0001171843-15-004087.txt : 20150727 0001171843-15-004087.hdr.sgml : 20150727 20150727154833 ACCESSION NUMBER: 0001171843-15-004087 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150724 FILED AS OF DATE: 20150727 DATE AS OF CHANGE: 20150727 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 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RITRIEVI RORY G CENTRAL INDEX KEY: 0001230831 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 151007107 MAIL ADDRESS: STREET 1: 1019 TUNBRIDGE LANE CITY: MECHANICSBURG STATE: PA ZIP: 17050 4 1 gff4_ritrievi072715.xml OWNERSHIP DOCUMENT X0306 4 2015-07-24 0 0000879635 MID PENN BANCORP INC MPB 0001230831 RITRIEVI RORY G 1019 TUNBRIDGE LANE MECHANICSBURG PA 17050 1 1 0 0 President and CEO Mid Penn Bancorp, Inc. Common Stock 2015-07-24 4 A 0 1000 0 A 9539.503 D Mid Penn Bancorp, Inc. Common Stock 3275.076 I IRA Shares granted in the form of restricted stock, which vests, subject to acceleration upon certain occurrences, 25% on each anniversary of the date of grant (each, a "vesting tranche"), but only if such reporting person (i) remains continuously employed through the applicable anniversary date and (ii) during each vesting tranche, purchases and holds an equal number of shares. Balance includes shares acquired through Employee Stock Purchase Plan and Dividend Reinvestment Plan. Balance includes shares acquired through Dividend Reinvestment Plan. /s/ Rory G. Ritrievi 2015-07-27