0001171843-21-003029.txt : 20210503 0001171843-21-003029.hdr.sgml : 20210503 20210503154754 ACCESSION NUMBER: 0001171843-21-003029 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: Moisey Robert J CENTRAL INDEX KEY: 0001634924 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21883366 MAIL ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 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 0001634924 Moisey Robert J 563 WEST FOOTHILLS DRIVE SUGARLOAF PA 18249 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2021-04-30 4 P 0 3000 25.00 A 21055.213 D Mid Penn Bancorp, Inc. Common Stock 500 D Mid Penn Bancorp, Inc. Common Stock 550 I IRA Mid Penn Bancorp, Inc. Common Stock 8674.198 I By Spouse Mid Penn Bancorp, Inc. Common Stock 4000 I By Spouse for PUTMA Balance includes shares acquired through the Dividend Reinvestment Plan. Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant. /s/ Robert J. Moisey 2021-05-03