0001493152-21-032035.txt : 20211220 0001493152-21-032035.hdr.sgml : 20211220 20211220161518 ACCESSION NUMBER: 0001493152-21-032035 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211220 FILED AS OF DATE: 20211220 DATE AS OF CHANGE: 20211220 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Morris Gabriel S CENTRAL INDEX KEY: 0001889967 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41159 FILM NUMBER: 211505413 MAIL ADDRESS: STREET 1: 11400 WEST OLYMPIC BLVD., STREET 2: 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] 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 X0306 4 2021-12-20 0 0001873835 Immix Biopharma, Inc. IMMX 0001889967 Morris Gabriel S C/O IMMIX BIOPHARMA, INC. 11400 WEST OLYMPIC BLVD., SUITE 200 LOS ANGELES CA 90064 1 1 0 0 Chief Financial Officer Common Stock 2021-12-20 4 C 0 74116 0.85 A 74116 D Common Stock 2021-12-20 4 C 0 123527 0.85 A 123527 I See footnote Common Stock 2021-12-20 4 C 0 123176 0.85 A 246703 I See footnote Common Stock 2021-12-20 4 P 0 2000 5.00 A 76116 D Convertible Note 0.85 2021-12-20 4 C 0 60000 0 D Common stock 74116 0 D Convertible Note 0.85 2021-12-20 4 C 0 100000 0 D Common stock 123527 0 I See footnote Convertible Note 0.85 2021-12-20 4 C 0 100000 0 D Common stock 123176 0 I See footnote On March 18, 2021, the Registrant issued the Reporting Person a note in the amount of $60,000 which is payable upon request of the majority holders of like tenure notes on or after March 1, 2023. Pursuant to the terms of the note, because the Registrant sold equity securities in its initial public offering resulting in proceeds of at least $10 million, the note automatically converted into shares of the Registrant's common stock. On March 18, 2021, the Registrant issued Alwaysraise LLC a note in the amount of $100,000 which is payable upon request of the majority holders of like tenure notes on or after March 1, 2023. Pursuant to the terms of the note, because the Registrant sold equity securities in its initial public offering resulting in proceeds of at least $10 million, the note automatically converted into shares of the Registrant's common stock. Gabriel Morris is the Managing Partner and Sole Member of Alwaysraise LLC ("Alwaysraise") and in such capacity has the right to vote and dispose of the securities held by such entity. On April 2, 2021, the Registrant issued Alwaysraise a note in the amount of $100,000 which is payable upon request of the majority holders of like tenure notes on or after March 1, 2023. Pursuant to the terms of the note, because the Registrant sold equity securities in its initial public offering resulting in proceeds of at least $10 million, the note automatically converted into shares of the Registrant's common stock. /s/ Gabriel S Morris 2021-12-20