-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, OcpkpvYNk7g5wTbnBDu9h+mqEjkbeDnIih11LrCYZ3j22+fv9LcCUmbDGqk0u/oK QCYiDqS0rgZPrC2ocyD7yA== 0000950165-99-000011.txt : 19990215 0000950165-99-000011.hdr.sgml : 19990215 ACCESSION NUMBER: 0000950165-99-000011 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19990212 SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: SEC FILE NUMBER: 005-43658 FILM NUMBER: 99534260 BUSINESS ADDRESS: STREET 1: 349 UNION ST CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 MAIL ADDRESS: STREET 1: 349 UNION STREET STREET 2: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: MID PENN BANK CENTRAL INDEX KEY: 0000928357 STANDARD INDUSTRIAL CLASSIFICATION: [] IRS NUMBER: 230880270 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 349 UNION ST CITY: MILLERSBURG STATE: PA ZIP: 17061 MAIL ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 SC 13G/A 1 13G/A FOR MID PENN BANK UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 SCHEDULE SC 13G/A Under the Securities Exchange Act of 1934 (Amendment No. 6 ) -- MID PENN BANCORP, INC. ------------------------------------- (Name of Issuer) Common Stock Par value $1.00 per share (Title of Class of Securities) 595 40G 107 ----------- (CUSIP Number) ------------------------------------------ (Date of Event Which Requires Filing) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: [X ] Rule 13d-1(b) [ ] Rule 13d-1(c) [ ] Rule 13d-1(d) *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). Page 2 of 6 Pages CUSIP No. 595 40G 107 13G 1) Names of Reporting Persons S.S. or I.R.S. Identification Nos. of Above Persons Mid Penn Bank, Trust Department 2) Check the Appropriate Box if a Member of a Group (See Instructions) Not Applicable (a) [ ] (b) [ ] 3) SEC Use Only 4) Citizenship or Place of Organization Commonwealth of Pennsylvania, U.S.A. [Reporting person is the Trust Department of a Pennsylvania state - Chartered Bank.] Number of Shares (5) Sole Voting Power Beneficially 324,076 Owned by Each ------- Reporting Person With (6) Shared Voting Power 0 ------- (7) Sole Dispositive Power 324,076 ------- (8) Shared Dispositive Power 0 ------- 9) Aggregate Amount Beneficially Owned by Each Reporting Person 324,076 10) Check Box if the Aggregate Amount in Row (9) Excludes Certain Shares* 11) Percent of Class Represented by Amount in Row 9 11.0% 12) Type of Reporting Person* BK* *BANK Page 3 of 6 Pages Reporting Person - ---------------- SCHEDULE 13G ------------ Filed by: Mid Penn Bank, Trust Department With: Securities and Exchange Commission Washington, DC 20549 Calendar Year Covered: 1998 Item 1(a) Name of Issuer: --------------- Mid Penn Bancorp, Inc. Item 1(b) Address of Issuer's Principal Executive Offices: ------------------------------------------------ 349 Union Street Millersburg, PA 17061 Item 2(a) Name of Person Filing: ---------------------- Mid Penn Bank, Trust Department Item 2(b) Address of Principal Business Office or, if none, Residence: ------------------------------------------------- 349 Union Street Millersburg, PA 17061 Item 2(c) Citizenship: ------------ Commonwealth of Pennsylvania, U.S.A. (Reporting Person is the Trust Department of a Pennsylvania State-Chartered Bank) Item 2(d) Title of Class of Securities: ----------------------------- Common Stock, par value $1.00 per share Page 4 of 6 Pages Item 2(e) CUSIP Number: 595 40G 107 Item 3. If this statement is filed pursuant to Sections 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a: (a) [ ] Broker or Dealer registered under Section 15 of the Act. (b) [X] Bank as defined in section 3(a)(6) of the Act. (c) [ ] Insurance Company as defined in section 3(a)(19) of the Act. (d) [ ] Investment Company registered under section 8 of the Investment Company Act of 1940. (e) [ ] An investment adviser in accordance with Section 240.13d-1(b)(1)(ii)(E); (f) [ ] An employee benefit plan or endowment fund in accordance with Section 240.13d-1(b)(1)(ii)(F); (g) [ ] A parent holding company or control person in accordance with Section 240.13d-1(b)(1)(ii)(G); (h) [ ] A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act; (i) [ ] A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940; (j) [ ]Group, in accordance with Section 240.13d-1(b)(1)(ii)(J). Item 4. Ownership (as of December 31, 1998) ---------------------------------- (a) Amount Beneficially Owned: 324,076 shares of Common Stock, par value $1.00 per share. (b) Percent of Class: 11.0% (c) Number of shares as to which such person has: (i) sole power to vote or to direct the vote 324,076 ----------- (ii) shared power to vote or to direct the vote 0 ----------- (iii) sole power to dispose or to direct the disposition of: 324,076 ----------- (iv) shared power to dispose or to direct the disposition of: 0 ----------- Page 5 of 6 Pages Item 5. Ownership of Five Percent or Less of a Class: Not Applicable. Item 6. Ownership of More than Five Percent on Behalf of Another Person. 324,076 shares of the Issuer that are "beneficially owned" by Mid Penn Bank, Trust Department, are held in its fiduciary capacity in its nominee name, NEBCO. Mid Penn Bank, Trust Department has sole Power to vote or to direct the vote of 324,076 shares of the Issuer and sole power to dispose or to direct the disposition of 324,076 shares of the Issuer. Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company. Not Applicable Item 8. Identification and Classification of Members of the Group: Not Applicable Item 9. Notice of Dissolution of Group: Not Applicable Item 10. Certification By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were acquired and are held in the ordinary course of business and were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the Issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect. Page 6 of 6 Pages Signature After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Date: February 11, 1999 /s/ Patricia A. Walter ----------------------- Patricia A. Walter, Trust Officer MID PENN BANK -----END PRIVACY-ENHANCED MESSAGE-----