologies.  Since  its  enactment,  there  have  been  ongoing  judicial  and  Congressional  efforts  to  modify  or  repeal  certain  aspects  of  the  ACA.  For
example, the Further Consolidated Appropriations Act, 2020, repealed the Cadillac tax, the health insurance provider tax, and the medical device excise
tax. It is impossible to determine whether similar taxes could be instated in the future or how future healthcare reform measures or other efforts, if any, to
challenge repeal or replace the ACA, will impact our business.

Data Privacy and Security Laws

We are also subject to various laws and regulations concerning data privacy in the United States, Europe, and elsewhere, including the General
Data Protection Regulation, or GDPR, in the European Union and the United Kingdom. These legal requirements impose stringent requirements on the
processing, administration, security, and confidentiality of personal data and empower enforcement agencies to impose large penalties for noncompliance.
In addition, various jurisdictions around the world continue to propose new laws that regulate the privacy and/or security of certain types of personal data.
Complying with these laws, if enacted, would require significant resources and leave us vulnerable to possible fines, penalties, litigation, and reputational
harm if we are unable to comply.

Environmental Laws

We  believe  that  we  are  in  compliance  with  all  foreign,  federal,  state,  and  local  environmental  regulations  with  respect  to  our  manufacturing

facilities. The cost of ongoing compliance with such environmental regulations does not have a material effect on our operations.

18

 
 
 
 
 
 
 
 
 
 
 
Seasonality

Our OA Pain Management and Non-Orthopedic product families are generally less seasonal in nature due to the nature of our product mix and
sales channels and order strategies of our customers. In Joint Preservation and Restoration, procedure volumes are normally higher in the fourth quarter due
to several factors including the satisfaction by patients of insurance deductible limits and the time of year patients prefer to have elective procedures. Our
Joint Preservation and Restoration business can be impacted by periodic restrictions on the performance of elective surgical procedures throughout the U.S.
and global markets, the unavailability of physicians and/or changes to their treatment prioritizations, reductions in the levels of healthcare facility staffing
and, in certain instances, and the willingness or ability of patients to seek treatment.

Environmental, Social and Governance

In  2021,  we  began  a  process  to  develop  a  foundational  Environmental,  Social  and  Governance,  or  ESG,  framework  for  our  organization.  This
framework  integrates  our  six  key  corporate  values:  People,  Quality,  Integrity,  Accountability,  Innovation  and  Teamwork.  The  initial  step  in  our  ESG
journey  included  the  completion  of  a  “materiality  assessment”  based  on  the  Sustainability  Accounting  Standards  Board,  or  SASB,  framework.  Our
materiality assessment was a research-intensive and stakeholder-inclusive process and included guidance and insight from external advisors, and crucial
feedback from key internal and external stakeholders, including investors, customers, suppliers, employees, and our board of directors.

As a result of the materiality assessment, we identified the themes that are most important to our stakeholders and our business within traditional
environmental, social and governance pillars. Most immediately, our materiality assessment enabled us to select our six key focus areas, with a goal to be
aligned with SASB standards for the medical device industry. We will continue to assess and update our ESG initiatives as our business grows and as we
implement processes and improvements over time.

In 2023, we committed to evaluate ways to reduce our carbon footprint in its contribution to the Paris Climate agreement which seeks to limit
global warming to 1.5o C and to achieve carbon neutrality by 2050. The first step in our process was to establish a baseline for greenhouse gas, GHG,
emissions by measuring Scope 1 and Scope 2 emissions across our global operations for 2022, and we continued to monitor our emissions in 2023, with
Scope 1 = 1559 mtCO2e and Scope 2 = 2085 mtCO2e. We are a low greenhouse gas, GHG, emitter due to our relatively small operational footprint. We are
committed to evaluating carbon reduction opportunities over the coming years in-line with our business priorities.  

Human Capital Management

We  believe  that  creating  a  diverse,  talented,  and  inclusive  workplace  is  a  central  aspect  to  our  culture,  employee  recruitment,  retention  and
engagement, innovation, operational excellence and overall performance. In turn, this culture and drive for performance is an important factor in our ability
to attract and retain key talent. Our culture is centered around our fundamental values of:

●

●

People: We engage and invest in each other in a community that values diversity and inclusion.

Innovation: We are agile and entrepreneurial in developing and delivering meaningful solutions to our healthcare stakeholders within our target
markets.

● Quality: We strive for the highest quality and compliance in everything we do.

●

●

●

Teamwork: We operate with mutual respect and trust and are collaborative as we grow together.

Integrity: We live up to our promises and do the right thing, every day.

Accountability: We are empowered and accountable to deliver results and value to all of our stakeholders.

19

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Talent Acquisition and Management

Our industry requires complex processes for product development and commercialization, each of which requires deep expertise and experience
across a broad array of disciplines. Medical device companies therefore compete for a limited number of qualified applicants to fill specialized positions.
This  requires  competitive  compensation  and  benefits  packages  and  an  attractive  culture  in  order  to  attract  and  retain  skilled  employees  to  support  the
growth and success of the company.

As of December 31, 2023, we employed 357 full-time employees in the United States and Europe.

We  believe  that  our  employees’  understanding  of  how  their  work  contributes  to  our  overall  strategy  and  performance  is  key  to  our  success.  In
order to communicate with respect to these important topics in a manner that is engaging to our team, we utilize a variety of channels. These include all-
employee town hall meetings led by senior management, hosted monthly information sessions known as Knowledge Boosters, regular email and intranet
updates  from  our  chief  executive  officer  and  other  key  members  of  the  executive  team.  In  addition,  to  assess  employee  perceptions  in  areas  such  as
inclusion,  professional  development/training,  reward/recognition,  equity,  engagement  and  overall  organizational  satisfaction,  we  conduct  company-wide
employee engagement surveys using an external survey platform. Our management team evaluates and measures the results with prior periods and peer
data and identifies potential opportunities for improvement.

Diversity, Equity and Inclusion

We are committed to a diverse, equitable and inclusive workplace where all employees, regardless of their gender, race, ethnicity, national origin,
age, sexual orientation or identity, education or disability are valued, respected and supported. Beginning in 2021, we made a commitment to comply with
key  elements  of  the  MassBio  CEO  Pledge  for  a  More  Equitable  and  Inclusive  Life  Science  Industry.  We  continue  to  work  on  a  multi-year  approach  at
providing the key deliverables to meet our commitment. This included the development and communication of a corporate Diversity, Equity and Inclusion
Policy  Statement  as  well  as  the  creation  of  a  Diversity  Dashboard.  The  Diversity  Dashboard  tracks  the  current  diversity  within  the  organization  and  is
shared with the board of directors to provide engagement and oversight at the highest levels of the organization. We have also conducted employee surveys
and  employee  focus  groups  to  discuss  diversity  and  inclusion.  We  will  continue  to  enhance  the  diversity  of  our  workforce  through  focused  talent
acquisition goals and development plans.

Employee Development

The ongoing development of our employees continues to be a catalyst for our growth and success as a company. Many of our employees have
obtained  advanced  degrees  in  their  professions.  We  support  our  employees’  further  development  with  individualized  development  plans,  mentoring,
coaching,  group  training,  conference  attendance.  We  also  provide  financial  support,  including  tuition  reimbursement  for  qualified  programs,  as  well  as
access to a broad-based learning management platform for self-directed learning and improvement.

Competitive Pay and Benefits

To attract and retain qualified employees and key talent, we offer our employees total rewards packages consisting of base salary, a cash bonus,
and a comprehensive benefit package. We also provide equity compensation for certain employees based on various criteria, including their level within our
company.  All  employees  globally  are  eligible  to  participate  in  the  annual  incentive  cash  bonus  plan  or  a  sales  incentive  plan  which  are  aligned  to  both
corporate  and  individual  performance.  Bonus  opportunity  and  equity  compensation  increase  as  a  percentage  of  total  compensation  based  on  level  of
responsibility. Our employee stock purchase plan, introduced in 2021, gives eligible employees the opportunity to purchase shares in Anika at a discounted
rate. Bravo, our global online employee recognition program, provides the opportunity for both peer to peer and manager to employee recognition, and has
been well received by our employees.

20

 
 
 
 
 
 
 
 
 
 
 
 
 
Health and Safety

We remain focused on promoting the total wellness of our employees including resources, programs and services to support their physical, mental
and financial wellness. We have established safety policies and protocols, and we regularly update our employees with respect to any changes. We also
have adjusted attendance policies to encourage those who may be ill to stay home. To further protect our on-site employees, we have provided personal
protective equipment and cleaning supplies. We have also provided general information updates and support for our employees to ensure that they have
resources and information to protect their health and that of those around them, including their families and co-workers.

Product Liability

The testing, marketing, and sale of human health care products entail an inherent risk of allegations of product liability, and we cannot assure that
substantial product liability claims will not be asserted against us. Although we have not received any material product liability claims to date, we cannot
assure that if material claims arise in the future, our insurance will be adequate to cover all situations. Moreover, we cannot assure that such insurance, or
additional insurance, if required, will be available in the future or, if available, will be available on commercially reasonable terms. Any product liability
claim, if successful, could have a material adverse effect on our business, financial condition, and results of operations.

Available Information

We are required to file annual, quarterly and current reports, proxy statements and other information with the SEC. The SEC maintains a website

at www.sec.gov that contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC.

Our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements, and other information,
including amendments and exhibits to such reports, filed or furnished pursuant to the Securities Exchange Act of 1934 are available free of charge in the
“SEC Filings” section of our website located at http://www.anika.com, as soon as reasonably practicable after the reports are electronically filed with or
furnished to the SEC. The information on our website is not part of this Annual Report on Form 10-K.

21

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 1A. RISK FACTORS

Our operating results and financial condition have varied in the past and could vary significantly in the future depending on a number of factors.
You should consider carefully the risks and uncertainties described below, in addition to the other information contained in this Annual Report on Form 10-
K,  before  deciding  whether  to  purchase  our  common  stock.  If  any  of  the  following  risks  actually  occur,  our  business,  financial  condition,  results  of
operations,  and  future  prospects  could  be  materially  and  adversely  affected.  In  that  event,  the  trading  price  of  our  common  stock  could  decline,  and
stockholders could lose part or all of their investment.

Risks Related to Our Business and Industry

Our financial performance depends on sales growth and increasing demand for our legacy and acquired product portfolios, and we may not be able to
successfully manage the recent, and future, expansion of our operations.

Through  our  acquisitions  of  Parcus  Medical  and  Arthrosurface  in  early  2020,  we  significantly  broadened  our  technology  and  development
platforms  and  commercialization  infrastructure  and  expanded  our  addressable  market  from  the  global  OA  pain  management  market  to  the  substantially
larger global joint preservation market. Our future success depends on growth in sales of both our legacy and acquired products. There can be no assurance
that such growth can be achieved or, if achieved, sustained. There can be no assurance that, even if substantial growth in product sales and the demand for
our products is achieved, we will be able to:

●

●
●

●
●

Gain  acceptance  of  our  broadened  portfolio  of  existing  products,  as  well  as  future  products,  by  the  medical  community,  hospitals,
physicians, other health care providers, third-party payers, and end-users, which acceptance may depend upon the extent to which the
medical community and end-users perceive our products as safer, more effective or more cost-competitive than other similar products.
Maintain, manage, and develop the necessary manufacturing capabilities and inventory management practices;
Develop, implement, and integrate the mix of appropriate sales channels needed to generate increased sales across our expanded product
platform and to develop marketing partners and viable commercial strategies for the distribution of our expanded mix of products;
Attract, retain, and integrate required key personnel; and
Implement the financial, accounting, and management systems needed to manage our expanded business and growing demand for our
products.

There can be no assurance that our current and future products will achieve significant market acceptance on a timely basis, or at all. The failure of
some or all of our products to achieve significant market acceptance, or our failure to successfully manage future growth, could have a material adverse
effect on our business, financial condition, and results of operations.

Substantial competition could materially affect our financial performance.

We compete with many companies, including large pharmaceutical companies and large and specialized medical devices companies, across all our
product lines. For our OA Pain Management products, our principal competitors include Sanofi Genzyme, Zimmer Biomet, Inc., Bioventus Inc., Avanos
Medical, Inc., and Ferring Pharmaceuticals, as well as other companies that are commercializing or developing competitive products. Our key competitors
for our Joint Preservation and Restoration products include Arthrex, Inc., the DePuy Synthes Companies of Johnson & Johnson, Smith & Nephew PLC.,
Stryker  Corporation,  and  Zimmer  Biomet,  Inc.,  as  well  as  certain  smaller  organizations  that  focus  on  subsets  of  the  larger  industry,  such  as  Catalyst
OrthoScience, Enovis Corporation and Shoulder Innovations. Many of these companies have substantially greater financial resources, larger research and
development staffs, more extensive marketing and manufacturing organizations, and more experience in the regulatory process than us. We also compete
with  academic  institutions,  government  agencies,  and  other  research  organizations  that  are  involved  in  the  research  and  development  and
commercialization of products similar to our own. Many of our competitors also compete against us in securing relationships with collaborators for their
research and development and commercialization programs.

Because  a  number  of  companies  are  developing  or  have  developed  products  for  similar  applications  as  our  products  and  have  received  FDA
clearance  or  approval,  the  successful  commercialization  of  a  particular  product  will  depend  in  part  upon  our  ability  to  complete  clinical  studies  and/or
obtain the FDA marketing and foreign regulatory clearance or approvals prior to our competitors, or, if regulatory clearance or approval is not obtained
prior to our competitors, to identify markets for our products that may be sufficient to permit meaningful sales of our products. Additionally, legislation and
regulation  aimed  at  curbing  rising  healthcare  costs  has  resulted  in  a  consolidation  trend  in  the  healthcare  industry  to  create  larger  companies,  including
hospitals,  with  greater  market  power.  In  turn,  this  has  led  to  greater  and  more  intense  competition  in  the  provision  of  products  and  services  to  market
participants. Important market makers, like group purchasing organizations and integrated delivery networks, have increased their negotiating leverage, and
if these market makers demand significant price concessions or if we are excluded as a supplier by these market makers, our product revenue could be
adversely impacted. There can be no assurance that we will be able to compete against current or future competitors or that competition will not have a
material adverse effect on our business, financial condition, and results of operations. 

22

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Our business may be adversely affected if consolidation in the healthcare industry leads to demand for price concessions or if we are excluded from
being a supplier by a group purchasing organization or similar entity.

Because  healthcare  costs  have  risen  significantly  over  the  past  decade,  numerous  initiatives  and  reforms  have  been  launched  by  legislators,
regulators, and third-party payers to curb these costs. As a result, there has been a consolidation trend in the healthcare industry to create larger companies,
including  hospitals,  with  greater  market  power.  As  the  healthcare  industry  consolidates,  competition  to  provide  products  and  services  to  industry
participants has become and may continue to become more intense. This may result in greater pricing pressures and the exclusion of certain suppliers from
important  markets  as  group  purchasing  organizations,  independent  delivery  networks,  and  large  single  accounts  continue  to  use  their  market  power  to
consolidate  purchasing  decisions.  If  a  group  purchasing  organization  excludes  us  from  being  one  of  their  suppliers,  our  net  sales  could  be  adversely
impacted. We expect that market demand, government regulation, third-party reimbursement policies, and societal pressures will continue to change the
worldwide  healthcare  industry,  which  may  exert  further  downward  pressure  on  the  prices  of  our  products  and  limit  our  access  to  sell  our  products  and
services to customers.

A  significant  portion  of  our  OA  Pain  Management  revenues  are  derived  from  a  small  number  of  customers,  the  loss  of  which  could  materially
adversely affect our business, financial condition and results of operations.

We  have  historically  derived  most  of  our  revenues  from  a  small  number  of  customers  who  resell  our  products  to  end-users.  Many  of  these
customers  are  significantly  larger  companies  than  us.  In  2023,  Mitek,  accounted  for  45%  of  our  revenue.  While  we  have  started  to  diversify  our  sales
channels, including through the implementation of a direct commercial model in the United States for our Joint Preservation and Restoration products, we
expect to continue to be dependent on a small number of large customers for a substantial portion of our business. The failure of key customers to purchase
our products in the amounts they historically have or in amounts that we expect would seriously harm our business.

In addition, if present and future customers terminate their purchasing arrangements with us, significantly reduce or delay their orders, or seek to
renegotiate  their  agreements  on  terms  less  favorable  to  us,  our  business,  financial  condition,  and  results  of  operations  will  be  adversely  affected.  If  we
accept  terms  less  favorable  than  the  terms  of  the  current  agreements,  such  renegotiations  may  have  a  material  adverse  effect  on  our  business,  financial
condition, and/or results of operations. Furthermore, in any future negotiations we may be subject to the perceived or actual leverage that these customers
may have given their relative size and importance to us. Any termination, change, reduction, or delay in orders could seriously harm our business, financial
condition, and results of operations. The loss of any one of our major customers, the delay of significant orders from such customers or our inability to
timely  supply  product  to  these  customers  (including  due  to  production  and  shipping  delays  attributable  to  supply  or  staffing  shortages),  even  if  only
temporary, could reduce or delay our recognition of revenues, harm our reputation in the industry, and reduce our ability to accurately predict cash flow,
and, as a consequence, could seriously harm our business, financial condition, and results of operations.

We experience quarterly sales volume variation, which makes our future results difficult to predict and makes period-to-period comparisons potentially
not meaningful.

We experience quarterly fluctuations in our product sales as a result of multiple factors, many of which are outside of our control including our
arrangements with Mitek which performs most of the downstream sales and marketing activities to customers and end-users for Monovisc and Orthovisc in
the United States. Therefore, we are subject to fluctuations in our customers’ sales patterns and corresponding ordering patterns, including Mitek. These
quarterly fluctuations create uncertainty as to the volume of sales that we may achieve in a given period. As a result, comparing our operating results on a
period-to-period basis might not be meaningful. You should not rely on our past results as an indication of our future performance. Our operating results
could be disproportionately affected by a reduction in revenue because a proportionately smaller amount of our expenses varies with our revenue. As a
result, our quarterly operating results are difficult to predict, even in the near term.

We  rely  on  a  small  number  of  suppliers  for  certain  key  raw  materials  and  components  for  the  manufacturing  and  delivery  of  our  products,  and
disruption could materially adversely affect our business, financial condition, and results of operations.

Although  we  believe  that  alternative  sources  for  many  of  these  and  other  components  and  raw  materials  that  we  use  in  our  manufacturing
processes are available, we cannot be certain that the supply of key raw materials will continue to be available at current levels or will be sufficient to meet
our future needs. We continue to see impacts on our supply chain as the companies that produce our products, product components or otherwise support our
manufacturing processes, the distribution centers where we manage our inventory, or the operations of our logistics and other service providers, including
third parties that sterilize and store our products, were disrupted, temporarily closed or experienced worker shortages for a sustained period of time during
and following the global pandemic or due to other supply chain disruptions. For example, for the manufacture of Arthrosurface joint solutions products, we
engage a single third-party organization as a contract manufacturer. This contract manufacturer has noted that there could be lead times up to a year or more
to deliver product. Any supply interruption could harm our ability to manufacture our products until a new source of supply is identified and qualified. We
may not be able to find sufficient alternative suppliers in a reasonable time period, or on commercially reasonable terms, if at all, and our ability to produce
and supply our products could be impaired.

23

 
 
 
 
 
 
 
 
 
 
 
Our manufacturing processes involve inherent risks, and disruption could materially adversely affect our business, financial condition, and results of
operations.

The  operation  of  biomedical  manufacturing  plants  involves  many  risks,  including  the  risks  of  breakdown,  failure,  substandard  performance  of
equipment,  the  inability  of  production  runs  to  pass  internal  quality  standards,  the  need  to  comply  with  the  requirements  of  directives  of  government
agencies, including the FDA, and the occurrence of natural and other disasters. Such occurrences could have a material adverse effect on our business,
financial condition, and results of operations during the period of such operational difficulties and beyond.

We could become subject to product liability claims, which, if successful, could materially adversely affect our business, financial condition, and results
of operations.

The  testing,  marketing,  and  sale  of  human  health  care  products  include  an  inherent  risk  of  allegations  of  product  liability,  and  there  can  be  no
assurance that substantial product liability claims will not be asserted against us. Although we have not received any material product liability claims to
date  and  we  believe  that  we  have  adequate  insurance  coverage  to  cover  such  product  liability  claims  should  they  arise,  there  can  be  no  assurance  that
material claims will not arise in the future or that our insurance will be adequate to cover all situations. Moreover, there can be no assurance that such
insurance,  or  additional  insurance,  if  required,  will  be  available  in  the  future  or,  if  available,  will  be  available  on  commercially  reasonable  terms.  Any
product liability claim, if successful, could have a material adverse effect on our business, financial condition, and results of operations.

Failure  to  comply  with  current  or  future  national,  international,  federal  or  state  laws  and  regulations,  regulatory  guidance  and  industry  standards
relating to data protection, privacy and information security, including restrictive European regulations, could lead to government enforcement actions
(which  could  include  civil  or  criminal  penalties),  private  litigation,  and/or  adverse  publicity  and  could  negatively  affect  our  operating  results  and
business.

We  and  our  third-party  providers  are  subject  to  national,  international,  federal  or  state  laws  and  regulations,  regulatory  guidance  and  industry
standards relating to data protection, privacy and information security. This includes the European Union, or EU, GDPR, and the United Kingdom, or UK,
equivalent of the same (the UK GDPR, together with the EU GDPR, referred to as the GDPR), as well as other national data protection legislation in force
in relevant European Economic Area, or EEA, Member States and the UK (including the UK Data Protection Act 2018), which governs the collection, use,
storage, disclosure, transfer, or other processing of personal data (including health data processed in the context of clinical trials): (i) regarding individuals
in the EEA and UK; and/or (ii) carried out in the context of the activities of our establishment in any EEA Member State or the UK.

The GDPR is wide-ranging in scope and imposes numerous additional requirements on companies that process personal data, including imposing
special requirements in respect of the processing of health and other sensitive data, requiring that consent of individuals to whom the personal data relates
is  obtained  in  certain  circumstances,  requiring  additional  disclosures  to  individuals  regarding  data  processing  activities,  requiring  that  safeguards  are
implemented to protect the security and confidentiality of personal data, creating mandatory data breach notification requirements in certain circumstances,
requiring data protection impact assessments for high risk processing and requiring that certain measures (including contractual requirements) are put in
place when engaging third-party processors. The GDPR also provide individuals with various rights in respect of their personal data. The GDPR defines
personal  data  to  include  pseudonymized  or  coded  data  and  requires  different  informed  consent  practices  and  more  detailed  notices  for  clinical  trial
participants and investigators than applies to clinical trials conducted in the United States. We are required to apply GDPR standards to any clinical trials
that our EEA and UK established businesses carry out anywhere in the world.

Significantly, the GDPR impose strict rules on the transfer of personal data out of the EEA or the UK to the U.S. or other regions that have not
been deemed to offer “adequate” privacy protections. Currently, we rely mainly on Standard Contractual Clauses approved by the European Commission,
or SCCs, to legitimize transfers of personal data out of the EEA and International Transfer Agreements approved the UK for transfers of personal data out
of  the  UK,  however,  there  continue  to  be  concerns  about  whether  the  SCCs  and  other  international  transfer  mechanisms  will  face  additional  legal
challenges. Any inability to transfer personal data from the EEA to the U.S. in compliance with data protection laws may impede our ability to conduct
trials and may adversely affect our business and financial position.

The  GDPR  increases  our  responsibilities  and  may  increase  our  liability  in  relation  to  personal  data  that  we  process  where  such  processing  is
subject to the GDPR. While we have taken steps to comply with the GDPR, and implementing legislation in applicable EEA member states and the UK,
including by seeking to establish appropriate lawful bases for the various processing activities we carry out, reviewing our security procedures and those of
our service providers, and entering into data processing agreements with relevant service providers we cannot be certain that our efforts to achieve and
remain  in  compliance  have  been,  and/or  will  continue  to  be,  fully  successful.  Given  the  breadth  and  depth  of  changes  in  data  protection  obligations,
complying  with  the  GDPR  and  similar  laws’  requirements  are  rigorous  and  time  intensive  and  require  significant  resources  and  a  review  of  our
technologies, systems and practices, as well as those of any third-party service providers, contractors or consultants that process or transfer personal data.

Although the EU GDPR and the UK GDPR currently impose substantially similar obligations, it is possible that over time the UK GDPR could
become less aligned with the EU GDPR, particularly with the UK plans to reform the country’s data protection legal framework in its Data Reform Bill
introduced into the UK legislative process. In addition, EEA Member States have adopted implementing national laws to implement the GDPR which may
partially  deviate  from  the  GDPR  and  the  competent  authorities  in  the  EEA  Member  States  may  interpret  GDPR  obligations  slightly  differently  from
country to country, so that we do not expect to operate in a uniform legal landscape in the EEA and UK with respect to data protection regulations. The
potential  of  the  respective  provisions  and  enforcement  of  the  EU  GDPR  and  UK  GDPR  further  diverging  in  the  future  creates  additional  regulatory
challenges and uncertainties for us. The lack of clarity on future UK laws and regulations and their interaction with EU laws and regulations could add
legal risk, uncertainty, complexity and compliance cost to the handling of European personal data and our privacy and data security compliance and could
require us to amend our processes and procedures to implement different compliance measures for the UK and the EEA.

24

 
 
 
 
 
 
 
 
 
 
 
 
 
In  the  United  States,  numerous  federal  and  state  laws  and  regulations,  including  federal  health  information  privacy  laws,  state  data  breach
notification  laws,  state  health  information  privacy  laws  and  federal  and  state  consumer  protection  laws  that  govern  the  collection,  use,  disclosure  and
protection of health-related and other personal information could apply to our operations or the operations of our collaborators and third-party providers.
For example, California enacted the California Consumer Privacy Act, or the CCPA. This law, which became effective on January 1, 2020 gives California
residents expanded rights to access and delete their personal information, opt out of certain personal information sharing and receive detailed information
about how their personal information is used. It also provides for civil penalties for violations, as well as a private right of action for data breaches that are
expected to increase data breach litigation. At this time, we do not collect personal data on residents of California but should we begin to do so, and in the
context of doing so, become subject to the CCPA, the CCPA will impose new and burdensome privacy compliance obligations on our business and will
raise new risks for potential fines and class actions.

In addition, the California Privacy Rights Act, or CPRA, which became effective on January 1, 2023, imposes additional obligations on companies
covered  by  the  legislation  and  significantly  modifies  the  CCPA,  including  by  expanding  consumers’  rights  with  respect  to  certain  sensitive  personal
information. The CPRA also created a new state agency that was vested with authority to implement and enforce the CCPA. The effects of the CCPA are
potentially significant and, should we begin to process personal information concerning California residents may require us to modify our data collection or
processing  practices  and  policies  and  to  incur  substantial  costs  and  expenses  in  an  effort  to  comply  and  increase  our  potential  exposure  to  regulatory
enforcement and/or litigation.

Some observers have noted that the CCPA could mark the beginning of a trend toward more stringent privacy legislation in the United States,
which  could  increase  our  potential  liability  and  adversely  affect  our  business.  New  consumer  privacy  laws  similar  to  the  CCPA  have  been  passed  in  a
number of states and many other states have proposed new privacy laws. Such proposed legislation, if enacted, may add additional complexity, variation in
requirements, restrictions and potential legal risk, require additional investment of resources in compliance programs, impact strategies and the availability
of previously useful data and could result in increased compliance costs and/or changes in business practices and policies. The existence of comprehensive
privacy laws in different states in the country would make our compliance obligations more complex and costly and may increase the likelihood that we
may be subject to enforcement actions or otherwise incur liability for noncompliance. In addition to these comprehensive laws and proposals, several other
states have passed or proposed more limited privacy laws focused on particular privacy issues.

In addition, many jurisdictions around the world have adopted legislation that regulates how businesses operate online and enforces information
security,  including  measures  relating  to  privacy,  data  security  and  data  breaches.  Many  of  these  laws  require  businesses  to  notify  data  breaches  to  the
regulators and/or data subjects. These laws are not consistent, and compliance in the event of a widespread data breach is costly and burdensome.

In  many  jurisdictions,  enforcement  actions  and  consequences  for  non-compliance  with  protection,  privacy  and  information  security  laws  and
regulations are rising. In the EEA and the UK, data protection authorities may impose large penalties for violations of the data protection laws, including
potential  fines  of  up  to  €20  million  (£17.5  million  in  the  UK)  or  4%  of  annual  global  revenue,  whichever  is  greater.  The  authorities  have  shown  a
willingness to impose significant fines and issue orders preventing the processing of personal data on non-compliant businesses. Data subjects also have a
private right of action, as do consumer associations, to lodge complaints with supervisory authorities, seek judicial remedies, and obtain compensation for
damages resulting from violations of applicable data protection laws. In the United States, possible consequences for non-compliance include enforcement
actions in response to rules and regulations promulgated under the authority of federal agencies and state attorneys general and legislatures and consumer
protection agencies.

The risk of our being found in violation of these laws is increased by the fact that the interpretation and enforcement of them is not entirely clear.
Efforts  to  ensure  that  our  business  arrangements  with  third  parties  will  comply  with  applicable  healthcare  laws  and  regulations  will  involve  substantial
costs. Any action against us for violation of these laws, 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. The shifting compliance environment and the need to build and maintain robust and
expandable systems to comply with multiple jurisdictions with different compliance and/or reporting requirements increases the possibility that a healthcare
company may run afoul of one or more of the requirements.

25

 
 
 
 
 
 
 
 
Compliance with data protection laws and regulations could require us to take on more onerous obligations in our contracts, restrict our ability to
collect,  use  and  disclose  data,  or  in  some  cases,  impact  our  ability  to  operate  in  certain  jurisdictions.  It  could  also  require  us  to  change  our  business
practices and put in place additional compliance mechanisms, which may interrupt or delay our development, regulatory and commercialization activities
and increase our cost of doing business. Failure by us or our and third-party providers to comply with data protection laws and regulations could result in
government enforcement actions (which could include civil or criminal penalties and orders preventing us from processing personal data), private litigation
and result in significant fines and penalties against us. Claims that we have violated individuals’ privacy rights, failed to comply with data protection laws
or breached our contractual obligations, even if we are not found liable, could be expensive and time-consuming to defend, could result in adverse publicity
and could have a material adverse effect on our business, financial condition, results of operations and prospects.

We are increasingly dependent on sophisticated information technology and if we fail to effectively maintain or protect our information systems or data,
including from data breaches, our business could be adversely affected.

We are increasingly dependent on sophisticated information technology for our products and infrastructure. As a result of technology initiatives,
recently enacted regulations, changes in our system platforms and integration of new business acquisitions, we have been consolidating and integrating the
number of systems we operate and have upgraded and expanded our information systems capabilities. We also have outsourced elements of our operations
to third parties, and, as a result, we manage a few third-party suppliers who may or could have access to our confidential intellectual property or business
information.

Our information systems, and those of third-party suppliers with whom we contract, require an ongoing commitment of significant resources to
maintain,  protect  and  enhance  existing  systems  and  develop  new  systems  to  keep  pace  with  continuing  changes  in  information  technology,  evolving
systems and regulatory standards and the increasing need to protect patient and customer information. In addition, given their size and complexity, these
systems could be vulnerable to service interruptions or to security breaches from inadvertent or intentional actions by our employees, third-party suppliers
and/or business partners, or from cyber-attacks by malicious third parties attempting to gain unauthorized access to our products, systems or Confidential
Information.

The  risk  of  a  security  breach  or  disruption,  particularly  through  cyberattacks  or  cyber  intrusion,  including  by  computer  hackers,  foreign
governments, and cyber terrorists, has generally increased as the number, intensity and sophistication of attempted attacks and intrusions from around the
world have increased. Cyberattacks could include wrongful conduct by hostile foreign governments, industrial espionage, wire fraud and other forms of
cyber  fraud,  the  deployment  of  harmful  malware,  denial-of-service,  social  engineering  fraud  or  other  means  to  threaten  data  security,  confidentiality,
integrity and availability. If such an event were to occur, it could result in the theft or destruction of intellectual property, data or other misappropriation of
assets,  or  otherwise  compromise  our  confidential  or  proprietary  information  and  result  in  a  material  disruption  of  our  development  programs  and  our
business operations.

Although we devote resources to protect our information systems, we realize that cyberattacks are a threat, and there can be no assurance that our
efforts will prevent information security breaches that would result in business, legal, financial or reputational harm to us, or would have a material adverse
effect on our business, financial condition, results of operations and prospects.

Likewise,  we  rely  on  third  parties  for  various  operations,  including  the  manufacture  of  our  products  and  to  conduct  clinical  trials,  and  similar
events  relating  to  their  computer  systems  could  also  have  a  material  adverse  effect  on  our  business.  We  rely  on  our  third-party  providers  to  implement
effective  security  measures  and  identify  and  correct  for  any  such  failures,  deficiencies  or  breaches.  Any  breach  in  our  or  our  third-party  providers’
information technology systems could lead to the unauthorized access, disclosure and use of non-public information, including protected health information
and other personally identifiable information which is protected by HIPAA, and other laws. Any such access, disclosure, or other loss of information could
result  in  legal  claims  or  proceedings,  liability  under  laws  that  protect  the  privacy  of  personal  information,  damage  to  our  reputation  and  the  further
development  and  commercialization  of  our  products  could  be  delayed.  If  we  or  our  third-party  providers  fail  to  maintain  or  protect  our  information
technology systems and data integrity effectively or fail to anticipate, plan for or manage significant disruptions to our information technology systems, we
or  our  third-party  providers  could  have  difficulty  preventing,  detecting  and  controlling  such  cyberattacks  and  any  such  attacks  could  result  in  losses
described  above  as  well  as  disputes  with  physicians,  participants  and  our  partners,  regulatory  sanctions  or  penalties,  increases  in  operating  expenses,
expenses or lost revenues or other adverse consequences, any of which could have a material adverse effect on our business, results of operations, financial
condition, prospects and cash flows. If we are unable to prevent or mitigate the impact of such security or data privacy breaches, we could be exposed to
litigation and governmental investigations, which could lead to a potential disruption to our business.

Any  compromise  to  our  information  security  or  that  of  our  third-party  service  providers  or  contractors  could  result  in  an  interruption  in  our
operations,  the  unauthorized  publication  of  our  confidential  business  or  proprietary  information,  the  unauthorized  release,  use,  disclosure  and/or
dissemination  of  customer,  vendor,  or  employee  data,  the  violation  of  privacy  and/or  data  protection  laws,  including  under  the  GDPR,  in  the  European
Union or the United Kingdom, or other laws and exposure to litigation, any of which could harm our business and operating results.

26

 
 
 
 
 
 
 
 
 
 
We may face circumstances in the future that will result in impairment charges, including, but not limited to, goodwill impairment, intangible assets
impairment and in-process research and development charges.

As of December 31, 2023, we had long-lived assets in the amount of $58.4 million, including property and equipment of $46.2 million, intangible
assets of $4.6 million and goodwill of $7.6 million. If the fair value of any of our long-lived assets, including those that we acquired in the acquisitions of
Arthrosurface  and  Parcus  Medical,  decrease  as  a  result  of  an  economic  slowdown,  a  downturn  in  the  markets  where  we  sell  products  and  services,  a
downturn in our stock price, financial performance or future outlook, or other reasons, we may be required to record an impairment charge on such assets.
We are required to test intangible assets with indefinite life periods for potential impairment annually and on an interim basis if there are indicators of a
potential impairment. We also are required to evaluate amortizable intangible assets and fixed assets for impairment if there are indicators of a possible
impairment. Impairment charges could have a negative impact on our results of operations and financial position, as well as on the market price of our
common  stock.  During  the  year  ended  December  31,  2023,  we  recorded  an  impairment  charge  of  $62.2  million  on  intangible  assets  related  to  the
acquisitions of Arthrosurface and Parcus Medical.

Our business is dependent upon hiring and retaining qualified management, operations and technical personnel.

We  are  highly  dependent  on  the  members  of  our  management,  operations  and  technical  staff,  the  loss  of  one  or  more  of  whom  could  have  a
material  adverse  effect  on  us.  We  have  experienced  a  number  of  management  changes  in  recent  years,  and  there  can  be  no  assurances  that  any  future
management changes will not adversely affect our business. We believe that our future success will depend in large part upon our ability to attract and
retain technical and highly skilled executive, managerial, professional, and technical personnel. We continue to engage with our employees on a regular
basis  to  limit  voluntary  employee  turnover.  We  face  significant  competition  for  such  personnel  from  competitive  companies,  research  and  academic
institutions,  government  entities,  and  other  organizations.  There  can  be  no  assurance  that  we  will  be  successful  in  hiring  or  retaining  the  personnel  we
require. The failure to hire and retain such personnel could have a material adverse effect on our business, financial condition, and results of operations.

