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