0001493152-23-028474.txt : 20230814 0001493152-23-028474.hdr.sgml : 20230814 20230814161531 ACCESSION NUMBER: 0001493152-23-028474 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230811 FILED AS OF DATE: 20230814 DATE AS OF CHANGE: 20230814 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hsu Jason CENTRAL INDEX KEY: 0001895035 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41159 FILM NUMBER: 231170376 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 X0508 4 2023-08-11 0 0001873835 Immix Biopharma, Inc. IMMX 0001895035 Hsu Jason C/O IMMIX BIOPHARMA, INC. 11400 WEST OLYMPIC BLVD., SUITE 200 LOS ANGELES CA 90064 1 0 0 0 0 Stock Options 1.86 2023-08-11 4 A 0 20000 0 A 2033-08-11 Common Stock 20000 20000 D Options vest monthly over 12 months from the date of grant. /s/ Ilya Rachman as Attorney-In-Fact for Jason Hsu 2023-08-14