We may require additional capital in the future. We cannot give any assurance that such capital will be available at all or on terms acceptable to us,
and if it is available, additional capital raised by us could dilute your ownership interest or the value of your shares.

We may need to raise capital in the future depending on numerous factors, including:

●
●

●
●
●
●
●
●
●
●
●

●
●
●

●
●

Market acceptance of our existing and future products;
The success and sales of our products under various distributor agreements and other appropriate commercial strategies, including the
ability of our partners to achieve third party reimbursement for our products;
The successful commercialization of products in development through appropriate commercial models and marketing channels;
Progress in our product development efforts;
The magnitude and scope of such product development efforts;
Any potential acquisitions of products, technologies, or businesses;
Progress with preclinical studies, clinical trials, and product approvals and clearances by the FDA and other agencies;
Requirement to conduct additional preclinical studies and clinical trials for future products; 
The cost and timing of our efforts to manage our manufacturing capabilities and related costs;
Expanding our manufacturing capacity to support growing demand for our products and add redundancies to our manufacturing process;
The cost of filing, prosecuting, defending, and enforcing patent claims and other intellectual property rights and the cost of defending any
other legal proceeding;
Competing technological and market developments;
The development of strategic alliances for the marketing of certain of our products;
The terms of such strategic alliances, including provisions (and our ability to satisfy such provisions) that provide upfront and/or
milestone payments to us;
The cost of maintaining adequate inventory levels to meet current and future product demand; and
Further expanding our business in international markets.

To the extent funds generated from our operations, together with our existing capital resources, are insufficient to meet future requirements, we
will be required to obtain additional funds through equity or debt financings, through strategic alliances with corporate partners and others, or through other
sources. The terms of any future equity financing may be dilutive to our investors and the terms of any debt financing may contain restrictive covenants,
which limit our ability to pursue certain courses of action. Our ability to obtain financing is dependent on the status of our future business prospects as well
as conditions prevailing in the relevant capital markets at the time, we seek financing. No assurance can be given that any additional financing will be made
available to us or will be available on acceptable terms should such a need arise.

27

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If  we  succeed  in  raising  additional  funds  through  the  issuance  of  equity  or  convertible  securities,  then  the  issuance  could  result  in  substantial
dilution to existing stockholders. Furthermore, the holders of these new securities or debt may have rights, preferences and privileges senior to those of the
holders of common stock. In addition, any preferred equity issuance or debt financing that we may obtain in the future could have restrictive covenants
relating to our capital raising activities and other financial and operational matters, which may make it more difficult for us to obtain additional capital and
to pursue business opportunities, including potential acquisitions.

Changes in tax law could adversely affect our business and financial condition.

The  rules  dealing  with  U.S.  federal,  state,  and  local  and  non-U.S.  taxation  are  constantly  under  review  by  persons  involved  in  the  legislative
process,  the  Internal  Revenue  Service,  the  U.S.  Treasury  Department  and  other  taxing  authorities.  Changes  to  tax  laws  or  tax  rulings,  or  changes  in
interpretations of existing laws (which changes may have retroactive application), could adversely affect us or the holders of our common stock. These
changes could subject us to additional income-based taxes and non-income taxes (such as payroll, sales, use, value-added, net worth, property, and goods
and services taxes), which in turn could materially affect our financial position and results of operations. For example, under Section 174 of the Code, in
taxable years beginning after December 31, 2021, expenses that are incurred for research and development in the U.S. will be capitalized and amortized,
which  may  have  an  adverse  effect  on  our  cash  flow.  Additionally,  new,  changed,  modified,  or  newly  interpreted  or  applied  tax  laws  could  increase  our
customers’ and our compliance, operating and other costs, as well as the costs of our products. In recent years, many such changes have been made, and
changes are likely to continue to occur in the future. As we expand the scale of our business activities, any changes in the U.S. and non-U.S. taxation of
such  activities  may  impact  our  effective  tax  rate,  result  in  higher  tax  payments  and  harm  our  business,  financial  condition,  cash  flows  and  results  of
operations.

Adverse developments affecting the financial services industry, such as actual events or concerns involving liquidity, defaults, or non-performance by
financial institutions or transactional counterparties, could adversely affect the Company’s current and projected business operations and its financial
condition and results of operations.

Actual events involving limited liquidity, defaults, non-performance, or other adverse developments that affect financial institutions, transactional
counterparties or other companies in the financial services industry or the financial services industry generally, or concerns or rumors about any events of
these kinds or other similar risks, have in the past and may in the future lead to market-wide liquidity problems. If any of our customers, suppliers or other
parties with whom we conduct business are unable to access funds pursuant to lending arrangements with financial institutions, such parties’ ability to pay
their obligations to us or to enter into new commercial arrangements requiring additional payments to us could be adversely affected.

Although we assess our banking and customer relationships as we believe necessary or appropriate, our access to funding sources and other credit
arrangements in amounts adequate to finance or capitalize our current and projected future business operations could be significantly impaired by factors
that  affect  the  Company,  the  financial  institutions  with  which  the  Company  has  credit  agreements  or  arrangements  directly,  or  the  financial  services
industry  or  economy  in  general.  These  factors  could  include,  among  others,  events  such  as  liquidity  constraints  or  failures,  the  ability  to  perform
obligations under various types of financial, credit or liquidity agreements or arrangements, disruptions or instability in the financial services industry or
financial markets, or concerns or negative expectations about the prospects for companies in the financial services industry. These factors could involve
financial  institutions  or  financial  services  industry  companies  with  which  the  Company  has  financial  or  business  relationships,  but  could  also  include
factors involving financial markets or the financial services industry generally.

The results of events or concerns that involve one or more of these factors could include a variety of material and adverse impacts on our current

and projected business operations and our financial condition and results of operations. These could include, but may not be limited to, the following:

● Delayed access to deposits or other financial assets or the uninsured loss of deposits or other financial assets;
● Delayed or lost access to, or reductions in borrowings available under revolving existing credit facilities or other working capital sources and/or
delays, inability or reductions in the company’s ability to refund, roll over or extend the maturity of, or enter into new credit facilities or other
working capital resources;

● Potential or actual breach of contractual obligations that require the Company to maintain letters of credit or other credit support arrangements;
● Potential or actual breach of financial covenants in our credit agreements or credit arrangements;
● Potential or actual cross-defaults in other credit agreements, credit arrangements or operating or financing agreements; or
● Termination of cash management arrangements and/or delays in accessing or actual loss of funds subject to cash management arrangements.

28

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risks Related to Our Commercialization Activities

Our license agreements with Mitek provide substantial control of Monovisc and Orthovisc in the United States to Mitek, and Mitek’s actions could have
a material impact on our business, financial condition and results of operations.

Our license and distribution agreements with Mitek related to Monovisc and Orthovisc provide Mitek with, among other things, the exclusive right
to market and sell Monovisc and Orthovisc in the United States, unilateral decision-making authority over the sale, price, and promotion of Monovisc and
Orthovisc in the United States, substantial control over the future development of Monovisc and Orthovisc related to the treatment of pain associated with
osteoarthritis, a license to manufacture and have manufactured such products in the event that we are unable to supply Mitek with Monovisc or Orthovisc
in accordance with the terms of the relevant agreement, and certain rights of first refusal with respect to future products we develop for the treatment of
pain associated with osteoarthritis. In exchange, Mitek pays us a transfer price calculated with reference to historical end-user prices in the market and a
fixed  royalty  rate  per  product  on  their  net  product  sales.  As  Mitek  accounts  for  a  large  percentage  of  our  revenue  and  has  unilateral  decision-making
authority  over  in-market  activities,  including  end-user  pricing  and  discounts,  reimbursement  strategy,  and  overall  promotion  strategy,  actions  taken  by
Mitek could impact our ability to predict and generate revenue and have a material impact on our business, financial condition, and results of operations.

We may not succeed in our integration and buildout of our direct sales channel in the United States, and our failure to do so could negatively impact
our business and financial results.

Beginning in 2019, and with our expanded commercial infrastructure, as a result of the Parcus Medical and Arthrosurface acquisitions, we sold
and marketed our Joint Preservation and Restoration family of products directly to customers, including hospitals and ASCs, through our direct Anika sales
team and large network of independent third-party distributors. This approach was a departure from our historical distribution model in the United States,
and we cannot be certain that we will be successful in implementing and executing on this commercial approach or that, even if we are able to implement
it, the approach will be successful at scale. We may not be able to attract or retain the sophisticated personnel required for our approach, to identify or
negotiate favorable or acceptable terms with distribution agents and ensure that they dedicate time and focus to our products, to achieve in-market pricing
at the levels we have targeted, to develop and tailor our product portfolio to be specifically desired by clinicians who practice in ASCs, or to timely execute
on  our  strategies  for  market  penetration  generally.  Our  failure  to  successfully  implement  and  execute  this  commercial  approach  could  have  a  material
adverse effect on our business, financial condition, and results of operations.

We are dependent upon marketing and distribution partners and the failure to maintain strategic alliances on acceptable terms will have a material
adverse effect on our business, financial condition, and results of operations.

Our success is dependent, in part, upon the efforts of our marketing, distribution, and logistics partners, including our sales agent partners in the
United States, and the terms and conditions of our relationships with such partners. We cannot assure you that our commercial partners, including Mitek,
will not seek to renegotiate their current agreements on terms less favorable to us or terminate such agreements. A failure to maintain relationships with our
commercial partners on terms satisfactory to us, or at all, could result in a material adverse effect on our operating results.

29

 
 
 
 
 
 
 
 
 
 
We continue to seek to establish long-term partnerships in regions and countries not covered by existing agreements, and we may need to obtain
the assistance of additional marketing partners to bring new and existing products to market and to replace certain marketing partners. There can be no
assurance that we will be able to identify or engage appropriate distribution or collaboration partners or effectively transition to any such new partnerships.
The failure to establish strategic partnerships for the marketing and distribution of our products on acceptable terms and within our planned timeframes
could have a material adverse effect on our business, financial condition, and results of operations.

Sales of our products are largely dependent upon third-party health insurance coverage and reimbursement and our performance may be harmed by
health care cost containment initiatives or decisions of individual third-party payers.

In the United States and other foreign markets, health care providers, such as hospitals and physicians, that purchase health care products, such as
our products, generally rely on third-party payers, including Medicare, Medicaid, and other health insurance and managed care plans, to provide coverage
and to reimburse for all or part of the cost of the health care product or procedures that use such products. Coverage and reimbursement by third-party
payers, both in the United States and internationally, may depend on several factors, including the individual payer’s determination that our products or
procedures  that  use  our  products  are  clinically  useful  and  cost-effective,  medically  necessary,  and  not  experimental  or  investigational.  Since  insurance
coverage determinations and reimbursement decisions are made by each payer individually, seeking positive coverage and reimbursement decisions can be
a time consuming and costly process, which could require us or our marketing partners to provide supporting scientific, clinical, and cost-effectiveness data
for the use of our products to each payer separately. Significant uncertainty exists as to the insurance coverage and reimbursement status of newly approved
health care products or procedures that use such products, and any failure or delay in obtaining reimbursement approvals can negatively impact sales of our
new products. In addition, we cannot be certain that payers who currently provide reimbursement for our products or procedures that use our products will
continue to provide such reimbursement in the future, and such payer decisions could negatively impact the sales of our current or future products.

In addition, third-party payers are increasingly attempting to contain the costs of health care products and services by limiting both coverage and
the  level  of  reimbursement  for  new  therapeutic  products  and  by  refusing,  in  some  cases,  to  provide  coverage  for  uses  of  approved  products  for  disease
indications  for  which  the  FDA,  or  the  applicable  foreign  regulatory  agency,  has  granted  marketing  approval.  Also,  the  U.S.  Congress,  certain  state
legislatures, and certain foreign governments and regulatory agencies have considered reforms, including, among other items, any material changes to the
ACA  or  the  potential  repeal  of  reference  drug  pricing  in  the  United  States,  which  may  affect  current  reimbursement  practices  and  create  additional
uncertainty about the pricing of our products, including the potential implementation of controls on health care spending through limitations on the growth
of Medicare and Medicaid spending. For example, in 2010, the ACA was enacted and was intended to expand access to health insurance coverage and
improve the quality of health care over time. There has been ongoing litigation and congressional efforts to modify or repeal all or certain provisions of the
ACA. There may be uncertainties that result from modification or repeal of any of the provisions of the ACA, including as a result of current and future
executive orders and legislative actions. We cannot predict what other health care programs and regulations will ultimately be implemented at the federal or
state level or the effect that any future legislation or regulation in the United States may have on our business There can be no assurance that third-party
coverage  will  be  available  or  that  reimbursement  will  be  adequate  for  any  products  or  services  developed  by  us  or  procedures  using  our  products  or
services.

Outside the United States, the success of our products is also dependent in part upon the availability of reimbursement and health care payment
systems. Domestic and international reimbursement laws and regulations may change from time to time. Lack of adequate coverage and reimbursement
provided  by  governments  and  other  third-party  payers  for  our  products  and  services,  including  continuing  coverage  for  Monovisc  and  Orthovisc  in  the
United States, and any change of classification by the Centers for Medicare and Medicaid Services for reimbursement of Orthovisc and Monovisc, could
have a material adverse effect on our business, financial condition, and results of operations.

30

 
 
 
 
 
 
 
 
Risks Related to Our Product Development and Regulatory Compliance

We are facing a longer than expected pathway to commercialize our Cingal product in the United States, and we may face other unforeseen difficulties
in achieving regulatory approval for Cingal, which could affect our business and financial results.

In 2018, we received and analyzed the results of our second Phase III clinical trial for Cingal and found that the data did not meet the primary
study endpoint of demonstrating a statistically significant difference in pain reduction between Cingal and the approved steroid component of Cingal at the
six-month time point. After discussions with the FDA, it was determined that an additional Phase III clinical trial would most likely be necessary to support
U.S. marketing approval for Cingal. In 2019, we began the design of our third Phase III clinical trial to enable us to evaluate our full-scale Phase III clinical
trial  design,  including  patient  and  site  selection  criteria,  and  increase  the  probability  of  success  for  the  Phase  III  trial.  In  2022,  we  completed  this  third
Phase III clinical trial, which achieved its primary endpoint. Together with previous clinical studies, Cingal has demonstrated superiority over each of its
active ingredients and placebo over 26 weeks for long-acting pain relief. We have been engaging with the FDA on next steps for U.S. regulatory approval.
In  parallel,  we  are  exploring  the  potential  to  advance  Cingal  through  commercial  partnerships  in  the  U.S.  and  select  Asian  markets.  These  efforts  will
inform next steps, including if and how to proceed with another clinical trial in the United States. We cannot guarantee the success of any additional future
clinical trials for Cingal. Because the results of any additional clinical trials, or other unforeseen future developments, could have a substantial negative
impact  on  the  timeline  for  and  the  cost  associated  with  a  potential  Cingal  regulatory  approval,  our  overall  business  condition,  financial  results,  and
competitive position could be affected. We also are conducting our clinical trial to support approval in the United States for Hyalofast, our single-stage, off-
the-shelf, cartilage repair therapy, currently sold only outside the United States. We have fully enrolled the 200 patients targeted in the trial. This pivotal
trial has a two-year follow-up protocol expected to be achieved in early 2025 before regulatory submission is completed.  We are targeting to file the first
module as part of a modular PMA in 2024 which is the first step in seeking FDA approval for Hyalofast in the U.S. The final module of the PMA will be
filed in 2025 once the clinical data becomes available to be submitted to the FDA.

Failure  to  obtain,  or  any  delay  in  obtaining,  FDA  or  other  U.S.  and  foreign  governmental  clearances  or  approvals  for  our  products  may  have  a
material adverse effect on our business, financial condition, and results of operations.

Several  of  our  current  products  under  development,  and  certain  future  products  we  may  develop,  will  require  clinical  trials  to  determine  their
safety and efficacy for marketing approval by regulatory bodies, including the FDA. Product development and clearance or approval within the FDA and
international regulatory frameworks takes several years and involves the expenditure of substantial resources. There can be no assurance that the FDA or
other regulatory authorities will accept submissions related to our new products or the expansion of the indications of our current products, and, even if
submissions are accepted, there can be no guarantee that the FDA or other regulatory authorities will grant clearance or approval for our new products, on a
timely basis, if at all. In addition to regulations enforced by the FDA, we are subject to other existing and future federal, state, local, and foreign regulations
applicable to product clearance or approval, which may vary significantly across jurisdictions. Additional clearance or approval of existing products may be
required  when  changes  to  such  products  may  affect  the  safety  and  effectiveness,  including  for  new  indications  for  use,  labeling  changes,  process  or
manufacturing changes, the use of a different facility to manufacture, process or package the product, and changes in performance or design specifications.
For our devices that are subject to 510(k) clearances, the FDA requires device manufacturers to make a determination of whether a modification requires a
clearance; however, the FDA can review a manufacturer’s decision not to submit for additional clearances. We cannot provide any assurance that the FDA
will agree with our decisions not to seek clearances for particular device modifications. If the FDA disagrees, and requires new clearances or approvals for
any modifications, and we fail to obtain such approvals or clearances or fail to secure approvals or clearances in a timely manner, we may be required to
recall  and  to  stop  the  manufacturing  and  marketing  of  the  modified  device  until  we  obtain  the  FDA  approval  or  clearance,  and  we  may  be  subject  to
significant regulatory fines or penalties. Failure to obtain regulatory clearance or approvals of our products, including any changes to existing products,
could have an adverse material impact on our business, financial condition, and results of operations.

Even  if  ultimately  granted,  the  FDA  and  international  regulatory  clearances  or  approvals  may  be  subject  to  significant,  unanticipated  delays
throughout the regulatory review process. Internally, we make assumptions regarding product clearance or approval timelines, both in the United States and
internationally, in our business planning, and any delay in clearance or approval could materially affect our competitive position in the relevant product
market and our projections related to future business results.

We cannot be certain that product clearance or approvals, both in the United States and internationally, will not include significant limitations on
the product indications, and other claims sought for use, under which the products may be marketed. The relevant approval or clearance may also include
other  significant  conditions  such  as  post-market  testing,  tracking,  or  surveillance  requirements.  Any  of  these  factors  could  significantly  impact  our
competitive position in relation to such products and could have a negative impact on the sales of such products. 

31

 
 
 
 
 
 
 
 
 
Once obtained, we cannot guarantee that the FDA or international product clearances or approvals will not be withdrawn or that relevant agencies will
not require other corrective action, and any withdrawal or corrective action could materially affect our business and financial results.

Once obtained, marketing approval can be withdrawn by the FDA or comparable foreign regulatory agencies for a number of reasons, including
the  failure  to  comply  with  ongoing  regulatory  requirements  or  the  occurrence  of  unforeseen  problems  following  initial  approval.  Regulatory  authorities
could also limit or prevent the manufacture or distribution of our products. Any regulatory limitations on the use of our products or any withdrawal or
suspension of approval or rescission of approval or reclassification by the FDA or a comparable foreign regulatory agency could have a material adverse
effect on our business, financial condition, and results of operations.

Our operations and products are subject to extensive regulation, compliance with which is costly and time consuming, and our failure to comply may
result in substantial penalties, including recalls of our products.

The FDA and foreign regulatory bodies impose extensive regulations applicable to our operations and products, including regulations governing
product  and  sterilization  standards,  packaging  requirements,  labeling  requirements,  adverse  event  reporting,  quality  system  and  manufacturing
requirements, import restrictions, tariff regulations, duties, and tax requirements. The FDA and other foreign regulatory bodies worldwide conduct periodic
inspections of our facilities to determine compliance with the FDA’s requirements and all comparable foreign regulations. We cannot assure you that we
will be able to achieve and maintain compliance required for the FDA, CE marking, or other foreign regulatory clearances or approvals for any or all our
operations and products or that we will be able to produce our products in a timely and profitable manner while complying with applicable requirements.

Failure to comply with applicable regulatory requirements could result in substantial penalties, including warning letters, fines, injunctions, civil
penalties, seizure of products, total or partial suspension of production, refusal to grant pre-market clearance or pre-market approval for devices or drugs,
withdrawal of approvals, and criminal prosecution. Additionally, regulatory authorities have the power to require the recall of our products. It also might be
necessary for us, in applicable circumstances, to initiate a voluntary recall per regulatory requirements of one or several of our products. The imposition of
any of the foregoing penalties, whether voluntarily or involuntary, could have a material negative impact on our business, financial condition, and results of
operations.

Any changes in the FDA or international regulations related to product approval or approval renewal, including those currently under consideration
by the FDA or those that apply retroactively, could adversely affect our competitive position and materially affect our business and financial results.

The FDA and foreign regulations depend heavily on administrative interpretation, and we cannot assure you that future interpretations made by
the FDA or other regulatory bodies, with possible retroactive effects, will not adversely affect us. Additionally, any changes, whether in interpretation or
substance, in existing regulations or policies, or any future adoption of new regulations or policies by relevant regulatory bodies, could prevent or delay
approval of our products. In the event our future, or current, products, including HA generally, are classified, or re-classified, as human drugs, combination
products,  or  biologics  by  the  FDA  or  an  applicable  international  regulatory  body,  the  applicable  review  process-related  to  such  products  is  typically
substantially longer and substantially more expensive than the review process to which they are currently subject as medical devices. In 2018, the FDA
publicly  indicated  its  intent  to  consider  HA  products  for  certain  indications  for  regulation  as  a  drug  and  has  indicated  that  industry  should  submit  new
products or indication expansions to its Office of Combination Products to designate the appropriate FDA office for review. There exists uncertainty with
respect to the final interpretation, implementation, and consequences of this development, and this or any other potential regulatory changes in approach or
interpretation  similar  in  substance  to  those  mentioned  in  this  paragraph  and  affecting  our  products  could  materially  impact  our  competitive  position,
business, and financial results.

Additionally,  the  implementation  of  the  new  EU  MDR  which  was  put  into  effect  in  2021,  has  changed  several  aspects  of  the  medical  device
regulatory  framework  in  the  EU.  Specifically,  the  EU  MDR  requires  (i)  changes  in  the  clinical  evidence  required  for  medical  devices,  (ii)  post-market
clinical follow-up evidence, (iii) annual reporting of safety information for Class III and Class IIb products, and reporting every two years for Class IIa
products, (iv) Unique Device Identification, or UDI, for all products and submission of core data elements to an EU UDI database prior to placement of a
device  on  the  market,  (v)  reclassification  of  some  medical  devices,  and  (vi)  multiple  other  labeling  changes.  Approvals  for  certain  of  our  currently
marketed products could be curtailed or withdrawn as a result of the implementation of the EU MDR, and acquiring approvals for new products could be
more challenging and costly. The EU MDR requires all devices to undergo review and approval for compliance to EU MDR by the expiry of a transitional
period.  The original expiry date of May 26, 2024 has been extended to December 2027 or December 2028 for certain devices, depending on the risk class
of the device, in response to concerns raised about notified body capacity and the ability for devices to be re-certified within the original time period. We
have reviewed our products that are sold in the EU market and have completed the product rationalization exercise to identify the products that we will
continue  to  market  in  the  EU.  Products  we  intend  to  continue  marketing  will  require  substantial  submissions  to  be  made  to  the  notified  bodies  for  a
conformity assessment under the EU MDR no later than May 26, 2024, for the MDR extension timelines to apply. Compliance with this and any other
requirements is time consuming and costly, and our failure to comply may subject us to significant liabilities, which could have a material adverse effect on
our business, financial condition, and results of operations. 

32

 
 
 
 
 
 
 
 
 
 
Notices of inspectional observations or deficiencies from the FDA or other regulatory bodies require us to undertake corrective and preventive actions
or other actions to address the FDA’s  or  other  regulatory  bodies'  concerns.  These  actions  could  be  expensive  and  time-consuming  to  complete  and
could impose an additional burden on us.

We are subject to periodic inspections by the FDA and other regulatory bodies related to regulatory requirements that apply to products designed
and manufactured, and clinical trials sponsored, by us. If we receive a notice of inspectional observations or deficiencies from the FDA or other regulatory
bodies following an inspection, we may be required to undertake corrective and protective actions or other actions in order to address the FDA or other
regulatory  bodies  concerns  which  could  be  expensive  and  time-consuming  to  complete  and  could  impose  additional  burdens  and  expenses.  We  have
previously received notices of observations or deficiencies from the FDA. Failure to adequately address the FDA’s or other regulatory bodies’ concerns
could expose us to enforcement or administrative actions.

We may rely on third parties to support certain aspects of our clinical trials. If these third parties do not successfully carry out their contractual duties
or meet expected deadlines, we may not be able to obtain regulatory clearance or approval or commercialize our products, and our business could be
substantially harmed.

We have hired experienced clinical development and regulatory staff, and we have also retained the services of knowledgeable external service
providers,  including  consultants  and  clinical  research  organizations,  to  develop  and  supervise  our  clinical  trials  and  regulatory  processes.  Despite  our
internal investment in staffing, we will remain dependent upon these third-party contract research organizations and consultants to carry out portions of our
clinical and preclinical research studies and regulatory filing assistance for the foreseeable future. As a result, we have had and will have less control over
the conduct of the clinical trials, the timing and completion of the trials, the required reporting of adverse events, and the management of data developed
through the trials than would be the case if we were relying entirely on our own staff. Outside parties may have staffing difficulties, may undergo changes
in  priorities  or  may  become  financially  distressed,  adversely  affecting  their  willingness  or  ability  to  conduct  our  trials.  Failure  by  these  third  parties  to
comply with regulatory requirements or to meet timing expectations may require us to repeat clinical trials or preclinical studies, which would delay the
regulatory clearance or approval process, or require substantial unexpected expenditures.

If we are found to have improperly promoted our products for off-label uses, we may become subject to significant fines and other liability.

The FDA and other regulatory agencies strictly regulate the promotional claims that may be made about medical devices and drugs. For example,
devices cleared under section 510(k) cannot be marketed for any intended use that is outside of the FDA’s substantial equivalence determination for such
devices. Physicians nevertheless may use our products on their patients in a manner that is inconsistent with the intended use cleared by the FDA. If we are
found to have promoted such “off-label” uses, we may become subject to significant government fines and other related liability. The federal government
has levied large civil and criminal fines against companies for alleged improper promotion and has enjoined several companies from engaging in off-label
promotion. The FDA has also requested that companies enter into consent decrees or permanent injunctions under which specified promotional conduct is
changed or curtailed.

We are subject to various healthcare laws and regulations, and any failure to comply with applicable laws could subject us to significant liability and
harm our business.

The  sales,  marketing  and  pricing  of  products  and  the  relationships  that  medical  products  companies  have  with  healthcare  providers  such  as
physicians, hospitals, ASCs, and others are under increased scrutiny. Our industry is subject to various laws and regulations pertaining to healthcare fraud
and abuse, as well as other laws that impose extensive tracking and reporting related to all transfers of value provided to certain health care providers and
others. These laws include the False Claims Act, the Anti-Kickback Statute, the Stark law, the Physician Payments Sunshine Act, the FDCA, and similar
laws and regulations in the U.S. and around the world. These laws and regulations are broad in scope and are subject to evolving interpretation. We could
be required to incur substantial costs to investigate, audit, and monitor compliance or to alter our practices, to the extent that we are subject to government
scrutiny under these laws. In addition, we are subject to various laws concerning anti-corruption and anti-bribery matters (including the Foreign Corrupt
Practices Act), sales to countries or persons subject to economic sanctions and other matters affecting our international operations. Violations of these laws
are  punishable  by  criminal  and/or  civil  sanctions,  including,  in  some  instances,  fines,  imprisonment  and,  within  the  United  States,  exclusion  from
participation in government healthcare programs, including Medicare, Medicaid and Veterans Administration health programs. These laws are administered
by,  among  others,  the  U.S.  Department  of  Justice,  the  U.S.  Department  of  Health  and  Human  Services  Office  of  Inspector  General,  the  Securities  and
Exchange  Commission,  the  Office  of  Foreign  Access  Control,  the  Bureau  of  Industry  and  Security  of  the  U.S.  Department  of  Commerce,  and  state
attorneys  general.  Any  failure  to  comply  with  these  laws  could  subject  us  to  significant  liabilities,  which  could  have  a  material  adverse  effect  on  our
business, financial condition, and results of operations.

33

 
 
 
 
 
 
 
 
 
 
We  are  subject  to  environmental  regulations  and  any  failure  to  comply  with  applicable  laws  could  subject  us  to  significant  liabilities  and  harm  our
business.

We  are  subject  to  a  variety  of  local,  state,  federal,  and  foreign  government  regulations  relating  to  the  storage,  discharge,  handling,  emission,
generation, manufacture, and disposal of toxic or other hazardous substances used in the manufacture of our products. Any failure by us to control the use,
disposal, removal, or storage of hazardous chemicals or toxic substances could subject us to significant liabilities, which could have a material adverse
effect on our business, financial condition, and results of operations.

Risks Related to Our Growth Initiatives

We may have difficulty managing our growth.

As  a  result  of  our  activities,  we  have  experienced  substantial  growth  in  the  number  of  our  employees,  the  scope  of  our  product  portfolio  and
pipeline, the size of our operating and financial systems, and the geographic area of our operations. This growth has resulted in increased responsibilities
for our management. To manage our growth effectively, we must continue to expand our management team, attract, motivate and retain employees, and
improve our operating and financial systems. There can be no assurance that our current management systems will be adequate or that we will be able to
manage our recent or future growth successfully. Any failure to do so could have a material adverse effect on our business, operating results and financial
condition. 

We may not generate the expected benefits of our acquisitions, and the ongoing integration of those acquisitions could disrupt our ongoing business,
distract our management and increase our expenses.

Through  our  acquisitions  of  Parcus  Medical  and  Arthrosurface,  we  expanded  our  product  portfolio  and  pipeline,  diversified  our  business,
expanded our commercial infrastructure, entered new markets, and increased the scope of our operations and the number of our employees. The continued
successful  integration  of  these  other  companies  into  our  operations  is  critical  to  our  future  financial  performance.  This  will  require  that  we  continue  to
integrate  more  closely  the  companies’  product  offerings  and  research  and  development  capabilities,  retain  key  employees,  assimilate  diverse  corporate
cultures,  further  integrate  management  and  financial  information  systems,  consolidate  the  acquired  operations  and  manage  geographically  dispersed
operations, among other things, each of which could pose significant challenges. The difficulty of combining the acquired companies with our company
may be increased by the need to integrate personnel, and changes effected in the combination may cause key employees to leave. To succeed in the market
for joint preservation and restoration, we must also invest additional resources, primarily in the areas of sales and marketing, to extend name recognition
and increase market share.

The integration of the two acquired companies into our operations has taken longer than originally anticipated and has required more effort and
expense than was originally planned. This has resulted, and may continue to result, in the loss of valuable employees, additional expenses, the disruption of
our ongoing business, processes and systems, or inconsistencies in standards, controls, procedures, practices, policies and compensation arrangements, any
of  which  could  adversely  affect  our  ability  to  achieve  the  anticipated  benefits  of  the  acquisitions.  There  may  be  increased  risk  due  to  the  ongoing
integration  of  financial  reporting  and  internal  control  systems.  Any  diversion  of  the  attention  of  management  created  by  the  integration  process,  any
disruptions or other difficulties encountered in the integration process, and unforeseen liabilities or unanticipated problems with the acquired businesses
could have a material adverse effect on our business, operating results and financial condition. We are working diligently to complete integration activities,
minimize  employee  disruptions  and  improve  production  and  communication  as  we  continue  to  integrate  Arthrosurface  and  Parcus  Medical.  It  has  been
more  challenging  than  anticipated  to  effectively  and  timely  complete  our  integration  goals.  The  acquisition  of  these  two  companies  and  the  related
investment in the business have contributed to our net loss in recent years. We recorded an impairment to goodwill in 2020 and to intangible assets in 2023
and a reduction in the fair value of contingent consideration in connection with the acquisitions that was driven in part by slower than expected revenue
growth with these businesses that have impacted near-term cash flows. 

There  can  be  no  assurance  that  these  acquisitions  will  provide  the  benefits  we  expect  or  that  we  will  be  able  to  integrate  and  develop  the
operations of Parcus Medical and Arthrosurface successfully. Any failure to do so could have a material adverse effect on our business, operating results
and financial condition.

We expect to continue to actively explore inorganic growth as a part of our future growth strategy, which exposes us to a variety of risks that could
adversely affect our business operations.

Our  business  and  future  growth  strategy  includes  as  an  important  component  the  acquisition  of  businesses,  technologies,  services,  assets  or
products that we believe are a strategic fit with or otherwise provide value to our business. We may fund these acquisitions by utilizing our cash, incurring
debt,  issuing  additional  shares  of  our  common  stock,  or  by  other  means.  Completed  transactions  may  expose  us  to  a  number  of  risks  and  expenses,
including unanticipated liabilities, amortization expenses related to intangible assets with definite lives, or risks associated with entering new markets with
which we have limited experience or where commercial alliances with experienced partners or existing sales channels are not available. Whether or not
completed,  transactions  may  result  in  diversion  of  management  resources  otherwise  available  for  ongoing  development  of  our  business  and  significant
expenditures.

34

 
 
 
 
 
 
 
 
 
 
 
 
 
Customer and employee uncertainty about the effects of any acquisitions could harm us.

Customers of any companies we acquire may, in response to the consummation of the acquisitions, delay or defer purchasing decisions, which
could adversely affect the success of our acquired businesses. Similarly, employees of acquired companies may experience uncertainty about their future
roles, which may adversely affect our ability to attract and retain key management, sales, marketing, and technical personnel following an acquisition. 

As our international sales and operations grow, we could become increasingly subject to additional economic, political, and other risks that could harm
our business.

Since  we  manufacture  our  products  for  sale  worldwide,  our  business  is  subject  to  risks  associated  with  doing  business  internationally.  During
2023, 2022, and 2021, 26%, 24%, and 23%, respectively, of our product sales were to international customers. We continue to be subject to a variety of
risks, which could cause fluctuations in the results of our international and domestic operations. These risks include:

●
●
●
●

●

●

●
●
●

●
●
●

The impact of recessions, inflation and other economic conditions in economies outside the United States;
Instability of foreign economic, political, and labor conditions;
Fluctuations in foreign currency exchange rates relative to the U.S. dollar;
Unfavorable labor regulations applicable to our European operations, such as severance and the unenforceability of non-competition
agreements in the European Union;
The impact of strikes, work stoppages, work slowdowns, grievances, complaints, claims of unfair labor practices, or other collective
bargaining disputes;
Difficulties in complying with restrictions imposed by regulatory or market requirements, tariffs, or other trade barriers or by U.S. export
laws;
Imposition of government controls limiting the volume of international sales;
Longer accounts receivable payment cycles;
Potentially adverse tax consequences, including, if required or applicable, difficulties transferring funds generated in non-U.S.
jurisdictions to the United States in a tax efficient manner;
Difficulties in protecting intellectual property, especially in international jurisdictions;
Difficulties in managing international operations; and
Burdens of complying with a wide variety of foreign laws, including the EU MDR and GDPR among others.

Our success depends, in part, on our ability to anticipate and address these and any new risks. We cannot guarantee that these or other factors will

not adversely affect our business or operating results.

Risks Related to Our Intellectual Property

We  may  be  unable  to  adequately  protect  our  intellectual  property  rights,  which  could  have  a  material  impact  on  our  business  and  future  financial
results.

Our efforts to enforce our intellectual property rights may not be successful. We rely on a combination of copyright, trademark, patent, and trade
secret laws, confidentiality procedures, and contractual provisions to protect our proprietary rights. Our success will depend, in part, on our ability to obtain
and enforce patents and trademarks, to protect trade secrets, to obtain licenses to technology owned by third parties when necessary, and to conduct our
business  without  infringing  on  the  valid  proprietary  rights  of  others.  The  patent  positions  of  pharmaceutical,  medical  product,  and  biotechnology  firms,
including ours, can be uncertain and involve complex legal and factual questions. There can be no assurance that any patent applications will result in the
issuance  of  patents  or,  if  any  patents  are  issued,  that  they  will  provide  significant  proprietary  protection  or  commercial  advantage  or  will  not  be
circumvented  by  others.  Filing  and  prosecution  of  patent  applications,  litigation  to  establish  the  validity  and  scope  of  patents,  assertion  of  patent
infringement  claims  against  others,  and  the  defense  of  patent  infringement  claims  by  others  can  be  expensive  and  time  consuming.  There  can  be  no
assurance that, in the event that any claims with respect to any of our patents, if issued, are challenged by one or more third parties, any court or patent
authority ruling on such challenge will determine that such patent claims are valid and enforceable. An adverse outcome in such litigation or patent review
process could cause us to lose exclusivity covered by the disputed rights. If a third party is found to have rights covering products or processes used by us,
we could be forced to cease using the technologies or marketing the products covered by such rights, we could be subject to significant liabilities to such
third party, and we could be required to license technologies from such third party in order to continue production of the products. Furthermore, even if our
patents  are  determined  to  be  valid,  enforceable,  and  broad  in  scope,  there  can  be  no  assurance  that  competitors  will  not  be  able  to  design  around  such
patents  and  compete  with  us  using  the  resulting  alternative  technology.  We  have  a  policy  of  seeking  patent  protection  for  patentable  aspects  of  our
proprietary  technology.  We  intend  to  seek  patent  protection  with  respect  to  products  and  processes  developed  in  the  course  of  our  activities  when  we
believe such protection is in our best interest and when the cost of seeking such protection is appropriate. However, no assurance can be given that any
patent  application  will  be  filed,  that  any  filed  applications  will  result  in  issued  patents,  or  that  any  issued  patents  will  provide  us  with  a  competitive
advantage or will not be successfully challenged by third parties. The protections afforded by patents will depend upon their scope and validity, and others
may be able to design around our patents. 

