0001171843-19-007710.txt : 20191121 0001171843-19-007710.hdr.sgml : 20191121 20191121144632 ACCESSION NUMBER: 0001171843-19-007710 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191105 FILED AS OF DATE: 20191121 DATE AS OF CHANGE: 20191121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SPARKS DAVID E CENTRAL INDEX KEY: 0001285758 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 191237197 MAIL ADDRESS: STREET 1: C/O HARLEYSVILLE NATIONAL CORP STREET 2: 483 MAIN ST CITY: HARLEYSVILLE STATE: PA ZIP: 19483 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 2019-11-05 0 0000879635 MID PENN BANCORP INC MPB 0001285758 SPARKS DAVID E 349 UNION STREET MILLERSBURG PA 17061 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2019-11-05 4 S 0 304 26.12 D 0 I 401(k) Mid Penn Bancorp, Inc. Common Stock 69442 D Mid Penn Bancorp, Inc. Common Stock 400 D Mid Penn Bancorp, Inc. Common Stock 26651.7 I By Spouse Mid Penn Bancorp, Inc. Common Stock 4062 I By Sparks Family Foundation Mid Penn Bancorp, Inc. Common Stock 8572 I IRA Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant. Balance includes shares acquired through the Dividend Reinvestment Plan. /s/ David E. Sparks 2019-11-21