0001171843-21-008297.txt : 20211202 0001171843-21-008297.hdr.sgml : 20211202 20211202155115 ACCESSION NUMBER: 0001171843-21-008297 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211130 FILED AS OF DATE: 20211202 DATE AS OF CHANGE: 20211202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kerwin Joseph D. CENTRAL INDEX KEY: 0001749452 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 211466473 MAIL ADDRESS: STREET 1: 100 IRISH ROAD CITY: LYKENS STATE: PA ZIP: 17048 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 2021-11-30 0 0000879635 MID PENN BANCORP INC MPB 0001749452 Kerwin Joseph D. 349 UNION STREET MILLERSBURG PA 17061 1 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2021-11-30 4 A 0 21085 0 A 49085.076 D Acquired pursuant to the Agreement and Plan of Merger, dated as of June 30, 2021, and amended on August 26, 2021 (the Merger Agreement), by and between Mid Penn Bancorp, Inc. (MPB) and Riverview Financial Corporation (RIVE), pursuant to which RIVE merged with and into MPB, with MPB continuing as the surviving corporation (Merger), on November 30, 2021. Pursuant to the Merger Agreement, at the effective time of the Merger (the Effective Time), each share of the common stock of RIVE issued and outstanding immediately prior to the Effective Time was converted into the right to receive 0.4833 shares of common stock of MPB. /s/ Joseph D. Kerwin 2021-12-02