35

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
We also rely upon trade secrets and proprietary know-how for certain non-patented aspects of our technology. To protect such information, we
have  a  policy  requiring  all  employees,  consultants,  and  licensees  to  enter  into  confidentiality  agreements  limiting  the  disclosure  and  use  of  such
information. There can be no assurance that these agreements provide meaningful protection or that they will not be breached, that we would have adequate
remedies for any such breach, or that our trade secrets, proprietary know-how, and our technological advances will not otherwise become known to others.
In  addition,  there  can  be  no  assurance  that,  despite  precautions  taken  by  us,  others  have  not  and  will  not  obtain  access  to  our  proprietary  technology.
Further, there can be no assurance that third parties will not independently develop substantially equivalent or better technology.

There  can  be  no  assurance  that  we  will  not  infringe  upon  the  intellectual  property  rights  of  others,  which  could  have  a  significant  impact  on  our
business and financial results.

Other entities have filed patent applications for, or have been issued patents concerning, various products or processes in the segments in which
we do business. There can be no assurance that the products or processes developed by us will not infringe on the patent rights of others in the future. The
cost  of  defending  infringement  suits  is  typically  large,  and  there  is  no  guarantee  that  any  future  defense  would  be  successful.  In  addition,  infringement
could lead to substantial damages payouts or our inability to produce or market certain of our current or future products. As a result, any such infringement
may have a material adverse effect on our business, financial condition, and results of operations.

Risks Related to Ownership of Our Common Stock

Our stock price may be highly volatile, and we cannot assure you that market making in our common stock will continue.

The  market  price  of  shares  of  our  common  stock  may  be  highly  volatile.  Factors  such  as  announcements  of  new  commercial  products  or
technological innovations by us or our competitors, disclosure of results of clinical testing or regulatory proceedings, government regulation and approvals,
developments in patent or other proprietary rights, public concern as to the safety of products developed by us, and general market conditions may have a
significant  effect  on  the  market  price  of  our  common  stock.  We  have  highlighted  to  investors  increased  volatility  and  uncertainty  in  the  global
macroeconomic environment and the changing dynamics associated with staffing shortages, supply chain disruption and inflation. These actions, as well as
general investor uncertainty, could create volatility and unpredictability in our stock price. The trading price of our common stock could also be subject to
wide  fluctuations  in  response  to  quarter-to-quarter  variations  in  our  operating  results,  material  announcements  by  us  or  our  competitors,  governmental
regulatory action, conditions in the health care industry generally or in the medical products industry specifically, or other events or factors, many of which
are beyond our control. In addition, the stock market has experienced extreme price and volume fluctuations, which have particularly affected the market
prices of many medical products companies, and which often have been unrelated to the operating performance of such companies. Our operating results in
future  quarters  may  be  below  the  expectations  of  equity  research  analysts  and  investors.  In  such  an  event,  the  price  of  our  common  stock  would  likely
decline, perhaps substantially. 

Our charter documents contain anti-takeover provisions that may prevent or delay an acquisition of our company.

Our charter documents contain anti-takeover provisions that could prevent or delay an acquisition of our company. The provisions include, among
others, a classified board of directors, advance notice to the board of stockholder proposals, limitations on the ability of stockholders to remove directors
and  to  call  stockholder  meetings,  and  a  provision  that  allows  vacancies  on  the  Board  of  Directors  to  be  filled  by  vote  of  a  majority  of  the  remaining
directors. We are also subject to Section 203 of the Delaware General Corporate Law which, subject to certain exceptions, prohibits a Delaware corporation
from engaging in any of a broad range of business combinations with any “interested stockholder” for a period of three years following the date that such
stockholder  becomes  an  interested  stockholder.  Those  provisions  could  have  the  effect  of  discouraging  a  third  party  from  pursuing  a  non-negotiated
takeover of our company at a price considered attractive by many stockholders and could have the effect of preventing or delaying a potential acquirer from
acquiring control of our company.

36

 
 
 
 
 
 
 
 
 
 
If  securities  or  industry  analysts  do  not  publish  or  cease  publishing  research  or  reports  about  us,  our  business,  or  our  market,  or  if  they  adversely
change their recommendations regarding our stock, our stock price and trading volume could decline.

The trading market for our common stock is influenced by the research and reports that securities or industry analysts may publish about us, our
business, our market, or our competitors. No person is under any obligation to publish research or reports on us, and any person publishing research or
reports on us may discontinue doing so at any time without notice. If adequate research coverage is not maintained on our company or if any of the analysts
who cover us downgrade our stock or publish inaccurate or unfavorable research about our business or provide relatively more favorable recommendations
about our competitors, our stock price would likely decline. If any analysts who cover us were to cease coverage of our company or fail to regularly publish
reports on us, we could lose visibility in the financial markets, which in turn could cause our stock price or trading volume to decline.

We  have  been,  and  may  continue  to  be,  subject  to  the  actions  of  activist  stockholders,  which  could  cause  us  to  incur  substantial  costs,  divert
management’s and the board’s attention and resources, and have an adverse effect on our business and stock price.

From  time  to  time,  we  may  be  subject  to  proposals  by  activist  stockholders  urging  us  to  take  certain  corporate  actions  or  to  nominate  certain
individuals  to  our  board  of  directors.  In  February  2023,  Caligan  Partners  LP,  or  Caligan,  indicated  that  it  intended  to  consider  all  available  options,
including nominating a slate of directors for election to the board of directors at our 2023 annual meeting of stockholders. In April 2023, we entered into a
Cooperation Agreement (the “Cooperation Agreement”) with Caligan. Pursuant to the Cooperation Agreement, we agreed to increase the size of our board
of directors to eight directors and appointed Mr. Gary Fischetti as an independent Class III director. On March 6, 2024, Caligan nominated two directors for
election to our board of directors at our 2024 annual meeting of stockholders. If Caligan solicits proxies for its candidates or proceeds with other similar
types of actions, our business could be adversely affected. Responding to such actions by activist stockholders can be costly and time-consuming, disrupt
our operations and divert the attention of management and our board of directors. For example, we have retained the services of various professionals to
advise us on activist stockholder matters, including legal, financial, and communications advisors, the costs of which negatively impact our financial results
and  we  may  be  required  to  retain  additional  services  in  the  future,  which  could  have  a  further  negative  impact  on  our  financial  results.  In  addition,
perceived uncertainties as to our future direction, strategy or leadership created as a consequence of activist stockholder initiatives may result in the loss of
potential business opportunities, harm our ability to attract new investors, customers, and employees, and cause our stock price to experience periods of
volatility or stagnation.

ITEM 1B. UNRESOLVED STAFF COMMENTS

None.

ITEM 1C. CYBERSECURITY

Cyber Risk Management and Strategy

We  rely  on  information  technology  and  data  to  operate  our  business  and  develop,  market,  and  deliver  our  products  to  our  customers.  We  have
implemented  and  maintain  various  information  security  processes  designed  to  identify,  assess  and  manage  material  risks  from  cybersecurity  threats  to
critical  computer  networks,  third  party  hosted  services,  communications  systems,  hardware,  manufacturing  equipment  and  processes,  lab  equipment,
software, and our critical data including confidential, personal, proprietary, financial and sensitive data. Accordingly, we maintain certain risk assessment
processes intended to identify risks from cybersecurity threats, determine their likelihood of occurring, and assess potential material impact to our business.

We use a layered approach designed to mitigate the constantly evolving risks from cybersecurity threats by investing in people, processes, and
cybersecurity technologies. Our approach is informed by recognized industry standards and frameworks, and incorporates elements of the same, including
elements  of  the  National  Institute  of  Standards  and  Technology  Cybersecurity  Framework,  or  NIST  CSF,  and  the  Center  for  Internet  Security,  or  CIS,
critical security controls.

Our  cybersecurity  risk  management  program  leverages  trusted  technology  partners  and  solutions  in  an  effort  to  identify  and  track  key
cybersecurity  risks.  This  program  includes  period  security  assessments  conducted  in  collaboration  with  our  key  stakeholders,  penetration  testing  and
vulnerability  assessments,  and  a  mandatory  cybersecurity  training  program  for  employees.  To  manage  cybersecurity  incidents,  our  global  security
operations team maintains a cybersecurity incident response plan, conducts readiness exercises, and takes steps to improve the program, as appropriate, to
manage the changing threats faced in our industry.

37

 
 
 
 
 
 
 
 
 
 
 
 
 
As  part  of  our  cybersecurity  risk  management  program,  we  take  a  risk-based  approach  to  the  evaluation  of  third-party  vendors.  We  apply
mitigations and processes based on our evaluation of the criticality of the vendor and the sensitivity of the data the vendor accesses. Our current vendor
evaluation procedures include, as appropriate, an assessment prior to onboarding and implementation of cybersecurity-specific contract provisions. We are
in the process of expanding and maturing these vendor risk management procedures.

We, like other companies in our industry, face a number of cybersecurity risks in connection with our business. Risks from cybersecurity threats
have, to date, not materially affected, and we do not believe they are reasonably likely to materially affect, us, our business strategy, results of operations or
financial condition; however, from time to time, we have experienced threats and security incidents relating to our and our third party vendors’ information
systems. For additional information, please see the section captioned “Part I. Item 1A. Risk Factors” in this Annual Report on Form 10-K.

Governance Related to Cybersecurity Risks

Our Vice President of Information Technology, or VP of IT, is responsible for the direction of our information technology organization. Our VP of
IT has over twenty-five years of cybersecurity and incident management experience. Our VP of IT is supported by a third-party virtual chief information
security  officer,  or  vCISO,  who  also  has  over  twenty-five  years  of  cybersecurity  experience.  Our  VP  of  IT,  supported  by  our  vCISO,  assesses  our
cybersecurity risks through regular meetings with our IT team, and escalates cybersecurity matters as needed to management.

The role of the Board of Directors in our risk oversight process includes receiving reports from management and the chairs of Board committees
on areas of material risk to our Company, including cybersecurity risks. The Board has delegated primary responsibility to the Audit Committee to review
these  matters.  As  established  in  the  Audit  Committee  Charter,  the  Audit  Committee  oversees  cybersecurity  risks  by  reviewing  reports,  summaries  and
presentations on data management and security initiatives and significant existing and emerging cybersecurity risks. This includes material cybersecurity
incidents, the impact to us and our stakeholders of any significant cybersecurity incident, and any disclosure obligations arising from any such incidents.
Our VP of IT presents on risks from cybersecurity threats to the Audit Committee at least annually and to the full Board, as necessary.

ITEM 2. PROPERTIES

We  maintain  leases  on  six  facilities,  including  our  corporate  headquarters  location  in  Bedford,  Massachusetts,  where  we  lease  approximately
134,000 square feet of administrative, research and development, and manufacturing space. The lease on this facility contains multiple extension options
that allow us to extend the term through October 2038. Our other lease locations are in Franklin, Massachusetts, Sarasota, Florida, Warsaw, Indiana and
Padova, Italy. These additional facilities provide us with an aggregate of over 80,000 square feet of additional space and have terms expiring between 2022
and 2032, subject to certain renewal provisions contained within the lease agreements.

See Note 8, Leases, to the consolidated financial statements included elsewhere in this Annual Report on Form 10-K for additional information

regarding our specific leaseholds.

ITEM 3. LEGAL PROCEEDINGS

We are involved from time-to-time in various legal proceedings arising in the normal course of business. Although the outcomes of these legal
proceedings  are  inherently  difficult  to  predict,  we  do  not  expect  the  resolution  of  these  proceedings  to  have  a  material  adverse  effect  on  our  financial
position, results of operations, or cash flows.

ITEM 4. MINE SAFETY DISCLOSURES

Not applicable.

38

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PART II

ITEM 5. MARKET FOR REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF
EQUITY SECURITIES

Common Stock Information

Our common stock has traded on the NASDAQ Global Select Market since November 25, 1997, under the symbol “ANIK.” At December 31,
2023,  the  closing  price  per  share  of  our  common  stock  was  $22.66  as  reported  on  the  NASDAQ  Global  Select  Market,  and  there  were  110  holders  of
record.  We  believe  that  the  number  of  beneficial  owners  of  our  common  stock  at  that  date  was  substantially  greater,  due  to  shares  being  held  by
intermediaries.

We have never declared or paid any cash dividends on our common stock. We currently intend to retain earnings, if any, for use in our business
and do not anticipate paying cash dividends on our common stock in the foreseeable future. Payment of future dividends, if any, on our common stock will
be at the discretion of our Board of Directors after considering various factors, including our financial condition, operating results, anticipated cash needs,
and plans for expansion.

Performance Graph

Set forth below is a graph comparing the total returns of our company, the NASDAQ Composite Index, and the NASDAQ Biotechnology Index.
The graph assumes $100 is invested on December 31, 2018, in our common stock and each of the indices. Past performance is not indicative of future
results.

Dec-18

Dec-19

Dec-20

Dec-21

Dec-22

Dec-23

Anika Therapeutics, Inc.
NASDAQ Composite Index
NASDAQ Biotechnology Index

  $
  $
  $

100.00    $
100.00    $
100.00    $

154.27    $
135.23    $
124.41    $

39

134.66    $
194.24    $
156.36    $

106.61    $
235.78    $
155.37    $

88.07    $
157.74    $
138.42    $

67.42 
226.24 
143.60 

 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
 
 
Issuer Purchases of Equity Securities

In April 2023, we agreed to establish a share repurchase program for an aggregate purchase price of $20.0 million. Of the $20.0 million, the first
$5.0 million was to be effected through an accelerated stock repurchase program, the second $5.0 million was to be purchased in the open market and the
remaining  $10.0  million  was  to  be  purchased  in  the  open  market  subject  to  positive  cash  flow.  On  May  12,  2023,  we  entered  into  an  accelerated  share
repurchase agreement with Bank of America, N.A., or Bank of America, pursuant to a Fixed Dollar Accelerated Share Repurchase Transaction, or ASR
Agreement, to purchase $5.0 million of shares of its common stock. During the second quarter of 2023, 158,983 shares were delivered to us, constituting
the initial delivery of shares and representing 80% of the then estimated total number of shares expected to be repurchased under the ASR Agreement. In
July 2023, we received the remaining 29,046 additional shares at a final settlement price based on the average purchase price of $26.59 per share.

Securities Authorized for Issuance Under Equity Compensation Plans

For information regarding securities authorized for issuance under our employee stock-based compensation plans, see Part III. Item 12. Security

Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters.

ITEM 6.

[RESERVED]

ITEM 7. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

The following section contains statements that are not statements of historical fact and are forward-looking statements within the meaning of the
federal  securities  laws.  These  statements  involve  known  and  unknown  risks,  uncertainties,  and  other  factors  that  may  cause  our  actual  results,
performance,  or  achievement  to  differ  materially  from  anticipated  results,  performance,  or  achievement,  expressed  or  implied  in  such  forward-looking
statements. These statements reflect our current views with respect to future events, are based on assumptions, and are subject to risks and uncertainties.
We discuss many of these risks and uncertainties at the beginning of this Annual Report on Form 10-K and under the sections captioned “Business” and
“Risk Factors.” The following discussion should also be read in conjunction with the consolidated financial statements and the Notes thereto appearing
elsewhere in this Annual Report on Form 10-K. 

Management Overview

We are a global joint preservation company that creates and delivers meaningful advancements in early intervention orthopedic care. Based on our
collaborations with clinicians to understand what they need most to treat their patients, we develop minimally invasive products that restore active living
for people around the world. We are committed to leading in high opportunity spaces within orthopedics, including OA pain management, regenerative
solutions, sports medicine and Arthrosurface joint solutions.

We have thirty years of global expertise developing, manufacturing and commercializing products based on our HA technology platform. HA is a
naturally occurring polymer found throughout the body that is vital for proper joint health and tissue function. Our proprietary technologies for modifying
the  HA  molecule  allow  product  properties  to  be  tailored  specifically  to  multiple  uses,  including  enabling  longer  residence  time  to  support  OA  pain
management and creating a solid form of HA called Hyaff, which is a platform utilized in our regenerative solutions portfolio.

In  early  2020,  we  expanded  our  overall  technology  platform,  product  portfolio,  and  significantly  expanded  our  commercial  infrastructure,
especially in the United States, through our strategic acquisitions of Parcus Medical, LLC, a sports medicine and instrumentation solutions provider, and
Arthrosurface, Inc., a company specializing in bone preserving partial and total joint replacement solutions. These acquisitions augmented our HA-based
OA pain management and regenerative products with a broad suite of products and capabilities focused on early intervention joint preservation primarily in
upper and lower extremities such as shoulder, foot/ankle, knee and hand/wrist.

As we look towards the future, our business is positioned to capture value within our target market of joint preservation. We believe our success

will be driven by our:

● Decades of experience in HA-based regenerative solutions and early intervention orthopedics combined under new seasoned leadership with a

strong financial foundation for future investment in meaningful solutions for our customers and their patients;

● Utilizing HA-based technology and manufacturing expertise to provide new and differentiated solutions for the growing joint preservation and

regenerative medicine markets;

40

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
● Introducing key HA-based products into the US market upon FDA approval/clearance, such as Cingal, Hyalofast and the Integrity Implant

System, our arthroscopic patch system for rotator cuff repair;

● Robust network of stakeholders in our target markets to identify evolving unmet patient treatment needs;

● Prioritized investment in differentiated pipeline of regenerative solutions, bone preserving implants and sports medicine products;

● Global commercial expertise which we will leverage to drive growth across our product portfolio, including an intentional site of care focus on

ambulatory surgical centers in the United States and continued international expansion;

● Opportunity to pursue strategic inorganic growth opportunities, including potential partnerships and smaller acquisitions, technology licensing,

and leveraging our strong financial foundation and operational capabilities;

● Pursuit of strategic inorganic growth opportunities, including potential partnerships and smaller acquisitions and technology licensing, by

leveraging our strong financial foundation and operational capabilities; and

● Energized and experienced team focused on strong values, talent, and culture.

For additional information regarding our business, please refer to “Item 1. Business” of this Annual Report on Form 10-K.

Key Developments during the Year Ended December 31, 2023

●

Strengthening Leadership Position in OA Pain Management
o Achieved  record  annual  revenues  of  $101.9  million  in  OA  Pain  Management  with  single-injection  Monovisc,  multi-injection  Orthovisc  and

o

Cingal outside the U.S.; Increasing leading U.S. market share position.
Cingal, Anika’s next generation non-opioid single-injection HA-based osteoarthritis pain product, continued strong double-digit growth outside
the U.S.

o Awaiting FDA feedback on proposed non-clinical next steps regarding Cingal U.S. regulatory approval following a Type C meeting with the FDA

in early 2023 and success in meeting its latest Phase III Pivotal primary endpoint in 2022.

● Advancing a Highly Differentiated Portfolio of HA-Based Regenerative Solutions

o

o

Successfully completed over 100 cases with the Integrity Implant System, Anika’s HA-based regenerative rotator cuff patch system, following the
limited market release in late November 2023; on-track for full market release in mid-2024.
Fully enrolled Hyalofast, Anika’s HA off-the-shelf single-stage cartilage repair product, Phase III clinical trial; modular PMA submission with
break-through device designation commencing in 2024; final PMA module filing expected in 2025 with product launching by 2026.

● Launched Key Products in Sports Medicine and Arthrosurface Joint Solutions

o X-Twist Biocomposite Fixation System launched in the first quarter of 2024, compliments the PEEK version launched in early 2023.
o

RevoMotion Reverse Shoulder Arthroplasty System full market release in September 2023.

41

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Products

OA Pain Management

Our OA Pain Management product family consists of Monovisc and Orthovisc, our injectable, HA-based OA Pain Management offerings that are
indicated  to  provide  pain  relief  from  osteoarthritis  conditions;  and  Cingal,  our  novel,  next-generation,  single-injection  OA  Pain  Management  product
consisting  of  our  proprietary  cross-linked  HA  material  combined  with  a  fast-acting  steroid.  Cingal  is  our  next  generation  fast-acting,  long-lasting,  non-
opioid, clinically proven osteoarthritis pain product which is designed to provide both short- and long-term pain relief,  through at least six months.  It is
currently sold outside the United States in over 35 countries.  In 2022, we completed a third Phase III clinical trial for Cingal, which achieved its primary
endpoint.  Cingal  is  currently  not  approved  for  commercial  use  in  the  United  States.  We  have  been  actively  engaging  with  the  U.S.  Food  and  Drug
Administration, or the FDA, on next steps for U.S. regulatory approval.

Joint Preservation and Restoration

Our Joint Preservation and Restoration product family consists of: (a) our portfolio of orthopedic regenerative solutions products utilizing HA,
including Integrity, our new arthroscopic regenerative patch system for rotator cuff repair and other tendon procedures, Tactoset products, and Hyalofast
outside of the United States in over 30 countries; (b) our line of sports medicine solutions used to repair and reconstruct damaged ligaments and tendons
due to sports injuries, trauma and disease; and (c) our Arthrosurface portfolio of bone preserving joint technologies, including partial joint replacement,
joint resurfacing, and minimally invasive and bone sparing implants, designed to treat upper and lower extremity orthopedic conditions caused by trauma,
injury and arthritic disease.

Non-Orthopedic

Our Non-Orthopedic product family consists of legacy HA-based products that are marketed principally for non-orthopedic applications, including
our adhesion barrier product, advanced wound care products, our ear, nose and throat products, and our ophthalmic products. Non-Orthopedic also includes
Hyvisc,  our  high  molecular  weight  injectable  HA  veterinary  product  approved  for  the  treatment  of  joint  dysfunction  in  horses  due  to  non-infectious
synovitis associated with equine OA. Hyvisc was previously reported in the OA Pain Management product family but has been reclassified to the Non-
Orthopedic product family beginning in 2023.

For  additional  information  with  respect  to  our  products,  including  information  related  to  how  they  are  sold  and  new  product  development
initiatives, please see the sections captioned “Products,” “Sales Channels,” and “Research and Development” contained within “Part I. Item I. Business” of
this Annual Report on Form 10-K.

42

 
 
 
 
 
 
 
 
 
 
 
Results of Operations

Year ended December 31, 2023 compared to year ended December 31, 2022

Statement of Operations Detail

2023

Year Ended December 31,
$ Change

2022

    % Change  

Revenue
Cost of revenue
Gross profit
Gross margin
Operating expenses:

Research & development
Selling, general & administrative
Impairment of intangible assets

Total operating expenses
Loss from operations

Interest and other expense, net

Loss before income taxes

Benefit from income taxes

Net loss

Revenue

(in thousands, except percentages)
  $

  $

  $

166,662 
63,574 
103,088 

156,236 
62,660 
93,576 

10,426     
914     
9,512     

62%   

60%   

32,690 
95,847 
62,190 
190,727 
(87,639)    
2,312 
(85,327)    
(2,660)    
(82,667)   $

28,182 
84,794 
- 
112,976 
(19,400)    
654 
(18,746)    
(3,887)    
(14,859)   $

4,508     
11,053     
62,190     
77,751     
(68,239)    
1,658     
(66,581)    
1,227     
(67,808)    

  $

7%
1%
10%

16%
13%
- 
69%
352%
254%
355%
(32%)
456%

The following table presents revenue by product family for fiscal years 2023 and 2022 (dollars in thousands): 

OA Pain Management
Joint Preservation and Restoration
Non-Orthopedic

2023

Years Ended December 31,
$ Change

2022

    % Change  

  $

  $

101,927    $
54,879     
9,856     
166,662    $

91,984    $
50,402     
13,850     
156,236    $

9,943     
4,477     
(3,994)    
10,426     

11%
9%
(29%)
7%

Revenue for the year ended December 31, 2023 was $166.7 million, an increase of $10.5 million, or 7%, compared to the prior year. The increase

in revenue was driven by growing global commercial adoption of our products as well as our introduction of new products in recent years.

Revenue from our OA Pain Management product family increased 11% for the year ended December 31, 2023, as compared to prior year, due to a
global sales growth of our Monovisc single injection pain product and favorable ordering patterns, as well as continued double-digit international growth of
our Cingal next generation non-opioid single injection pain product. 

Revenue from our Joint Preservation and Restoration product family increased 9% for the year ended December 31, 2023, as compared to prior

year, due to commercial adoption of our newest products, such as X-Twist, and higher international sales.

43

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
   
   
      
  
     
 
     
 
     
       
 
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
 
 
 
 
 
 
 
   
   
 
     
       
       
       
 
   
   
 
 
 
 
 
Revenue from our Non-Orthopedic product family decreased 29% for the year ended December 31, 2023, as compared to prior year, primarily due
to lower sales to veterinary customers due to timing of ordering patterns and lower sales following last-time-buys in 2022 associated with termination of
certain legacy distributor contracts. 

Effective  January  1,  2023,  we  began  to  report  revenue  from  product  sales  to  veterinary  customers  within  the  Non-Orthopedic  product  family
whereas such revenue had historically been reported within the OA Pain Management revenue product family for the prior period year ended December 31,
2022.  Revenue  from  product  sales  to  veterinary  customers  amounted  to  $4.2  million  and  $5.9  million  for  2023  and  2022,  respectively,  with  the  2022
revenue reclassified to Non-Orthopedic to conform to current presentation.

Gross Profit and Margin

Gross profit for the year ended December 31, 2023 was $103.1 million, or gross margin of 62%, as compared with $93.6 million, or gross margin
of 60%, for the year ended December 31, 2022. The increase in gross profit for the year ended December 31, 2023, primarily resulted from higher revenue
growth, improved manufacturing efficiency and lower product rationalization charges. This increase was partially offset by higher costs due to inflationary
pressures for raw materials and freight charges.

Research and Development

Research and development expenses for the year ended December 31, 2023 were $32.7 million, an increase of $4.5 million, or 16%, as compared
to the prior year, primarily due to increased costs to ensure compliance with growing regulatory requirements globally, such as EU MDR, as well as new
product  development  associated  with  our  research  and  development  pipeline,  led  by  Integrity,  which  received  FDA  clearance  in  August  2023  and  was
launched with first surgeries in rotator cuff repair and other tendon procedures in November 2023.

For additional information on our research and development activities, please see the section captioned “Part I. Item 1. Business—Research and

Development” in this Annual Report on Form 10-K.

Selling, General and Administrative

Selling, general and administrative, or SG&A, expenses for the year ended December 31, 2023 were $95.9 million, an increase of $11.0 million,
or 13%, as compared to the prior year. The increase in SG&A expenses for the year ended December 31, 2023 was primarily due to $13.0 million of non-
recurring costs related to the Parcus Medical unitholder arbitration settlement, shareholder activism, discontinuation of a software development project and
other  non-recurring  corporate  costs.  During  the  year,  spending  increased  as  we  continued  to  expand  our  commercial  capability  in  the  United  States,
including  increased  marketing,  medical  education  and  other  operational  capabilities  to  support  our  business  growth,  as  well  as  due  to  increased
commissions resulting from sales growth.

Impairment of Intangible Assets

We assess our long-lived assets for impairment under certain circumstances, such as when events or changes in circumstances indicate there may
be impairment. During the fourth quarter of 2023, we performed a quantitative assessment of intangible assets impairment related to the Parcus Medical
and Arthrosurface reporting unit. The results of these impairment tests indicated that the estimated fair value of this reporting unit was less than its carrying
value. Consequently, a non-cash impairment of intangible assets charge of $62.2 million was recorded in the quarter ended December 31, 2023. The decline
in  fair  value  was  primarily  due  to  lower  growth  expectations  for  future  revenue  and  related  cash  flows  related  the  Parcus  Medical  and  Arthrosurface
reporting unit.

Income Taxes

The benefit from income taxes was $2.7 million for the year ended December 31, 2023, resulting in an effective tax rate of 3.1%. The benefit from
income taxes was $3.9 million for the year ended December 31, 2022, resulting in an effective tax rate of 20.7%. The decrease in our effective rate for the
year  ended  December  31,  2023  as  compared  to  the  year  ended  December  31,  2022  is  primarily  due  to  a  valuation  allowance  being  recorded  on  U.S.
deferred tax assets in 2023 offset somewhat by non-deductible stock-based compensation.

Net Loss

For the year ended December 31, 2023, the net loss was $82.7 million, or $5.64 per basic and diluted loss per share, compared to a net loss of
$14.9  million,  or  $1.02  per  basic  and  diluted  share,  for  the  prior  year.  The  $67.8  million  increase  in  the  net  loss  was  due  to  the  $62.2  million  pre-tax
impairment charge on intangible assets recorded in the fourth quarter of 2023 and $13.0 million in pre-tax expenses associated with other non-recurring
costs earlier in 2023.

44

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-GAAP Financial Measures

We  present  certain  information  with  respect  to  adjusted  gross  profit  and  adjusted  gross  margin,  adjusted  Earnings  Before  Interest,  Tax,
Depreciation and Amortization, or EBITDA, adjusted net income, adjusted diluted earnings per share or adjusted Earnings Per Share, or EPS, which are
financial measures not based on any standardized methodology prescribed by accounting principles generally accepted in the United States, or GAAP, and
is not necessarily comparable to similarly titled measures presented by other companies.

We have presented adjusted gross profit and adjusted gross margin, adjusted EBITDA, adjusted net income, adjusted EPS, because they are key
measures  used  by  our  management  and  board  of  directors  to  understand  and  evaluate  our  operating  performance  and  to  develop  operational  goals  for
managing our business. We believe these financial measures help identify underlying trends in our business that could otherwise be masked by the effect of
the  expenses  that  we  exclude.  We  believe  that  the  exclusion  of  these  items  in  calculating  these  measures  can  provide  a  useful  tool  for  period-to-period
comparisons  of  our  core  operating  performance.  Accordingly,  we  believe  that  these  measures  provide  useful  information  to  investors  and  others  in
understanding  and  evaluating  our  operating  results,  enhancing  the  overall  understanding  of  our  past  performance  and  future  prospects  and  allowing  for
greater transparency with respect to key financial metrics used by our management in their financial and operational decision-making. 

Adjusted Gross Profit and Adjusted Gross Margin

We define adjusted gross profit as our gross profit excluding amortization of certain acquired intangible assets, the impact of inventory fair-value
step up associated with our recent acquisitions and certain product rationalization charges. The amortized assets contribute to revenue generation, and the
amortization  of  such  assets  will  likely  continue  in  future  periods  until  such  assets  are  fully  amortized.  These  assets  include  the  fair  value  of  certain
identified assets acquired in acquisitions, including developed technology and acquired trade names. We define adjusted gross margin as adjusted gross
profit divided by total revenue.

The following is a reconciliation of adjusted gross profit to gross profit for the years ended December 31, 2023 and 2022, respectively:

Years Ended December 31,
2022
2023

Gross profit

Product rationalization charges
Acquisition related intangible asset amortization

Adjusted gross profit
Adjusted gross margin

  $

  $

  $

103,088 
748 
6,244 
110,080 

  $
66%   

93,576 
3,199 
6,240 
103,015 

66%

Adjusted gross profit for the year ended December 31, 2023 increased $7.1 million to $110.1 million representing 66% of revenue. Adjusted gross
profit for the year ended December 31, 2022 was $103.0 million, or 66% of revenue. The increase in adjusted gross profit for the year ended December 31,
2023 as compared to 2022, primarily resulted from the growth of revenue. There was no change in adjusted gross margin for the year ended December 31,
2023 as compared to 2022, as the benefits of higher revenue and related production volumes were offset by increased supply chain costs due to inflationary
pressures and a higher proportion of international sales in which product margins are generally lower.

Adjusted EBITDA

We present information below with respect to adjusted EBITDA, which we define as our net loss excluding interest and other income, net, income

tax benefit, depreciation and amortization, stock-based compensation, product rationalization charges, and other non-recurring expenses.

Adjusted EBITDA is not prepared in accordance with U.S. GAAP, and should not be considered in isolation of, or as an alternative to, measures
prepared in accordance with U.S. GAAP. There are a number of limitations related to the use of adjusted EBITDA rather than net income (loss), which is
the nearest U.S. GAAP equivalent. Some of these limitations are:

45

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
 
 
 
 
 
•

•

•

•

•

•

•

•

•

•

adjusted  EBITDA  excludes  depreciation  and  amortization,  and,  although  these  are  non-cash  expenses,  the  assets  being  depreciated  or
amortized may have to be replaced in the future, the cash requirements for which are not reflected in adjusted EBITDA;

we exclude stock-based compensation expense from adjusted EBITDA although (a) it has been, and will continue to be for the foreseeable
future, a significant recurring expense for our business and an important part of our employee compensation strategy and (b) if we did not pay
out  a  portion  of  our  compensation  in  the  form  of  stock-based  compensation,  the  cash  salary  and  bonus  expense  included  in  operating
expenses likely would be higher, which would affect our cash position;

we  exclude  acquisition  related  expenses,  including  transaction  costs  and  other  related  expenses,  amortization  and  depreciation  of  acquired
assets in recent acquisitions, and the impact of inventory fair-value step up on cost of goods sold;

we exclude certain impairment charges, including impairment related to intangible assets, certain product rationalization charges;

we exclude goodwill impairment charges and changes in the fair value of contingent consideration;’

we  exclude  certain  other  non-recurring  costs,  such  as  the  arbitration  settlement  with  Parcus  Medical,  costs  associated  with  shareholder
activism, and discontinuation of a software project;

the expenses and other items that we exclude in our calculation of adjusted EBITDA may differ from the expenses and other items, if any,
that other companies may exclude from adjusted EBITDA when they report their operating results;

adjusted EBITDA does not reflect changes in, or cash requirements for, working capital needs;

adjusted EBITDA does not reflect provision for (benefit from) income taxes or the cash requirements to pay taxes; and

adjusted EBITDA does not reflect historical cash expenditures or future requirements for capital expenditures or contractual commitments.

The following is a reconciliation of adjusted EBITDA to net loss for the years ended December 31, 2023 and 2022 respectively:

Net loss

Interest and other expense, net
Benefit from income taxes
Depreciation and amortization
Stock-based compensation
Product rationalization charges
Arbitration settlement
Acquisition related intangible asset amortization
Impairment of intangible assets
Discontinuation of software development project
Costs of shareholder activism

Adjusted EBITDA

Years Ended December 31,
2022
2023

(82,667)   $
(2,312)    
(2,660)    
7,069     
15,243     
748     
3,250     
7,148     
62,190     
4,473     
3,033     
15,515    $

(14,859)
(654)
(3,887)
7,340 
14,315 
3,199 
- 
7,147 
- 
- 
- 
12,601 

  $

  $

Adjusted  EBITDA  for  year  ended  December  31,  2023  was  $15.5  million,  an  increase  of  $2.9  million  as  compared  to  2022.  The  increase  in
adjusted EBITDA was primarily due to an increase in revenue and adjusted gross profit as well as a slower ramp up of commercial spending in 2023 and
overall spending control.

46

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
   
   
   
   
   
   
   
   
 
 
Adjusted Net Loss and Adjusted EPS

We  present  information  below  with  respect  to  adjusted  net  loss  and  adjusted  EPS.  We  define  adjusted  net  loss  as  our  net  loss  excluding
amortization  and  depreciation  of  acquired  assets,  the  impact  of  inventory  fair-value  step  up  on  cost  of  revenue,  changes  in  the  fair  value  of  contingent
consideration, as well as certain impairment charges, including impairment related to IPR&D assets and non-cash product rationalization charges, each on a
tax  effected  basis.  Acquisition-related  expenses  are  those  that  we  would  not  have  incurred  except  as  a  direct  result  of  acquisition  transactions.  The
amortized  assets  contribute  to  revenue  generation  and  the  amortization  of  such  assets  will  recur  in  future  periods  until  such  assets  are  fully  amortized.
These  assets  include  the  estimated  fair  value  of  certain  identified  assets  acquired  in  acquisitions,  including  in-process  research  and  development,  or
IPR&D,  developed  technology,  customer  relationships  and  acquired  trade  names.  We  define  adjusted  EPS  as  U.S.  GAAP  diluted  earnings  per  share
excluding the above adjustments to net loss used in calculating adjusted net loss, each on a per share and tax effected basis.

