-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, NsqQCCl/+fqUhSbztmAEPS0oM7a45tScfY0t2a5iax8u7bD0lF5utmB86+e5H5cB A0hCDhALC3lyI7EBfbKHmQ== 0001179110-10-002928.txt : 20100216 0001179110-10-002928.hdr.sgml : 20100215 20100216172155 ACCESSION NUMBER: 0001179110-10-002928 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091231 FILED AS OF DATE: 20100216 DATE AS OF CHANGE: 20100216 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: 10609844 MAIL ADDRESS: STREET 1: P O BOX 6199 CITY: FAIR HAVEN STATE: NJ ZIP: 07704 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 5 1 edgar.xml FORM 5 - X0303 5 2009-12-31 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 1534583 D Common Stock 167590 I By Spouse Series A 10% Convertible Preferred Stock .10 Common 1542000 1542000 D Series A 10% Convertible Preferred Stock .10 Common 218000 218000 I By Spouse Warrants .15 2012-09-07 Common 623500 623500 D Warrants .15 2012-09-07 Common 89000 89000 I By Spouse 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, 2008 and December 1, 2009. 266,500 common shares, 266,500 warrants, and 658 preferred shares convertible into 658,000 common shares are held in Reporting Person's IRA Rollover. Herbert M. Gardner 2010-02-16 -----END PRIVACY-ENHANCED MESSAGE-----