0001171843-21-003991.txt : 20210602 0001171843-21-003991.hdr.sgml : 20210602 20210602142200 ACCESSION NUMBER: 0001171843-21-003991 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210601 FILED AS OF DATE: 20210602 DATE AS OF CHANGE: 20210602 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Grubic Robert C CENTRAL INDEX KEY: 0001348171 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21988704 MAIL ADDRESS: STREET 1: 4315 STONELEIGH COURT CITY: HARRISBURG STATE: PA ZIP: 17112 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 2021-06-01 0 0000879635 MID PENN BANCORP INC MPB 0001348171 Grubic Robert C 4315 STONELEIGH COURT HARRISBURG PA 17112 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2021-06-01 4 A 0 703 0 A 1203 D Mid Penn Bancorp, Inc. Common Stock 52019.619 D Shares granted in the form of restricted stock which vests according to the terms of each respective grant. Balance includes shares acquired through the Dividend Reinvestment Plan. /s/ Robert C. Grubic 2021-06-02