Cytosorbents Corp
EXHIBIT 10.1
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<TYPE>EX-10.1
<SEQUENCE>2
<FILENAME>tm223143d1_ex10-1.htm
<DESCRIPTION>EXHIBIT 10.1
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<P STYLE="margin: 0">&nbsp;</P>

<P STYLE="text-align: right; margin: 0"><B>Exhibit 10.1</B></P>

<P STYLE="margin: 0; text-align: left"><B>&nbsp;</B></P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: center">FOURTH AMENDMENT TO THE AMENDED AND RESTATED
LOAN AND SECURITY AGREEMENT</P>

<P STYLE="font: bold 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-align: center">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">THIS FOURTH AMENDMENT to the Amended and Restated
Loan and Security Agreement (this &ldquo;<B>Amendment</B>&rdquo;) is made effective as of January 19, 2022 (the &ldquo;<B>Fourth Amendment
Date</B>&rdquo;) and made by and among <B>WESTERN ALLIANCE BANK</B>, an Arizona corporation (&ldquo;<B>Bank</B>&rdquo;) and <FONT STYLE="font-variant: small-caps"><B>CYTOSORBENTS
CORPORATION</B>, </FONT>a Delaware corporation and <FONT STYLE="font-variant: small-caps"><B>CYTOSORBENTS MEDICAL</B></FONT><B>, <FONT STYLE="font-variant: small-caps">INC</FONT>.</B>,
a Delaware corporation (individually and collectively, jointly and severally &ldquo;<B>Borrower</B>&rdquo;).</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">WHEREAS, Bank and Borrower have entered into that
certain Amended and Restated Loan and Security Agreement, dated as of March 29, 2018 (as amended, supplemented, restated or otherwise
modified from time to time, the &ldquo;<B>Loan Agreement</B>&rdquo;) pursuant to which Bank has provided to Borrower certain loans in
accordance with the terms and conditions thereof; and</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">WHEREAS, Bank and Borrower desire to amend certain
provisions of the Loan Agreement as provided herein and subject to the terms and conditions set forth herein.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">NOW, THEREFORE, in consideration of the promises,
covenants and agreements contained herein, and other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged,
Bank and Borrower hereby agree as follows:</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in">&nbsp;</P>
<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font-size: 10pt; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">1.</TD><TD STYLE="text-align: justify">Capitalized terms used herein but not otherwise defined shall
have the respective meanings given to them in the Loan Agreement.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>
<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font-size: 10pt; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">2.</TD><TD STYLE="text-align: justify">Section 1.1 of the Loan Agreement is hereby amended by amending
and restating the following definitions therein as follows:</TD>
</TR></TABLE>
<P STYLE="margin: 0; text-align: left"><B>&nbsp;</B></P>

<P STYLE="margin: 0; text-align: left"><B></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0in">&ldquo;Amortization Date&rdquo; means (i)
January 1, 2024, if the I/O Extension Event does not occur, and (ii) July 1, 2024, if the I/O Extension Event occurs.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0in">&ldquo;Effective Interest Rate&rdquo; means,
with respect to the Term Loan, the per annum rate of interest (based on a year of three hundred sixty (360) days) equal to the lesser
of (a) Eight percent (8.00%) and (b) the sum of (i) Index Rate on the last Business Day of the month that immediately precedes the month
in which the interest will accrue, plus (ii) One and Twenty-Five Hundredths percent (1.25%).</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&ldquo;Maturity Date&rdquo; is December 1, 2025.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&ldquo;Required Reserves Test&rdquo; means that on the date
of its determination, Borrower shall have sufficient cash reserves (including the proceeds of the Term C Loans) to meet all of its projected
expenses in accordance with its then applicable annual operating budget and financial projections delivered and accepted by Bank in accordance
with Section 6.3 hereof (including, but not limited to, interest expenses and any applicable principal repayment expenses) for the then
immediately following 12 month period, as reasonably determined by the Bank based on evidence reasonably acceptable to the Bank.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&ldquo;Third Draw Period&rdquo; means the period commencing
on the Fourth Amendment Date and ending on the earlier of (i) December 31, 2022 and (ii) the occurrence of an Event of Default; provided
further that no Term C Loan as would cause the aggregate principal amount of Term C Loans to exceed Five Million Dollars ($5,000,000.00)
shall be made during the Third Draw Period unless on the Funding Date of such Term C Loan, the Required Reserves Test is met and on or
before the Funding Date of such Term C Loan (but no earlier than ten (10) days prior to the Funding Date), the Seventy Five Percent Test
is met.</P>
<P STYLE="margin: 0; text-align: left"><B>&nbsp;</B></P>

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<P STYLE="margin: 0; text-align: left"><B></B></P>

<P STYLE="margin: 0; text-align: left"><B>&nbsp;</B></P>

<P STYLE="margin: 0; text-align: left"><B></B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&ldquo;I/O Extension Event&rdquo; is the meeting by Borrower,
of both the Required Reserves Test and the Seventy Five Percent Test as of November 30, 2023 as determined by Bank after receipt of the
financial statements for November 2023 from Borrower that Borrower is obligated to provide under Section 6.3 of this Agreement.</P>
<P STYLE="margin: 0; text-align: left"><B></B></P>

