0001477932-19-001484.txt : 20190405 0001477932-19-001484.hdr.sgml : 20190405 20190405145246 ACCESSION NUMBER: 0001477932-19-001484 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181231 FILED AS OF DATE: 20190405 DATE AS OF CHANGE: 20190405 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: 19734807 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 form5.xml FORM 5 X0306 5 2018-12-31-07:00 false 0 0 0001025771 CHASE PACKAGING CORP CPKA 0000923414 GARDNER HERBERT M 255 W 94TH STREET APT 21E NEW YORK NY 10025 true false false false Common Stock 2018-12-31-07:00 5 M false 3087060 A 4014357 D Common Stock 2018-12-31-07:00 5 M false 548236 A 715826 I By GST U/W/O Mary K Gardner Series A Convertible Preferred 0.085 2018-12-31-07:00 5 M false 2624 0 D 2018-12-31-07:00 2018-12-31-07:00 Common Stock 3087060 0 D Series A Convertible Preferred 0.085 2018-12-31-07:00 5 M false 466 0 D 2018-12-31-07:00 2018-12-31-07:00 Common Stock 548236 0 I By GST U/W/O Mary K Gardner Warrants 0.15 2019-09-07-06:00 Common Stock 623500 623500 D Warrants 0.15 2019-09-07-06:00 Common Stock 89000 89000 I By GST U/W/O Mary K Gardner Conversion Price: $0.085/share pursuant to a recapitalization. Reporting Person disclaims beneficial ownership of shares and warrants owned by the Generation Skipping Marital Trust U/W/O Mary K. Gardner, of which the reporting person is a Co-Trustee. Adjusted to reflect the annual 10% stock dividend paid by the Company to all holders of Series A Convertible Preferred Stock. Currently exercisable. /s/ Herbert M. Gardner 2019-04-05-06:00