0001171843-21-006779.txt : 20211001 0001171843-21-006779.hdr.sgml : 20211001 20211001150903 ACCESSION NUMBER: 0001171843-21-006779 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210930 FILED AS OF DATE: 20211001 DATE AS OF CHANGE: 20211001 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: 211298547 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 2021-09-30 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 2021-09-30 4 P 0 109 27.55 A 22042.824 D Mid Penn Bancorp, Inc. Common Stock 440 D Mid Penn Bancorp, Inc. Common Stock 550 I IRA Mid Penn Bancorp, Inc. Common Stock 8713.456 I By Spouse Mid Penn Bancorp, Inc. Common Stock 4000 I By Spouse for PUTMA Shares purchased through the Director Stock Purchase Plan. 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 2021-10-01