The following is a reconciliation of adjusted net income to net loss for the years ended December 31, 2023 and 2022, respectively:

Net loss

Product rationalization charges, tax effected
Arbitration settlement, tax effected
Acquisition related intangible asset amortization, tax effected
Impairment of intangible assets, tax effected
Discontinuation of software development project, tax effected
Costs of shareholder activism, tax effected

Adjusted net loss

Years Ended December 31,
2022
2023

(82,667)   $
725     
3,148     
6,926     
60,250     
4,333     
2,938     
(4,347)   $

(14,859)
2,410 
- 
5,386 
- 
- 
- 
(7,063)

  $

  $

The following is a reconciliation of adjusted diluted loss per share to diluted loss per share for the years ended December 31, 2023 and 2022,

respectively (in thousands, expect per share data):

Diluted loss per share

Product rationalization charges, tax effected
Arbitration settlement, tax effected
Acquisition related intangible asset amortization, tax effected
Impairment of intangible assets, tax effected
Discontinuation of software development project, tax effected
Costs of shareholder activism, tax effected

Adjusted diluted loss per share

Years Ended December 31,
2022
2023

(5.64)   $
0.05     
0.21     
0.47     
4.11     
0.30     
0.20     
(0.30)   $

(1.02)
0.17 
- 
0.36 
- 
- 
- 
(0.49)

  $

  $

Adjusted net loss in 2023 was $4.3 million, a decrease of $2.7 million as compared to 2022. The decrease in adjusted net loss and adjusted diluted

loss per share for the period was primarily due to higher revenues and improved operating performance during the year.

47

 
 
 
 
 
 
 
 
 
 
   
 
   
   
   
   
   
   
 
 
 
 
 
 
 
   
 
   
   
   
   
   
   
 
 
Results of Operations

Year ended December 31, 2022 compared to year ended December 31, 2021

Statement of Operations Detail

2022

Year Ended December 31,
$ Change

2021

    % Change  

Revenue
Cost of revenue
Gross profit
Gross margin
Operating expenses:

Research & development
Selling, general & administrative
Change in fair value of contingent consideration

Total operating expenses
(Loss) income from operations

Interest and other expense, net
(Loss) income before income taxes

Benefit from income taxes

Net (loss) income

Revenue

(in thousands, except percentages)
  $

  $

  $

156,236 
62,660 
93,576 

147,794 
64,851 
82,943 

8,442     
(2,191)    
10,633     

60%   

56%   

28,182 
84,794 
- 
112,976 
(19,400)    
654 
(18,746)    
(3,887)    
(14,859)   $

27,327 
74,096 
(21,095)    
80,328 
2,615 
(188)    
2,427 
(1,707)    
  $
4,134 

855     
10,698     
21,095     
32,648     
(22,015)    
842     
(21,173)    
(2,180)    
(18,993)    

  $

6%
(3%)
13%

3%
14%
(100%)
41%
(842%)
(448%)
(872%)
128%
(459%)

The following table presents product revenue by product family for fiscal years 2022 and 2021 (dollars in thousands):

OA Pain Management
Joint Preservation and Restoration
Non-Orthopedic

2022

Years Ended December 31,
$ Change

2021

    % Change  

  $

  $

91,984    $
50,402     
13,850     
156,236    $

85,084    $
48,588     
14,122     
147,794    $

6,900     
1,814     
(272)    
8,442     

8%
4%
(2%)
6%

Revenue for the year ended December 31, 2022 was $156.2 million, an increase of $8.4 million, or 6%, compared to the prior year. The increase in
revenue was driven by recovery outside the U.S. from the initial impact of the COVID-19 pandemic on sales volumes and related strategic partner ordering
patterns, as well as from growing global commercial adoption of our products.

Revenue  from  our  OA  Pain  Management  product  family  increased  8%  for  the  year  ended  December  31,  2022,  as  compared  to  prior  year,  due
primarily to higher international sales on recovery from the initial impact of the COVID-19 pandemic, favorable ordering patterns and growth in adoption
of  our  products  globally.  The  increase  was  also  a  result  of  growth  in  Mitek  revenues  as  well  as  higher  veterinary  sales  on  favorable  order  patterns  and
COVID-19 recovery.

Revenue from our Joint Preservation and Restoration product family increased 4% for the year ended December 31, 2022, as compared to prior

year, due to improving elective procedure volumes and rapidly growing commercial adoption of our newest products.

48

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
   
   
      
  
     
 
     
 
     
       
 
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
 
 
 
 
 
 
 
   
   
 
     
       
       
       
 
   
   
 
 
 
 
 
Revenue from our Non-Orthopedic product family decreased 2% for the year ended December 31, 2022, as compared to prior year, primarily due

to timing of distributor sales as well as last-time purchases of legacy products during 2021.

Effective  January  1,  2023,  we  began  to  report  revenue  from  product  sales  to  veterinary  customers  within  the  Non-Orthopedic  product  family
whereas such revenue had historically been reported within the OA Pain Management revenue product family for the prior period years ended December
31, 2022 and 2021. Revenue from product sales to veterinary customers amounted to $5.9 million and $4.4 million for 2022 and 2021, respectively, with
the 2022 and 2021 revenue reclassified to Non-Orthopedic to conform to current presentation.

Gross Profit and Margin

Gross profit for the year ended December 31, 2022 was $93.6 million, or gross margin of 60%, as compared with $82.9 million, or gross margin of
56%, for the year ended December 31, 2021. The increase in gross profit for the year ended December 31, 2022, primarily resulted from higher revenue
growth and the conclusion of the amortization of inventory step-up costs related to the 2020 Arthrosurface and Parcus Medical acquisitions. This increase
was  partially  offset  by  higher  product  rationalization  charges,  as  well  as  higher  manufacturing-related  costs.  Gross  margin  includes  acquisition-related
amortization  expenses  and  the  impact  of  inventory  step-up  costs  associated  with  the  Arthrosurface  and  Parcus  Medical  acquisitions.  These  expenses
together increased cost of revenue by $6.2 million, or 7 points of gross margin, for the year ended December 31, 2022, as compared to increased cost of
revenue of $12.7 million, or 9 points of gross margin for the same periods in 2021. 

Research and Development

Research and development expenses for the year ended December 31, 2022 were $28.2 million, an increase of $0.9 million, or 3%, as compared to
the prior year, primarily due to increased costs to ensure compliance with growing regulatory requirements globally as well as new product development
associated with our research and development pipeline. Also included in research and development expenses are clinical costs. We completed a third Phase
III clinical trial for Cingal in 2022, which achieved its primary endpoint, and made significant progress in completing enrollment in our Hyalofast clinical
trial.

Selling, General and Administrative

Selling, general and administrative, or SG&A, expenses for the year ended December 31, 2022 were $84.8 million, an increase of $10.7 million,
or 14%, as compared to the prior year. The increase in SG&A expenses for the year ended December 31, 2022 was primarily related to the expansion of our
commercial  capability  in  the  United  States,  including  increased  marketing,  medical  education  and  other  operational  capabilities  to  support  our  growing
business needs, as well as increased commissions on higher sales. The growth in SG&A expenses also reflects the increase in certain activities that were
curtailed  in  the  early  stages  of  the  COVID-19  pandemic,  such  as  travel,  as  well  as  higher  stock-based  compensation  expense  driven  by  the  growth  in
personnel to support Anika’s strategic transformation, and higher general corporate costs.

Contingent Consideration Fair Value Change

In the year ended December 31, 2021, we recorded a $21.1 million net benefit related to the change in fair value of our contingent consideration
liabilities incurred associated with the acquisitions of Parcus Medical and Arthrosurface in 2020. The liability for contingent consideration is remeasured at
each reporting period until the contingency is resolved. The decrease in fair value of the contingent consideration was due primarily to the decrease in the
likelihood  that  certain  contingent  milestones  would  be  achieved  or  because  certain  contingent  milestones  were  not  achieved.  In  July  2021,  we  made  a
regulatory milestone payment in connection with the Arthrosurface acquisition in the amount of $10.0 million upon obtaining a regulatory clearance for a
reverse shoulder implant system. In September 2022, we made a milestone payment in connection with the Parcus Medical acquisition in the amount of
$4.3 million.

Income Taxes

The benefit from income taxes was $3.9 million for the year ended December 31, 2022, resulting in an effective tax rate of 20.7%. The benefit
from income taxes was $1.7 million for the year ended December 31, 2021, resulting in an effective tax rate of (70.4%). The increase in our effective rate
for  the  year  ended  December  31,  2022  as  compared  to  the  year  ended  December  31,  2021  is  primarily  due  to  the  change  in  fair  value  of  contingent
consideration and the release of the valuation allowance related to the net deferred tax assets in Italy during 2021.

49

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Net Income (Loss)

For the year ended December 31, 2022, net loss was $14.9 million, or $1.02 per diluted share, compared to net income of $4.1 million, or $0.28
per diluted share, for the prior year. The decrease in net income and diluted earnings per share was primarily due to the net of tax benefit of $17.0 million
recorded  in  2021  related  to  the  reduction  in  fair  value  of  contingent  consideration,  as  well  as  higher  operating  expenses  in  2022  primarily  driven  by
increased spending to expand our commercial capability and development of new products, partially offset by higher revenues and favorable gross profit in
2022.

Concentration of Risk

We have historically derived the majority of our revenue from a small number of customers, most of whom resell our products to end-users and
are significantly larger companies than us. For the year ended December 31, 2023, Mitek accounted for 45% of revenue, as compared to 43% in prior year.
While  we  believe  that  our  expanded  commercial  infrastructure  has  been  and  will  continue  to  diversify  our  revenue  base,  we  expect  to  continue  to  be
dependent  on  a  small  number  of  large  customers,  especially  Mitek,  for  a  sizeable  portion  of  our  revenues  in  the  near-term  future.  The  failure  of  these
customers to purchase our products in the amounts they historically have or in amounts that we expect could materially impact our business.

In addition, if present and future customers terminate their purchasing arrangements with us, significantly reduce or delay their orders, or seek to
renegotiate  their  agreements  on  terms  less  favorable  to  us,  our  business,  financial  condition,  and  results  of  operations  will  be  adversely  affected.  If  we
accept  terms  less  favorable  than  the  terms  of  the  current  agreements,  such  renegotiations  may  have  a  material  adverse  effect  on  our  business,  financial
condition, and/or results of operations. Furthermore, in any future negotiations we may be subject to the perceived or actual leverage that these customers
may have given their relative size and importance to us. Any termination, change, reduction, or delay in orders could seriously harm our business, financial
condition, and results of operations. Accordingly, unless and until we diversify and expand our customer base, our future success will significantly depend
upon the timing and size of future purchases by our largest customers and the financial and operational success of these customers. The loss of any one of
our major customers or the delay of significant orders from such customers, even if only temporary, could reduce or delay our recognition of revenues,
harm our reputation in the industry, and reduce our ability to accurately predict cash flow, and, consequently, it could seriously harm our business, financial
condition, and results of operations.

See Note 12, Revenue and Geographic Information; Geographic Information, to the consolidated financial statements included elsewhere in this

Annual Report on Form 10-K for information regarding significant customers.

Liquidity and Capital Resources

We  require  cash  to  fund  our  operating  activities  and  to  make  capital  expenditures  and  other  investments  in  the  business.  We  expect  that  our
requirements for cash to fund these uses will increase as our operations expand. We believe that our operating cash flows, cash currently on our balance
sheet and availability under our credit facility will be sufficient to allow us to continue to invest in our existing business, to manage our capital structure on
a short and long-term basis, and to meet our anticipated operating cash needs. Cash, cash equivalents, and investments aggregated $72.9 million and $86.3
million, and working capital totaled $132.2 million and $141.6 million, at December 31, 2023 and 2022, respectively.

We entered into a Third Amendment to Credit Agreement, on November 12, 2021, with Bank of America N.A. as administrative agent, which
amended our existing revolving line of credit agreement dated October 24, 2017 and provides up to $75.0 million in the form of a senior revolving line of
credit.  Subject  to  certain  conditions,  we  may  request  up  to  an  additional  $75.0  million  for  a  maximum  aggregate  commitment  of  $150.0  million.  As  of
December 31, 2023, and 2022, there were no outstanding borrowings, and we are in compliance with the terms of the credit facility.

Summary of Cash Flows (in thousands):

Cash provided by (used in)
Operating activities
Investing activities
Financing activities
Effect of exchange rate changes on cash
Net decrease in cash and cash equivalents

2023

Years Ended December 31,
2022

2021

  $

  $

(1,788)   $
(5,427)    
(6,324)    
79     
(13,460)   $

4,409    $
(7,486)    
(4,852)    
(130)    
(8,059)   $

8,397 
(3,118)
(6,779)
69 
(1,431)

50

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
     
       
       
 
   
   
   
 
The following changes contributed to the net change in cash and cash equivalents from 2022 to 2023.

Operating Activities

Cash  (used  in)  provided  by  operating  activities  was  $(1.8)  million,  $4.4  million  and  $8.4  million  for  2023,  2022  and  2021,  respectively.  The
change in 2023 was primarily attributable to non-recurring expenses for the Parcus arbitration settlement and shareholder activism costs and an increase in
inventories, primarily related to new product launches, partially offset by an increase in product sales.

For the foreseeable future, we expect to continue to invest in research and development for new products and clinical trials to support our growth

strategy. These costs will be funded with a combination of cash on hand and cash expected to be generated from future operations.

Investing Activities

Cash  used  in  investing  activities  was  $5.4  million,  $7.5  million  and  $3.1  million  for  2023,  2022  and  2021,  respectively.  Most  of  the  spend  on
investing activities was for capital investments in manufacturing operations to support growing product demand and instruments to support clinical cases.
The change in 2023 was due to lower spending on software implementation.

Financing Activities

Cash used in financing activities was $6.3 million, $4.9 million and $6.8 million for 2023, 2022 and 2021, respectively. The change in 2023 was

primarily due to $5.0 million used to fund an accelerated stock repurchase program completed during 2023. 

For a discussion of our liquidity and capital resources as of December 31, 2022, and our cash flow activities for the fiscal year ended December
31, 2022, see “Part II, Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations” of our annual report on Form 10-
K for the fiscal year ended December 31, 2022, filed with the SEC on March 16, 2023, which is incorporated by reference in this Report.

Contractual Obligations and Other Commercial Commitments 

The  table  below  summarizes  our  non-cancelable  operating  leases,  purchase  commitments,  and  contractual  obligations  related  to  future  periods
which  are  not  reflected  in  our  consolidated  balance  sheet  at  December  31,  2023.  Purchase  commitments  relate  primarily  to  non-cancellable  inventory
commitments and capital expenditures entered in the normal course of business:

Operating Leases
Year Ended December 31, 2023

Payments due by period (in thousands)

Less than      

Total

1 year

1 - 3 years

3 - 5 years

    More than  
5 years

  $
  $

36,983    $
36,983    $

3,131    $
3,131    $

5,979    $
5,979    $

4,972    $
4,972    $

22,901 
22,901 

We  also  have  purchase  orders  and  commitments  for  materials  and  other  day-to-day  business  requirements  in  which  there  are  no  material

commitments greater than one year.

Critical Accounting Policies and Estimates

Our  discussion  and  analysis  of  our  financial  condition  and  results  of  operations  are  based  upon  our  consolidated  financial  statements  included
elsewhere  in  this  Annual  Report  on  Form  10-K,  which  consolidated  financial  statements  have  been  prepared  in  accordance  with  accounting  principles
generally accepted in the United States. The preparation of these consolidated financial statements requires us to make estimates and judgments that affect
the reported amounts of assets, liabilities, revenues and expenses, and the related disclosure of contingent assets and liabilities. We monitor our estimates
on an ongoing basis for changes in facts and circumstances, and material changes in these estimates could occur in the future. Changes in estimates are
recorded in the period in which they become known. We base our estimates on historical experience and other assumptions that we believe to be reasonable
under the circumstances. Actual results may differ from our estimates if past experience or other assumptions do not turn out to be substantially accurate.

51

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
     
 
 
 
   
   
   
   
 
 
 
 
 
We have identified the policies below as critical to our business operations and the understanding of our results of operations. The impact and any
associated  risks  related  to  these  policies  on  our  business  operations  are  discussed  throughout  this  section  captioned  “Management’s  Discussion  and
Analysis of Financial Condition and Results of Operations” where such policies affect our reported and expected financial results. For a detailed discussion
on the application of these and other accounting policies, see Note 2 to the consolidated financial statements included elsewhere in this Annual Report on
Form 10-K.

Revenue Recognition – General

Pursuant  to  ASC  606,  we  recognize  revenue  when  a  customer  obtains  control  of  promised  goods  or  services.  The  amount  of  revenue  that  is
recorded reflects the consideration that we expect to receive in exchange for those goods or services. We apply the following five-step model in order to
determine this amount: (i) identification of the promised goods or services in the contract; (ii) determination of whether the promised goods or services are
performance obligations, including whether they are capable of being distinct or distinct in the context of the contract; (iii) measurement of the transaction
price,  including  the  constraint  on  variable  consideration;  (iv)  allocation  of  the  transaction  price  to  the  performance  obligations;  and  (v)  recognition  of
revenue when (or as) we satisfy each performance obligation.

We generate sales principally through three types of customers: (i) commercial partnerships (ii) hospitals and ASCs, and (iii) distributors, referred

to as distribution model.

For  commercial  partnership  sales,  we  sell  our  products  directly  to  these  partners,  who  perform  most  of  the  downstream  sales  and  marketing
activities to customers and end-users. These arrangements may include the grant of certain licenses, performance of development services, and the supply
of  product.  Our  largest  such  customer,  Mitek,  represented  45%  of  total  revenues  for  the  year  ended  December  31,  2023.  We  recognize  revenue  from
product sales when the customer obtains control of our product, which typically occurs upon shipment to the customer. Commercial partnership agreements
may  also  include  sales-based  royalties  and  milestones.  As  we  considered  the  license  to  be  the  predominant  item  to  which  the  royalties  relate  for  these
agreements, sales-based royalties and milestones are only recognized when the later of the underlying sale occurs or the performance obligation to which
some or all of the sales-based royalty has been satisfied (or partially satisfied). This is generally in the same period that our licensees complete their product
sales in their territory, for which we are contractually entitled to a percentage-based royalty. We record royalty revenues based on estimated net sales of
licensed products as reported to us by our commercial partners. The differences between actual and estimated royalty revenues have not been material and
are  typically  adjusted  in  the  following  quarter  when  the  actual  amounts  are  known.  Revenue  from  sales-based  royalties  is  included  in  revenues  in  our
consolidated statement of operations.

For sales to hospitals and ASCs, which generally pairs in-house sales representatives with local or regional distributors, the inventory is generally
consigned so that products are available when needed for surgical procedures. No revenue is recognized upon the placement of inventory into consignment,
as we retain the ability to control the inventory. Revenue is recognized typically as of the date of surgical implantation of the product.

For distributor sales, we sell our products to our distributors, generally outside the United States, who subsequently resell the products to sub-
distributors and health care providers, among others. We recognize revenue from product sales when the distributor obtains control of our product, which
typically occurs upon shipment to the distributor, in return for agreed-upon, fixed-price consideration. Performance obligations are generally settled quickly
after purchase order acceptance; therefore, the value of unsatisfied performance obligations at the end of any reporting period is generally insignificant. We
sell to a diversified base of distributors and, therefore, we believe there is no material concentration of credit risk.

Certain  of  our  supply  agreements  contain  terms  that  represent  a  promise  to  deliver  product  at  the  customer’s  discretion  that  are  considered
distributor options. We assess if these options provide a material right to the licensee, and if so, they are accounted for as separate performance obligations.
Our supply agreements do not provide options that are considered material rights.

Our  payment  terms  are  consistent  with  prevailing  practice  in  the  respective  markets  in  which  we  do  business.  Most  of  our  customers  make
payments based on contract terms, which are not affected by contingent events that could impact the transaction price. Payment terms fall within the one-
year  guidance  for  the  practical  expedient,  which  allows  us  to  forgo  adjustment  of  the  contractual  payment  amount  of  consideration  for  the  effects  of  a
significant financing component.

Some of our distributor agreements have volume-based discounts with tiered pricing which are generally prospective in nature. These prospective
discounts  together  with  any  free-of-charge  sample  units  offered  are  evaluated  as  potential  material  rights.  If  the  prospective  discounts  or  free-of-charge
sample units are considered material rights, these would be separate performance obligations and a portion of the sales transaction price is allocated to the
material right. Revenue allocated to the material right is recognized when the additional goods are transferred to the customer or when the option expires.
During 2023, the consideration allocated to material rights was not significant.

We  receive  payments  from  our  customers  based  on  billing  schedules  established  in  each  contract.  Up-front  payments  and  fees  are  recorded  as
deferred revenue upon receipt or when due and may require deferral of revenue recognition to a future period until we perform our obligations under these
arrangements.  Amounts  are  recorded  as  accounts  receivable  when  our  right  to  consideration  is  unconditional.  There  was  no  deferred  revenue  as  of
December 31, 2023 and 2022, respectively.

52

 
 
 
 
 
 
 
 
 
 
 
 
 
Generally, customer contracts contain Free on Board, or FOB, or Ex-Works shipping point terms where the customer pays the shipping company
directly for all shipping and handling costs. In those contracts in which we pay for the shipping and handling, the associated costs are generally recorded
along with the product sale at the time of shipment in cost of revenue when control over the products has transferred to the customer. Value-add and other
taxes we collected concurrently with revenue-producing activities are excluded from revenue. Our general product warranty does not extend beyond an
assurance  that  the  product  or  services  delivered  will  be  consistent  with  stated  contractual  specifications,  which  does  not  create  a  separate  performance
obligation.  We  recognize  the  incremental  costs  of  obtaining  contracts  as  an  expense  when  incurred  as  the  amortization  period  of  the  assets  that  we
otherwise would have recognized is one year or less in accordance with the practical expedient in paragraph ASC 340-40-25-4. These costs are included in
selling, general and administrative expenses.

Inventories

Inventories are primarily stated at the lower of standard cost and net realizable value, with approximate cost determined using the first-in, first-out
method.  Work-in-process  and  finished  goods  inventories  include  materials,  labor,  and  manufacturing  overhead.  Manufacturing  variances  attributable  to
abnormally low production are expensed in the period incurred. Inventory costs associated with product candidates that have not yet received regulatory
approval are capitalized if we believe there is probable future commercial use and future economic benefit.

Our policy is to write down inventory when conditions exist that suggest inventory may be in excess of anticipated demand or is obsolete based
upon assumptions about future demand for our products and market conditions. We regularly evaluate the ability to realize the value of inventory based on
a combination of factors including, but not limited to, historical usage rates, forecasted sales or usage, product end of life dates, and estimated current or
future market values. Inventory needs and alternative usage avenues are explored within these processes to mitigate inventory exposure.

When recorded, inventory write-downs are intended to reduce the carrying value of inventory to its net realizable value. If actual demand for our
products deteriorates, or if market conditions are less favorable than those projected, additional inventory write-downs may be required. Other long-term
assets include inventory expected to remain on hand beyond one year.

Goodwill

Goodwill is the amount by which the purchase price of acquired net assets in a business combination exceeded the fair values of net identifiable
assets  on  the  date  of  acquisition.  Goodwill  is  not  amortized  but  is  subject  to  impairment  test  annually  or  more  frequently  if  events  or  changes  in
circumstances suggest that the carrying value of goodwill may not be recoverable, utilizing either the qualitative or quantitative method.

We test goodwill for impairment at the reporting unit level on an annual basis as of November 30 or more frequently if we believe indicators of
impairment exist. We have two reporting units: the legacy Anika reporting unit and a reporting unit established in 2020 upon the acquisitions of Parcus
Medical and Arthrosurface. The remaining goodwill as of December 31, 2023 pertains to the legacy Anika reporting unit, as the goodwill with respect to
the Parcus Medical and Arthrosurface reporting unit was fully impaired in 2020.

We have the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less

than its carrying value. We used the quantitative method in 2023, we considered several factors, including the following:

●

●

●

●

●

●

the amount by which the fair value of the reporting unit exceeded its carrying value as of the date of the most recent quantitative impairment
analysis, which indicated there would need to be substantial negative developments in the markets in which the reporting unit operates for there
to be potential impairment;

the carrying value of the reporting unit as of the assessment date compared to their previously calculated fair value as of the date of the most
recent quantitative impairment analysis;

the current forecasts as compared to the forecasts included in the most recent quantitative impairment analysis;

public information from competitors and other industry information to determine if there were any significant adverse trends in our competitors'
businesses;

changes in the value of major U.S. stock indices that could suggest declines in overall market stability that could impact the valuation of our
reporting unit;

whether there had been any significant increases in the weighted-average cost of capital rates for the reporting unit, which could materially
lower our prior valuation conclusions under a discounted cash flow approach.

53

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Significant  assumptions  utilized  in  the  impairment  analysis  included  valuation  multiple  with  respect  to  revenue  and  weighted-average  cost  of
capital. Based on sensitivity analysis performed on key assumptions at November 30, 2023, a 10% decrease in valuation multiples or a 10% increase in the
weighted average cost of capital assumption would not have resulted in a fair value below the reporting unit’s carrying value. Accordingly, we determined
it was not more likely than not that the fair value of the legacy Anika reporting unit is less than its carrying amount and thus goodwill was not impaired as
of November 30, 2023.

Long-Lived Assets

Long-lived  assets  primarily  include  property  and  equipment  and  intangible  assets  with  finite  lives.  Our  intangible  assets  are  comprised  of
purchased developed technologies, patents, trade names, customer relationships and distributor relationships. These intangible assets are carried at cost, net
of  accumulated  amortization.  Amortization  is  recorded  on  a  straight-line  basis  over  the  intangible  assets'  useful  lives,  which  range  from  approximately
five to sixteen years. We review long-lived assets for impairment when events or changes in business circumstances indicate that the carrying amount of the
assets may not be fully recoverable or that the useful lives of those assets are no longer appropriate. Each impairment test is based on a comparison of the
undiscounted  cash  flows  to  the  recorded  value  of  the  asset.  If  impairment  is  indicated,  the  asset  is  written  down  to  its  estimated  fair  value  based  on  a
discounted  cash  flow  analysis.  During  the  year  ended  December  31,  2023,  the  Company  determined  that  certain  of  its  intangible  assets  related  to  its
Arthrosurface and Parcus reporting unit were impaired mainly due to slower than expected revenue growth from product sales that have impacted cash
flows with this reporting unit.  As a result, we recorded a $62.2 million charge to intangible assets related to its Arthrosurface and Parcus reporting units
during the year ended December 31, 2023.

In  determining  the  useful  lives  of  intangible  assets,  we  consider  the  expected  use  of  the  assets  and  the  effects  of  obsolescence,  demand,
competition,  anticipated  technological  advances,  changes  in  surgical  techniques,  market  influences  and  other  economic  factors.  For  technology-based
intangible  assets,  we  consider  the  expected  life  cycles  of  products,  absent  unforeseen  technological  advances,  which  incorporate  the  corresponding
technology.

Recent Accounting Pronouncements

A discussion of recent accounting pronouncements is included in Note 2 to the consolidated financial statements in this Annual Report on Form

10-K.

ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Interest Rate Risk

We manage our investment portfolio in accordance with our investment policy. The primary objectives of our investment policy are to preserve
principal,  maintain  a  high  degree  of  liquidity  to  meet  operating  and  other  needs,  and  obtain  competitive  returns  subject  to  prevailing  market  conditions
without significantly increasing risk. To achieve this objective, we maintain our portfolio of cash equivalents and investments in a variety of high-quality
securities, including money market funds and U.S. treasury bills. The investments are classified as available-for-sale and consequently are recorded at fair
value  with  unrealized  gains  or  losses  reported  as  a  separate  component  of  accumulated  other  comprehensive  income  (loss).  Our  portfolio  of  cash
equivalents and investments is subject to interest rate fluctuations, changes in credit quality of the issuer, and other factors.

Foreign Currency Exchange Risk

Foreign  currency  risk  arises  from  our  investments  in  subsidiaries  owned  and  operated  in  non-U.S.  countries.  Such  risk  is  also  a  result  of
transactions  with  customers  in  countries  outside  the  United  States.  Approximately  $12.8  million  of  our  revenue  was  denominated  in  foreign  currencies
(primarily  the  Euro  and  UK  pound  sterling)  for  the  year  ended  December  31,  2023.  Gains  and  losses  arising  from  transactions  denominated  in  foreign
currencies are primarily related to intercompany accounts that have been determined to be temporary in nature and cash, accounts payable, and accounts
receivable denominated in non-functional currencies. We also utilize clinical vendors that are located in various countries outside of the United States and
invoice  us  in  their  local  currency  and  we  have  one  major  supplier  contract  denominated  in  a  foreign  currency.  We  do  not  engage  in  foreign  currency
hedging arrangements for these transactions, and, consequently, foreign currency fluctuations may adversely affect our earnings. Unfavorable fluctuations
in exchange rates would have a negative impact on our financial statements. The impact of currency exchange rate fluctuations related to our international
subsidiaries on our financial statements were insignificant in 2023. We recognize foreign currency gains or losses arising from our operations in the period
incurred. 

54

 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA

ANIKA THERAPEUTICS, INC. AND SUBSIDIARIES

INDEX TO CONSOLIDATED FINANCIAL STATEMENTS

Report of Independent Registered Public Accounting Firm (PCAOB ID No. 34)
Consolidated Balance Sheets as of December 31, 2023 and 2022
Consolidated Statements of Operations and Comprehensive Income (Loss) for the Years Ended December 31, 2023, 2022 and 2021
Consolidated Statements of Stockholders’ Equity for the Years Ended December 31, 2023, 2022 and 2021
Consolidated Statements of Cash Flows for the Years Ended December 31, 2023, 2022 and 2021
Notes to Consolidated Financial Statements

56
58
59
60
61
62

55

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

To the Board of Directors and Stockholders of Anika Therapeutics, Inc.

Opinion on the Financial Statements

We have audited the accompanying consolidated balance sheets of Anika Therapeutics, Inc. and subsidiaries (the "Company") as of December 31, 2023
and 2022, the related consolidated statements of operations and comprehensive income (loss), stockholders’ equity, and cash flows for each of the three
years in the period ended December 31, 2023, and the related notes (collectively referred to as the “financial statements”). In our opinion, the financial
statements present fairly, in all material respects, the financial position of the Company as of December 31, 2023 and 2022, and the results of its operations
and its cash flows for each of the three years in the period ended December 31, 2023, in conformity with accounting principles generally accepted in the
United States of America (GAAP).

We  have  also  audited,  in  accordance  with  the  standards  of  the  Public  Company  Accounting  Oversight  Board  (United  States)  (PCAOB),  the  Company's
internal control over financial reporting as of December 31, 2023, based on criteria established in Internal Control — Integrated Framework (2013) issued
by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated March 15, 2024, expressed an unqualified opinion on the
Company's internal control over financial reporting.

Basis for Opinion

These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on the Company's financial
statements  based  on  our  audits.  We  are  a  public  accounting  firm  registered  with  the  PCAOB  and  are  required  to  be  independent  with  respect  to  the
Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the
PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable
assurance  about  whether  the  financial  statements  are  free  of  material  misstatement,  whether  due  to  error  or  fraud.  Our  audits  included  performing
procedures to assess the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond to
those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits
also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the
financial statements. We believe that our audits provide a reasonable basis for our opinion.

Critical Audit Matters

The  critical  audit  matters  communicated  below  are  matters  arising  from  the  current-period  audit  of  the  financial  statements  that  were  communicated  or
required  to  be  communicated  to  the  audit  committee  and  that  (1)  relate  to  accounts  or  disclosures  that  are  material  to  the  financial  statements  and  (2)
involved our especially challenging, subjective, or complex judgments. The communication of critical audit matters does not alter in any way our opinion
on the financial statements, taken as a whole, and we are not, by communicating the critical audit matters below, providing separate opinions on the critical
audit matters or on the accounts or disclosures to which they relate.

Reserve for Excess and Obsolete Inventories — Refer to Notes 2 and 4 to the financial statements

Critical Audit Matter Description

The  Company  evaluates  inventory  each  reporting  period  for  excess  quantities  and  obsolescence,  establishing  reserves  when  necessary,  based  upon
historical experience, assessment of economic conditions, and expected demand. Once recorded, the inventory reserve write-offs are considered permanent
adjustments to the carrying value of inventory. As of December 31, 2023, the Company has total inventories of $64.6 million, net of excess quantities and
obsolescence reserves.

We  identified  the  reserve  for  excess  quantities  and  obsolete  inventory  as  a  critical  audit  matter  because  of  the  significant  estimates  and  assumptions
management makes to quantify and to record the reserve, including the determination of expected demand. This required a high degree of auditor judgment
and an increased extent of effort when performing audit procedures to evaluate the methodology and the reasonableness of assumptions including expected
demand.

56

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
How the Critical Audit Matter Was Addressed in the Audit

Our audit procedures related to the reserve for excess quantities and obsolete inventory including management’s estimate of expected demand, included the
following, among others:

● We tested the effectiveness of controls over the estimation of reserve for excess quantities and obsolete inventory.
● We  evaluated  the  reasonableness  of  the  Company's  excess  and  obsolete  inventory  policy,  considering  historical  experience  and  the

underlying assumptions.

● We  tested  the  calculation  of  the  excess  and  obsolescence  reserve  pursuant  to  the  Company's  policy,  on  a  sample  basis,  including  the

completeness and accuracy of the data used in the calculation.

● We performed procedures to evaluate management’s ability to accurately forecast by comparing the historical expiring inventory estimates to

subsequent inventory destructions and expirations.

● We performed a retrospective review by comparing management’s prior year projections of future demand by product, with actual product

sales in the current year to identify potential bias in the inventory reserve.

● We made inquiries of senior financial and operating management to determine whether any strategic, regulatory, or operational changes in
the business were consistent with the projections of future demand that were utilized as the basis for the excess and obsolescence reserve
recorded.

● We considered the existence of contradictory evidence based on consideration of internal communications to management and the board of

directors, Company press releases, and analysts' reports, as well as any changes within the business.

Fair Value of Intangible Assets within the Arthrosurface and Parcus Asset Groups — Refer to Notes 2 and 6 to the financial statements

Critical Audit Matter Description

The Company has amortizing definite lived intangible assets consisting of the developed technology, tradenames, and customer relationships, which arose
from  the  prior  acquisitions  for  Parcus  Medical  and  Arthrosurface.  The  Company's  evaluation  of  the  intangible  assets  for  impairment  involves  the
comparison  of  the  fair  value  to  the  recorded  carrying  value.  Management  estimated  the  fair  value  of  these  intangible  assets  upon  identification  of
impairment indicators, using the income approach method of valuation, including a combination of the distributor method for the customer relationships
asset and the relief of royalty method for each of the developed technology and tradename assets. The determination of fair value requires management to
make significant estimates and assumptions related to forecasted revenues, including growth rates, the royalty rate, and the discount rate used to estimate
the  fair  value  of  the  intangible  assets.  Changes  in  these  assumptions  could  have  a  significant  impact  on  the  fair  value  of  the  intangible  assets  and  the
amount  of  any  impairment  charge.  As  of  December  31,  2023,  the  carrying  value  of  each  of  the  developed  technology,  customer  relationships,  and
tradename assets were $2.0 million, $0.4 million, and $0.6 million, respectively. During the year ended December 31, 2023, the Company recognized an
impairment charge of $62.2 million related to these intangible assets, since their fair values were lower than the carrying values.

We identified the valuation of these intangible assets as a critical audit matter because of the significant judgments and assumptions management makes in
estimating the fair value of these intangible assets. This required a high degree of auditor judgment and an increased extent of effort when performing audit
procedures  to  evaluate  the  reasonableness  of  management’s  forecasted  revenues,  the  selection  of  the  royalty  rate  and  the  selection  of  the  discount  rate,
including the need to involve our fair value specialists.

How the Critical Audit Matter Was Addressed in the Audit

Our audit procedures related to the forecasted revenues, the selected royalty rate, and the selected discount rate utilized in estimating the fair value of the
intangible assets included the following, among others:

● We tested the effectiveness of controls over management’s impairment evaluation, including those over the determination of the fair value of
the  intangible  assets,  such  as  controls  related  to  management’s  forecasts  of  future  revenue,  and  the  selection  of  the  royalty  rate  and  the
discount rate.

● We evaluated management’s ability to accurately forecast revenues by comparing actual revenues to management’s historical forecasts.
● We evaluated the reasonableness of management’s forecasts by comparing forecasted revenues to:

The Company’s business strategies and growth plans including consideration of the effects of new products;

o
o Historical results and trends; and
o

Industry reports.

● With  the  assistance  of  our  fair  value  specialists,  we  evaluated  the  reasonableness  of  the  valuation  methodology  and  management’s

assumptions including the royalty rate and the discount rate by:

o

Testing the source information underlying the determination of the royalty rate, the discount rate, and the mathematical accuracy of
the calculations.

o Developing  a  range  of  independent  estimates  for  the  discount  rate  and  comparing  those  to  the  discount  rate  selected  by

management.