<P STYLE="margin: 0; text-align: left"><B>&nbsp;</B></P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">3.</TD><TD STYLE="text-align: justify">Section 1.1 of the Loan Agreement is hereby further amended
by adding the following definition thereto in alphabetical order:</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&ldquo;Fourth Amendment Date&rdquo; is January 19, 2022.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">4.</TD><TD STYLE="text-align: justify">Section 2.2(a) of the Loan Agreement is hereby amended and restated
as follows:</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">(a)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<U>Availability</U>.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0.5in">(i)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Subject
to the terms and conditions of this Agreement, on the Closing Date, Bank shall make a term loan to Borrower in the amount of Ten Million
Dollars ($10,000,000) (the &ldquo;Term A Loan&rdquo;). After repayment, the Term A Loan may not be re-borrowed. The parties hereby acknowledge
that the Term A Loans have been made previously, the outstanding amount of the Term A Loans immediately prior to the Third Amendment Date
was $ 8,888,888.89 and the Term A Loans were fully repaid on the Third Amendment Date.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0.5in">(ii)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Subject
to the terms and conditions of this Agreement, during the Second Draw Period, Bank shall make a term loan to Borrower in the amount of
Five Million Dollars ($5,000,000) (the &ldquo;Term B Loans&rdquo;). After repayment, the Term B Loan may not be re-borrowed. The parties
hereby acknowledge that the Term B Loans have been made previously, the outstanding amount of the Term B Loans immediately prior to the
Third Amendment Date was $4,444,444.45 and the Term B Loans were fully repaid on the Third Amendment Date.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0.5in">(iii)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Subject
to the terms and conditions of this Agreement, during the Third Draw Period, Bank shall make term loans to Borrower in the aggregate amount
of Fifteen Million Dollars ($15,000,000) (the &ldquo;Term C Loans&rdquo;, and together with the Term A Loans and the Term B Loans, the
 &ldquo;Term Loans,&rdquo; and each individually, a &ldquo;Term Loan&rdquo;). At the option of Borrower, the Term C Loans may be drawn
in three tranches of Five Million Dollars ($5,000,000.00) each. After repayment, the Term C Loans may not be re-borrowed.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">5.</TD><TD STYLE="text-align: justify">Section 2.5 of the Loan Agreement is hereby amended by deleting
the text &ldquo; and&rdquo; at the end of Section 2.5(g), replacing the text &ldquo;.&rdquo; at the end of Section 2.5(h) with &ldquo;;
and&rdquo; and adding the following Section 2.5(i) thereto:</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">(i)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;A fully earned
and non-refundable fourth amendment fee equal to Eighteen Thousand Seven Hundred Fifty Dollars ($18,750.00) which shall be due and payable
on the Fourth Amendment Date.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">6.</TD><TD STYLE="text-align: justify">Section 6.13 of the Loan Agreement is hereby amended and restated
in its entirety as follows:</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in"><B>6.13&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Financial
Covenant</B>.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0.5in">(a)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Following
the funding of any Term C Loans hereunder after the funding of which the aggregate principal amount of Term C Loans funded shall be in
excess of in excess of Five Million Dollars ($5,000,000.00), but subject to the provisions of Section 6.13(b) below, the Borrower must
satisfy the Seventy Five Percent Test each month, as determined by the Bank on the date of the receipt of the monthly financial statements
by the Bank in accordance with Section 6.3 hereof.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in; text-indent: 0.5in">(b)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;If,
after the applicable Funding Date of the Term C Loan the aggregate principal amount of Term C Loans funded are in excess of Five Million
Dollars ($5,000,000.00), the aggregate cash reserves of Borrower (held in accounts maintained with the Bank or in such accounts as are
subject to one or more account control agreements with the Bank in form and substance satisfactory to Bank) for any given month, as determined
by the Bank based on evidence reasonably acceptable to the Bank, exceed One Hundred Twenty Five percent (125%) of the then outstanding
aggregate outstanding principal amount of the Term Loans, Borrower shall not be required to comply with the provisions of Section 6.13(a)
for such month.</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">7.</TD><TD STYLE="text-align: justify">Limitation of Amendment.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">a.</TD><TD STYLE="text-align: justify">The amendments and the consents set forth above are effective for the purposes set forth herein and
                                                                               shall be limited precisely as written and shall not be deemed to (a) be a consent to any amendment, waiver or modification of any
                                                                               other term or condition of any Loan Document, or (b) otherwise prejudice any right, remedy or obligation which the Bank or Borrower
                                                                               may now have or may have in the future under or in connection with any Loan Document, as amended hereby.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 1in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">b.</TD><TD STYLE="text-align: justify">This Amendment shall be construed in connection with and as
part of the Loan Documents and all terms, conditions, representations, warranties, covenants and agreements set forth in the Loan Documents,
except as herein amended, are hereby ratified and confirmed and shall remain in full force and effect.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">8.</TD><TD STYLE="text-align: justify">To induce the Bank to enter into this Amendment, Borrower hereby
represents and warrants to the Bank as follows:</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">a.</TD><TD STYLE="text-align: justify">Immediately after giving effect to this Amendment (a) the representations
and warranties contained in the Loan Documents are true, accurate and complete in all material respects as of the date hereof (except
to the extent such representations and warranties relate to an earlier date, in which case they are true and correct in all material
respects as of such date), and (b) no Event of Default has occurred and is continuing;</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 1in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">b.</TD><TD STYLE="text-align: justify">Borrower has the power and due authority to execute and deliver
this Amendment and to perform its obligations under the Loan Agreement, as amended by this Amendment;</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">c.</TD><TD STYLE="text-align: justify">The organizational documents of Borrower delivered to the Bank
on the Effective Date, and updated pursuant to subsequent deliveries by the Borrower to the Bank, if any, remain true, accurate and complete
and have not been amended, supplemented or restated and are and continue to be in full force and effect;</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">d.</TD><TD STYLE="text-align: justify">The execution and delivery by Borrower of this Amendment and
the performance by Borrower of its obligations under the Loan Agreement, as amended by this Amendment, will not constitute an event of
default under any material agreement with a Person binding on Borrower, or a breach of any provision contained in the Articles of Incorporation
or Bylaws of Borrower; and</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 1in"></TD><TD STYLE="width: 0.25in; text-align: left">e.</TD><TD STYLE="text-align: justify">This Amendment has been duly executed and delivered by Borrower
and is the binding obligation of Borrower, enforceable against Borrower in accordance with its terms, except as such enforceability may
be limited by bankruptcy, insolvency, reorganization, liquidation, moratorium or other similar laws of general application and by general
equitable principles.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">9.</TD><TD STYLE="text-align: justify">Except as expressly set forth herein, the Loan Agreement shall
continue in full force and effect without alteration or amendment. This Amendment and the Loan Documents represent the entire agreement
about this subject matter and supersede prior negotiations or agreements.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">10.</TD><TD STYLE="text-align: justify">This Amendment shall be deemed effective as of the Amendment
Date upon (i) the due execution and delivery to the Bank of this Amendment by each party hereto, and (ii) the payment by Borrower to
the Bank of the fourth amendment fee of Eighteen Thousand Seven Hundred Fifty Dollars ($18,750.00) in accordance with the provisions
of Section 2.5(i) of the Loan Agreement.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0"></P>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;</P>

