0001171843-21-000613.txt : 20210129
0001171843-21-000613.hdr.sgml : 20210129
20210129134454
ACCESSION NUMBER: 0001171843-21-000613
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201231
FILED AS OF DATE: 20210129
DATE AS OF CHANGE: 20210129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SPARKS DAVID E
CENTRAL INDEX KEY: 0001285758
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-13677
FILM NUMBER: 21570115
MAIL ADDRESS:
STREET 1: C/O HARLEYSVILLE NATIONAL CORP
STREET 2: 483 MAIN ST
CITY: HARLEYSVILLE
STATE: PA
ZIP: 19483
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
5
1
ownership.xml
X0306
5
2020-12-31
0
0
0
0000879635
MID PENN BANCORP INC
MPB
0001285758
SPARKS DAVID E
349 UNION STREET
MILLERSBURG
PA
17061
1
0
0
0
Mid Penn Bancorp, Inc. Common Stock
2020-12-24
5
G
0
1000
0.00
D
67842
D
Mid Penn Bancorp, Inc. Common Stock
2020-12-24
5
G
0
1000
0.00
A
6062
I
By Sparks Family Foundation
Mid Penn Bancorp, Inc. Common Stock
500
D
Mid Penn Bancorp, Inc. Common Stock
10572
I
IRA
Mid Penn Bancorp, Inc. Common Stock
25901
I
By Spouse
The reported transaction involves a transfer of securities by gift for which no payment of consideration was received by the reported person.
The reported transaction involves a transfer of securities by gift for which no consideration was paid.
Shares granted in the form of restricted stock, which vests 100% on the first anniversary of the date of grant.
/s/ David E. Sparks
2021-01-29