0001493152-24-024821.txt : 20240621
0001493152-24-024821.hdr.sgml : 20240621
20240621174510
ACCESSION NUMBER: 0001493152-24-024821
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240611
FILED AS OF DATE: 20240621
DATE AS OF CHANGE: 20240621
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Adams Helen C.
CENTRAL INDEX KEY: 0001488486
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41159
FILM NUMBER: 241061531
MAIL ADDRESS:
STREET 1: 15378 AVENUE OF SCIENCE
STREET 2: STE 100
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Immix Biopharma, Inc.
CENTRAL INDEX KEY: 0001873835
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
ORGANIZATION NAME: 03 Life Sciences
IRS NUMBER: 454869378
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 11400 WEST OLYMPIC BLVD.
STREET 2: SUITE 200
CITY: LOS ANGELES
STATE: CA
ZIP: 90064
BUSINESS PHONE: (888) 958-1084
MAIL ADDRESS:
STREET 1: 10573 W. PICO BLVD.
STREET 2: #58
CITY: LOS ANGELES
STATE: CA
ZIP: 90064
4
1
ownership.xml
X0508
4
2024-06-11
0
0001873835
Immix Biopharma, Inc.
IMMX
0001488486
Adams Helen C.
C/O IMMIX BIOPHARMA, INC.
11400 WEST OLYMPIC BLVD., SUITE 200
LOS ANGELES
CA
90064
1
0
0
0
0
Common Stock
174754
D
Stock Option (Right to Buy)
2.04
2024-06-11
4
A
0
33000
0.00
A
2034-06-11
Common Stock
33000
33000
D
The Stock Option will vest in twelve (12) equal monthly installments following the date of grant, subject to the Reporting Person's continued service on the Board of Directors.
See Power of Attorney filed as Exhibit 24.1 to the Form 3 filed by the Reporting Person on December 15, 2021.
/s/ Ilya Rachman as Attorney-In-Fact for Helen C. Adams
2024-06-21