0001213900-22-002005.txt : 20220113
0001213900-22-002005.hdr.sgml : 20220113
20220113193013
ACCESSION NUMBER: 0001213900-22-002005
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220110
FILED AS OF DATE: 20220113
DATE AS OF CHANGE: 20220113
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CHASE DONALD R
CENTRAL INDEX KEY: 0001247473
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41031
FILM NUMBER: 22530161
MAIL ADDRESS:
STREET 1: 39 TIMBER RIDGE RD.
CITY: WEST SPRINGFIELD
STATE: MA
ZIP: 01089
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Bluejay Diagnostics, Inc.
CENTRAL INDEX KEY: 0001704287
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 473552922
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 360 MASSACHUSETTS AVENUE, SUITE 203
CITY: ACTON
STATE: MA
ZIP: 01720
BUSINESS PHONE: (978) 631-0152
MAIL ADDRESS:
STREET 1: 360 MASSACHUSETTS AVENUE, SUITE 203
CITY: ACTON
STATE: MA
ZIP: 01720
4
1
ownership.xml
X0306
4
2022-01-10
0
0001704287
Bluejay Diagnostics, Inc.
BJDX
0001247473
CHASE DONALD R
C/O BLUEJAY DIAGNOSTICS, INC
360 MASSACHUSETTS AVENUE, SUITE 203
ACTON
MA
01720
1
0
0
0
Option to purchase common stock
2.79
2022-01-10
4
A
0
25000
A
2032-01-10
Common Stock
25000
110762
D
The stock options set forth in this table vest on December 15, 2022, subject to the grantee's continued service to the Company on the vesting date.
The stock options were issued in connection with the reporting person's Board of Director services to the Company.
/s/ Donald Chase
2022-01-13