0001567619-19-002250.txt : 20190204 0001567619-19-002250.hdr.sgml : 20190204 20190204162558 ACCESSION NUMBER: 0001567619-19-002250 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190201 FILED AS OF DATE: 20190204 DATE AS OF CHANGE: 20190204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shea Steven L CENTRAL INDEX KEY: 0001472916 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14120 FILM NUMBER: 19564020 MAIL ADDRESS: STREET 1: C/O BLONDER TONGUE LABORATORIES, INC. STREET 2: ONE JAKE BROWN ROAD CITY: OLD BRIDGE STATE: NJ ZIP: 08857 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BLONDER TONGUE LABORATORIES INC CENTRAL INDEX KEY: 0001000683 STANDARD INDUSTRIAL CLASSIFICATION: RADIO & TV BROADCASTING & COMMUNICATIONS EQUIPMENT [3663] IRS NUMBER: 521611421 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ONE JAKE BROWN RD STREET 2: PO BOX 1000 CITY: OLD BRIDGE STATE: NJ ZIP: 08857 BUSINESS PHONE: 9086794000 MAIL ADDRESS: STREET 1: ONE JAKE BROWN ROAD CITY: OLD BRIDGE STATE: NJ ZIP: 08857 4 1 doc1.xml FORM 4 X0306 4 2019-02-01 0 0001000683 BLONDER TONGUE LABORATORIES INC BDR 0001472916 Shea Steven L C/O BLONDER TONGUE LABORATORIES, INC. ONE JAKE BROWN ROAD OLD BRIDGE NJ 08857 1 0 0 0 Common Stock, par value $0.001 2019-02-01 4 A 0 259983 0.54 A 632109 D Common Stock, par value $0.001 15000 I By Spouse Shares were issued upon the conversion of $140,390.57 (principal and accrued interest) of outstanding convertible subordinated indebtedness of Blonder Tongue Laboratories, Inc. held by the reporting person. Represents the conversion price of the convertible subordinated indebtedness. /s/ Steven L. Shea by Eric Skolnik Under Power of Attorney 2019-02-04