0001171843-21-004049.txt : 20210602 0001171843-21-004049.hdr.sgml : 20210602 20210602163939 ACCESSION NUMBER: 0001171843-21-004049 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: Moisey Robert J CENTRAL INDEX KEY: 0001634924 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 21989675 MAIL ADDRESS: STREET 1: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 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 0001634924 Moisey Robert J 563 WEST FOOTHILLS DRIVE SUGARLOAF PA 18249 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2021-06-01 4 A 0 440 0 A 940 D Mid Penn Bancorp, Inc. Common Stock 21184.328 D Mid Penn Bancorp, Inc. Common Stock 550 I IRA Mid Penn Bancorp, Inc. Common Stock 8693.321 I By Spouse Mid Penn Bancorp, Inc. Common Stock 4000 I By Spouse for PUTMA 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 J. Moisey 2021-06-02