/s/ Deloitte & Touche LLP

Boston, Massachusetts
March 15, 2024

We have served as the Company’s auditor since 2017.

57

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anika Therapeutics, Inc. and Subsidiaries
Consolidated Balance Sheets
(in thousands, except per share data)

ASSETS
Current assets:

Cash and cash equivalents
Accounts receivable, net
Inventories
Prepaid expenses and other current assets

Total current assets
Property and equipment, net
Right-of-use assets
Other long-term assets
Deferred tax assets
Intangible assets, net
Goodwill
Total assets

LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:

Accounts payable
Accrued expenses and other current liabilities

Total current liabilities
Other long-term liabilities
Deferred tax liability
Lease liabilities
Commitments and contingencies (Note 11)
Stockholders’ equity:

Preferred stock, $0.01 par value; 1,250 shares authorized, no shares issued and outstanding at December

31, 2023 and 2022, respectively

Common stock, $.01 par value; 90,000 shares authorized, 14,848 issued and 14,660 outstanding and

14,625 shares issued and outstanding at December 31, 2023 and 2022, respectively

Additional paid-in-capital
Accumulated other comprehensive loss
Retained earnings

Total stockholders’ equity

Total liabilities and stockholders’ equity

December 31,

2023

2022

72,867    $
35,961     
46,386     
8,095     
163,309     
46,198     
28,767     
18,672     
1,489     
4,626     
7,571     
270,632    $

9,860    $
21,199     
31,059     
404     
-     
26,904     

86,327 
34,627 
39,765 
8,828 
169,547 
48,279 
30,696 
17,219 
1,449 
74,599 
7,339 
349,128 

9,074 
18,840 
27,914 
398 
6,436 
28,817 

-     

- 

147     
90,009     
(5,943)    
128,052     
212,265     
270,632    $

146 
81,141 
(6,443)
210,719 
285,563 
349,128 

  $

  $

  $

  $

The accompanying notes are an integral part of these consolidated financial statements.

58

 
 
 
     
 
 
 
 
   
 
     
       
 
   
   
   
   
   
   
   
   
   
   
 
     
       
 
   
 
     
 
 
     
       
 
   
   
   
   
   
      
        
 
     
       
 
   
   
   
   
   
   
 
 
Anika Therapeutics, Inc. and Subsidiaries
Consolidated Statements of Operations and Comprehensive Income (Loss)
(in thousands, except per share data)

Revenue
Cost of revenue
Gross profit

Operating expenses:

Research & development
Selling, general & administrative
Impairment of intangible assets
Change in fair value of contingent consideration

Total operating expenses
(Loss) income from operations

Interest and other income (expense), net

(Loss) income before income taxes
Benefit from for income taxes

Net (loss) income

Net income (loss) per share:

Basic
Diluted

Weighted average common shares outstanding:

Basic
Diluted

Net (loss) income

Foreign currency translation adjustment

Comprehensive (loss) income

For the Years Ended December 31,
2022

2023

2021

166,662    $
63,574     
103,088     

32,690     
95,847     
62,190     
-     
190,727     
(87,639)    
2,312     
(85,327)    
(2,660)    
(82,667)   $

156,236    $
62,660     
93,576     

28,182     
84,794     
-     
-     
112,976     
(19,400)    
654     
(18,746)    
(3,887)    
(14,859)   $

(5.64)   $
(5.64)   $

(1.02)   $
(1.02)   $

14,656     
14,656     

(82,667)   $
500     
(82,167)   $

14,561     
14,561     

(14,859)   $
(725)    
(15,584)   $

147,794 
64,851 
82,943 

27,327 
74,096 
- 
(21,095)
80,328 
2,615 
(188)
2,427 
(1,707)
4,134 

0.29 
0.28 

14,401 
14,634 

4,134 
(1,176)
2,958 

  $

  $

  $
  $

  $

  $

The accompanying notes are an integral part of these consolidated financial statements.

59

 
 
 
         
 
 
 
 
 
   
   
 
   
   
 
     
       
       
 
     
       
       
 
   
   
   
   
   
   
   
   
   
 
     
       
       
 
     
       
       
 
 
     
       
       
 
     
       
       
 
   
   
 
     
       
       
 
   
 
 
 
 
Anika Therapeutics, Inc. and Subsidiaries
Consolidated Statements of Stockholders' Equity
(in thousands, except per share data)

Common Stock

  Number of

Shares

$.01 Par
Value

Additional
Paid
in Capital

    Accumulated      
Other

Total

Retained
Earnings

    Comprehensive    Stockholders'  

Loss

Equity

14,329    $

143    $

55,355    $

221,444    $

(4,542)   $

272,400 

32     
92     
-     

(12)    
-     
-     
14,441    $

-     
184     

35     
-     

(35)    
-     
-     
14,625    $

2     
262     

41     
-     
(188)    

(82)    
-     
-     
14,660    $

-     
1     
-     

-     
-     
-     
144    $

-     
2     

-     
-     

-     
-     
-     
146    $

-     
3     

-     
-     
(2)    

-     
-     
-     
147    $

1,128     
(1)    
11,085     

(486)    
-     
-     
67,081    $

16     
(2)    

665     
14,315     

(934)    
-     
-     
81,141    $

23     
(3)    

805     
15,243     
(5,048)    

(2,152)    
-     
-     
90,009    $

-     
-     
-     

-     
4,134     
-     
225,578    $

-     
-     

-     
-     

-     
-     
-     

-     
-     
(1,176)    
(5,718)   $

-     
-     

-     
-     

-     
(14,859)    
-     
210,719    $

-     
-     
(725)    
(6,443)   $

-     
-     

-     
-     
-     

-     
-     

-     
-     
-     

-     
(82,667)    
-     
128,052    $

-     
-     
500     
(5,943)   $

1,128 
- 
11,085 

(486)
4,134 
(1,176)
287,085 

16 
- 

665 
14,315 

(934)
(14,859)
(725)
285,563 

23 
- 

805 
15,243 
(5,050)

(2,152)
(82,667)
500 
212,265 

Balance, December 31, 2020

Issuance of common stock for equity

awards

Vesting of restricted stock units
Stock-based compensation expense
Retirement of common stock for
minimum tax withholdings

Net income
Other comprehensive loss
Balance, December 31, 2021

Issuance of common stock for equity

awards

Vesting of restricted stock units
Issuance of common stock from

employee purchase plan

Stock-based compensation expense
Retirement of common stock for
minimum tax withholdings

Net loss
Other comprehensive loss
Balance, December 31, 2022

Issuance of common stock for equity

awards

Vesting of restricted stock units
Issuance of common stock from

employee purchase plan

Stock-based compensation expense
Repurchase of common stock
Retirement of common stock for
minimum tax withholdings

Net loss
Other comprehensive income

Balance, December 31, 2023

The accompanying notes are an integral part of these consolidated financial statements.

60

 
 
 
 
 
   
 
     
 
     
 
     
 
 
 
 
 
     
 
   
   
 
 
   
   
   
 
 
   
   
   
   
   
 
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
 
 
 
 
Anika Therapeutics, Inc. and Subsidiaries
Consolidated Statements of Cash Flows
(in thousands)

Cash flows from operating activities:

Net (loss) income
Adjustments to reconcile net income (loss) to net cash provided by operating

For the years ended December 31,
2022

2023

2021

  $

(82,667)   $

(14,859)   $

4,134 

activities:
Depreciation
Amortization of acquisition related intangible assets
Amortization of acquisition related inventory step-up
Non-cash operating lease cost
Change in fair value of contingent consideration
Loss on disposal of fixed assets
Loss on impairment of intangible assets
Stock-based compensation expense
Deferred income taxes
Provision for doubtful accounts
Provision for inventory
Other
Changes in operating assets and liabilities:

Accounts receivable
Inventories
Prepaid expenses, other current and long-term assets
Accounts payable
Operating lease liabilities
Accrued expenses, other current and long-term liabilities
Income taxes
Payments of contingent consideration

Net cash (used in) provided by operating activities

Cash flows from investing activities:

Acquisition of Parcus Medical and Arthrosurface, net of cash acquired
Proceeds from maturities of investments
Purchases of property and equipment

Net cash used in investing activities

Cash flows from financing activities:
Payments made on finance leases
Repurchases of common stock
Proceeds from employee stock purchase program
Cash paid for tax withheld on vested restricted stock awards
Proceeds from exercises of equity awards
Payments of contingent consideration

Net cash used in financing activities

6,434     
7,783     
-     
2,231     
-     
1,917     
62,190     
15,243     
(6,327)    
190     
3,341     
-     

(1,305)    
(11,396)    
560     
(11)    
(2,149)    
1,648     
530     
-     
(1,788)    

-     
-     
(5,427)    
(5,427)    

-     
(5,000)    
805     
(2,152)    
23     
-     
(6,324)    

6,704     
7,783     
-     
1,850     
-     
-     
-     
14,315     
(5,270)    
378     
5,329     
-     

(5,630)    
(6,873)    
(792)    
1,965     
(1,485)    
(443)    
1,437     
-     
4,409     

-     
-     
(7,486)    
(7,486)    

(284)    
-     
665     
(934)    
16     
(4,315)    
(4,852)    

Exchange rate impact on cash

79     

(130)    

Decrease in cash and cash equivalents
Cash and cash equivalents at beginning of period
Cash and cash equivalents at end of period
Supplemental disclosure of cash flow information:

Cash paid for income taxes, net of refunds
Right-of-use assets obtained in exchange for operating lease liabilities

Non-cash investing activities:

Purchases of property and equipment included in accounts payable and accrued

expenses

  $

  $
  $

  $

(13,460)    
86,327     
72,867    $

3,117    $
268    $

(8,059)    
94,386     
86,327    $

106    $
11,703    $

815    $

108    $

15 

The accompanying notes are an integral part of these consolidated financial statements.

61

6,480 
7,837 
6,465 
1,708 
(21,095)
993 
600 
11,085 
(1,766)
64 
6,628 
(18)

(6,216)
(6,619)
1,424 
(1,100)
(1,626)
3,510 
(1,311)
(2,780)
8,397 

(476)
2,501 
(5,143)
(3,118)

(201)
- 
- 
(486)
1,128 
(7,220)
(6,779)

69 

(1,431)
95,817 
94,386 

1,233 
220 

 
 
 
 
 
 
 
 
 
   
   
 
     
       
       
 
     
       
       
 
   
   
   
   
   
   
   
   
   
   
   
   
     
       
       
 
   
   
   
   
   
   
   
   
   
 
     
       
       
 
     
       
       
 
   
   
   
   
 
     
       
       
 
     
       
       
 
   
   
   
   
   
   
   
 
     
       
       
 
   
 
     
       
       
 
   
   
     
       
       
 
     
       
       
 
 
 
Anika Therapeutics, Inc. and Subsidiaries
Notes to Consolidated Financial Statements
(amounts in thousands, except share and per share amounts or as otherwise noted)

1. Nature of Business

Anika Therapeutics, Inc. (“the Company”) is a global joint preservation company that creates and delivers meaningful advancements in early
intervention  orthopedic  care,  including  in  the  areas  of  osteoarthritis  (“OA”)  pain  management,  regenerative  solutions,  sports  medicine  and
Arthrosurface joint solutions.

In  early  2020,  the  Company  expanded  its  overall  technology  platform  through  its  strategic  acquisitions  of  Parcus  Medical,  LLC  (“Parcus
Medical”), a sports medicine implant and instrumentation company, and Arthrosurface Inc. (“Arthrosurface”), a company specializing in less invasive,
bone  preserving  partial  and  total  joint  replacement  solutions.  These  acquisitions  broadened  the  Company's  product  portfolio,  developed  over  its  30
years of expertise in hyaluronic acid technology, into joint preservation and restoration, added higher-growth revenue streams, increased its commercial
capabilities, diversified its revenue base, and expanded its product pipeline and research and development expertise.

The Company is subject to risks common to companies in the life sciences industry including, but not limited to, development by the Company
or its competitors of new technological innovations, dependence on key personnel, protection of proprietary technology, commercialization of existing
and new products, and compliance with U.S. Food and Drug Administration (“FDA”) and foreign regulations and approval requirements, as well as the
ability to grow the Company’s business through appropriate commercial strategies.

2. Summary of Significant Accounting Policies

Use of Estimates

The  preparation  of  financial  statements  in  conformity  with  generally  accepted  accounting  principles  in  the  United  States  of  America  (“US
GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent
assets  and  liabilities  at  the  date  of  the  financial  statements  and  the  reported  amounts  of  revenues  and  expenses  during  the  reporting  period.  Actual
results could differ from those estimates.

Principles of Consolidation

The accompanying consolidated financial statements include the accounts of Anika Therapeutics, Inc. and its wholly owned subsidiaries, Anika
Securities, Inc., Anika Therapeutics S.r.l. (“Anika S.r.l.”), Anika Therapeutics Limited, Parcus Medical and Arthrosurface. All intercompany balances
and transactions have been eliminated in consolidation.

Foreign Currency Translation

The  functional  currency  of  Anika  S.r.l.  is  the  Euro  and  the  functional  currency  of  Anika  Therapeutics  Limited  is  the  British  Pound  Sterling.
Assets and liabilities of the foreign subsidiaries are translated using the exchange rate existing on each respective balance sheet date. Revenues and
expenses  are  translated  using  the  average  exchange  rates  for  the  period.  The  translation  adjustments  resulting  from  this  process  are  included  in
stockholders’  equity  as  a  component  of  accumulated  other  comprehensive  income  (loss)  which  resulted  in  a  gain  (loss)  from  foreign  currency
translation of $0.5 million, ($0.7) million, and ($1.2) million for the years ended December 31, 2023, 2022, and 2021, respectively.

Gains and losses resulting from foreign currency transactions are recognized in the consolidated statements of operations. Recorded balances that
are denominated in a currency other than the functional currency are remeasured to the functional currency using the exchange rate at the balance sheet
date  and  gains  or  losses  are  recorded  in  the  statements  of  operations.  The  Company  recognized  a  gain  (loss)  from  foreign  currency  transactions  of
($0.1) million, ($0.5) million, and ($0.4) million during the years ended December 31, 2023, 2022, and 2021, respectively.

62

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Accounts Receivable

The Company estimates an allowance for credit losses with its accounts receivable resulting from the inability of its customers to make required
payments, which is included in selling, general and administrative expenses in the accompanying consolidated statements of operations. In determining
the  adequacy  of  the  allowance,  management  specifically  analyzes  individual  accounts  receivable,  historical  bad  debts,  customer  concentrations,
customer  creditworthiness,  current  and  reasonable  and  supportable  forecasts  of  future  economic  conditions,  accounts  receivable  aging  trends,  and
changes in the Company’s customer payment terms.

The components of the Company’s accounts receivables are as follows:

Accounts Receivable
Less: Allowance for credit losses
Net balance, end of the year

A summary of activity in the allowance for credit losses is as follows:

Balance, beginning of the year

Amounts provided
Amounts recovered
Amounts written off
Translation adjustments

Balance, end of the year

Revenue Recognition

As of December 31,

2023

2022

  $

  $

37,580    $
1,619     
35,961    $

36,235 
1,608 
34,627 

2023

As of December 31,
2022

2021

  $

  $

1,608    $
508     
(318)    
(153)    
(26)    
1,619    $

1,442    $
554     
(180)    
(158)    
(50)    
1,608    $

1,523 
156 
(92)
(73)
(72)
1,442 

Pursuant  to  Accounting  Standard  Codification  606, Revenue  from  Contracts  with  Customers  (“ASC  606”),  the  Company  recognizes  revenue
when a customer obtains control of promised goods or services. The amount of revenue that is recorded reflects the consideration that the Company
expects to receive in exchange for those goods or services. The Company applies the following five-step model in order to determine this amount: (i)
identification  of  the  promised  goods  or  services  in  the  contract;  (ii)  determination  of  whether  the  promised  goods  or  services  are  performance
obligations, including whether they are capable of being distinct or distinct in the context of the contract; (iii) measurement of the transaction price,
including the constraint on variable consideration; (iv) allocation of the transaction price to the performance obligations; and (v) recognition of revenue
when (or as) the Company satisfies each performance obligation.

Revenue

The Company generates sales principally through three types of customers: (i) commercial partnerships (ii) hospitals and ambulatory surgical

centers (“ASCs”), and (iii) distributors, referred to as the distribution model.

For  commercial  partnership  sales,  the  Company  sells  its  products  directly  to  these  partners,  who  perform  most  of  the  downstream  sales  and
marketing activities to customers and end-users. These arrangements may include the grant of certain licenses, performance of development services,
and the supply of product. The Company’s largest such customer, DePuy Synthes Mitek Sports Medicine, a division of DePuy Orthopedics, Inc., part of
the Johnson & Johnson Medical Companies (“Mitek”), represented 45%, 43% and 45% of total revenues for the years-ended December 31, 2023, 2022
and 2021 respectively. The Company completed the performance obligations related to granted licenses and development services under the agreements
with  Mitek  prior  to  2016  and  has  no  remaining  material  performance  obligations.  The  Company  recognizes  revenue  from  product  sales  when  the
customer obtains control of the Company’s product, which typically occurs upon shipment to the customer. Commercial partnership agreements may
also include sales-based royalties and milestones. As the Company considered the license to be the predominant item to which the royalties relate for
these agreements, sales-based royalties and milestones are only recognized when the later of the underlying sale occurs or the performance obligation to
which the sales-based royalty has been satisfied (or partially satisfied). This is generally in the same period that the Company’s licensees complete their
product sales in their territory, for which the Company is contractually entitled to a percentage-based royalty. The Company records royalty revenues
based on estimated net sales of licensed products as reported to the Company by its commercial partners. The differences between actual and estimated
royalty revenues have not been material and are typically adjusted in the following quarter when the actual amounts are known. Revenue from sales-
based royalties is included in revenue in the consolidated statement of operations. The Company’s certain supply agreements represent a promise to
deliver products at the customer’s discretion that are considered distributor options. The Company assesses if these options provide a material right to
the licensee, and if so, they are accounted for as separate performance obligations. Substantially all of the Company’s supply agreements do not provide
options that are considered material rights.

63

 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
   
 
   
   
   
   
 
 
 
 
 
 
For  sales  to  hospitals  and  ASCs,  which  generally  pairs  in-house  sales  representatives  with  local  or  regional  distributors,  the  inventory  is
generally consigned so that products are available when needed for surgical procedures. No revenue is recognized upon the placement of inventory into
consignment, as the Company retains the ability to control the inventory. Revenue is typically recognized as of the date of surgical implantation of the
product.

For distributor sales, the Company sells its products principally to distributors, generally outside the United States, who subsequently resell the
products to sub-distributors and health care providers, among others. The Company recognizes revenue from product sales when the distributor obtains
control  of  the  Company’s  product,  which  typically  occurs  upon  shipment  to  the  distributor,  in  return  for  agreed-upon,  fixed-price  consideration.
Performance obligations are generally settled quickly after purchase order acceptance; therefore, the value of unsatisfied performance obligations at the
end of any reporting period is generally insignificant. The Company sells to a diversified base of international distributors and, therefore, believes there
is no material concentration of credit risk.

The Company’s payment terms are consistent with prevailing practice in the respective markets in which the Company does business. Most of
the Company’s customers make payments based on contract terms, which are not affected by contingent events that could impact the transaction price.
Payment terms fall within the one-year guidance for the practical expedient, which allows the Company to forgo adjustment of the contractual payment
amount of consideration for the effects of a significant financing component.

Some of the Company’s distributor agreements have volume-based discounts with tiered pricing which are generally prospective in nature. These
prospective discounts together with any free-of-charge sample units offered are evaluated as potential material rights. If the prospective discounts or
free-of-charge sample units are considered material rights, these would be separate performance obligations and a portion of the sales transaction price
is  allocated  to  the  material  right.  Revenue  allocated  to  the  material  right  is  recognized  when  the  additional  goods  are  transferred  to  the  customer  or
when the option expires. During 2023, 2022 and 2021, the consideration allocated to material rights was not significant.

The Company receives payments from its customers based on billing schedules established in each contract. Any up-front payments and fees are
recorded as deferred revenue upon receipt or when due and may require deferral of revenue recognition to a future period until the Company performs
its obligations under these arrangements. Amounts are recorded as accounts receivable when its right to consideration is unconditional. The Company
had no deferred revenue as of December 31, 2023 and 2022, respectively.

Generally, customer contracts contain Free on Board (“FOB”) or Ex-Works shipping point terms where the customer pays the shipping company
directly  for  all  shipping  and  handling  costs.  In  those  contracts  in  which  the  Company  pays  for  the  shipping  and  handling,  the  associated  costs  are
generally recorded along with the product sale at the time of shipment in cost of revenue when control over the products has transferred to the customer.
Value-add  and  other  taxes  collected  by  the  Company  concurrently  with  revenue-producing  activities  are  excluded  from  revenue.  The  Company’s
general  product  warranty  does  not  extend  beyond  an  assurance  that  the  product  or  services  delivered  will  be  consistent  with  stated  contractual
specifications, which does not create a separate performance obligation. The Company recognizes the incremental costs of obtaining contracts as an
expense when incurred as the amortization period of the assets that the Company otherwise would have recognized is one year or less in accordance
with the practical expedient in paragraph ASC 340-40-25-4. These costs are included in selling, general and administrative expenses.

Licensing, Milestone and Contract Revenue

The agreements with Mitek include variable consideration such as contingent development and regulatory milestones. Since 2016,  there  have
been no remaining regulatory milestones related to the Mitek agreements. In general, variable consideration is included in the transaction price only to
the extent a significant reversal in the amount of cumulative revenue recognized is not probable to occur.

Cash and Cash Equivalents

The Company considers only those investments which are highly liquid, readily convertible to cash, and that mature within 90 days from the date

of purchase to be cash equivalents. The Company’s cash equivalents consist of money market funds.

64

 
 
 
 
 
 
 
 
 
 
 
 
Investments

The Company may invest its excess cash in investments, which are classified as available-for-sale. Investments are recognized on a recurring
basis at fair value with unrealized gains and losses recorded as a component of accumulated other comprehensive income (loss), net of related income
taxes. For securities sold prior to maturity, the cost of securities sold is based on the specific identification method. Realized gains and losses on the sale
of  investments  are  recorded  in  interest  and  other  income,  net.  Interest  is  recorded  when  earned.  Investments  with  original  maturities  greater  than
approximately three months and remaining maturities less than one year are classified as short-term investments. Investments with remaining maturities
greater than one year are classified as long-term investments. The Company had no investments as of December 31, 2023 or December 31, 2022.

Investments are subject to a periodic impairment review. For available-for-sale debt securities in an unrealized loss position, the Company first
assesses whether (i) the Company intends to sell, or (ii) it is more likely than not that the Company will be required to sell the security before recovery
of  its  amortized  cost  basis.  If  either  case  is  affirmative,  any  previously  recognized  allowances  are  charged-off  and  the  security's  amortized  cost  is
written down to fair value through earnings. If neither case is affirmative, the security is evaluated to determine whether the decline in fair value has
resulted from credit losses or other factors.

Any impairment that has not been recorded through an allowance for credit losses is recognized in other comprehensive income. Adjustments to
the allowance are reported in the consolidated statement of operations as a component of credit loss expense. Available-for-sale securities are charged-
off against the allowance or, in the absence of any allowance, written down through earnings when deemed uncollectible by management or when either
of the criteria regarding intent or requirement to sell is met.

During  the  years  ended    December  31, 2023, 2022  and  2021,  the  Company  did  not  record  any  impairment  charges  on  its  available-for-sale

securities because it is not more likely than not that the Company will be required to sell these securities before the recovery of their cost basis.

Concentration of Credit Risk

The  Company  has  no  significant  off-balance  sheet  risks  related  to  foreign  exchange  contracts,  option  contracts,  or  other  foreign  hedging

arrangements. The Company’s cash equivalents and investments are held with three major financial institutions.

The Company, by policy, routinely assesses the financial strength of its customers. As a result, the Company believes that its accounts receivable

credit risk exposure is limited.

As of December 31, 2023 and 2022,  Mitek  represented  46%  and  47%,  respectively,  of  the  Company’s  accounts  receivable  balance.  No  other

single customer accounted for more than 10% of accounts receivable in either period.

Inventories

Inventories are primarily stated at the lower of standard cost and net realizable value, with cost determined using the first-in, first-out method.
Work-in-process and finished goods inventories include materials, labor, and certain manufacturing overhead. Manufacturing variances attributable to
abnormally low production are expensed in the period incurred.  

The Company’s policy is to write down inventory when conditions exist that suggest inventory may be in excess of anticipated demand or is
obsolete based upon assumptions about future demand for the Company’s products and market conditions. The Company regularly evaluates the ability
to realize the value of inventory based on a combination of factors including, but not limited to, historical usage rates, forecasted sales or usage, product
end  of  life  dates,  and  estimated  current  or  future  market  values.  Purchasing  requirements  and  alternative  usage  avenues  are  explored  within  these
processes to mitigate inventory exposure.

When recorded, inventory write-downs are intended to reduce the carrying value of inventory to its net realizable value. If actual demand for the
Company’s products deteriorates, or if market conditions are less favorable than those projected, additional inventory write-downs may be  required.
Other long-term assets include inventory expected to remain on hand beyond one year.

Leases

At the inception of an arrangement, the Company determines whether the arrangement is or contains a lease based on the circumstances present
and evaluates whether the lease is an operating lease or a finance lease at the commencement date. Operating and finance leases with a term greater
than one year are recognized on the consolidated balance sheet as right-of-use assets, lease liabilities, and, if applicable, long-term lease liabilities. The
Company includes renewal options to extend the lease in the lease term where it is reasonably certain that it will exercise these options. Operating and
finance lease liabilities and the corresponding right-of-use assets are recorded based on the present values of lease payments over the lease terms. The
Company elected an accounting policy to combine the non-lease components (which include common area maintenance, taxes and insurance) with the
related lease component. The interest rate implicit in lease contracts is typically not readily determinable. As such, the Company utilizes the appropriate
incremental borrowing rates, which are the rates that would be incurred to borrow on a collateralized basis, over similar terms, amounts equal to the
lease payments in a similar economic environment. Variable payments that do not depend on a rate or index are not included in the lease liability and
are  recognized  as  incurred.  Lease  contracts  do  not  include  residual  value  guarantees  nor  do  they  include  restrictions  or  other  covenants.  Certain
adjustments to the right-of-use assets may be required for items such as initial direct costs paid, incentives received or lease prepayments. If significant
events,  changes  in  circumstances,  or  other  events  indicate  that  the  lease  term  or  other  inputs  have  changed,  the  Company  would  reassess  lease
classification, remeasure the finance and operating lease liabilities by using revised inputs as of the reassessment date, and adjust the right-of-use asset.
Operating lease expense is recognized on a straight-line basis over the lease term. Finance lease expense is recognized based on the effective-interest
method over the lease term.

65

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Property and Equipment

Property and equipment are recorded at cost and depreciated using the straight-line method over their estimated useful lives, which are typically:

Asset
Computer equipment and software
Furniture and fixtures
Equipment
Leasehold improvements

Estimated useful life
(in years)
10
-
3
7
-
5
5
20
-
Shorter of useful life or term of lease

Maintenance and repairs are charged to expense when incurred; additions and improvements are capitalized. Fully depreciated assets are retained
in the accounts until they are no longer used and no further charge for depreciation is made in respect of these assets. When an item is sold, retired or
removed from service, the cost and related accumulated depreciation is relieved, and the resulting gain or loss, if any, is recognized in income.

Construction-in-process assets are stated at cost, which includes the cost of construction and other direct costs attributable to the construction.

Construction-in-process assets are not depreciated until such time as the relevant assets are completed and put into use.

Goodwill and IPR&D Assets

Goodwill is the amount by which the purchase price of acquired net assets in a business combination exceeded the fair values of net identifiable
assets  on  the  date  of  acquisition.  Acquired  In-Process  Research  and  Development  (“IPR&D”)  represents  the  fair  value  assigned  to  research  and
development assets that the Company acquires that have not been completed at the date of acquisition or are pending regulatory approval in certain
jurisdictions. The value assigned to the acquired IPR&D is determined by estimating the costs to develop the acquired technology into commercially
viable products, estimating the resulting revenue from the projects, and discounting the net cash flows to present value.  

Goodwill and IPR&D are not  amortized  but  are  evaluated  for  impairment  annually  or  more  frequently  if  events  or  changes  in  circumstances
indicate  that  the  asset  might  be  impaired.  The  goodwill  impairment  assessment  is  performed  by  reporting  unit.  A  reporting  unit  is  the  operating
segment,  or  a  business  one  level  below  that  operating  segment  (the  component  level)  if  discrete  financial  information  is  prepared  and  regularly
reviewed by segment management. However, components are aggregated as a single reporting unit if they have similar economic characteristics. The
Company  has  two  reporting  units:  the  legacy  Anika  reporting  unit,  which  specializes  in  therapies  based  on  its  hyaluronic  acid,  or  HA,  technology
platform,  and  a  reporting  unit  established  in  2020  upon  the  acquisitions  of  Parcus  Medical  and  Arthrosurface.  Factors  that  the  Company  considers
important, on an overall company basis, that could trigger an impairment review include significant underperformance relative to historical or projected
future operating results, significant changes in the Company’s use of the acquired assets or the strategy for its overall business, significant negative
industry or economic trends, a significant decline in the Company’s stock price for a sustained period, or a reduction of its market capitalization relative
to net book value.

66

 
 
 
 
 
 
   
     
     
 
   
     
     
 
   
     
     
 
 
 
 
 
 
 
 
 
Under U.S. GAAP, the Company has the option to perform a qualitative assessment to determine if it is necessary to perform the impairment test.
If  the  Company  concludes,  based  on  a  qualitative  assessment,  it  is  not  more  likely  than  not  that  the  Goodwill  or  the  IPR&D  asset  is  impaired,  the
Company is not required to perform the quantitative test. The Company has an unconditional option to bypass the qualitative assessment in any period
and proceed directly to the quantitative impairment test.

To conduct quantitative impairment tests of goodwill, the fair value of the reporting unit is compared to its carrying value. If the reporting unit’s
carrying value exceeds its fair value, the Company records an impairment loss to the extent that the carrying value of goodwill exceeds its implied fair
value, not to exceed the recorded amount of goodwill.

The Company performed a quantitative annual assessment for impairment of the remaining goodwill with respect to legacy Anika reporting unit
as of November 30, 2023, including consideration of (i) general macroeconomic factors, (ii) industry and market conditions, and (iii) the extent of the
excess of the fair value over the carrying value indicated in prior impairment testing. Accordingly, the Company determined it was not more likely than
not that the fair value of the legacy Anika reporting unit is less than its carrying amount and thus goodwill was not impaired as of November 30, 2023.

To conduct impairment tests of IPR&D, the fair value of the IPR&D project is compared to its carrying value. If the carrying value exceeds its
fair value, the Company records an impairment loss to the extent that the carrying value of the IPR&D project exceeds its fair value. The Company
estimates the fair value for IPR&D using the income approach, which is based on the Multi-Period Excess Earnings Method (“MPEEM”). MPEEM
measures economic benefit indirectly by calculating the income attributable to an asset after appropriate returns are paid to complementary assets used
in conjunction with the subject asset to produce the earnings associated with the subject asset, commonly referred to as contributory asset charges. This
approach incorporates significant estimates and assumptions related to the forecasted results including revenues, expenses, expected economic life of
the asset, contributory asset charges and discount rates to estimate future cash flows.

Long-Lived Assets

Long-lived  assets  primarily  include  property  and  equipment  and  intangible  assets  with  finite  lives.  The  Company’s  intangible  assets  are
comprised of purchased developed technologies, patents, trade names, customer relationships and distributor relationships. These intangible assets are
carried at cost, net of accumulated amortization. Amortization is recorded on a straight-line basis over the intangible assets' useful lives, which range
from approximately five to sixteen years. The Company reviews long-lived assets for impairment when events or changes in business circumstances
indicate  that  the  carrying  amount  of  the  assets  may not  be  fully  recoverable  or  that  the  useful  lives  of  those  assets  are  no longer appropriate. Each
impairment  test  is  based  on  a  comparison  of  the  undiscounted  cash  flows  to  the  recorded  value  of  the  asset.  If  impairment  is  indicated,  the  asset  is
written down to its estimated fair value based on a discounted cash flow analysis. During the year ended December 31, 2023, the Company determined
that certain of its intangible assets related to its Arthrosurface and Parcus reporting unit were impaired.  Please see Note 6 – Acquired Intangible Assets,
net for further details.

In  determining  the  useful  lives  of  intangible  assets,  the  Company  considers  the  expected  use  of  the  assets  and  the  effects  of  obsolescence,
demand,  competition,  anticipated  technological  advances,  changes  in  surgical  techniques,  market  influences  and  other  economic  factors.  For
technology-based  intangible  assets,  the  Company  considers  the  expected  life  cycles  of  products,  absent  unforeseen  technological  advances,  which
incorporate the corresponding technology.

Fair Value Measurements

Fair value is defined as the price that would be received from selling an asset, or paid to transfer a liability, in an orderly transaction between
market participants at the measurement date. When determining the fair value measurements for assets and liabilities required to be recorded at fair
value, the Company considers the principal or most advantageous market in which it would transact and considers assumptions that market participants
would  use  when  pricing  the  asset  or  liability,  such  as  inherent  risk,  transfer  restrictions,  and  risk  of  non-performance.  The  accounting  standard
establishes a fair value hierarchy that requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when
measuring fair value.

A financial instrument’s categorization within the fair value hierarchy is based upon the lowest level of input that is significant to the fair value

measurement. Three levels of inputs that may be used to measure fair value are:

• Level 1  –  Valuation  is  based  upon  quoted  prices  (unadjusted)  for  identical  instruments  traded  in  active  markets.  Level  1 instruments

include securities traded on active exchange markets, such as the New York Stock Exchange.

• Level 2 – Valuation is based upon inputs other than quoted prices, for similar instruments in active markets, quoted prices for identical or
similar instruments in markets that are not active and model-based valuation techniques for which all significant assumptions are directly
observable in the market.

67

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Level 3  –  Valuation  is  generated  from  model-based  techniques  that  use  significant  assumptions  not  observable  in  the  market.  These
unobservable assumptions reflect the Company’s own estimates of assumptions market participants would use in pricing the instrument.

The  Company’s  financial  assets  have  been  classified  as  Level  1.  The  Company’s  financial  assets  (which  include  cash  equivalents  and
investments) have been initially valued at the transaction price and subsequently valued, at the end of each reporting period, utilizing third-party pricing
services. The Company’s financial liabilities have been classified as Level 3.

Non-Recurring Fair Value Measurement

In measuring the impairment of intangible assets, the fair value of the Company's developed technology, customer relationship and tradename
definite lived intangible assets within the Parcus and Arthrosurface reporting unit are classified within Level 3 of the fair value hierarchy because of the
use of unobservable inputs in measuring the estimated fair value. When performing a quantitative assessment for impairment of these definite lived
intangible  assets,  the  Company  measures  the  amount  of  impairment  by  calculating  the  amount  by  which  the  carrying  value  of  the  definite  lived
intangible assets exceeds its estimated fair value (as discussed in Note 6 – Acquired Intangible Assets, Net).

Research and Development

Research and development costs consist primarily of salaries and related expenses for personnel, clinical trial expenses and fees paid to outside

consultants and outside service providers. Research and development costs are expensed as incurred.

Stock-Based Compensation

The Company has stock-based compensation plans under which it grants various types of equity-based awards, the cost of which is based on the
grant-date fair value of the underlying award and recognized over the period during which an employee is required to provide service in exchange for
the award, which is generally the vesting period.

For performance-equity awards with market-based conditions, compensation cost is measured at the date of the award and is recorded over the
vesting  period,  regardless  of  the  likelihood  of  achievement  of  the  market-based  performance  criteria.  For  performance-based  equity  awards  with
financial and business milestone achievement targets, compensation cost is based on the probable outcome of the performance conditions. Changes to
the probability assessment and the estimated shares expected to vest will result in adjustments to the related stock-based compensation expense that will
be recorded in the period of the change. If the performance targets are not achieved, no compensation cost is recognized, and any previously recognized
compensation cost is reversed.

See  Note  13, Equity  Incentive  Plan,  for  a  description  of  the  types  of  stock-based  awards  granted,  the  compensation  expense  related  to  such

awards, and detail of equity-based awards outstanding.

Income Taxes

We account for income taxes under the asset and liability method, which requires the recognition of deferred tax assets, or DTAs, and deferred
tax liabilities, or DTLs, for the expected future tax consequences of events that have been included in the financial statements. Under this method, we
determine DTAs and DTLs based on the differences between the financial statement and tax bases of assets and liabilities by using enacted tax rates in
effect for the year in which the differences are expected to reverse. The effect of a change in tax rates on DTAs and DTLs is recognized in income in the
period that includes the enactment date.

