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