0001171843-19-004860.txt : 20190725 0001171843-19-004860.hdr.sgml : 20190725 20190725092118 ACCESSION NUMBER: 0001171843-19-004860 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: Peduzzi Michael D CENTRAL INDEX KEY: 0001409722 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 19972783 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 2019-07-25 0 0000879635 MID PENN BANCORP INC MPB 0001409722 Peduzzi Michael D 817 HOUSMAN PLACE LANCASTER PA 17601 0 1 0 0 SEVP/CFO Mid Penn Bancorp, Inc. Common Stock 2019-07-25 4 A 0 750 0 A 3000 D Mid Penn Bancorp, Inc. Common Stock 2350 I Roth IRA Mid Penn Bancorp, Inc. Common Stock 2200 I IRA Shares granted in the form of restricted stock, which vests, subject to acceleration upon certain occurrences, 25% on each anniversary date of grant (each, a "vesting tranche"), but only if such reporting person remains continuously employed through the applicable anniversary date. Balance includes shares granted in the form of restricted stock. /s/ Michael D. Peduzzi 2019-07-25