SEC Form 5 · accession 0001179110-16-019360
CHASE PACKAGING CORP · WHLT
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
William J Barrett
Officer — Secretary · Director · 10% Owner
Period of report
Dec 31, 2015
Accepted (ET)
Feb 16, 2016 · 7:39 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 | — | — | — | 1,288,560 | D | ||
| Common Stock | holding | — | — | — | 286,345 | I | By spouse |
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 StockF4,F2,F3 | $0.10 | holding | — | — | — | — | — | Common Stock | 4,000,000 | 4,000,000 | D |
| Series A 10% Convertible Preferred StockF4,F1,F2,F3 | $0.10 | holding | — | — | — | — | — | Common Stock | 729,000 | 729,000 | I |
| WarrantsF2 | $0.15 | holding | — | — | — | — | Sep 7, 2017 | Common Stock | 78,500 | 78,500 | D |
| WarrantsF1,F2 | $0.15 | holding | — | — | — | — | Sep 7, 2017 | Common Stock | 167,000 | 167,000 | I |
| Incentive Stock OptionF2 | $0.03 | holding | — | — | — | — | Jun 24, 2018 | Common Stock | 50,000 | 50,000 | D |
Explanation of responses
- F1Reporting Person disclaims beneficial ownership of shares and warrants owned by spouse.
- F2Currently exercisable.
- F3Not applicable.
- F4Adjusted to reflect the annual 10% stock dividend paid by the Company to all holders of Series A Convertible Preferred Stock on December 1, 2015.