0001171843-21-005348.txt : 20210802 0001171843-21-005348.hdr.sgml : 20210802 20210802104303 ACCESSION NUMBER: 0001171843-21-005348 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210729 FILED AS OF DATE: 20210802 DATE AS OF CHANGE: 20210802 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOWERY THEODORE W CENTRAL INDEX KEY: 0001278504 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 211135065 MAIL ADDRESS: STREET 1: 841 WYNNEWOOD ROAD CITY: CAMP HILL STATE: PA ZIP: 17011 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 2021-07-29 0 0000879635 MID PENN BANCORP INC MPB 0001278504 MOWERY THEODORE W 129 SOUTH LEWISBERRY ROAD MECHANICSBURG PA 17055 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2021-07-29 4 P 0 150 26.4778 A 18480.717 D Mid Penn Bancorp, Inc. Common Stock 2021-07-29 4 P 0 250 26.5571 A 7664.772 I IRA Mid Penn Bancorp, Inc. Common Stock 703 D 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/ Theodore W. Mowery 2021-08-02