0001171843-17-004313.txt : 20170725 0001171843-17-004313.hdr.sgml : 20170725 20170725110842 ACCESSION NUMBER: 0001171843-17-004313 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: QUANDEL NOBLE C JR CENTRAL INDEX KEY: 0001634923 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 17979648 MAIL ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 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 0001634923 QUANDEL NOBLE C JR 230 SOUTH 15TH STREET POTTSVILLE PA 17901 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2017-07-25 4 A 0 400 0 A 67634.981 D Mid Penn Bancorp, Inc. Common Stock 53787.557 I By Spouse Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant. Balance includes shares acquired through Dividend Reinvestment Plan and shares granted in the form of restricted stock. /s/ Noble C. Quandel, Jr. 2017-07-25