0001171843-21-006492.txt : 20210915
0001171843-21-006492.hdr.sgml : 20210915
20210915095948
ACCESSION NUMBER: 0001171843-21-006492
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210915
FILED AS OF DATE: 20210915
DATE AS OF CHANGE: 20210915
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HOLT DONALD
CENTRAL INDEX KEY: 0001225044
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-13677
FILM NUMBER: 211254505
MAIL ADDRESS:
STREET 1: 21 FIELD STONE DR
CITY: MECHANICSBURG
STATE: PA
ZIP: 17055
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
2021-09-15
0
0000879635
MID PENN BANCORP INC
MPB
0001225044
HOLT DONALD
ONE WINCHESTER COURT
MECHANICSBURG
PA
17050
0
1
0
0
Interim CFO
Mid Penn Bancorp, Inc. Common Stock
2021-09-15
4
A
0
500
0
A
500
D
Shares granted in the form of restricted stock, all of which shall vest upon completion of Mr. Holt's appointment as Interim Chief Financial Officer.
/s/ Donald F. Holt
2021-09-15