0001171843-19-004861.txt : 20190725
0001171843-19-004861.hdr.sgml : 20190725
20190725092144
ACCESSION NUMBER: 0001171843-19-004861
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: Specht William A III
CENTRAL INDEX KEY: 0001348170
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-13677
FILM NUMBER: 19972785
MAIL ADDRESS:
STREET 1: 202 NELSON TERRACE
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
0001348170
Specht William A III
144 CORNELL DRIVE
MILLERSBURG
PA
17061
1
0
0
0
Mid Penn Bancorp, Inc. Common Stock
2019-07-25
4
A
0
400
0
A
4605
D
Mid Penn Bancorp, Inc. Common Stock
2400
I
By entity wholly-owned
Mid Penn Bancorp, Inc. Common Stock
2235
I
IRA
Mid Penn Bancorp, Inc. Common Stock
31210
I
Trustee
Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant.
Represents shares held by Seal Glove Manufacturing, Inc., an entity wholly-owned by the Reporting Person.
William A. Specht, III is trustee of a family trust of which 15,783 shares are held for the benefit of Janet E. Specht and 15,427 shares are held for the benefit of William A. Specht, Jr.
/s/ William A. Specht, III
2019-07-25