0001213900-22-015476.txt : 20220328 0001213900-22-015476.hdr.sgml : 20220328 20220328145730 ACCESSION NUMBER: 0001213900-22-015476 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220323 FILED AS OF DATE: 20220328 DATE AS OF CHANGE: 20220328 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fisher Kenneth R CENTRAL INDEX KEY: 0001812485 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41031 FILM NUMBER: 22775093 MAIL ADDRESS: STREET 1: 67 PROSPECT STREET CITY: PEABODY STATE: MA ZIP: 01960 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 2022-03-23 0 0001704287 Bluejay Diagnostics, Inc. BJDX 0001812485 Fisher Kenneth R C/O BLUEJAY DIAGNOSTICS, INC 360 MASSACHUSETTS AVENUE, SUITE 203 ACTON MA 01720 0 1 0 0 Chief Financial Officer Option (right to buy) 1.31 2022-03-23 4 A 0 65000 A 2032-03-23 Common Stock 65000 65000 D Of the option grant, 5,000 shares were fully-vested on the Transaction Date and 60,000 shares will vest in three equal annual installments beginning on the first anniversary of the Transaction Date, subject to the grantee's continued service to the Company on each vesting date. Issued in connection with the reporting person's employment with the Company. /s/ Kenneth Fisher 2022-03-28