0001179110-12-002506.txt : 20120214
0001179110-12-002506.hdr.sgml : 20120214
20120214163851
ACCESSION NUMBER: 0001179110-12-002506
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111231
FILED AS OF DATE: 20120214
DATE AS OF CHANGE: 20120214
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: 12610840
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 -
X0304
5
2011-12-31
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
Series A 10% Convertible Preferred Stock
0.10
Common Stock
1864000
1864000
D
Series A 10% Convertible Preferred Stock
0.10
Common Stock
262000
262000
I
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, 2010 and December 1, 2011.
Reporting person disclaims beneficial ownership of shares owned by spouse.
795 shares of Series A Convertible Preferred Stock (convertible into 795,000 Common shares) are held in reporting person's IRA Rollover.
Herbert M. Gardner
2012-02-14