0001179110-15-002652.txt : 20150219 0001179110-15-002652.hdr.sgml : 20150216 20150217175117 ACCESSION NUMBER: 0001179110-15-002652 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141231 FILED AS OF DATE: 20150217 DATE AS OF CHANGE: 20150217 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: GARDNER HERBERT M CENTRAL INDEX KEY: 0000923414 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21609 FILM NUMBER: 15624770 MAIL ADDRESS: STREET 1: P O BOX 6199 CITY: FAIR HAVEN STATE: NJ ZIP: 07704 5 1 edgar.xml FORM 5 - X0306 5 2014-12-31 0 0 0 0001025771 CHASE PACKAGING CORP CPKA 0000923414 GARDNER HERBERT M P. O. BOX 463 WADING RIVER NY 11792 1 1 1 0 Vice President Common Stock 927297 D Common Stock 167590 I By GST U/W/O Mary Gardner Series A 10% Convertible Preferred Stock .10 Common Stock 1970000 1970000 D Series A 10% Convertible Preferred Stock .10 Common Stock 349000 349000 I By GST U/W/O Mary K. Gardner Warrants .15 2015-09-07 Common Stock 623500 623500 D Warrants .15 2015-09-07 Common Stock 89000 89000 I By GST U/W/O Mary K. Gardner Incentive Stock Option 0.03 2018-06-24 CommonStock 50000 50000 D Reporting person disclaims beneficial ownership of shares and warrants owned by the Generation Skipping Marital Trust U/W/O Mary K. Gardner, of which the reporting person is a Co-Trustee. 1,058 shares of Series A Convertible Preferred Stock (convertible into 1,058,000 Common shares) are held in IRA Rollover. Adjusted to reflect the annual 10% stock dividends paid by the Company to all holders of Series A Convertible Preferred Stock on December 1, 2013 and December 1, 2014. Currently exercisable. Not applicable. /s/ Julia A. Gardner, Attorney-in-Fact for Herbert M. Gardner 2015-02-17