0001171843-21-003031.txt : 20210503 0001171843-21-003031.hdr.sgml : 20210503 20210503155715 ACCESSION NUMBER: 0001171843-21-003031 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: Webb Justin T. CENTRAL INDEX KEY: 0001555503 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21883416 MAIL ADDRESS: STREET 1: 147 BURROUGHS DRIVE CITY: AMHERST STATE: NY ZIP: 14226 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 0001555503 Webb Justin T. 734 LINDEN ROAD HERSHEY PA 17033 0 1 0 0 SEVP and COO Mid Penn Bancorp, Inc. Common Stock 2021-04-30 4 P 0 1000 25.00 A 5104.879 D Mid Penn Bancorp, Inc. Common Stock 3750 I IRA Mid Penn Bancorp, Inc. Common Stock 2812 D Balance includes shares acquired through the 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. /s/ Justin T. Webb 2021-05-03