0001171843-17-004311.txt : 20170725
0001171843-17-004311.hdr.sgml : 20170725
20170725110453
ACCESSION NUMBER: 0001171843-17-004311
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: Webb Justin T.
CENTRAL INDEX KEY: 0001555503
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-13677
FILM NUMBER: 17979630
MAIL ADDRESS:
STREET 1: 147 BURROUGHS DRIVE
CITY: AMHERST
STATE: NY
ZIP: 14226
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
0001555503
Webb Justin T.
734 LINDEN ROAD
HERSHEY
PA
17033
0
1
0
0
EVP and Chief Risk Officer
Mid Penn Bancorp, Inc. Common Stock
2017-07-25
4
A
0
500
0
A
2339.539
D
Mid Penn Bancorp, Inc. Common Stock
1250
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 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/ Justin T. Webb
2017-07-25