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