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