SEC Form 5 · accession 0001179110-16-019355
CHASE PACKAGING CORP · WHLT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ann C W Green
Officer — CFO & Asst. Secy.
Period of report
Dec 31, 2015
Accepted (ET)
Feb 16, 2016 · 7:34 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001025771
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | holding | — | — | — | 307,275 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A 10% Convertible Preferred StockF3,F4,F1,F2 | $0.10 | holding | — | — | — | — | — | Common Stock | 513,000 | 513,000 | D |
| WarrantsF5,F1 | $0.15 | holding | — | — | — | — | Sep 7, 2017 | Common Stock | 118,500 | 118,500 | D |
| Incentive Stock OptionF1 | $0.03 | holding | — | — | — | — | Jun 24, 2018 | Common Stock | 50,000 | 50,000 | D |
Explanation of responses
- F1Currently exercisable.
- F2Not applicable.
- F3Adjusted 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, 2015.
- F4491 shares of Series A Convertible Preferred Stock (convertible into 491,000 shares of Common Stock) are held in reporting persons Roth IRA.
- F5112,500 Warrants (exercisable into 112,500 shares of Common Stock) are held in reporting persons Roth IRA.