0001171843-16-011249.txt : 20160726 0001171843-16-011249.hdr.sgml : 20160726 20160726175615 ACCESSION NUMBER: 0001171843-16-011249 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160725 FILED AS OF DATE: 20160726 DATE AS OF CHANGE: 20160726 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: Neiderer Kelly K CENTRAL INDEX KEY: 0001571102 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 161785251 MAIL ADDRESS: STREET 1: 281 N. OLD STONEHOUSE RD. CITY: CARLISLE STATE: PA ZIP: 17015 4 1 formfour.xml OWNERSHIP DOCUMENT X0306 4 2016-07-25 0 0000879635 MID PENN BANCORP INC MPB 0001571102 Neiderer Kelly K 281 N. OLD STONEHOUSE RD. CARLISLE PA 17015 0 1 0 0 EVP and Chief Retail Officer Mid Penn Bancorp, Inc. Common Stock 2016-07-25 4 A 0 500 0 A 2623.177 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 and shares granted in the form of restricted stock. /s/ Kelly K. Neiderer 2016-07-26