0001171843-22-002347.txt : 20220405 0001171843-22-002347.hdr.sgml : 20220405 20220405103736 ACCESSION NUMBER: 0001171843-22-002347 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220401 FILED AS OF DATE: 20220405 DATE AS OF CHANGE: 20220405 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RITRIEVI RORY G CENTRAL INDEX KEY: 0001230831 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 22805536 MAIL ADDRESS: STREET 1: 2407 PARK DRIVE CITY: HARRISBURG STATE: PA ZIP: 17110 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: 2407 PARK DRIVE CITY: HARRISBURG STATE: PA ZIP: 17110 BUSINESS PHONE: 8666427736 MAIL ADDRESS: STREET 1: 2407 PARK DRIVE CITY: HARRISBURG STATE: PA ZIP: 17110 4 1 ownership.xml X0306 4 2022-04-01 0 0000879635 MID PENN BANCORP INC MPB 0001230831 RITRIEVI RORY G 2407 PARK DRIVE HARRISBURG PA 17110 1 1 0 0 President and CEO Mid Penn Bancorp, Inc. Common Stock 2022-04-01 4 A 0 8494 0 A 21774 D Mid Penn Bancorp, Inc. Common Stock 28719.714 D Mid Penn Bancorp, Inc. Common Stock 3981.858 I IRA 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. Balance includes shares acquired through Dividend Reinvestment Plan. /s/ Rory G. Ritrievi 2022-04-05