0001179110-12-002535.txt : 20120214 0001179110-12-002535.hdr.sgml : 20120214 20120214165420 ACCESSION NUMBER: 0001179110-12-002535 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: Green Ann C W CENTRAL INDEX KEY: 0001411838 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-21609 FILM NUMBER: 12611510 MAIL ADDRESS: STREET 1: 636 RIVER ROAD 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 0001411838 Green Ann C W 636 RIVER ROAD FAIR HAVEN NJ 07704 0 1 0 0 CFO & Asst. Secy. Series A 10% Convertible Preferred Stock 0.10 Common Stock 350000 350000 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, 2010 and December 1, 2011. 335 shares of Series A Convertible Preferred Stock (convertible into 335,000 shares of Common Stock) are held in reporting person's IRA. Ann C.W. Green 2012-02-14