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