0001493152-24-024823.txt : 20240621 0001493152-24-024823.hdr.sgml : 20240621 20240621174516 ACCESSION NUMBER: 0001493152-24-024823 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: Chudnovsky Yekaterina CENTRAL INDEX KEY: 0001979324 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41159 FILM NUMBER: 241061537 MAIL ADDRESS: STREET 1: C/O ELICIO THERAPEUTICS, INC. STREET 2: 451 D STREET, 5TH FLOOR, SUITE 501 CITY: BOSTON STATE: MA ZIP: 02210 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 0001979324 Chudnovsky Yekaterina C/O IMMIX BIOPHARMA, INC. 11400 WEST OLYMPIC BLVD., SUITE 200 LOS ANGELES CA 90064 1 0 1 0 0 Common Stock 3241076 I Held by GKCC, LLC 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 Yekaterina (Katie) Chudnovsky is the sole member and manager of GKCC, LLC and may be deemed to beneficially own the shares held by GKCC, LLC. 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. /s/ Yekaterina Chudnovsky 2024-06-21