We recognize DTAs to the extent that we believe that these assets are more likely than not to be realized. In making such a determination, we
consider  all  available  positive  and  negative  evidence,  including  future  reversals  of  existing  taxable  temporary  differences,  projected  future  taxable
income, tax-planning strategies, carryback potential if permitted under the tax law, and results of recent operations.

We record uncertain tax positions in accordance with ASC 740, Income Taxes, on the basis of a two-step  process  in  which  (1)  we  determine
whether  it  is  more  likely  than  not  that  the  tax  positions  will  be  sustained  on  the  basis  of  the  technical  merits  of  the  position  and  (2)  for  those  tax
positions that meet the more-likely-than-not recognition threshold, we recognize the largest amount of tax benefit that is more than 50 percent likely to
be realized upon ultimate settlement with the related tax authority. Interest and penalties associated with income tax filings are recorded in income tax
expense.

Comprehensive Income (Loss)

Comprehensive income (loss) consists of net income (loss) and other comprehensive income (loss), which includes foreign currency translation
adjustments. For the purposes of comprehensive income (loss) disclosures, the Company does not record tax provisions or benefits for the net changes
in the foreign currency translation adjustment, as it intends to indefinitely reinvest undistributed earnings of its foreign subsidiary. Accumulated other
comprehensive income (loss) is reported as a component of stockholders' equity.

Segment Information

Operating segments are components of an enterprise about which separate financial information is available that is evaluated regularly by the
chief operating decision maker, or decision-making group, in deciding how to allocate resources and in assessing performance. The Company’s chief
operating decision maker is its President and Chief Executive Officer as of December 31, 2023. Based on the criteria established by ASC 280, Segment
Reporting, the Company has one operating and reportable segment.

Contingencies

In the normal course of business, the Company is involved from time-to-time in various legal proceedings and other matters such as contractual
disputes, which are complex in nature and have outcomes that are difficult to predict. The Company records accruals for loss contingencies to the extent
that  it  concludes  that  it  is  probable  that  a  liability  has  been  incurred  and  the  amount  of  the  related  loss  can  be  reasonably  estimated.  The  Company
considers all relevant factors when making assessments regarding these contingencies. Although the outcomes of any potential legal proceedings are

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
inherently difficult to predict, the Company does not expect the resolution of any potential legal proceedings to have a material adverse effect on its
financial position, results of operations, or cash flows.

68

 
Recent Issued Accounting Pronouncements

No new accounting pronouncements issued or effective during the period had, or are expected to have, a material impact on the consolidated

financial statements.

3. Fair Value Measurements

There were no available-for-sale securities as of December 31, 2023 and 2022.

The Company’s investments, including cash equivalents, are all classified within Levels 1 of the fair value hierarchy and are valued based on
quoted  prices  in  active  markets.  For  cash,  current  receivables,  accounts  payable,  and  accrued  interest,  the  carrying  amounts  approximate  fair  value,
because  of  the  short  maturity  of  these  instruments,  and  therefore  fair  value  information  is  not included in the table below. Contingent consideration
related to the previously described business combinations are classified within Level 3 of the fair value hierarchy as the determination of fair value uses
considerable judgement and represents the Company’s best estimate of an amount that could be realized in a market exchange for the asset or liability. 

The classification of the Company’s cash equivalents and investments within the fair value hierarchy is as follows:

    Active Markets   
for Identical
Assets

Significant
Other
Observable
Inputs

Significant
Unobservable
Inputs

December 31,
2023

(Level 1)

(Level 2)

(Level 3)

Amortized
Cost

  $

55,485    $

55,485    $

-    $

-    $

55,485 

    Active Markets   
for Identical
Assets

Significant
Other
Observable
Inputs

Significant
Unobservable
Inputs

December 31,
2022

(Level 1)

(Level 2)

(Level 3)

Amortized
Cost

  $

67,801    $

67,801    $

-    $

-    $

67,801 

Cash equivalents:

Money Market Funds

Cash equivalents:

Money Market Funds

There were no transfers between fair value levels in 2023 or 2022.

4. Inventories

Total inventories included in the balance sheet consist of the following:

Raw materials
Work-in-process
Finished goods

Total

Inventories
Other long-term assets

Total

As of December 31,

2023

2022

15,507    $
17,002     
32,084     
64,593    $

46,386    $
18,207     
64,593    $

20,535 
10,648 
25,306 
56,489 

39,765 
16,724 
56,489 

  $

  $

  $

  $

Inventories  are  stated  net  of  inventory  reserves  of  approximately  $11.7  million  and  $9.9  million,  as  of  December  31,  2023  and  2022,

respectively.

69

 
 
 
 
 
 
 
 
 
 
   
 
   
     
 
 
 
   
 
   
   
   
     
 
 
 
 
   
   
   
   
 
     
       
       
       
       
 
 
 
   
 
   
     
 
 
 
   
 
   
   
   
     
 
 
 
 
   
   
   
   
 
     
       
       
       
       
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
     
       
 
   
 
 
5. Property and Equipment

Property and equipment is stated at cost and consists of the following:

Equipment and software
Furniture and fixtures
Leasehold improvements
Construction in progress

Subtotal

Less accumulated depreciation

Total

December 31,

2023

2022

  $

  $

52,278    $
1,884     
34,975     
4,730     
93,867     
(47,669)    
46,198    $

52,112 
2,413 
34,916 
5,021 
94,462 
(46,183)
48,279 

Depreciation expense was $6.4 million, $6.7 million, and $6.5 million for the years ended December 31, 2023, 2022, and 2021, respectively.

6. Acquired Intangible Assets, Net

Intangible assets consist of the following:

Year Ended December 31, 2023

Less:
Accumulated
Currency
Translation
Adjustment

Less: Current
Period
Impairment
Charge

Less:
Accumulated
Amortization    

Net Book
Value

(1,608)   $
(1,006)    
-     
(415)    
(189)    
-     
(3,218)   $

(56,518)   $
-     
(5,113)    
-     
-     
(559)    
(62,190)   $

(29,481)   $
-     
(3,527)    
(4,285)    
(728)    
(4,081)    
(42,102)   $

Year Ended December 31, 2022

Weighted
Average Useful
Life (in Years)  
15 
Indefinite 
10 
5 
16 
5 
13 

1,973     
1,650   

360     
-     
83     
560     
4,626     

Less:
Accumulated
Currency
Translation
Adjustment

Less: Current
Period
Impairment
Charge

Less:
Accumulated
Amortization    

Net Book
Value

Weighted
Average Useful
Life

(1,608)   $
(1,006)    
-     
(415)    
(189)    
-     
(3,218)   $

70

-    $
-     
-     
-     
-     
-     
-    $

(23,686)   $
-     
(2,627)    
(4,285)    
(680)    
(3,041)    
(34,319)   $

64,286     
1,650   
6,373     
-     
131     
2,159     
74,599     

15 
Indefinite 
10 
5 
16 
5 
13 

  Gross Cost
  $

89,580    $
2,656     
9,000     
4,700     
1,000     
5,200     
112,136    $

  $

  $

  Gross Cost
  $

89,580    $
2,656     
9,000     
4,700     
1,000     
5,200     
112,136    $

Developed technology
IPR&D
Customer relationships
Distributor relationships
Patents
Tradenames

Total

Developed technology
IPR&D
Customer relationships
Distributor relationships
Patents
Tradenames

Total

 
 
 
 
 
 
 
 
 
 
   
 
   
   
   
   
   
 
 
 
 
 
 
   
 
   
 
 
   
   
   
   
   
   
   
   
   
 
 
   
 
   
 
 
   
   
   
   
 
   
   
   
   
   
 
Total amortization expense with respect to the definite lived acquired intangible assets was $7.8 million for each of the years ended December

31, 2023, 2022 and 2021, respectively.

The  Company  performed  an  assessment  of  its  definite  lived  acquired  intangible  assets  during  the  quarter  ended  December  31,  2023.  The
Company  estimated  the  fair  value  of  its  definite  lived  acquired  intangible  assets  using  an  income  approach  method  of  valuation,  including  a
combination  of  the  distributor  method  for  the  customer  relationships  intangible  asset  and  the  relief  of  royalty  method  for  each  of  the  developed
technology  and  tradename  intangible  assets.  These  valuation  approaches  incorporate  significant  estimates  and  assumptions  related  to  the  forecasted
results  including  revenues,  expenses,  expected  economic  life  of  the  asset,  royalty  rates,  after-tax  royalty  savings  expected  from  ownership  of  the
developed technology and tradename assets, contributory asset charges and discount rates to estimate future cash flows. While assumptions utilized are
subject  to  a  high  degree  of  judgment  and  complexity,  the  Company  made  its  best  estimate  of  future  cash  flows  under  a  high  degree  of  economic
uncertainty  that  existed  as  of  December  31,  2023.  In  developing  its  assumptions,  the  Company  also  considered  observed  trends  of  its  industry
participants. The Company recorded a $62.2 million charge to intangible assets related to its Arthrosurface and Parcus asset groups during the year
ended December  31,  2023  mainly  due  to  slower  than  expected  revenue  growth  from  product  sales  that  have  impacted  cash  flows  with  these  asset
groups.

The Company performed its annual assessment of the IPR&D intangible asset as of November 30, 2023. The Company estimated the fair value
of  the  IPR&D  intangible  assets  using  the  income  approach  which  is  based  on  the  Multi-Period  Excess  Earnings  Method  (“MPEEM”).  MPEEM
measures economic benefit indirectly by calculating the income attributable to an asset after appropriate returns are paid to complementary assets used
in conjunction with the subject asset to produce the earnings associated with the subject asset, commonly referred to as contributory asset charges. This
approach incorporates significant estimates and assumptions related to the forecasted results including revenues, expenses, expected economic life of
the  asset,  contributory  asset  charges  and  discount  rates  to  estimate  future  cash  flows.  While  assumptions  utilized  are  subject  to  a  high  degree  of
judgment  and  complexity,  the  Company  made  its  best  estimate  of  future  cash  flows  under  a  high  degree  of  economic  uncertainty  that  existed  as  of
November 30, 2023. In developing its assumptions, the Company also considered observed trends of its industry participants. No impairment existed as
the estimated fair value of the remaining IPR&D intangible asset was greater than its carrying value.

7. Goodwill

The following table provides a roll forward of goodwill for the years ended December 31, 2023 and 2022:

Balance, beginning January 1
Effect of foreign currency adjustments
Balance, ending December 31

As of December 31,

2023

2022

  $

  $

7,339    $
232     
7,571    $

7,781 
(442)
7,339 

The goodwill balance at December 31, 2023 and 2022 was related to the legacy Anika reporting unit.

71

 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
The  Company  estimated  the  fair  value  of  the  reporting  units  using  a  discounted  cash  flow  method,  which  is  based  on  the  present  value  of
projected cash flows and a terminal value, which represents the expected normalized cash flows of the reporting units beyond the cash flows from the
discrete projection period. The Company determined that a discounted cash flow model provided the best approximation of fair value of the reporting
units  for  the  purpose  of  performing  the  impairment  test.  This  approach  incorporates  significant  estimates  and  assumptions  related  to  the  forecasted
results including revenues, expenses, the achievement of certain cost synergies, terminal growth rates and discount rates to estimate future cash flows.
While assumptions utilized are subject to a high degree of judgment and complexity, the Company made its best estimate of future cash flows under a
high  degree  of  economic  uncertainty  that  existed  as  of  November  30,  2023.  In  developing  its  assumptions,  the  Company  also  considered  observed
trends of its industry participants.

For the legacy Anika reporting unit, the Company performed a quantitative assessment as of November 30, 2023. The results of the impairment
test indicated that the estimated fair value of the legacy Anika reporting unit was greater than its carrying value, therefore the Company determined that
was more likely than not that the fair value of the legacy Anika reporting unit was not impaired as of November 30, 2023. There  was  no remaining
goodwill with respect to the reporting unit for Parcus Medical and Arthrosurface as of December 31, 2023.

8. Leases

The Company leases its buildings and manufacturing facilities under operating leases. As of December 31, 2023, the Company had real estate

leases in Bedford, Massachusetts, Franklin, Massachusetts, Sarasota, Florida, Warsaw, Indiana and Padova, Italy.

In June 2022, the Company finalized a renewal option to extend the current term for its operating headquarters and manufacturing facility in

Bedford through 2027. There are also lease renewal options into 2038.

The  Company  leases  office  space  in  Padova,  Italy.  The  current  term  of  the  Padova  lease  extends  to  2032,  with  a  right  to  terminate  at  the

Company’s option in 2026 without penalty.

the Company also has operating leases for corporate offices, manufacturing and warehouse facilities. The operating leases consist of one real
estate lease in Franklin, Massachusetts (Franklin lease) and two real estate leases in Sarasota, Florida (Sarasota lease). In October 2022, the Company
entered  into  an  option  to  extend  the  current  term  of  the  Franklin  lease  through  2024.  In  June  2022,  the  Company  finalized  an  option  to  extend  the
current term of the two Sarasota leases through 2027.

The significant assumptions in recognizing the right-of-use asset and lease liability are as follows:

Incremental borrowing rate. The Company derives its incremental borrowing rate from information available at the lease commencement date in
determining the present value of lease payments. The incremental borrowing rate represents a collateralized rate of interest the Company would have to
pay to borrow over a similar term an amount equal to the lease payments in a similar economic environment. The Company’s lease agreements do not
provide implicit rates. As the Company did not have any external borrowings at either the transition or subsequent renewal dates with comparable terms
to its lease agreements, the Company estimated its incremental borrowing rate based on its credit quality, line of credit agreement and by comparing
interest rates available in the market for similar borrowings, and adjusting this amount based on the impact of collateral over the term of the lease. The
weighted average discount rate at December 31, 2023 was 3.6% for operating leases.

72

 
 
 
 
 
 
 
 
 
 
 
 
Lease term. The lease term begins at the lease commencement date and is determined on that date based on the non-cancelable term of the lease
together with periods covered by an option to extend the lease if the Company is reasonably certain to exercise that option, or periods covered by an
option to terminate the lease if the Company is reasonably certain not to exercise that option.

The components of lease expense and other information are as follows: 

Finance lease amortization of right-of-use assets
Interest on finance lease liabilities

Finance lease expense
Operating lease expense
Short-term lease expense
Variable lease expense
Total lease expense

Weighted Average Remaining Lease Term (in years)

Operating leases

Weighted Average Discount Rate

Operating leases

Other information

Operating cash flows from operating leases

2023

Years Ended December 31
2022

2021

  $

  $

-    $
-     
-     
3,320     
-     
425     
3,745    $

121    $
11     
132     
2,839     
17     
413     
3,401    $

143 
19 
162 
2,468 
2 
319 
2,951 

Years Ended December 31
2022
2023

13.9 

14.8 

3.6%   

3.6%

  $

3,239 

  $

2,471 

Future commitments due under these lease agreements as of December 31, 2023 are as follows:

Years ended December 31,

  Operating Leases  

2024
2025
2026
2027
2028
Thereafter
Present value adjustment
Present value of lease payments
Less current portion included in accrued expenses and other current liabilities
Total lease liabilities

  $

  $

9. Accrued Expenses

Accrued expenses consist of the following:

Compensation and related expenses
Professional fees
Operating lease liability- current
Discontinuation of software development project
Income taxes payable
Clinical trial costs
Other

Total

73

As of December 31,

2023

2022

  $

  $

11,828    $
3,240     
2,133     
1,904     
1,240     
460     
394     
21,199    $

3,131 
3,142 
2,837 
2,643 
2,329 
22,901 
(7,946)
29,037 
(2,133)
26,904 

11,303 
3,145 
2,073 
- 
810 
999 
510 
18,840 

 
 
 
 
 
 
 
 
 
   
   
 
   
   
   
   
   
 
 
 
 
 
 
 
 
 
     
 
     
 
   
   
 
     
 
     
 
     
 
     
 
   
 
     
 
     
 
     
 
     
 
 
 
 
     
 
   
   
   
   
   
   
   
   
 
 
 
 
 
 
 
 
 
   
 
 
     
       
 
   
   
   
   
   
   
 
 
10. Revolving Credit Agreement

On November 12, 2021, the Company, entered into a “Third Amendment to Credit Agreement” amending the existing revolving line of credit
agreement dated October 24, 2017 with Bank of America, N.A., as administrative agent, swingline lender and issuer of letters of credit, for a $75.0
million  senior  revolving  line  of  credit  (the  “Credit  Agreement”).  Subject  to  certain  conditions,  the  Company  may request  up  to  an  additional  $75.0
million  in  commitments  for  a  maximum  aggregate  commitment  of  $150.0  million,  which  requests  must  be  approved  by  the  Revolving  Lenders  (as
defined in the Credit Agreement). Loans under the Credit Agreement generally bear interest at a rate equal to (a) the Bloomberg Short-Term Bank Yield
Index, (“BSBY”), rate plus (b) an additional percentage that will range from 0.25% to 1.00%, based on the Company’s consolidated leverage ratio at
the time of the borrowings. The Company is required to pay a commitment fee in an amount that is equal to 0.20% to 0.30% per annum, based on the
Company’s consolidated leverage ratio, on the actual daily unused amount of the credit facility and that is due and payable quarterly in arrears. Loan
origination costs are included as assets on the balance sheet and are being amortized over the five-year term of the Credit Agreement. As of December
31, 2023 and 2022, there were no outstanding borrowings under the Credit Agreement and the Company is in compliance with the terms of the Credit
Agreement. 

The Credit Agreement contains customary representations, warranties, affirmative and negative covenants, including financial covenants, events
of default, and indemnification provisions in favor of the Lenders. These include restrictive covenants that require the Company not to exceed certain
maximum  leverage  and  interest  coverage  ratios,  limit  its  incurrence  of  liens  and  indebtedness,  and  its  entry  into  certain  merger  and  acquisition
transactions or dispositions and place additional restrictions on other matters, all subject to certain exceptions. The Revolving Lenders has been granted
a first priority lien and security interest in substantially all of the Company’s assets, except for certain intangible assets.

11. Commitments and Contingencies

In certain of its contracts, the Company warrants to its customers that the products it manufactures conform to the product specifications as in
effect at the time of delivery of the specific product. The Company may also warrant that the products it manufactures do not infringe, violate or breach
any  U.S.  or  international  patent  or  intellectual  property  rights,  trade  secret,  or  other  proprietary  information  of  any  third  party.  On  occasion,  the
Company contractually indemnifies its customers against any and all losses arising out of, or in any way connected with, any claim or claims of breach
of its warranties or any actual or alleged defect in any product caused by the negligent acts or omissions of the Company. The Company maintains a
products liability insurance policy that limits its exposure to these risks. Based on the Company’s historical activity, in combination with its liability
insurance coverage, the Company believes the estimated fair value of these indemnification agreements is immaterial. The Company had no accrued
warranties at December 31, 2023 or 2022, respectively, and has no history of claims paid.  

The Company is also involved from time-to-time in various legal proceedings arising in the normal course of business. Although the outcomes of
these legal proceedings are inherently difficult to predict, the Company does not expect the resolution of these occasional legal proceedings to have a
material adverse effect on its financial position, results of operations, or cash flows.

12. Revenue and Geographic Information

The Company categorizes its product portfolio into three product families: OA Pain Management, Joint Preservation and Restoration, and Non-

Orthopedic.

74

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Product revenue by product family is as follows:

2023

Percentage of
Product
Revenue

Revenue

Years Ended December 31,
2022

Percentage of
Product
Revenue

Revenue

2021

Percentage of
Product
Revenue

Revenue

OA Pain Management
Joint Preservation and

Restoration
Non-Orthopedic

Total

  $

101,927     

61%  $

91,984     

59%  $

85,084     

54,879     
9,856     
166,662     

  $

33%   
6%   
100%  $

50,402     
13,850     
156,236     

32%   
9%   
100%  $

48,588     
14,122     
147,794     

58%

33%
9%
100%

Effective January 1, 2023, the Company reported revenue from product sales to veterinary customers within the Non-Orthopedic product family
whereas  such  revenue  had  historically  been  reported  within  the  OA  Pain  Management  revenue  product  family  for  the  prior  period  years  ended
December 31, 2022 and 2021. Revenue from product sales to veterinary customers amounted to $4.2 million, $5.9 million and $4.4 million for 2023,
2022 and 2021, respectively, with the 2022 and 2021 revenue reclassified to Non-Orthopedic to conform to current presentation.

Product revenue from the Company’s sole significant customer, Mitek, as a percentage of the Company’s total product revenue was 45%, 43%,

and 45% for the years ended December 31, 2023, 2022, and 2021, respectively.

Total revenue by geographic location based on the location of the customer in total and as a percentage of total revenue are as follows:

Total
Revenue

2023
    Percentage of  
Revenue

Years Ended December 31,
2022
    Percentage of  
Revenue

Total
Revenue

Total
Revenue

2021
    Percentage of  
Revenue

Geographic Location:

United States
Europe
Other

Total

  $

  $

123,129     
21,724     
21,809     
166,662     

74%  $
13%   
13%   
100%  $

119,151     
20,639     
16,446     
156,236     

76%  $
13%   
11%   
100%  $

113,833     
19,580     
14,381     
147,794     

77%
13%
10%
100%

Net long-lived assets, consisting primarily of net property and equipment, are subject to geographic risks because they are generally difficult to
move and to effectively utilize in another geographic area in a reasonable time period and because they are relatively illiquid. Net tangible long-lived
assets by principal geographic areas are as follows:

United States
Italy
United Kingdom

Total

75

As of December 31,

2023

2022

  $

  $

45,077    $
1,075     
46     
46,198    $

47,068 
1,211 
- 
48,279 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
   
 
     
       
 
     
       
 
     
       
 
   
   
 
 
 
 
 
 
 
   
 
   
   
 
 
13. Equity Incentive Plan

Equity Incentive Plan

The Anika Therapeutics, Inc. 2017 Omnibus Incentive Plan (the “2017 Plan”) was approved by the Company’s stockholders on June 13, 2017
and subsequently amended on June 18, 2019, June 16, 2020 and June 16, 2021 and June 14, 2023. The 2017 Plan provides for the grant of incentive
stock  options,  nonqualified  stock  options,  stock  appreciation  rights  (“SARs”),  restricted  stock  awards  (“RSAs”),  performance  restricted  stock  units
(“PSUs”),  restricted  stock  units  (“RSUs”),  total  shareholder  return  options  (“TSRs”)  and  performance  options  that  may be  settled  in  cash,  stock,  or
other property. In accordance with the 2017 Plan approved by the Company’s stockholders, including the amendments thereto, each share award other
than  stock  options  or  SAR’s  will  reduce  the  number  of  total  shares  available  for  grant  by  two  shares.  Subject  to  adjustment  for  specified  types  of
changes in the Company’s capitalization, no more than 4.6 million shares of common stock may be issued under the 2017 Plan. There are 1.0 million
shares available for future grant at December 31, 2023 under the 2017 Plan.

The Anika Therapeutics, Inc. 2021 Inducement Plan (the “Inducement Plan”) was adopted by the Company’s board of directors on November 4,
2021in which the Company reserved 125,000 shares of common stock for issuance pursuant to equity-based awards granted under the Inducement Plan.
Such awards may be granted only to an individual who was not previously the Company’s employee or director with the Company. The Inducement
Plan provides for the grant of awards under terms substantially similar to the 2017 Plan (as amended). The Inducement Plan was amended in December
2023 to add 125,000 shares. There are 0.1 million shares available for future grant at December 31, 2023 under the Inducement Plan.

The Company may satisfy the awards upon exercise, or upon fulfillment of the vesting requirements for other equity-based awards, with either
newly issued shares or shares reacquired by the Company. Stock-based awards are granted with an exercise price equal to or greater than the market
price of the Company’s stock on the date of grant. Awards contain service conditions or service and performance conditions, and they generally become
exercisable ratably over one to four years with a maximum contractual term of ten years.

For the years ended December 31, 2023, and 2022, the tax benefit associated with stock-based compensation was $2.6 million and $1.1 million,

respectively. A summary of the stock-based compensation in the Company’s statements of operations is as follows (in thousands):

Cost of revenue
Research and development
Selling, general and administrative
Total stock-based compensation expense

2023

Years Ended December 31,
2022

2021

  $

  $

646    $
2,189     
12,408     
15,243    $

820    $
1,646     
11,849     
14,315    $

716 
1,233 
9,136 
11,085 

For  the  years  ended  December  31,  2023,  2022  and  2021,  windfall  tax  benefits  (expense)  of  ($0.1)  million,  ($0.5)  million  and  $0.1  million,

respectively, are associated with the stock-based compensation expense above.

Stock Options

Stock options are granted to purchase common shares at prices that are equal to the fair market value of the shares on the date the options are
granted or, in the case of premium options, are granted with an exercise price at 110% of the market price of the Company’s common stock on the date
of grant. Options generally vest in equal annual installments over a period of three to four years and expire 10 years after the date of grant. The grant-
date fair value of options is recognized as expense on a straight-line basis over the requisite service period, which is generally the vesting period.

76

 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
   
   
 
 
 
 
 
The following summarizes the activity under the Company’s stock option plans:

Outstanding as of December 31, 2022
Granted
Exercised
Forfeited and canceled
Outstanding as of December 31, 2023
Vested, December 31, 2023
Vested or expected to vest, December 31, 2023

Weighted
Average
Remaining
Contractual
Term (in
years)

Weighted
Average
Exercise
Price

Aggregate
Intrinsic
Value
(in thousands) 

34.93     
28.58     
18.30     
36.59     
33.42     
36.66     
33.42     

     $

7.5    $
6.7    $
7.5    $

20 

127 
5 
127 

Number of

Options    
1,530,703    $
404,903    $
(2,034)   $
(120,843)   $
1,812,729    $
983,834    $
1,812,729    $

The aggregate intrinsic value of options exercised was immaterial for the years ended December 31, 2023 and 2022, respectively and was $0.3

million for the year ended December 31, 2021.

The Company granted 404,903 stock options during the year ended December 31, 2023, of which 323,993 shares were premium-priced options.

The Company uses the Black-Scholes pricing model to determine the fair value of options granted. The calculation of the fair value of stock
options is affected by the stock price on the grant date, the expected volatility of the Company’s common stock over the expected term of the award, the
expected life of the award, the risk-free interest rate and the dividend yield.

The assumptions used in the Black-Scholes pricing model for options granted during the years ended December 31, 2023, 2022 and 2021, along

with the weighted-average grant-date fair values, were as follows:

Risk-free interest rate
Expected stock price volatility
Expected life of options (in years)
Expected dividend yield
Fair value per option

3.52%
48.19%

2023
-
-
4.5
0.0%  
11.45  

4.64%  
49.44%  

1.28%
53.80%

4.28%  
55.55%  

2022
-
-
4.5
0.0%  
11.45  

0.29%
54.80%

1.00%
56.35%

2021
-
-
4.0
0.0%  
14.80  

As of December 31, 2023, there was $5.9 million of unrecognized compensation cost related to unvested stock options. This expense is expected

to be recognized over a weighted average period of 1.7 years.

77

 
 
 
 
 
   
   
   
      
  
   
      
  
   
   
      
  
   
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Restricted Stock Units

RSUs generally vest in equal annual installments over a three- or four-year periods. The grant-date fair value of RSUs is recognized as expense
on a straight-line basis over the requisite service period, which is generally the vesting period. The Company determines the fair value of restricted
stock units based on the closing price of its common stock on the date of grant.

RSU activity for the year ended December 31, 2023 is as follows:

Outstanding as of December 31, 2022
Granted
Vested
Forfeited and cancelled
Outstanding as of December 31, 2023

Number of
Shares

675,405    $
442,762    $
(261,939)   $
(84,870)   $
771,358    $

  $

  $

Weighted
Average
Fair Value  
28.40 
26.66 
29.44 
27.11 
27.19 

The weighted-average grant-date fair value per share of RSUs granted was $26.66, $25.14 and $35.88 for the years ended December 31, 2023,
2022 and 2021, respectively. The total fair value of RSUs vested was $6.9 million, $6.0 million and $3.7 million for the years ended December 31,
2023, 2022 and 2021, respectively.

As  of  December 31, 2023, there  was  $11.9  million  of  unrecognized  compensation  cost  related  to  time-based  RSUs,  which  is  expected  to  be

recognized over a weighted-average period of 1.7 years.

Performance Stock Units

The Company granted performance stock units (“PSUs”) to employees in 2019 and 2020 which contained performance conditions with business
and financial targets. The business target, amounting to 30% of the total performance condition awards, was measured and achieved in the 2019 fiscal
year. One of the financial targets, amounting to 55% of the total performance condition awards, was measured and achieved in the 2022  fiscal  year,
while the remaining financial target, amounting to 15% of the total performance condition awards, was not achieved. The PSUs granted to employees in
2020  contained  performance  conditions  with  business  and  financial  targets.  One  of  the  business  targets,  amounting  to  20%  of  the  total  performance
condition  awards,  was  not  achieved  in  the  2021  fiscal  year,  while  the  remaining  business  target  related  to  a  certain  timely  regulatory  approval,
amounting to 20% of the total performance condition awards, was not achieved in the 2022 fiscal year. The financial targets, amounting to 60% of the
total performance condition awards, were not achieved in the 2022 fiscal year. The Company has no PSUs outstanding at December 31, 2023.

PSU activity for the year ended December 31, 2023 is as follows:

Outstanding as of December 31, 2022
Granted
Vested
Forfeited and cancelled
Outstanding as of December 31, 2023

Number of
Shares

117,897    $
-    $
-    $
(117,897)   $
-    $

Weighted
Average
Fair Value  
34,98 
- 
- 
34.98 
- 

The weighted-average grant-date fair value per share of PSUs granted was $32.53 for the year ended December 31, 2022. The total fair value of
PSUs vested was $0.6 million for the year ended December 31, 2022. There were no PSUs granted or vested during the years ended December 31, 2023
and 2021, respectively. There are no PSUs outstanding as of December 31, 2023.

78

 
 
 
 
 
 
 
   
   
   
   
 
 
 
 
 
 
 
 
   
   
   
   
   
   
 
 
14. Employee Benefit Plan

The  Company’s  U.S.  employees  are  eligible  to  participate  in  the  Company’s  401(k)  savings  plan.  Employees  may  elect  to  contribute  a
percentage of their compensation to the plan, and the Company will make 140% matching contributions up to a limit of 5% of an employee’s eligible
compensation. In addition, the Company may make  annual  discretionary  contributions.  The  Company  made  matching  contributions  of  $2.7 million,
$2.3 million, and $2.0 million for the years ended December 31, 2023, 2022, and 2021, respectively.

15. Income Taxes 

Income Tax Expense

The components of the Company’s income (loss) before income taxes and its provision for (benefit from) income taxes consist of the following:

(Loss) income before income taxes
Domestic
Foreign

Provision for (benefit from) income taxes:
Current:
Federal
State
Foreign
Total current
Deferred:
Federal
State
Foreign
Total deferred
Total benefit from income taxes

2023

Years ended December 31,
2022

2021

(86,061)   $
734     
(85,327)   $

(19,080)   $
334     
(18,746)   $

2023

Years ended December 31,
2022

2021

3,153    $
309     
312     
3,774     

(5,045)    
(1,418)    
29     
(6,434)    
(2,660)   $

1,005    $
285     
96     
1,386     

(3,243)    
(1,256)    
(774)    
(5,273)    
(3,887)   $

(2,529)
4,956 
2,427 

494 
(635)
167 
26 

(553)
(426)
(754)
(1,733)
(1,707)

  $

  $

  $

  $

79

 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
     
       
       
 
   
 
 
 
 
 
 
 
   
   
 
     
       
       
 
     
       
       
 
   
   
   
     
       
       
 
   
   
   
   
 
 
Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities consist of the following:

Deferred tax assets:

Capitalized research expenditures
Lease liability
Acquisition-related intangible asset
Stock-based compensation expense
Inventory reserves
Compensation accrual
Net operating loss carry forwards
Accrued expenses
Tax credits
Foreign currency exchange
Gross deferred tax assets
Less: Valuation allowance
Deferred tax assets

Deferred tax liabilities:

Acquisition-related intangible asset
Depreciation
Right of use asset
Deferred tax liabilities

Net deferred tax liabilities

December 31,  

2023

2022

11,266    $
7,082     
5,040     
3,881     
3,552     
1,685     
1,161     
947     
515     
121     
35,250     
(18,062)    
17,188    $

December 31,

2023

2022

(288)   $
(8,567)    
(6,844)    
(15,699)   $

1,489    $

5,451 
7,468 
- 
2,795 
2,763 
1,635 
1,551 
519 
741 
221 
23,144 
- 
23,144 

(12,075)
(8,804)
(7,252)
(28,131)

(4,987)

  $

  $

  $

  $

  $

As of December 31, 2023, the  Company  had  no  Federal  net  operating  loss  (“NOL”)  carryforwards  and  state  net  NOL  carryforwards  of  $1.0
million that will begin to expire in 2027. The Company also had NOL carryforwards in Italy of $4.7 million that do not expire but are limited to 80% of
taxable  income.  As  of  December  31,  2023,  the  Company  had  no  federal  research  and  development  tax  credit  carryforwards  and  state  research  and
development tax credit carryforwards of $0.7 million that will begin expiring in 2024.

The  Tax  Cuts  and  Jobs  Act  (“TCJA”)  requires  taxpayers  to  capitalize  and  amortize  research  and  experimental  (“R&D”)  expenditures  for  tax
years beginning after December 31, 2021. This rule became effective for the Company during the year ended December 31, 2022 and resulted in the
capitalization of R&D costs of $22.9 million and $23.4 million as of December 31, 2023 and 2022,  respectively.  The  Company  will  amortize  these
costs for tax purposes over 5 years if the R&D was performed in the U.S. and over 15 years if the R&D was performed outside the U.S.

The Company recognizes deferred tax assets to the extent that it believes that these assets are more likely than not to be realized. In making such
a  determination,  the  Company  considers  all  available  positive  and  negative  evidence,  including  future  reversals  of  existing  taxable  temporary
differences, projected future taxable income, tax-planning strategies, carryback potential if permitted under the tax law, and results of recent operations.
Based upon future reversals of existing taxable temporary differences and projected future taxable income, the Company believes it is more likely than
not it will realize its foreign deferred tax assets.

During  the  year  ended  December  31,  2023,  the  Company  determined  that  its  domestic  deferred  tax  assets  originating  during  the  year  ended
December  31,  2023  would  exceed  the  availability  of  reversing  taxable  temporary  differences.  Due  to  significant  negative  evidence,  including  the
Company’s current and prior year operating losses, the Company concluded its net deferred tax assets in the U.S. are not more likely than not to be
realizable. As a result, the Company recorded a valuation allowance of $18.1 million against its U.S deferred tax assets at December 31, 2023. As of
December 31, 2023, the  Company  continues  to  believe  its  foreign  deferred  tax  assets  are  realizable  based  upon  future  reversals  of  existing  taxable
temporary differences and projected future taxable income in the Company’s foreign jurisdictions.

Undistributed  earnings  of  certain  of  the  Company’s  foreign  subsidiaries  amounted  to  approximately  $0.6  million  at  December  31,  2023.  The
Company expects to be able to take a 100% dividend received deduction to offset any U.S. federal income tax liability on the undistributed earnings.
Determination of the amount of unrecognized state and local deferred income tax liability is not practicable due to the complexities associated with its
hypothetical calculation.

80

 
 
 
 
 
 
 
 
 
   
 
     
       
 
   
   
   
   
   
   
   
   
   
   
   
 
 
 
 
 
 
   
 
     
       
 
   
   
 
     
       
 
 
 
 
 
 
 
Effective Tax Rate

The reconciliation between the U.S. federal statutory rate and the Company’s effective rate is summarized as follows:

Statutory federal income tax rate
State tax expense, net of federal benefit
Stock compensation
Section 162(m) limitation
Change in fair value of contingent consideration
Change in tax rates and state apportionment
Federal, state and foreign tax credits
Valuation allowance
Return to provision adjustments
Other permanent items
Effective income tax rate

Accounting for Uncertainty in Income Taxes

2023

Years ended December 31,
2022

2021

21.0%    
3.2%    
(0.5%)   
(1.0%)   
-%    
-%    
1.3%    
(21.2%)   
0.2%    
0.1%    
3.1%    

21.0%    
1.4%    
(4.7%)   
(8.2%)   
-%    
1.2%    
5.1%    
-%    
5.0%    
(0.1%)   
20.7%    

21.0%
(3.2%)
22.3%
8.7%
(36.7%)
(29.8%)
(28.4%)
(35.3%)
-%
11.0%
(70.4%)

The  Company  had  no  unrecognized  tax  benefits  for  the  years  ended  December  31,  2023  and  2022,  respectively.  The  Company  does  not

anticipate experiencing any significant increase or decrease in its unrecognized tax benefits within the twelve months following December 31, 2023.

