1. Organization and Principal Activities Description of Business Spruce Biosciences, Inc. (the Company) is a late-stage biopharmaceutical company focused on developing and commercializing novel therapies for rare endocrine disorders with significant unmet medical need. The Company is initially developing its wholly-owned product candidate, tildacerfont, as the potential first non-steroidal therapy to offer markedly improved disease control and reduce steroid burden for adult patients suffering from classic congenital adrenal hyperplasia (CAH). The Company is located in Daly City, California and was incorporated in the state of Delaware in April 2016. Reverse Stock Split In October 2020, the Company filed an amendment to the Companys amended and restated certificate of incorporation to effect a reverse split of shares of the Companys common stock on a 1-for-6.541 basis (Reverse Stock Split). Adjustments corresponding to the Reverse Stock Split were made to the ratio at which the Companys redeemable convertible preferred stock converted into common stock in connection with the closing of the Companys initial public offering (IPO). The par value of the common stock and number of shares authorized were not adjusted as a result of the Reverse Stock Split. All references to common stock, options to purchase common stock, warrants, share data, per share data, and related information contained in the financial statements and related footnotes have been retrospectively adjusted to reflect the effect of the Reverse Stock Split for all periods presented. Liquidity and Capital Resources In October 2020, the Company consummated its IPO and issued a total of 6,900,000 shares of common stock, which includes 900,000 shares issued pursuant to the exercise of the underwriters option to purchase additional shares, at an offering price of $15.00 per share. In aggregate, the Company received net proceeds of approximately $96.3 million, after deducting underwriting discounts and commissions of approximately $7.2 million and before deducting offering related expenses. Upon the closing of the IPO, all outstanding shares of the Companys redeemable convertible preferred stock automatically converted into 15,492,019 shares of common stock. See Note 11 to these condensed financial statements for additional details. As of September 30, 2020, the Company had cash and cash equivalents of $72.2 million, which together with the net proceeds from the IPO of $96.3 million, will be sufficient to fund its planned operations for a period of at least twelve months following the issuance of the accompanying condensed financial statements. The Company has incurred significant losses and negative cash flows from operations. During the nine months ended September 30, 2020, the Company incurred a net loss of $21.2 million and used $18.3 million of cash in operations. As of September 30, 2020, the Company had an accumulated deficit of $52.5 million and does not expect positive cash flows from operations in the foreseeable future. In recent years, the Company has funded its operations primarily through the issuance and sale of redeemable convertible preferred stock and debt. In February 2020, the Company issued and sold 36,666,665 shares of Series B redeemable convertible preferred stock (Series B preferred stock) for approximately $43.6 million in net proceeds. In August 2020, the Company issued and sold an additional 36,666,665 shares of Series B preferred stock for approximately $44.0 million in net proceeds. The Company anticipates that it will need to raise substantial additional financing in the future to fund its operations. In order to meet these additional cash requirements, the Company may seek to sell additional equity or issue debt, convertible debt or other securities that may result in dilution to its stockholders. If the Company raises additional funds through the issuance of debt or convertible debt securities, these securities could have rights senior to those of its shares of common stock and could contain covenants that restrict its operations. There can be no assurance that the Company will be able to obtain additional equity or debt financing on terms acceptable to it, if at all. Debt financing, if available, would result in increased fixed payment obligations and may involve agreements that include covenants limiting or restricting the Companys ability to take specific actions such as incurring debt, making capital expenditures or declaring dividends. The Companys failure to obtain sufficient funds on acceptable terms when needed could have a material adverse effect on its business, results of operations, and financial condition.