Immix Biopharma, Inc. — Director's Dealing 2021

Dec 16, 2021

SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: Immix Biopharma, Inc. (IMMX)
CIK: 0001873835
Period of Report: 2021-12-15

Reporting Person: Hsu Jason (Director)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common stock	675000	Direct

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Convertible Note	$		Common stock ()		Indirect

Footnotes

F1: On September 1, 2016, the Registrant issued VERITAS LIBERABIT VOS, LLC("VL") a note in the amount of $3 million which is payable upon request of the majority holders of like tenure notes on or after March 31, 2022. If the Registrant sells its equity securities prior to such date resulting in proceeds of not less than $10 million("Qualified Financing"), then the note will automatically convert into such number of equity securities sold in the Qualified Financing at a conversion price equal to the lesser of (i) the price paid per equity security in the Qualified Financing multiplied by 0.80 and (ii) the quotient resulting from dividing $10 million by the number of outstanding shares of common stock immediately prior to the Qualified Financing (assuming the conversion of all securities convertible into common stock and the exercise of all outstanding options and warrants, including shares of common stock reserved and available for future grant under any equity incentive or similar plans).

F2: Jason Hsu is the Sole Member of VL and in such capacity has the right to vote and dispose of the securities held by such entity.