0001171843-15-004091.txt : 20150727
0001171843-15-004091.hdr.sgml : 20150727
20150727155009
ACCESSION NUMBER: 0001171843-15-004091
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: Williams Edward P.
CENTRAL INDEX KEY: 0001459838
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-13677
FILM NUMBER: 151007113
MAIL ADDRESS:
STREET 1: 349 UNION ST.
CITY: MILLERSBURG
STATE: PA
ZIP: 17061
4
1
form4williams.xml
OWNERSHIP DOCUMENT
X0306
4
2015-07-24
0
0000879635
MID PENN BANCORP INC
MPB
0001459838
Williams Edward P.
4329 VALLEYVIEW ROAD
HARRISBURG
PA
17112
0
1
0
0
Interim PFO
Mid Penn Bancorp, Inc. Common Stock
2015-07-24
4
A
0
400
0
A
1360.226
D
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.
/s/ Edward P. Williams
2015-07-27