0001171843-15-000488.txt : 20150130 0001171843-15-000488.hdr.sgml : 20150130 20150130162141 ACCESSION NUMBER: 0001171843-15-000488 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150130 FILED AS OF DATE: 20150130 DATE AS OF CHANGE: 20150130 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 ST CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 MAIL ADDRESS: STREET 1: 349 UNION STREET STREET 2: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 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: 15563341 MAIL ADDRESS: STREET 1: 1019 TUNBRIDGE LANE CITY: MECHANICSBURG STATE: PA ZIP: 17050 4 1 form4.xml OWNERSHIP DOCUMENT X0306 4 2015-01-30 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 2015-01-30 4 P 0 20 15.739 A 3233.8895 I IRA Mid Penn Bancorp, Inc. Common Stock 2015-01-30 4 P 0 1000 15.4906 A 5503.395 D Mid Penn Bancorp, Inc. Common Stock 2186.6141 D Balance includes shares acquired through Dividend Reinvestment Plan. Balance includes shares acquired through Employee Stock Purchase Plan and Dividend Reinvestment Plan. /s/ Rory G. Ritrievi 2015-01-30