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