0001213900-23-010890.txt : 20230213 0001213900-23-010890.hdr.sgml : 20230213 20230213174246 ACCESSION NUMBER: 0001213900-23-010890 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230201 FILED AS OF DATE: 20230213 DATE AS OF CHANGE: 20230213 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: 23620369 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 2023-02-01 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 Common Stock 2023-02-01 4 A 0 27500 0.44 A 792852 D (1) These shares of restricted stock vest at 100% on the first anniversary of the grant date. /s/ Donald R Chase 2023-02-13