0001171843-17-004314.txt : 20170725 0001171843-17-004314.hdr.sgml : 20170725 20170725112747 ACCESSION NUMBER: 0001171843-17-004314 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: Paese Joseph L CENTRAL INDEX KEY: 0001672207 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 17979749 MAIL ADDRESS: STREET 1: 1416 FARMHOUSE LANE CITY: MIDDLETOWN STATE: PA ZIP: 17057 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 0001672207 Paese Joseph L 1416 FARMHOUSE LANE MIDDLETOWN PA 17057 0 1 0 0 EVP, Dir. Trust, Wealth Mgmt Mid Penn Bancorp, Inc. Common Stock 2017-07-25 4 A 0 500 0 A 2000 D Mid Penn Bancorp, Inc. Common Stock 2042.082 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 Dividend Reinvestment Plan. /s/ Joseph L. Paese 2017-07-25