0001171843-21-003068.txt : 20210503 0001171843-21-003068.hdr.sgml : 20210503 20210503173556 ACCESSION NUMBER: 0001171843-21-003068 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: RITRIEVI RORY G CENTRAL INDEX KEY: 0001230831 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21884918 MAIL ADDRESS: STREET 1: 1019 TUNBRIDGE LANE CITY: MECHANICSBURG STATE: PA ZIP: 17050 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 0001230831 RITRIEVI RORY G 1019 TUNBRIDGE LANE MECHANICSBURG PA 17050 1 1 0 0 President and CEO Mid Penn Bancorp, Inc. Common Stock 2021-04-30 4 P 0 1000 25.00 A 21104.671 D Mid Penn Bancorp, Inc. Common Stock 13184 D Mid Penn Bancorp, Inc. Common Stock 3871.191 I IRA Balance includes shares acquired through Employee Stock Purchase Plan and Dividend Reinvestment Plan. Shares granted in the form of Restricted Stock which vests according to the terms of each respective grant. Balance includes shares acquired through Dividend Reinvestment Plan. /s/ Rory G. Ritrievi 2021-05-03