0001179110-16-019355.txt : 20160216 0001179110-16-019355.hdr.sgml : 20160215 20160216193409 ACCESSION NUMBER: 0001179110-16-019355 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151231 FILED AS OF DATE: 20160216 DATE AS OF CHANGE: 20160216 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CHASE PACKAGING CORP CENTRAL INDEX KEY: 0001025771 STANDARD INDUSTRIAL CLASSIFICATION: AGRICULTURE SERVICES [0700] IRS NUMBER: 931216127 STATE OF INCORPORATION: NJ FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 636 RIVER ROAD CITY: FAIRHAVEN STATE: NJ ZIP: 07704 BUSINESS PHONE: 732-741-1500 MAIL ADDRESS: STREET 1: POB 6199 STREET 2: 636 RIVER ROAD CITY: FAIRHAVEN STATE: NJ ZIP: 07704 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Green Ann C W CENTRAL INDEX KEY: 0001411838 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21609 FILM NUMBER: 161431124 MAIL ADDRESS: STREET 1: 636 RIVER ROAD CITY: FAIR HAVEN STATE: NJ ZIP: 07704 5 1 edgar.xml FORM 5 - X0306 5 2015-12-31 0 0 0 0001025771 CHASE PACKAGING CORP CPKA 0001411838 Green Ann C W 636 RIVER ROAD FAIR HAVEN NJ 07704 0 1 0 0 CFO & Asst. Secy. Common Stock 307275 D Series A 10% Convertible Preferred Stock 0.10 Common Stock 513000 513000 D Warrants 0.15 2017-09-07 Common Stock 118500 118500 D Incentive Stock Option 0.03 2018-06-24 Common Stock 50000 50000 D Currently exercisable. Not applicable. Adjusted to reflect the annual 10% stock dividends paid by the Company to all holders of record of Series A Convertible Preferred Stock on December 1, 2015. 491 shares of Series A Convertible Preferred Stock (convertible into 491,000 shares of Common Stock) are held in reporting persons Roth IRA. 112,500 Warrants (exercisable into 112,500 shares of Common Stock) are held in reporting persons Roth IRA. /s/ Julia A. Gardner, Attorney-in-Fact for Ann C.W. Green 2016-02-16