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