0001171843-19-004859.txt : 20190725
0001171843-19-004859.hdr.sgml : 20190725
20190725092056
ACCESSION NUMBER: 0001171843-19-004859
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190725
FILED AS OF DATE: 20190725
DATE AS OF CHANGE: 20190725
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Dickinson Joan E
CENTRAL INDEX KEY: 0001755400
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-13677
FILM NUMBER: 19972780
MAIL ADDRESS:
STREET 1: 1456 ROCKY WAY
CITY: MECHANICSBURG
STATE: PA
ZIP: 17055
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
2019-07-25
0
0000879635
MID PENN BANCORP INC
MPB
0001755400
Dickinson Joan E
1456 ROCKY WAY
MECHANICSBURG
PA
17055
0
1
0
0
EVP/Chief of Staff
Mid Penn Bancorp, Inc. Common Stock
2019-07-25
4
A
0
400
0
A
691.706
D
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.
/s/ Joan E. Dickinson
2019-07-25