0001493152-24-024827.txt : 20240621 0001493152-24-024827.hdr.sgml : 20240621 20240621174511 ACCESSION NUMBER: 0001493152-24-024827 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: Ng Carey CENTRAL INDEX KEY: 0001889522 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41159 FILM NUMBER: 241061533 MAIL ADDRESS: STREET 1: 11400 WEST OLYMPIC BLVD., SUITE 200 CITY: LOS ANGELES STATE: CA ZIP: 90064 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 0001889522 Ng Carey C/O IMMIX BIOPHARMA, INC. 11400 WEST OLYMPIC BLVD., SUITE 200 LOS ANGELES CA 90064 1 0 0 0 0 Common Stock 10000 D Common Stock 1025221 I See footnote 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 Carey Ng is the Managing Director of Mesa Verde Venture Partners III, LP ("Mesa Verde") and in such capacity has the right to vote and dispose of the securities held by such entity. Mr. Ng disclaims beneficial ownership of the securities held by Mesa Verde, except to the extent of his pecuniary interest therein. 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 Carey Ng 2024-06-21