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