0001171843-21-004039.txt : 20210602 0001171843-21-004039.hdr.sgml : 20210602 20210602162442 ACCESSION NUMBER: 0001171843-21-004039 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: SPARKS DAVID E CENTRAL INDEX KEY: 0001285758 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21989446 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 4 1 ownership.xml X0306 4 2021-06-01 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 2021-06-01 4 A 0 703 0 A 1203 D Mid Penn Bancorp, Inc. Common Stock 68842 D Mid Penn Bancorp, Inc. Common Stock 10572 I IRA Mid Penn Bancorp, Inc. Common Stock 25901 I By Spouse Mid Penn Bancorp, Inc. Common Stock 6062 I By Sparks Family Foundation Shares granted in the form of restricted stock which vests according to the terms of each respective grant. /s/ David E. Sparks 2021-06-02