0001179110-16-019360.txt : 20160216 0001179110-16-019360.hdr.sgml : 20160215 20160216193929 ACCESSION NUMBER: 0001179110-16-019360 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: BARRETT WILLIAM J CENTRAL INDEX KEY: 0000923415 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21609 FILM NUMBER: 161431148 MAIL ADDRESS: STREET 1: P O BOX 6199 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 0000923415 BARRETT WILLIAM J P. O. BOX 6199 FAIR HAVEN NJ 07704 1 1 1 0 Secretary Common Stock 1288560 D Common Stock 286345 I By spouse Series A 10% Convertible Preferred Stock 0.10 Common Stock 4000000 4000000 D Series A 10% Convertible Preferred Stock 0.10 Common Stock 729000 729000 I By Spouse Warrants 0.15 2017-09-07 Common Stock 78500 78500 D Warrants 0.15 2017-09-07 Common Stock 167000 167000 I By spouse Incentive Stock Option 0.03 2018-06-24 Common Stock 50000 50000 D Reporting Person disclaims beneficial ownership of shares and warrants owned by spouse. Currently exercisable. Not applicable. Adjusted to reflect the annual 10% stock dividend paid by the Company to all holders of Series A Convertible Preferred Stock on December 1, 2015. /s/ Julia A. Gardner, Attorney-in-Fact for William J. Barrett 2016-02-16