0001171843-17-004309.txt : 20170725
0001171843-17-004309.hdr.sgml : 20170725
20170725110415
ACCESSION NUMBER: 0001171843-17-004309
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170725
FILED AS OF DATE: 20170725
DATE AS OF CHANGE: 20170725
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: 17979627
MAIL ADDRESS:
STREET 1: 281 N. OLD STONEHOUSE RD.
CITY: CARLISLE
STATE: PA
ZIP: 17015
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
formfour.xml
OWNERSHIP DOCUMENT
X0306
4
2017-07-25
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
2017-07-25
4
A
0
500
0
A
5237.829
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 remains continuously employed through the applicable anniversary date.
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
2017-07-25