0001171843-19-005337.txt : 20190808 0001171843-19-005337.hdr.sgml : 20190808 20190808163927 ACCESSION NUMBER: 0001171843-19-005337 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190808 FILED AS OF DATE: 20190808 DATE AS OF CHANGE: 20190808 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: 191010135 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 2019-08-08 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 2019-08-08 4 P 0 1000 24.64 A 3400 I By entity wholly-owned Mid Penn Bancorp, Inc. Common Stock 4205 D Mid Penn Bancorp, Inc. Common Stock 400 D Mid Penn Bancorp, Inc. Common Stock 2235 I IRA Mid Penn Bancorp, Inc. Common Stock 31210 I Trustee Represents shares held by Seal Glove Manufacturing, Inc., an entity wholly-owned by the Reporting Person. Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant. William A. Specht, III is trustee of a family trust of which the shares are held for the benefit of Janet E. Specht. /s/ William A. Specht, III 2019-08-08