0001171843-21-004047.txt : 20210602 0001171843-21-004047.hdr.sgml : 20210602 20210602163756 ACCESSION NUMBER: 0001171843-21-004047 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: Micklewright Scott W CENTRAL INDEX KEY: 0001494991 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21989648 MAIL ADDRESS: STREET 1: 7742 MANADA CREEK DRIVE 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 0001494991 Micklewright Scott W 7742 MANADA CREEK DRIVE HARRISBURG PA 17112 0 1 0 0 SEVP and Chief Revenue Officer Mid Penn Bancorp, Inc. Common Stock 2021-06-01 4 A 0 703 0 A 3515 D Mid Penn Bancorp, Inc. Common Stock 8624.948 D Shares granted in the form of restricted stock which vests according to the terms of each respective grant. Balance includes shares acquired through Employee Stock Purchase Plan and Dividend Reinvestment Plan. /s/ Scott W. Micklewright 2021-06-02