0001171843-21-003033.txt : 20210503 0001171843-21-003033.hdr.sgml : 20210503 20210503155901 ACCESSION NUMBER: 0001171843-21-003033 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210430 FILED AS OF DATE: 20210503 DATE AS OF CHANGE: 20210503 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Smith Patrick M. CENTRAL INDEX KEY: 0001749288 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21883427 MAIL ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17601 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MID PENN BANCORP INC CENTRAL INDEX KEY: 0000879635 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 251666413 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 8666427736 MAIL ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 4 1 ownership.xml X0306 4 2021-04-30 0 0000879635 MID PENN BANCORP INC MPB 0001749288 Smith Patrick M. 349 UNION STREET MILLERSBURG PA 17061 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2021-04-30 4 P 0 1007 25.00 A 6380 D Mid Penn Bancorp, Inc. Common Stock 870 I IRA Mid Penn Bancorp, Inc. Common Stock 500 I 401k Mid Penn Bancorp, Inc. Common Stock 500 D Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant. /s/ Patrick M. Smith 2021-05-03