In  the  normal  course  of  business,  Anika  and  its  subsidiaries  may be  periodically  examined  by  various  taxing  authorities.  The  Company  files
income tax returns in the United States on a federal basis, in certain U.S. states, and in certain foreign jurisdictions. The associated tax filings remain
subject  to  examination  by  applicable  tax  authorities  for  a  certain  length  of  time  following  the  tax  year  to  which  those  filings  relate.  With  a  few
exceptions, the Company is no longer subject to income tax examinations for years prior to 2019.

16. Earnings per Share (“EPS”)

Basic  EPS  is  calculated  by  dividing  net  income  (loss)  by  the  weighted  average  number  of  shares  outstanding  during  the  period.  Unvested
restricted  shares,  although  legally  issued  and  outstanding,  are  not  considered  outstanding  for  purposes  of  calculating  basic  EPS.  Diluted  EPS  is
calculated by dividing net income by the weighted average number of shares outstanding plus the dilutive effect, if any, of outstanding share-based
awards using the treasury stock method.

The following table provides share information used in the calculation of the Company's basic and diluted EPS (in thousands):

Shares used in the calculation of basic EPS
Effect of dilutive securities:

Share based awards

Diluted shares used in the calculation of EPS

2023

Years Ended December 31,
2022

14,656     

14,561     

2021

-     
14,656     

-     
14,561     

14,401 

233 
14,634 

Stock options of 1.1 million shares were outstanding for the year ended December 31, 2021 and were not included in the computation of diluted
EPS because the awards’ impact on EPS would have been anti-dilutive. The Company was in a loss position during the years ended December 31, 2023
and 2022, therefore all potential common shares would have been anti-dilutive and accordingly were excluded from the computation of diluted EPS.

81

 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
   
   
   
   
   
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
   
     
       
       
 
   
   
 
 
ITEM 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE

None.

ITEM 9A. CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

Our  management,  with  the  participation  of  our  chief  executive  officer  and  chief  financial  officer  (our  principal  executive  officer  and  principal
financial officer, respectively), evaluated the effectiveness of our disclosure controls and procedures as of the period covered by this report. Based upon
that  evaluation,  our  chief  executive  officer  and  chief  financial  officer  have  concluded  that  our  disclosure  controls  and  procedures  are  effective  as  of
December 31, 2023 to ensure that information required to be disclosed by us in reports we file and submit under the Exchange Act is recorded, processed,
summarized  and  reported  within  the  time  periods  specified  in  the  Securities  and  Exchange  Commission’s  rules  and  forms.  Disclosure  controls  and
procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by a company in the reports
that it files or submits under the Exchange Act is accumulated and communicated to our management, including our chief executive officer and chief
financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure. On an on-going basis,
we review and document our disclosure controls and procedures, and our internal control over financial reporting, and we may from time to time making
changes aimed at enhancing their effectiveness and ensuring that our systems evolve with our business.

Management’s Annual Report on Internal Control over Financial Reporting

Our management, with the participation of our chief executive officer and chief financial officer, is responsible for establishing and maintaining
adequate internal control over financial reporting as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act. Our internal control over financial
reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements
for external purposes in accordance with generally accepted accounting principles in the United States.

Because of its inherent limitations, internal control over financial reporting can provide only reasonable assurance, and it may not prevent or detect
misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because
of changes in conditions or that the degree of compliance with the policies or procedures may deteriorate.

Our management assessed the effectiveness of our internal control over financial reporting as of December 31, 2023. In making this assessment,
management  used  the  criteria  set  forth  by  the  Committee  of  Sponsoring  Organizations  of  the  Treadway  Commission  in  its  2013  Internal  Control—
Integrated Framework.

Based on its assessment and those criteria, our management believes that our company maintained effective internal control over financial reporting

as of December 31, 2023.

The  effectiveness  of  our  internal  control  over  financial  reporting  as  of  December  31,  2023  has  been  audited  by  Deloitte  &  Touche  LLP,  an

independent registered public accounting firm, as stated in their report which is included below in this Item 9A.

82

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Remediation of Prior Year Material Weaknesses

In assessing the effectiveness of our internal controls over financial reporting as of December 31, 2022, we identified material weaknesses in our
internal control over financial reporting resulting from a misappropriation of assets under a legacy credit card program utilized by a limited number of
our employees affiliated with one of our subsidiaries. Specifically, in March 2023, during the process of retiring this credit card program, we determined
that  a  mid-level  accounting  employee  had  charged  approximately  $4,000  in  personal  expenses  on  his  corporate  credit  card,  and  that  certain  non-
accounting  employees  also  charged  personal  expenses  of  an  immaterial  amount  in  aggregate.  This  accounting  employee  had  roles  in  our  system  of
internal control over financial reporting, including controls for this subsidiary’s corporate credit card program. As a result, there were individually and in
aggregate deficiencies that represent material weaknesses including: (i) inadequate segregation of duties; (ii) a failure to identify fraud risks; and (iii) a
failure in the design and operating effectiveness of control activities for which the accounting employee’s competent authority was compromised. These
control deficiencies did not have any material impact on our current or prior period consolidated annual or interim financial statements, but could have
resulted  in  material  misstatements  to  the  annual  or  interim  financial  statements  that  would  not  have  been  prevented  or  detected.  Accordingly,
management concluded that the control deficiencies were material weaknesses in our internal control over financial reporting.

During  the  year  ended  December  31,  2023,  our  management,  under  the  oversight  of  the  Audit  Committee,  implemented  a  plan  of  remediation
designed  to  directly  address,  or  contribute  to,  the  remediation  of  our  material  weaknesses  and  the  enhancement  of  our  internal  control  over  financial
reporting.  The remediation plan implemented by us included:

●

●

●

●

Termination of the mid-level accounting employee referenced above and reassignment of this employee’s roles and responsibilities within
impacted control activities.

Completed  the  transition  of  all  employees  from  the  legacy  subsidiary  credit  card  program  to  the  our  established  credit  card  program,
which is subject to centralized review, approval, monitoring, and reconciliation processes and controls.

Enhancement of our fraud risk assessment in order to more fully tailor the design of internal control over financial reporting to ensure
appropriate segregation of duties and mitigate the risk of material misstatement caused by fraud.

Training and certification for employees on compliance with our Travel and Expense policy and Code of Conduct, as well as its internal
control over financial reporting.

Based on the successful implementation and testing of these new and enhanced control processes, we have concluded that the material weakness

reported has been remediated as of December 31, 2023.

Changes in Internal Control over Financial Reporting

Except as noted above, there were no changes in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) of the
Securities Exchange Act) that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting during
the fourth quarter of our fiscal year ended December 31, 2023.

83

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

To the Board of Directors and Stockholders of Anika Therapeutics, Inc.

Opinion on Internal Control over Financial Reporting

We have audited the internal control over financial reporting of Anika Therapeutics, Inc. and subsidiaries (the “Company”) as of December 31, 2023, based
on  criteria  established  in  Internal  Control  —  Integrated  Framework  (2013)  issued  by  the  Committee  of  Sponsoring  Organizations  of  the  Treadway
Commission (COSO). In our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December
31, 2023, based on criteria established in Internal Control — Integrated Framework (2013) issued by COSO.

We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the consolidated
financial  statements  as  of  and  for  the  year  ended  December  31,  2023,  of  the  Company  and  our  report  dated  March  15,  2024,  expressed  an  unqualified
opinion on those financial statements.

Basis for Opinion

The Company’s management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of
internal  control  over  financial  reporting,  included  in  the  accompanying  Management's  Report  on  Internal  Control  over  Financial  Reporting.  Our
responsibility  is  to  express  an  opinion  on  the  Company’s  internal  control  over  financial  reporting  based  on  our  audit.  We  are  a  public  accounting  firm
registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the
applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable
assurance  about  whether  effective  internal  control  over  financial  reporting  was  maintained  in  all  material  respects.  Our  audit  included  obtaining  an
understanding of internal control over financial reporting, assessing the risk that a material weakness exists, testing and evaluating the design and operating
effectiveness of internal control based on the assessed risk, and performing such other procedures as we considered necessary in the circumstances. We
believe that our audit provides a reasonable basis for our opinion.

Definition and Limitations of Internal Control over Financial Reporting

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting
and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company’s internal control
over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly
reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit
preparation  of  financial  statements  in  accordance  with  generally  accepted  accounting  principles,  and  that  receipts  and  expenditures  of  the  company  are
being  made  only  in  accordance  with  authorizations  of  management  and  directors  of  the  company;  and  (3)  provide  reasonable  assurance  regarding
prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial
statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of
effectiveness  to  future  periods  are  subject  to  the  risk  that  controls  may  become  inadequate  because  of  changes  in  conditions,  or  that  the  degree  of
compliance with the policies or procedures may deteriorate.

/s/ Deloitte & Touche LLP
Boston, Massachusetts
March 15, 2024

84

 
 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 9B. OTHER INFORMATION

Rule 10b5-1 Trading Plans

During the fiscal quarter ended December 31, 2023, none of the Company’s directors or executive officers adopted or terminated any contract, instruction
or written plan for the purchase or sale of Company securities that was intended to satisfy the affirmative defense conditions of Rule 10b5-1(c) or any non-
Rule 10b5-1 trading arrangement. 

ITEM 9C. DISCLOSURE REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTIONS

Not applicable.

85

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 10. DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE

PART III

The  information  required  under  this  item  is  incorporated  herein  by  reference  to  our  definitive  proxy  statement  pursuant  to  Regulation  14A,  which

proxy statement will be filed with the SEC not later than 120 days after the close of our fiscal year ended December 31, 2023.

ITEM 11. EXECUTIVE COMPENSATION

The  information  required  under  this  item  is  incorporated  herein  by  reference  to  our  definitive  proxy  statement  pursuant  to  Regulation  14A,  which

proxy statement will be filed with the SEC not later than 120 days after the close of our fiscal year ended December 31, 2023.

ITEM 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER
MATTERS

The information required under this item and Item 5 of this Annual Report on Form 10-K under the heading “Equity Compensation Plan Information”
is incorporated herein by reference to our definitive proxy statement pursuant to Regulation 14A, which proxy statement will be filed with the SEC not later
than 120 days after the close of our fiscal year ended December 31, 2023.

ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE

The  information  required  under  this  item  is  incorporated  herein  by  reference  to  our  definitive  proxy  statement  pursuant  to  Regulation  14A,  which

proxy statement will be filed with the SEC not later than 120 days after the close of our fiscal year ended December 31, 2023.

ITEM 14. PRINCIPAL ACCOUNTANT FEES AND SERVICES

The  information  required  under  this  item  is  incorporated  herein  by  reference  to  our  definitive  proxy  statement  pursuant  to  Regulation  14A,  which

proxy statement will be filed with the SEC not later than 120 days after the close of our fiscal year ended December 31, 2023.

Our independent public accounting firm is Deloitte & Touche LLP, PCAOB Auditor ID 34.

86

 
 
 
 
 
 
 
 
 
 
 
ITEM 15. EXHIBITS AND FINANCIAL STATEMENT SCHEDULES

(a)

Documents filed as part of Form 10-K.

(1)            Financial Statements

PART IV

Report of Independent Registered Public Accounting Firm
Consolidated Balance Sheets
Consolidated Statements of Operations and Comprehensive Income
Consolidated Statements of Stockholders’ Equity
Consolidated Statements of Cash Flows
Notes to Consolidated Financial Statements

(2)            Schedules

56
58
59
60
61
62-81

Schedules have been omitted as all required information has been disclosed in the financial statements and related footnotes. 

(3)            Exhibits

Exhibit 
Number

Description

+2.1

+2.2

3.1

3.2

4.1

10.1a

10.1b

10.2a

10.2b

10.3a

10.3b

10.3c

10.4a

10.4b

10.4c

Agreement and Plan of Merger, dated January 4, 2020, by and between Anika Therapeutics, Inc., Arthrosurface, Inc., Button Merger
Sub, Inc. and Boston Millennia Partners Button Shareholder Representation, Inc. (incorporated by reference to Exhibit 2.1 to the
Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on January 7, 2020)
Agreement and Plan of Merger, dated January 4, 2020, by and between Anika Therapeutics, Inc., Parcus Medical, LLC, Sunshine
Merger Sub, LLC and Philip Mundy (incorporated by reference to Exhibit 2.2 to the Registrant’s Current Report on Form 8-K (File No.
001-14027) filed on January 7, 2020)
Certificate of Incorporation of Anika Therapeutics, Inc. (incorporated by reference to Exhibit 3.1 to the Registrant’s Current Report on
Form 8-K (File No. 001-14027) filed on June 6, 2018)
Bylaws of Anika Therapeutics, Inc., effective as of June 6, 2018 (incorporated by reference to Exhibit 3.2 to the Registrant’s Current
Report on Form 8-K (File No. 001-14027) filed on June 6, 2018)
Description of Securities of Anika Therapeutics, Inc. (incorporated by reference to Exhibit 4.1 to the Registrant’s Annual Report on
Form 10-K (File No. 001-14027) filed by the Registrant on March 16, 2023)
Lease, dated January 3, 2007, between Anika Therapeutics, Inc. and Farley White Wiggins, LLC, relating to 32 Wiggins Avenue,
Bedford, Massachusetts (incorporated by reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No. 001-
14027) filed by on January 10, 2007)
Amendment No. 1 to Lease, dated February 1, 2007, between Anika Therapeutics, Inc. and Farley White Wiggins, LLC, relating to 32
Wiggins Avenue, Bedford, Massachusetts (incorporated by reference to Exhibit 10.1A to the Registrant’s Annual Report on Form 10-K
(File No. 001-14027) filed by the Registrant on February 24, 2017)
Translation of Lease Agreement, dated October 9, 2015, between Anika Therapeutics S.r.l. and Consorzio Zona Industriale E Porto
Fluviale di Padova relating to Land Registry of the Municipality of Padova, Page 148, cadastral map 516 and 517 (incorporated by
reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed by the Registrant on October 14,
2015)
Translation of Amendment No. 1 to Lease Agreement, dated February 2, 2017, between Anika Therapeutics S.r.l. and Consorzio Zona
Industriale E Porto Fluviale di Padova relating to Land Registry of the Municipality of Padova, Page 148, cadastral map 516 and 517
(incorporated by reference to Exhibit 10.3A to the Registrant’s Annual Report on Form 10-K (File No. 001-14027) filed by the
Registrant on February 24, 2017)
Lease Agreement, dated November 26, 2012, between High Properties and Parcus Medical LLC relating to 6423 Parkland Drive, Suites
101 and 102, Sarasota, FL (incorporated by reference to Exhibit 10.3A to the Registrant’s Annual Report on Form 10-K (File No. 001-
14027) filed by the Registrant on March 11, 2022)
Amendment #1 to the Lease, Renewal Amendment, dated January 4, 2018, between High Properties and Parcus Medical LLC relating
to 6423 Parkland Drive, Suites 101 and 102, Sarasota, FL (incorporated by reference to Exhibit 10.3B to the Registrant’s Annual Report
on Form 10-K (File No. 001-14027) filed by the Registrant on March 11, 2022)
Lease Agreement, dated May 25, 2017, between High Properties and Parcus Medical, LLC relating to 6455 Parkland Drive, Suite 101,
Sarasota, FL (incorporated by reference to Exhibit 10.3C to the Registrant’s Annual Report on Form 10-K (File No. 001-14027) filed
by the Registrant on March 11, 2022)
Credit Agreement, dated as of October 24, 2017, among Anika Therapeutics, Inc., certain subsidiaries of Anika Therapeutics, Inc. as
are or may from time to time become parties to the Credit Agreement, Bank of America, N.A., as administrative agent, swingline lender
and issuer of letters of credit, and the lenders party thereto (incorporated by reference to Exhibit 10.1 to the Registrant’s Quarterly
Report on Form 10-Q (File No. 001-14027) filed by the Registrant on October 27, 2017)
Security and Pledge Agreement, dated as of October 24, 2017, among Anika Therapeutics, Inc., certain subsidiaries of Anika
Therapeutics, Inc. listed on the signature pages thereto, and Bank of America, N.A., as administrative agent (incorporated by reference
to Exhibit 10.2 to the Registrant’s Quarterly Report on Form 10-Q (File No. 001-14027) filed by the Registrant on October 27, 2017)
First Amendment effective August 13, 2019, with respect to the Credit Agreement dated as of October 24, 2017 and the Security and
Pledge Agreement dated as of October 24, 2017 (incorporated by reference to Exhibit 10.3 to the Registrant’s Quarterly Report on Form
10-Q (File No. 001-14027) filed by the Registrant on May 22, 2020)

87

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10.4d

10.4e

*10.5

*10.6

†10.7

†10.8
†10.9a

†10.9b

Second Amendment effective May 14, 2020, with respect to the Credit Agreement dated as of October 24, 2017 and First Amendment to
the Security and Pledge Agreement dated as of October 24, 2017 (incorporated by reference to Exhibit 10.4 to the Registrant’s Quarterly
Report on Form 10-Q (File No. 001-14027) filed on May 22, 2020)
Third Amendment to Credit Agreement dated as of November 12, 2021, by and among Anika Therapeutics, Inc., the Subsidiary
Guarantors party thereto, the Lenders party thereto, Bank of America, N.A., as administrative agent, L/C Issuer and Swingline Lender,
and the other parties thereto (incorporated by reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No. 001-
14027) filed on November 15, 2021)
License Agreement, dated as of December 20, 2003, by and between Anika Therapeutics, Inc. and Ortho Biotech Products,
L.P. (incorporated by reference to Exhibit 10.38 to the Registrant’s Annual Report on Form 10-K (File No. 001-14027) filed on March
30, 2004)
License Agreement, dated as of December 21, 2011, by and between Anika Therapeutics, Inc. and DePuy Mitek, Inc. (incorporated by
reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on December 22, 2011)
Anika Therapeutics, Inc. Senior Executive Incentive Compensation Plan (incorporated by reference to Exhibit 10.2 to the Registrant’s
Current Report on Form 8-K (File No. 001-14027) filed on February 6, 2008)

  Anika Therapeutics, Inc. Non-Employee Director Compensation Policy (restated as of December 22, 2023)

Second Amended and Restated 2003 Stock Option and Incentive Plan (adopted April 5, 2011) (incorporated by reference to Exhibit 10.1
to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on June 10, 2011)
Amendment to Second Amended and Restated 2003 Stock Option and Incentive Plan (adopted April 11, 2013) (incorporated by
reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on June 21, 2013)

†10.9c

  Form of Incentive Stock Option Agreement under Second Amended and Restated 2003 Stock Option and Incentive Plan  (incorporated

by reference to Exhibit 10.3 to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on October 5, 2004)

†10.9d

  Form of Non-Qualified Stock Option Agreement for Non-Employee Directors under Second Amended and Restated 2003 Stock Option
and Incentive Plan (incorporated by reference to Exhibit 10.4 to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed
on October 5, 2004)

†10.10a

  Anika Therapeutics, Inc. 2017 Omnibus Incentive Plan (as amended effective June 14, 2023) (incorporated by reference to Exhibit 10.1

†10.10b

†10.10c

†10.10d

†10.10e

†10.10f

†10.10g

†10.10h

†10.10i

†10.10j

†10.10k

†10.11

†10.12

†10.13

†10.14
10.15

21.1
23.1
31.1
31.2
**32.1
97
***101

to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on June 21, 2023)
Form of Notice of Grant of Incentive Stock Option, including Terms and Conditions of Stock Option, granted under Anika Therapeutics,
Inc. 2017 Omnibus Incentive Plan. (incorporated by reference to Exhibit 10.13D to the Registrant’s Annual Report on Form 10-K (File
No. 001-14027) filed on March 5, 2021)
Form of Notice of Grant of Nonqualified Stock Option, including Terms and Conditions of Stock Option, granted under Anika
Therapeutics, Inc. 2017 Omnibus Incentive Plan (incorporated by reference to Exhibit 10.13E to the Registrant’s Annual Report on Form
10-K (File No. 001-14027) filed on March 5, 2021)
Form of Notice of Grant of Restricted Stock Award, including Terms and Conditions of Restricted Stock Award, granted under Anika
Therapeutics, Inc. 2017 Omnibus Incentive Plan. (incorporated by reference to Exhibit 99.4 to the Registrant’s Current Report on Form
8-K (File No. 001-14027) filed on June 19, 2017)
Form of Notice of Grant of Restricted Stock Units, including Terms and Conditions of Restricted Stock Units, granted under Anika
Therapeutics, Inc. 2017 Omnibus Incentive Plan (incorporated by reference to Exhibit 10.13G to the Registrant’s Annual Report on
Form 10-K (File No. 001-14027) filed on March 5, 2021)
Form of Notice of Grant of Deferred Stock Awards Units, including Terms and Conditions of Deferred Stock Units, granted under Anika
Therapeutics, Inc. 2017 Omnibus Incentive Plan (incorporated by reference to Exhibit 10.13H to the Registrant’s Annual Report on
Form 10-K (File No. 001-14027) filed on March 5, 2021)
Anika Therapeutics, Inc. 2021 Employee Stock Purchase Plan (adopted March 17, 2021) (incorporated by reference to Exhibit 99.2 to
the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on June 22, 2021)
Anika Therapeutics, Inc. 2021 Inducement Plan (as amended on December 22, 2023)  (incorporated by reference to Exhibit 99.1 to the
Registrant’s Post-Effective Amendment No. 1 to Form S-8 Registration Statement (File No. 333-276622) filed January 22, 2024)
Form of Notice of Grant of Nonqualified Stock Option, including Terms and Conditions of Stock Option, granted under Anika
Therapeutics, Inc. 2021 Inducement Plan (incorporated by reference to Exhibit 10.10I to the Registrant’s Annual Report on Form 10-K
(File No. 001-14027) filed on March 11, 2022)
Form of Notice of Grant of Restricted Stock Units Award, including Terms and Conditions of Restricted Stock Award, granted under
Anika Therapeutics, Inc. 2021 Inducement Plan (incorporated by reference to Exhibit 10.10J to the Registrant’s Annual Report on Form
10-K (File No. 001-14027) filed on March 11, 2022)
Form of Notice of Grant of Deferred Stock Awards Units, including Terms and Conditions of Deferred Stock Units, granted under Anika
Therapeutics, Inc. 2021 Inducement Plan (incorporated by reference to Exhibit 10.10K to the Registrant’s Annual Report on Form 10-K
(File No. 001-14027) filed on March 11, 2022)
Employment Agreement, dated April 23, 2020, by and between Anika Therapeutics, Inc., and Dr. Cheryl R. Blanchard (incorporated by
reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No. 001-14027) filed on April 29, 2020)
Executive Retention Agreement, dated August 10, 2020, by and between Anika Therapeutics, Inc. and Michael Levitz (incorporated by
reference to Exhibit 10.12 to the Registrant’s Annual Report on Form 10-K (File No. 001-14027) filed on March 11, 2022)
Executive Retention Agreement, dated March 9, 2020, by and between Anika Therapeutics, Inc. and David Colleran (incorporated by
reference to Exhibit 10.13 to the Registrant’s Annual Report on Form 10-K (File No. 001-14027) filed on March 16, 2023)

  Executive Retention Agreement, dated September 27, 2021, by and between Anika Therapeutics, Inc. and Anne Nunes

Cooperation Agreement, dated April 13, 2023, by and between Anika Therapeutics, Inc. and Caligan Partners LP, Caligan Partners
Master Fund LP and David Johnson (incorporated by reference to Exhibit 10.1 to the Registrant’s Current Report on Form 8-K (File No.
001-14027) filed on April 13, 2023)

  List of Subsidiaries of Anika Therapeutics, Inc.
  Consent of Deloitte & Touche LLP
  Certification of Principal Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
  Certification of Principal Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
  Certification pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
  Anika Therapeutics, Inc. Compensation Recovery Policy adopted on November 27, 2023
  The following materials from the Annual Report on Form 10-K of Anika Therapeutics, Inc. for the fiscal year ended December 31, 2023,

formatted in Inline XBRL:  (i) Consolidated Balance Sheets as of December 31, 2023 and December 31, 2022; (ii) Consolidated
Statements of Operations and Comprehensive Income for the Years Ended December 31, 2023, December 31, 2022, and December 31,
2021; (iii) Consolidated Statements of Stockholders’ Equity for the Years Ended December 31, 2023, December 31, 2022, and December

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
31, 2021; (iv) Consolidated Statements of Cash Flows for the Years Ended December 31, 2023, December 31, 2022, and December 31,
2021; and (v) Notes to Consolidated Financial Statements

104

  Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)

88

 
+

†
*

**

***

Portions of this exhibit have been redacted in compliance with Regulation S-K Item 601(b)(2). The omitted information is not material
and would likely cause competitive harm to the Company if publicly disclosed.
Management contract or compensatory plan or arrangement.
Certain portions of this document have been omitted pursuant to a confidential treatment request filed with the Securities and Exchange
Commission. The omitted portions have been filed separately with the Commission.
The  certification  attached  as  Exhibit  32.1  that  accompanies  this  Form  10-K  is  not  deemed  filed  with  the  SEC  and  is  not  to  be
incorporated by reference into any filing of Anika Therapeutics, Inc. under the Securities Act of 1933 or the Securities Exchange Act of
1934,  whether  made  before  or  after  the  date  of  this  Form  10-K,  irrespective  of  any  general  incorporation  language  contained  in  such
filing.
Pursuant to Rule 406T of Regulation S-T, XBRL (Extensible Business Reporting Language) information is deemed not filed or a part of
a registration statement or prospectus for purposes of sections 11 or 12 of the Securities Act of 1933, is deemed not filed for purposes of
section 18 of the Securities Exchange Act of 1934 and otherwise is not subject to liability under these sections.

ITEM 16. FORM 10-K SUMMARY

Not applicable.

89

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, as amended, the registrant has duly caused this

report to be signed on its behalf by the undersigned, thereunto duly authorized.

SIGNATURES

Date: March 15, 2024

By: 

/s/ CHERYL BLANCHARD
Cheryl R. Blanchard, Ph.D.
Chief Executive Officer

ANIKA THERAPEUTICS, INC.

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the

registrant and in the capacities and on the dates indicated.

Signature

Title

Date

/s/ CHERYL BLANCHARD
Cheryl R. Blanchard, Ph.D.

  President and Chief Executive Officer

(Principle Executive Officer)

/s/ MICHAEL LEVITZ
Michael Levitz

/s/ IAN MCLEOD
Ian McLeod

/s/ JOHN B. HENNEMAN, III
John B. Henneman, III

/s/ SHERYL L. CONLEY
Sheryl L. Conley

/s/ GARY P. FISCHETTI
Gary P. Fischetti

/s/ GLENN R. LARSEN, PH.D.
Glenn R. Larsen, Ph.D.

/s/ STEPHEN O. RICHARD
Stephen O. Richard

/s/ JEFFERY S. THOMPSON
Jeffery S. Thompson

/s/ SUSAN L.N. VOGT
Susan L.N. Vogt

  Executive Vice President, Chief Financial Officer and Treasurer

(Principal Financial Officer)

  Vice President, Chief Accounting Officer

(Principal Accounting Officer)

  Director, Chairman of the Board

  Director

  Director

  Director

  Director

  Director

  Director

90

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

March 15, 2024

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ANIKA THERAPEUTICS, INC.

Restated Director Compensation Policy

Exhibit 10.8

The Board of Directors (the “Board”) of Anika Therapeutics, Inc. (including its subsidiaries, “Anika”) has approved this Restated Director Compensation
Policy (this “Policy”) in order to provide a total compensation package that enables Anika to attract and retain, on a long-term basis, high caliber directors
to serve on the Board. This Policy applies to each non-employee who serves as a director of Anika (each, a “Qualifying Director”).

Initial Compensation

For any individual who is elected to the Board and becomes a Qualifying Director on the date of Anika’s annual meeting of
stockholders (“Annual Meeting”), the Qualifying Director will receive an initial grant of equity as set forth below in the
section titled “Annual Equity Compensation”.

For any individual who is elected to the Board and becomes a Qualifying Director at a time other than at the Annual
Meeting, upon his or her initial election to the Board, the Qualifying Director shall receive restricted stock units (“RSUs”)
having a value of the amount set forth below in the section titled “Annual Equity Compensation” (or such other value as
approved by the Board), pro-rated based on the number of months remaining between the first day of the month following
the date on which the Qualifying Director is elected to the Board and the next May 31. By way of example, if an individual
is elected to the Board on September 18, they would receive a pro-rated equity grant equivalent to $100,000 (October 1
through May 31 – 8 months at $12,500 per month).

Such grant shall vest on the earlier of (a) immediately prior to the next Annual Meeting or (b) the close of business on the
first anniversary of the date on which such grant was made; provided, however, that all vesting shall cease if the director
resigns from the Board or otherwise ceases to serve on the Board of Anika, unless the Board determines that the
circumstances warrant continuation of vesting.

In either case, the number of RSUs to be issued will be determined based on the fair market value (as determined in
accordance with Anika’s 2017 Omnibus Incentive Plan (“Plan”)) of a share of Common Stock of Anika on the grant date,
which grant shall be documented on Anika’s standard form of restricted stock unit agreement.

Annual Cash Compensation Annually, generally in January or February of each year, the Compensation Committee of the Board recommends, and the
Board approves, a cash retainer for each Qualifying Director for the current fiscal year. The amount of such cash retainer
varies by year as approved by the Board. The current value of the cash retainer is as follows:

Board
Lead Director or Chair
Other Directors
Audit Committee
Committee Chair
Other Committee Members
Compensation Committee
Committee Chair
Other Committee Members
Governance and Nominating
Committee
Committee Chair
Other Committee Members
Capital Allocation
Committee
Committee Chair
Other Committee Members

Annual Retainer

$87,500 
$50,000 

$20,000 
$10,000 

$15,000 
$7,500 

$10,000 
$5,000 

$10,000 
$5,000 

Chair  and  committee  member  retainers  are  in  addition  to  retainers  for  members  of  the  Board  of  Directors.  No  additional
compensation will be paid for attending individual committee meetings of the Board of Directors. The annual retainer will
be  paid  quarterly,  in  arrears  (or  upon  the  earlier  resignation,  removal  or  other  separation  from  service  of  the  Qualifying
Director). Amounts owing to Qualifying Directors as annual retainer shall be annualized, meaning that Qualifying Directors
who join the Board during the calendar year shall receive a pro-rated amount based on the number of calendar days served
by such Qualifying Director.

Page 1 of 2

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
Annual Equity Compensation On the date of each Annual Meeting, each Qualifying Director who is continuing as a Qualifying Director following the

date of such Annual Meeting shall receive RSUs having a value of $150,000 (or such other value as approved by the
Board), with the number of RSUs to be issued being determined based on the fair market value (as determined in
accordance with the Plan) of a Common Share of Anika on the grant date, which grant shall be documented on Anika’s
standard form of restricted stock unit agreement.

Such grant shall vest on the earlier of (a) immediately prior to the next Annual Meeting or (b) the close of business on the
first anniversary of the date on which such grant was made; provided, however, that all vesting shall cease if the director
resigns from the Board or otherwise ceases to serve on the Board of Anika, unless the Board determines that the
circumstances warrant continuation of vesting.

Reimbursement of Expenses

The foregoing compensation will be in addition to reimbursement of all reasonable out-of-pocket expenses incurred by
Qualifying Directors in attending meetings of the Board and its committees and any other approved expenses associated
with serving on the Board.

General

Administration

Dissemination

This Policy shall be administered and interpreted by the Compensation Committee of the Board and may be amended or
repealed by the Board.

This Policy shall be distributed to each Qualifying Director of Anika upon its adoption by the Board and to each
subsequently elected Qualifying Director upon commencement of his or her directorship.

LAST REVISED: December 22, 2023

Page 2 of 2

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ANIKA THERAPEUTICS, INC.

EXECUTIVE RETENTION AGREEMENT

Exhibit 10.14

Anika  Therapeutics,  Inc.,  a  Massachusetts  corporation  (the  “Company”),  and  Anne  Nunes  (the  “Executive”)  enter  into  this  Executive  Retention

Agreement (the “Agreement”) dated as of September 27, 2021 (the “Effective Date”).

WHEREAS,  THE  COMPANY  DESIRES  TO  PROVIDE  AND  THE  EXECUTIVE  DESIRES  TO  ACCEPT  THE  SEVERANCE  PROTECTIONS  PROVIDED  HEREIN  IN  THE  EVENT  OF  THE

EXECUTIVE’S INVOLUNTARY OR CONSTRUCTIVE TERMINATION, INCLUDING IN CONNECTION WITH A CHANGE IN CONTROL OF THE COMPANY.

NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS AND AGREEMENTS HEREIN CONTAINED AND OTHER GOOD AND VALUABLE CONSIDERATION, THE RECEIPT

AND SUFFICIENCY OF WHICH IS HEREBY ACKNOWLEDGED, THE PARTIES AGREE AS FOLLOWS:

1.       Key Definitions. As used herein, the following terms shall have the following respective meanings:

(a)     “Cause” shall be defined as that term is defined in the Executive’s offer letter, employment agreement, or other similar agreement; or if
there is no such definition, “Cause” means, as determined by the Company in its sole discretion exercised reasonably and in good faith, any of the
following:

(i)     substantial and continuing neglect or inattention to the Executive’s duties;

(ii)    willful misconduct or gross negligence in connection with the performance of such duties;

(iii)   the commission of an act of embezzlement, fraud, or deliberate disregard of the rules or policies of the Company, which results in

economic loss, damage, or injury to the Company;

(iv)   the unauthorized disclosure of any trade secret or confidential information of the Company or any third party who has a business

relationship with the Company or the violation of any non-competition obligation to the Company;

(v)        the  commission  of  an  act  that  induces  any  customer  or  prospective  customer  of  the  Company  to  break  a  contract  with  the

Company or to decline to do business with the Company;

(vi)   the commission of an act that induces any investor or prospective investor in any investment entity affiliated with or managed by

the Company to break a contract with such investment entity or to decline to invest in such investment entity;

(vii)    the  conviction  of  a  felony  involving  any  financial  impropriety  or  which  would  materially  interfere  with  the  performance  of

services or otherwise be injurious to the Company; or

(viii) the failure to perform in a material respect the Executive’s services or duties without proper cause.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
(b)     “Change in Control” shall mean any of the following:

(i)     any “person,” as such term is used in Sections 13(d) and 14(d) of the Securities Exchange Act of 1934, as amended (the “Act”)
(other  than  the  Company,  any  of  its  subsidiaries,  or  any  trustee,  fiduciary  or  other  person  or  entity  holding  securities  under  any  employee
benefit plan or trust of the Company or any of its subsidiaries), together with all “affiliates” and “associates” (as such terms are defined in Rule
12b-2  under  the  Act)  of  such  person,  becoming  the  “beneficial  owner”  (as  such  term  is  defined  in  Rule  13d-3  under  the  Act),  directly  or
indirectly, of securities of the Company representing more than 50 percent of the combined voting power of the Company’s then outstanding
securities having the right to vote in an election of the Board (“Voting Securities”)  (in  such  case  other  than  as  a  result  of  an  acquisition  of
securities directly from the Company); or

(ii)        the  date  a  majority  of  the  members  of  the  Board  is  replaced  during  the  longer  of  (a)  any  12-month  period  or  (b)  the  period
covering  two  consecutive  annual  meetings  of  the  Company’s  stockholders,  in  either  case  by  directors  whose  appointment  or  election  is  not
endorsed by a majority of the members of the Board before the date of the appointment or election (other than an endorsement that occurs as a
result of an actual or threatened election contest with respect to the election or removal of directors or other actual or threatened solicitation of
proxies or consent by or on behalf of a person other than the Board); or

(iii)   the consummation of (A) any consolidation or merger of the Company where the stockholders of the Company, immediately prior
to the consolidation or merger, would not, immediately after the consolidation or merger, beneficially own (as such term is defined in Rule
13d-3 under the Act), directly or indirectly, shares representing in the aggregate more than 50 percent of the voting shares of the Company
issuing cash or securities in the consolidation or merger (or of its ultimate parent corporation, if any), or (B) any sale or other transfer (in one
transaction or a series of transactions contemplated or arranged by any party as a single plan) of all or substantially all of the assets of the
Company.

Notwithstanding the foregoing, a “Change in Control” shall not be deemed to have occurred for purposes of the foregoing clause (i) solely as
the result of an acquisition of securities by the Company which, by reducing the number of shares of Voting Securities outstanding, increases the
proportionate number of Voting Securities beneficially owned by any person to more than 50 percent of the combined voting power of all of the then
outstanding Voting Securities; provided, however, that if any person referred to in this sentence shall thereafter become the beneficial owner of any
additional shares of Voting Securities (other than pursuant to a stock split, stock dividend, or similar transaction or as a result of an acquisition of
securities directly from the Company) and immediately thereafter beneficially owns more than 50 percent of the combined voting power of all of the
then outstanding Voting Securities, then a “Change in Control” shall be deemed to have occurred for purposes of the foregoing clause (i).