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<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">11.</TD><TD STYLE="text-align: justify">This Amendment may be executed in any number of counterparts,
each of which shall be deemed an original, and all of which, taken together, shall constitute one and the same instrument.</TD>
</TR></TABLE>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0 0pt 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" STYLE="font: 10pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0; width: 100%"><TR STYLE="vertical-align: top; text-align: justify">
<TD STYLE="width: 0.25in"></TD><TD STYLE="width: 0.25in; text-align: left">12.</TD><TD STYLE="text-align: justify">This Amendment and the rights and obligations of the parties
hereto shall be governed by and construed in accordance with the laws of the State of California.</TD>
</TR></TABLE>

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<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0">&nbsp;<B>&nbsp;</B></P>

<P STYLE="font: 10pt Times New Roman, Times, Serif; margin: 0pt 0; text-indent: 0.5in"><B>IN WITNESS WHEREOF</B>, the parties hereto have
caused this Fourth Amendment to the Amend and Restated Loan and Security Agreement to be executed as of the date first set forth above.</P>

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<TABLE CELLSPACING="0" CELLPADDING="0" STYLE="width: 100%; font: 10pt Times New Roman, Times, Serif; border-collapse: collapse">
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD COLSPAN="2"><FONT STYLE="font-size: 10pt; font-variant: small-caps"><B>CytoSorbents Corporation, a Delaware corporation</B></FONT></TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD STYLE="width: 50%">&nbsp;</TD>
    <TD STYLE="width: 6%"><FONT STYLE="font-size: 10pt">By:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid; width: 44%">/s/ Kathleen P. Bloch</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">Name:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">Kathleen P. Bloch</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">Title:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">Chief Financial Officer</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD COLSPAN="2"><FONT STYLE="font-size: 10pt; font-variant: small-caps"><B>CytoSorbents Medical, Inc., a Delaware corporation</B></FONT></TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">By:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">/s/ Kathleen P. Bloch</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">Name:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">Kathleen P. Bloch</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">Title:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">Chief Financial Officer</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD COLSPAN="2"><FONT STYLE="font-size: 10pt; font-variant: small-caps"><B>Western Alliance Bank, an Arizona corporation</B></FONT></TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD COLSPAN="2">&nbsp;</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">By:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">/s/ Christian Ebert</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">Name:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">Christian Ebert</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD><FONT STYLE="font-size: 10pt">Title:</FONT></TD>
    <TD STYLE="border-bottom: Black 1pt solid">Vice President</TD></TR>
  <TR STYLE="vertical-align: top">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  </TABLE>

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