0001171843-18-007778.txt : 20181108 0001171843-18-007778.hdr.sgml : 20181108 20181108130440 ACCESSION NUMBER: 0001171843-18-007778 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181107 FILED AS OF DATE: 20181108 DATE AS OF CHANGE: 20181108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Moisey Robert J CENTRAL INDEX KEY: 0001634924 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 181169063 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 ownership.xml X0306 4 2018-11-07 0 0000879635 MID PENN BANCORP INC MPB 0001634924 Moisey Robert J 563 WEST FOOTHILLS DRIVE SUGARLOAF PA 18249 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2018-11-07 4 P 0 550 26.6215 A 550 I IRA Mid Penn Bancorp, Inc. Common Stock 13544.02 D Mid Penn Bancorp, Inc. Common Stock 400 D Mid Penn Bancorp, Inc. Common Stock 7464.94 I By Spouse Mid Penn Bancorp, Inc. Common Stock 4000 I By Spouse for PUTMA Balance includes shares acquired through the Dividend Reinvestment Plan. Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant. /s/ Robert J. Moisey 2018-11-08