(c)     “Disability” means inability to perform the essential functions of the Executive’s then existing position or positions under this Agreement

with or without reasonable accommodation for a period of 180 days (which need not be consecutive) in any 12-month period.

(d)          “Good  Reason”  shall  mean  that  the  Executive  has  complied  with  the  Good  Reason  Process  (hereinafter  defined)  following  the
occurrence of any of the following events: (i) a material diminution in the Executive’s responsibilities, authority or duties; (ii) a material diminution
in the Executive’s annual base salary except for across-the-board salary reductions based on the Company’s financial performance similarly affecting
all  or  substantially  all  senior  management  employees  of  the  Company;  (iii)  a  material  change  in  the  geographic  location  at  which  the  Executive
provides services to the Company, which is a relocation of more than 75 miles from the Executive’s current residence; or (iv) a material breach of
any provision of this Agreement by the Company.

 
 
 
 
 
 
 
 
 
 
(e)          “Good  Reason  Process”  shall  mean  that  (i)  the  Executive  reasonably  determines  in  good  faith  that  a  “Good  Reason”  condition  has
occurred; (ii) the Executive notifies the Company in writing of the occurrence of the Good Reason condition within 60 days of the occurrence of such
condition; (iii) the Executive cooperates in good faith with the Company’s efforts, for a period not less than 30 days following such notice (the “Cure
Period”), to remedy the condition; (iv) notwithstanding such efforts, the Good Reason condition continues to exist; and (v) the Executive terminates
his employment within 60 days after the end of the Cure Period. If the Company cures the Good Reason condition during the Cure Period, Good
Reason shall be deemed not to have occurred.

(f)     “Qualifying Termination” shall mean (i) a termination of the Executive’s employment by the Company without Cause within 3 months
prior to or 12 months after a Change in Control, or (ii) a termination of the Executive’s employment by the Executive for Good Reason within 12
months after a Change in Control.

2.      Term of Agreement. This Agreement shall take effect upon the Effective Date and shall expire upon the first to occur of (a) the expiration of the
Term (as defined below) if a Change in Control has not occurred during the Term, (b) the date 12 months after the Change in Control Date, if the Executive
is  still  employed  by  the  Company  as  of  such  later  date,  or  (c)  the  fulfillment  by  the  Company  of  all  of  its  obligations  under  Sections  4  and  5  if  the
Executive’s employment with the Company terminates during the Term or within 12 months following the Change in Control Date. “Term” shall mean the
period commencing as of the Effective Date and continuing in effect through December 31, 2021; provided, however, that commencing on January 1, 2022
and  each  January  1  thereafter,  the  Term  shall  be  automatically  extended  for  one  additional  year  unless,  not  later  than  90  days  prior  to  the  scheduled
expiration of the Term (or any extension thereof), the Company shall have given the Executive written notice that the Term will not be extended.

3.       Date of Termination.

(a)     Termination by Company for Cause. The Company may terminate the Executive’s employment for Cause at any time, subject to any

applicable notice or cure requirement related to the specific event triggering Cause.

(b)     Termination Without Cause. Any termination by the Company of the Executive’s employment that does not constitute a termination for

Cause or a termination due to the death or Disability of the Executive shall be deemed a termination without Cause.

(c)      Termination by Executive for Good Reason. In order to terminate employment for Good Reason, the Executive must comply with the

Good Reason Process.

(d)        Notice  of  Termination.  Except  for  termination  due  to  the  Executive’s  death,  any  termination  of  the  Executive’s  employment  by  the
Company or any such termination by the Executive shall be communicated by written Notice of Termination to the other party hereto. For purposes
of this Agreement, a “Notice of Termination” shall mean a notice that indicated the specific termination provision in this Agreement relied upon.

 
 
 
 
 
 
 
 
 
 
 
(e)     Date of Termination. “Date of Termination” shall mean: (i) if the Executive’s employment is terminated by the Company without Cause,
the date specified in the Notice of Termination (not earlier than the date the Notice of Termination is given); (ii) if the Executive’s employment is
terminated  by  the  Executive  without  Good  Reason,  the  date  specified  in  the  Notice  of  Termination  (not  earlier  than  the  date  the  Notice  of
Termination  is  given);  and  (iii)  if  the  Executive’s  employment  is  terminated  by  the  Executive  for  Good  Reason,  the  date  on  which  a  Notice  of
Termination is given after the end of the Cure Period. Notwithstanding the foregoing, in the event that the Executive gives a Notice of Termination to
the  Company,  the  Company  may  unilaterally  accelerate  the  Date  of  Termination  and  such  acceleration  shall  not  result  in  a  termination  by  the
Company for purposes of this Agreement.

4.       Compensation Upon Termination.

(a)     Termination Generally. If the Executive’s employment with the Company is terminated for any reason during the Term, the Company
shall pay or provide to the Executive (or to his authorized representative or estate) any earned but unpaid base salary, incentive compensation earned
but not yet paid, unpaid expense reimbursements, accrued but unused vacation and any vested benefits the Executive may have under any employee
benefit plan of the Company (the “Accrued Benefit”) within the timeframe required by law, and where payment is not dictated by law, within 30 days
of the Executive’s Date of Termination.

(b)          Termination  by  Company  Without  Cause.  If  the  Executive’s  employment  is  terminated  by  the  Company  without  Cause,  then  the
Company shall, through the Date of Termination, pay the Executive his Accrued Benefit. If the Executive signs a general release of claims in a form
and manner satisfactory to the Company (the “Release”) within 45 days of the receipt of the Release (which shall be provided no later than within
two business days after the Date of Termination) and does not revoke such Release during the seven-day revocation period,

(i)     the Company shall pay the Executive an amount (the “Severance Amount”) equal to ½ the Executive’s annual base salary for the
fiscal year in which the Date of Termination occurs. The Severance Amount shall be paid out in substantially equal installments in accordance
with the Company’s payroll practice over six months, beginning within 60 days after the Date of Termination; provided, however, that if the
60-day  period  begins  in  one  calendar  year  and  ends  in  a  second  calendar  year,  the  Severance  Amount  commence  to  be  paid  in  the  second
calendar year. Solely for purposes of Section 409A of the Internal Revenue Code of 1986, as amended (the “Code”), each installment payment
is considered a separate payment. Notwithstanding the foregoing, if the Executive breaches any of the obligations contained in Section 7 of this
Agreement, all payments of the Severance Amount shall immediately cease; and

(ii)          subject  to  the  Executive’s  copayment  of  premium  amounts  at  the  active  employees’  rate,  the  Executive  may  continue  to
participate  in  the  Company’s  group  health,  dental  and  vision  program  for  six  months;  provided,  however,  that  the  continuation  of  health
benefits under this Section shall reduce and count against the Executive’s rights under the Consolidated Omnibus Budget Reconciliation Act of
1985, as amended (“COBRA”); provided, however, that if the Company determines necessary to avoid any adverse tax or other consequences
for the Executive or the Company, the Company may instead pay to the Executive on a monthly basis during the period covered by this Section
4(b)(ii) an amount equal to the difference between the applicable COBRA premium and the applicable active employees’ rate for the coverage.

 
 
 
 
 
 
 
 
 
5.      Change in Control. The provisions of this Section set forth certain terms of an agreement reached between the Executive and the Company
regarding the Executive’s rights and obligations upon the occurrence of a Change in Control of the Company. These provisions are intended to assure and
encourage  in  advance  the  Executive’s  continued  attention  and  dedication  to  his  assigned  duties  and  his  objectivity  during  the  pendency  and  after  the
occurrence of any such event. These provisions shall apply in lieu of, and expressly supersede, the provisions of Section 4(b) regarding severance pay and
benefits upon a termination of employment, if such termination of employment occurs within 3 months prior to or 12 months after the occurrence of the
first event constituting a Change in Control, provided that such first event occurs during the Term. These provisions shall terminate and be of no further
force or effect beginning 12 months after the occurrence of a Change in Control, in which case the provisions of Section 4(b) shall once again become
applicable.

(a)     Change in Control Benefits.

(i)      If the Executive incurs a Qualifying Termination, then:

(A)     Subject to the signing of the Release by the Executive within 45 days of the receipt of the Release (which shall be provided
no later than two business days after the Date of Termination) and not revoking the Release during the seven-day revocation period, the
Company shall pay the Executive a lump sum in cash in an amount (the “Change in Control Severance Amount”) equal to ¾ the sum of
(I)  the  Executive’s  current  annual  base  salary  (or  the  Executive’s  annual  base  salary  in  effect  immediately  prior  to  the  Change  in
Control, if higher) plus (II) the Executive’s target annual bonus for the current fiscal year (or if higher, the target annual bonus for the
fiscal year immediately prior to the Change in Control). The Change in Control Severance Amount shall be paid to the Executive by the
60th day after the later of the date of the Change in Control and the Date of Termination; provided, however, that (x) if the Date of
Termination  occurs  during  the  three-month  period  before  the  Change  in  Control,  the  payment  under  this  Section  5(a)(i)(A)  shall  be
reduced by any payments made under Section 4(b)(i) before the date of the Change in Control; and (y) to the extent that the Company
determines necessary to comply with Section 409A of the Code, all or a portion of the payments under this Section 5(a)(i)(A) shall be
made on the schedule set forth in Section 4(b)(i) rather than in a lump sum.

(B)     The Company shall pay to the Executive in a cash lump sum by the 60th day after the later of the date of the Change in
Control  and  the  Date  of  Termination,  an  amount  equal  to  nine  times  the  excess  of  (I)  the  monthly  premium  payable  by  former
employees  for  continued  coverage  under  COBRA  for  the  same  level  of  coverage,  including  dependents,  provided  to  the  Executive
under the Company’s group health benefit plans in which the Executive participates immediately prior to the Date of Termination over
(II) the monthly premium paid by active employees for the same coverage immediately prior to the Notice of Termination.

(ii)     Notwithstanding anything to the contrary in any applicable option agreement or stock-based award agreement:

 
 
 
 
 
 
 
 
 
(A)     [Reserved.]

(B)     All stock options and other stock-based awards held by the Executive, (I) if assumed or continued by the successor in the
Change in Control (as set forth in Section 15.2.1(b) of the Company’s 2017 Omnibus Incentive Plan, or any similar provision in any
predecessor or successor plan), and the Executive incurs a Qualifying Termination, shall only immediately accelerate and become fully
exercisable or nonforfeitable upon the later of the Date of Termination or the effective date of the Change in Control, and (II) if not
assumed or continued by the successor in the Change in Control, shall immediately accelerate and become fully vested, exercisable and
nonforfeitable upon the effective date of the Change in Control.  In that regard, for any such award that includes a performance-based
vesting condition, vesting shall be based on the greater of assumed target performance or actual performance measured through the date
of accelerated vesting.

For  the  avoidance  of  any  doubt,  the  provisions  of  this  Section  5(a)(ii)  shall  supersede  the  provisions  contained  in  the  applicable  award
agreements,  provided  that  the  provisions  of  the  award  agreements  will  control  to  the  extent  such  provisions  are  more  favorable  to  the
Executive.

(b)     Section 280G. If any of the payments or benefits received or to be received by the Executive (including, without limitation, any payment
or benefits received in connection with a Change in Control or the Executive’s termination of employment, whether pursuant to the terms of this
Agreement or any other plan, arrangement or agreement, or otherwise) (all such payments collectively referred to herein as the “280G Payments”)
constitute “parachute payments” within the meaning of Section 280G of the Code and would, but for this Section 6(b), be subject to the excise tax
imposed under Section 4999 of the Code (the “Excise Tax”), then prior to making the 280G Payments, a calculation shall be made comparing (i) the
Net Benefit (as defined below) to the Executive of the 280G Payments after payment of the Excise Tax to (ii) the Net Benefit to the Executive if the
280G Payments are limited to the extent necessary to avoid being subject to the Excise Tax. Only if the amount calculated under (i) above is less than
the amount under (ii) above will the 280G Payments be reduced to the minimum extent necessary to ensure that no portion of the 280G Payments is
subject  to  the  Excise  Tax.  “Net Benefit”  shall  mean  the  present  value  of  the  280G  Payments  net  of  all  federal,  state,  local,  and  foreign  income,
employment,  and  excise  taxes.  Any  reduction  made  pursuant  to  this  Section  5(b)  shall  be  made  in  a  manner  determined  by  the  Company  that  is
consistent with the requirements of Section 409A of the Code.

6.     Section 409A.

(a)     Anything in this Agreement to the contrary notwithstanding, if at the time of the Executive’s separation from service within the meaning
of Section 409A of the Code, the Company determines that the Executive is a “specified employee” within the meaning of Section 409A(a)(2)(B)(i)
of the Code, then to the extent any payment or benefit that the Executive becomes entitled to under this Agreement would be considered deferred
compensation  subject  to  the  20  percent  additional  tax  imposed  pursuant  to  Section  409A(a)  of  the  Code  as  a  result  of  the  application  of  Section
409A(a)(2)(B)(i) of the Code, such payment shall not be payable and such benefit shall not be provided until the date that is the earlier of (i) six
months  and  one  day  after  the  Executive’s  separation  from  service,  or  (ii)  the  Executive’s  death.  If  any  such  delayed  cash  payment  is  otherwise
payable on an installment basis, the first payment shall include a catch-up payment covering amounts that would otherwise have been paid during the
six-month  period  but  for  the  application  of  this  provision,  and  the  balance  of  the  installments  shall  be  payable  in  accordance  with  their  original
schedule. Any such delayed cash payment shall earn interest at an annual rate equal to the applicable federal short-term rate published by the Internal
Revenue Service for the month in which the date of separation from service occurs, from such date of separation from service until the payment.

 
 
 
 
 
 
 
 
 
 
(b)          The  parties  intend  that  this  Agreement  will  be  administered  in  accordance  with  Section  409A  of  the  Code.  To  the  extent  that  any
provision of this Agreement is ambiguous as to its compliance with Section 409A of the Code, the provision shall be read in such a manner so that all
payments hereunder comply with Section 409A of the Code. The parties agree that this Agreement may be amended, as reasonably requested by
either party, and as may be necessary to fully comply with Section 409A of the Code and all related rules and regulations in order to preserve the
payments and benefits provided hereunder without additional cost to either party.

(c)     The determination of whether and when a separation from service has occurred shall be made in accordance with the presumptions set
forth  in  Treasury  Regulation  Section  1.409A-1(h).  To  the  extent  required  by  Section  409A  of  the  Code,  each  reimbursement  or  in-kind  benefit
provided under the Agreement shall be provided in accordance with the following: (i) the amount of expenses eligible for reimbursement, or in-kind
benefits provided, during each calendar year cannot affect the expenses eligible for reimbursement, or in-kind benefits to be provided, in any other
calendar year, (ii) any reimbursement of an eligible expense shall be paid to the Executive on or before the last day of the calendar year following the
calendar year in which the expense was incurred, and (iii) any right to reimbursements or in-kind benefits under the Agreement shall not be subject to
liquidation or exchange for another benefit.

(d)     The Company makes no representation or warranty and shall have no liability to the Executive or any other person if any provisions of
this Agreement are determined to constitute deferred compensation subject to Section 409A of the Code but do not satisfy an exemption from, or the
conditions of, such Section.

7.          Confidentiality  and  Proprietary  Rights  Agreement.  Nothing  in  this  Agreement  supersedes  the  terms  of  the  Confidentiality  and  Proprietary
Rights  Agreement  between  the  Executive  and  the  Company.  Any  and  all  obligations  of  the  Company  under  this  Agreement  are  contingent  upon  the
Executive’s compliance with the Executive’s obligations under the Confidentiality and Proprietary Rights Agreement.

8.     Arbitration of Disputes. Except for any request by the Company or by you for temporary, preliminary or permanent injunctive relief from a
court of competent jurisdiction to enforce or enjoin any portion of the Confidentiality and Proprietary Rights Agreement (which right shall remain in full
force and effect following the termination of your employment with the Company) and the Executive Retention Agreement, in the event of any dispute,
controversy  or  claim  arising  out  of  or  relating  to  your  offer  letter,  this  Executive  Retention  Agreement,  your  employment  with  the  Company,  or  the
termination  of  your  employment  including  but  not  limited  to,  any  claims  arising  out  of  M.G.L.  ch.151B,  Title  VII  of  the  Civil  Rights  Act  of  1964,  the
Americans with Disabilities Act, the Age Discrimination in Employment Act, the Older Workers’ Benefit Protection Act, the Family and Medical Leave
Act, the Small Necessities Leave Act, the Massachusetts Civil Rights Act (M.G.L. ch. 12), the Massachusetts Paid Sick Leave Act, the Massachusetts Paid
Family Leave Act, the Massachusetts Domestic Violence Leave Act, the Massachusetts Equal Pay Act,or any other federal, state or local statute, regulation
or  ordinance  that  provides  protection  against  employment  discrimination,  harassment  or  retaliation;  any  claims  under  the  Fair  Labor  Standards  Act  or
M.G.L. ch. 149, including without limitation the Massachusetts Wage Act, or any other federal, state or local statute, regulation or ordinance that provides
protection  against  wage  and  hour  and/or  wage  payment  violations;  any  claims  under  the  federal  or  state  equal  pay  act;  any  tort  and/or  privacy  claims,
including those under the Massachusetts Privacy Statute (M.G.L. ch. 214), that dispute, controversy or claim shall, to the fullest extent permitted by law, be
settled  by  binding  arbitration  before  an  arbitrator  experienced  in  employment  law.  This  arbitration  provision  does  not  waive  or  limit  a  right  to  file  an
administrative  charge  or  to  cooperate  with  an  administrative  agency  (e.g.,  the  National  Labor  Relations  Board,  the  Equal  Employment  Opportunity
Commission, or similar agencies). You also understand that you are not waiving rights under Section 7 of the National Labor Relations Act and will not be
disciplined  or  threatened  with  discipline  for  exercising  such  rights.  Said  arbitration  will  be  conducted  in  accordance  with  the  Employment  Dispute
Resolution Rules and Mediation Procedures of the American Arbitration Association (“AAA”) in Boston, Massachusetts, including, but not limited to, the
rules and procedures applicable to the selection of arbitrators (or alternatively, in any other forum or in any other form agreed upon by the parties). Each
party will pay the fees for his, her, or its own attorneys, subject to any remedies to which that party may later be entitled under applicable law. Unless
otherwise prohibited by law, if you initiate arbitration, you are responsible for paying an initial filing fee of $200, or an amount equal to the applicable
filing fee had the claim been brought in a court of law, whichever is less. However, in all cases, the Company will pay the Arbitrator’s and any fee for
administering the arbitration. In the event that any person or entity other than you or Anika may be a party with regard to any such controversy or claim,
such controversy or claim shall be submitted to arbitration subject to such other person or entity's agreement. Judgment upon the award rendered by the
arbitrator may be entered in any court having jurisdiction thereof. This provision shall be specifically enforceable. Arbitration as provided in this section
shall be the exclusive, final and binding remedy for any such dispute and will be used instead of any court action, which is hereby expressly waived. The
Federal Arbitration Act shall govern the interpretation and enforcement of such arbitration proceeding.

 
 
 
 
 
 
 
 
The  arbitrator  shall  apply  the  substantive  law  (and  the  law  of  remedies,  if  applicable)  of  the  Commonwealth  of  Massachusetts,  or  federal  law,  if
Massachusetts law is preempted. You acknowledge and understand that by agreeing to arbitrate, you are waiving any right to bring an action against the
company in a court of law, either state or federal, and the right to a trial by jury, except as otherwise expressively set forth in this agreement. 

9.     Consent to Jurisdiction. To the extent that any court action is permitted consistent with or to enforce Section 7 of this Agreement, the parties
hereby consent to the jurisdiction of the Superior Court of the Commonwealth of Massachusetts and the United States District Court for the District of
Massachusetts. Accordingly, with respect to any such court action, the Executive (a) submits to the personal jurisdiction of such courts; (b) consents to
service of process; and (c) waives any other requirement (whether imposed by statute, rule of court, or otherwise) with respect to personal jurisdiction or
service of process.

10.   Integration; Non-Duplication. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and
supersedes all prior agreements, including any severance provisions under an offer letter, employment agreement, or other similar agreement.  In no event
shall  the  Executive  be  eligible  for  severance  benefits  under  both  this  Agreement  and  any  other  agreement  with  the  Company  or  under  and  statutory
requirements under applicable law.

11.   Withholding. All payments made by the Company to the Executive under this Agreement shall be net of any tax or other amounts required to be

withheld by the Company under applicable law.

12.   Successor to Executive. This Agreement shall inure to the benefit of and be enforceable by the Executive’s personal representatives, executors,
administrators,  heirs,  distributees,  devisees,  and  legatees.  In  the  event  of  the  Executive’s  death  after  his  termination  of  employment  but  prior  to  the
completion  by  the  Company  of  all  payments  due  him  under  this  Agreement,  the  Company  shall  continue  such  payments  to  the  Executive’s  beneficiary
designated in writing to the Company prior to his death (or to his estate, if the Executive fails to make such designation).

 
 
 
 
 
 
 
 
13.   Enforceability.  If  any  portion  or  provision  of  this  Agreement  (including,  without  limitation,  any  portion  or  provision  of  any  section  of  this
Agreement)  shall  to  any  extent  be  declared  illegal  or  unenforceable  by  a  court  of  competent  jurisdiction,  then  the  remainder  of  this  Agreement,  or  the
application  of  such  portion  or  provision  in  circumstances  other  than  those  as  to  which  it  is  so  declared  illegal  or  unenforceable,  shall  not  be  affected
thereby, and each portion and provision of this Agreement shall be valid and enforceable to the fullest extent permitted by law.

14.   Waiver. No waiver of any provision hereof shall be effective unless made in writing and signed by the waiving party. The failure of any party to
require the performance of any term or obligation of this Agreement, or the waiver by any party of any breach of this Agreement, shall not prevent any
subsequent enforcement of such term or obligation or be deemed a waiver of any subsequent breach.

15.      Notices.  Any  notices,  requests,  demands,  and  other  communications  provided  for  by  this  Agreement  shall  be  sufficient  if  in  writing  and
delivered in person or sent by a nationally recognized overnight courier service or by registered or certified mail, postage prepaid, return receipt requested,
to the Executive at the last address the Executive has filed in writing with the Company or, in the case of the Company, at its main offices, attention of the
Board.

16.    Amendment. This Agreement may be amended or modified only by a written instrument signed by the Executive and by a duly authorized

representative of the Company.

17.        Governing  Law.  This  is  a  Massachusetts  contract  and  shall  be  construed  under  and  be  governed  in  all  respects  by  the  laws  of  the
Commonwealth of Massachusetts, without giving effect to the conflict of laws principles of such Commonwealth. With respect to any disputes concerning
federal law, such disputes shall be determined in accordance with the law as it would be interpreted and applied by the United States Court of Appeals for
the First Circuit.

18.    Counterparts. This Agreement may be executed in any number of counterparts, each of which when so executed and delivered shall be taken to

be an original; but such counterparts shall together constitute one and the same document.

19.    Successor to Company. The Company shall require any successor (whether direct or indirect, by purchase, merger, consolidation or otherwise)
to all or substantially all of the business or assets of the Company expressly to assume and agree to perform this Agreement to the same extent that the
Company would be required to perform it if no succession had taken place. Failure of the Company to obtain an assumption of this Agreement at or prior to
the effectiveness of any succession shall be a material breach of this Agreement.

20.    Gender Neutral.  Wherever  used  herein,  a  pronoun  in  the  masculine  gender  shall  be  considered  as  including  the  feminine  gender  unless  the

context clearly indicates otherwise.

21.    At-Will Employment. The Executive acknowledges that the Executive’s employment remains at-will, subject to the above notice and severance

provisions. Nothing in this Agreement shall be construed otherwise.

 
 
 
 
 
 
 
 
 
 
 
 
IN WITNESS WHEREOF, THE PARTIES HEREBY EXECUTE THIS AGREEMENT AS OF THE DATE FIRST WRITTEN ABOVE.

Anika Therapeutics, Inc.

By:  /s/ Cheryl Blanchard                                    
      Name:  Cheryl Blanchard
      Title:    President & Chief Executive Officer

Anne  Nunes:
/s/ Anne Nunes                                                    

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SUBSIDIARIES OF THE REGISTRANT

Exhibit 21.1

Name of Subsidiary

Anika Securities, Inc. 

Anika Therapeutics Limited 

Anika Therapeutics S.r.l.
(Formerly: Fidia Advanced Biopolymers S.r.l.)

ArthroSurface Incorporated

Parcus Medical, LLC 

Jurisdiction of Formation

Massachusetts

United Kingdom

Italy

Delaware

Wisconsin

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CONSENT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

We  consent  to  the  incorporation  by  reference  in  Registration  Statement  Nos.    333-219190,  333-232254,  333-239304,  333-258529,  333-258530,  333-
260821,  333-266550,  333-273812,  and  333-276622  on  Form  S-8  of  our  reports  dated  March  15,  2024,  relating  to  the  financial  statements  of  Anika
Therapeutics, Inc. (the “Company”), and the effectiveness of the Company’s internal control over financial reporting, appearing in this Annual Report on
Form 10-K of Anika Therapeutics, Inc. for the year ended December 31, 2023.

Exhibit 23.1

/s/ Deloitte & Touche LLP

Boston, Massachusetts
March 15, 2024

 
 
 
 
 
 
 
Exhibit 31.1 

I, Cheryl Blanchard, certify that:

CERTIFICATION

1.

I have reviewed this annual report on Form 10-K for the year ended December 31, 2023 of Anika Therapeutics, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the
statements  made,  in  light  of  the  circumstances  under  which  such  statements  were  made,  not  misleading  with  respect  to  the  period  covered  by  this
report;

3. Based  on  my  knowledge,  the  financial  statements,  and  other  financial  information  included  in  this  report,  fairly  present  in  all  material  respects  the

financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined

in Exchange Act Rules 13a-15I and 15d-15I) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d- 15(f))
for the registrant and have:

a. Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to
ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those
entities, particularly during the period in which this report is being prepared;

b. Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our

supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external
purposes in accordance with generally accepted accounting principles;

c. Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the
effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d. Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal
quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect,
the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the

registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a. All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably

likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b. Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control

over financial reporting.

Date: March 15, 2024

/s/ Cheryl Blanchard
President and Chief Executive Officer
(Principal Executive Officer) 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Exhibit 31.2

I, Michael Levitz, certify that:

CERTIFICATION

1.

I have reviewed this annual report on Form 10-K for the year ended December 31, 2023 of Anika Therapeutics, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the
statements  made,  in  light  of  the  circumstances  under  which  such  statements  were  made,  not  misleading  with  respect  to  the  period  covered  by  this
report;

3. Based  on  my  knowledge,  the  financial  statements,  and  other  financial  information  included  in  this  report,  fairly  present  in  all  material  respects  the

financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined

in Exchange Act Rules 13a-15I and 15d-15I) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d- 15(f))
for the registrant and have:

a. Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to
ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those
entities, particularly during the period in which this report is being prepared;

b. Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our

supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external
purposes in accordance with generally accepted accounting principles;

c. Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the
effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d. Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal
quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect,
the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the

registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a. All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably

likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b. Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control

over financial reporting.

Date: March 15, 2024

/s/ Michael Levitz
Executive Vice President, Chief Financial Officer and Treasurer
(Principal Financial Officer) 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CERTIFICATION

PURSUANT TO SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

Exhibit 32.1

Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002 (subsections (a) and (b) of Section 1350, Chapter 63 of Title 18, United States Code), each

of the undersigned officers of Anika Therapeutics, Inc., a Delaware corporation (the “Company”), does hereby certify, to such officer’s knowledge, that:

The Annual Report on Form 10-K for the year ended December 31, 2023 (the “Form 10-K”) of the Company fully complies with the requirements of
Section 13(a) or 15(d) of the Securities Exchange Act of 1934, and the information contained in the Form 10-K fairly presents, in all material respects, the
financial condition and results of operations of the Company.

Date: March 15, 2024

/s/ Cheryl Blanchard
President and Chief Executive Officer
(Principal Executive Officer)

/s/ Michael Levitz
Executive Vice President, Chief Financial Officer and Treasurer
(Principal Financial Officer) 

A signed original of this written statement required by Section 906 has been provided to the Company and will be retained by the Company and

furnished to the Securities and Exchange Commission or its staff upon request.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ANIKA THERAPEUTICS, INC.
COMPENSATION RECOVERY POLICY

Exhibit 97

Anika Therapeutics, Inc., a Delaware corporation (the “Company”), has adopted a Compensation Recovery Policy (this “Policy”) as described below. 

1.           Overview

The Policy sets forth the circumstances and procedures under which the Company shall recover Erroneously Awarded Compensation from Covered Persons
(as defined below) in accordance with rules issued by the United States Securities and Exchange Commission (the “SEC”) under the Securities Exchange
Act of 1934, as amended (the “Exchange Act”), and the Nasdaq Stock Market. Capitalized terms used and not otherwise defined herein shall have the
meanings given in Section 3 below.

2.           Compensation Recovery Requirement

In the event the Company is required to prepare a Financial Restatement, the Company shall recover reasonably promptly all Erroneously Awarded
Compensation with respect to such Financial Restatement.

3.           Definitions

a.

“Applicable Recovery Period” means the three completed fiscal years immediately preceding the Restatement Date for a Financial
Restatement. In addition, in the event the Company has changed its fiscal year: (i) any transition period of less than nine months occurring
within or immediately following such three completed fiscal years shall also be part of such Applicable Recovery Period and (ii) any
transition period of nine to twelve months will be deemed to be a completed fiscal year.

b.

“Applicable Rules” means any rules or regulations adopted by the Exchange pursuant to Rule 10D-1 under the Exchange Act and any
applicable rules or regulations adopted by the SEC pursuant to Section 10D of the Exchange Act.

c.

“Board” means the Board of Directors of the Company.

d.

e.

“Committee” means the Compensation Committee of the Board or, in the absence of such committee, a majority of independent directors
serving on the Board.

“Covered Person” means any Executive Officer. A person’s status as a Covered Person with respect to Erroneously Awarded Compensation
shall be determined as of the time of receipt of such Erroneously Awarded Compensation regardless of the person’s current role or status with
the Company (e.g., if a person began service as an Executive Officer after the beginning of an Applicable Recovery Period, that person would
not be considered a Covered Person with respect to Erroneously Awarded Compensation received before the person began service as an
Executive Officer, but would be considered a Covered Person with respect to Erroneously Awarded Compensation received after the person
began service as an Executive Officer where such person served as an Executive Officer at any time during the performance period for such
Erroneously Awarded Compensation).

f.

“Effective Date” means October 2, 2023.

g.

“Erroneously Awarded Compensation” means the amount of any Incentive-Based Compensation received by a Covered Person on or after the
Effective Date and during the Applicable Recovery Period that exceeds the amount that otherwise would have been received by the Covered
Person had such compensation been determined based on the restated amounts in a Financial Restatement, computed without regard to any
taxes paid. Calculation of Erroneously Awarded Compensation with respect to Incentive-Based Compensation based on stock price or total
shareholder return, where the amount of Erroneously Awarded Compensation is not subject to mathematical recalculation directly from the
information in a Financial Restatement, shall be based on a reasonable estimate of the effect of the Financial Restatement on the stock price or
total shareholder return upon which the Incentive-Based Compensation was received, and the Company shall maintain documentation of the
determination of such reasonable estimate and provide such documentation to the Exchange in accordance with the Applicable Rules.
Incentive-Based Compensation is deemed received, earned, or vested when the Financial Reporting Measure is attained, not when the actual
payment, grant, or vesting occurs.

 
 
 
 
 
 
 
 
 
h.

“Exchange” means the Nasdaq Stock Market LLC.

i. An “Executive Officer” means any person who served the Company in any of the following roles at any time during the performance period
applicable to Incentive-Based Compensation such person received during service in such role: the president, principal financial officer,
principal accounting officer (or if there is no such accounting officer the controller), any vice president in charge of a principal business unit,
division, or function (such as sales, administration, or finance), any other officer who performs a policy making function, or any other person
who performs similar policy making functions for the Company. Executive officers of parents or subsidiaries of the Company may be deemed
executive officers of the Company if they perform such policy making functions for the Company.

j.

k.

“Financial Reporting Measures” mean measures that are determined and presented in accordance with the accounting principles used in
preparing the Company’s financial statements, any measures that are derived wholly or in part from such measures (including, for example, a
non-GAAP financial measure), and stock price and total shareholder return.  

“Incentive-Based Compensation” means any compensation provided, directly or indirectly, by the Company or any of its subsidiaries that is
granted, earned, or vested based, in whole or in part, upon the attainment of a Financial Reporting Measure.

l. A “Financial Restatement” means a restatement of previously issued financial statements of the Company due to the material noncompliance

of the Company with any financial reporting requirement under the securities laws, including any required restatement to correct an error in
previously-issued financial statements that is material to the previously-issued financial statements or that would result in a material
misstatement if the error were corrected in the current period or left uncorrected in the current period.

m. “Restatement Date” means, with respect to a Financial Restatement, the earlier to occur of: (i) the date the Board or the Audit Committee of
the Board concludes, or reasonably should have concluded, that the Company is required to prepare the Financial Restatement or (ii) the date
a court, regulator or other legally authorized body directs the Company to prepare the Financial Restatement.

4.           Exception to Compensation Recovery Requirement

The Company may elect not to recover Erroneously Awarded Compensation pursuant to this Policy if the Committee determines that recovery would be
impracticable, and one or more of the following conditions, together with any further requirements set forth in the Applicable Rules, are met: (i) the direct
expense paid to a third party, including outside legal counsel, to assist in enforcing this Policy would exceed the amount to be recovered, and the Company
has made a reasonable attempt to recover such Erroneously Awarded Compensation; or (ii) recovery would likely cause an otherwise tax-qualified
retirement plan to fail to be so qualified under applicable regulations. 

5.           Tax Considerations

To the extent that, pursuant to this Policy, the Company is entitled to recover any Erroneously Awarded Compensation that is received by a Covered Person,
the gross amount received (i.e., the amount the Covered Person received, or was entitled to receive, before any deductions for tax withholding or other
payments) shall be returned by the Covered Person.

 
 
 
 
 
 
 
 
 
6.           Method of Compensation Recovery

The Committee shall determine, in its sole discretion, the method for recovering Erroneously Awarded Compensation hereunder, which may include,
without limitation, any one or more of the following:

a.

requiring reimbursement of cash Incentive-Based Compensation previously paid;

b.

seeking recovery of any gain realized on the vesting, exercise, settlement, sale, transfer or other disposition of any equity-based awards;

c.

cancelling or rescinding some or all outstanding vested or unvested equity-based awards;

d.

adjusting or withholding from unpaid compensation or other set-off;

e.

cancelling or offsetting against planned future grants of equity-based awards; and/or

f.

any other method permitted by applicable law or contract.

Notwithstanding the foregoing, a Covered Person will be deemed to have satisfied such person’s obligation to return Erroneously Awarded Compensation
to the Company if such Erroneously Awarded Compensation is returned in the exact same form in which it was received; provided that equity withheld to
satisfy tax obligations will be deemed to have been received in cash in an amount equal to the tax withholding payment made.

7.          Policy Interpretation

This Policy shall be interpreted in a manner that is consistent with the Applicable Rules and any other applicable law. The Committee shall take into
consideration any applicable interpretations and guidance of the SEC in interpreting this Policy, including, for example, in determining whether a financial
restatement qualifies as a Financial Restatement hereunder. To the extent the Applicable Rules require recovery of Incentive-Based Compensation in
additional circumstances besides those specified above, nothing in this Policy shall be deemed to limit or restrict the right or obligation of the Company to
recover Incentive-Based Compensation to the fullest extent required by the Applicable Rules.

8.           Policy Administration

This Policy shall be administered by the Committee. The Committee shall have such powers and authorities related to the administration of this Policy as
are consistent with the governing documents of the Company and applicable law. The Committee shall have full power and authority to take, or direct the
taking of, all actions and to make all determinations required or provided for under this Policy and shall have full power and authority to take, or direct the
taking of, all such other actions and make all such other determinations not inconsistent with the specific terms and provisions of this Policy that the
Committee deems to be necessary or appropriate to the administration of this Policy.  The interpretation and construction by the Committee of any
provision of this Policy and all determinations made by the Committee under this policy shall be final, binding and conclusive. 

9.           Compensation Recovery Repayments Not Subject to Indemnification

Notwithstanding anything to the contrary set forth in any agreement with, or the organizational documents of, the Company or any of its subsidiaries,
Covered Persons are not entitled to indemnification for Erroneously Awarded Compensation or for any claim or losses arising out of or in any way related
to Erroneously Awarded Compensation recovered under this Policy.

Adopted as of November 27, 2023