0001171843-23-003518.txt : 20230523 0001171843-23-003518.hdr.sgml : 20230523 20230523153511 ACCESSION NUMBER: 0001171843-23-003518 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230519 FILED AS OF DATE: 20230523 DATE AS OF CHANGE: 20230523 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GUMINA FRANK JR CENTRAL INDEX KEY: 0001256425 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 23948758 MAIL ADDRESS: STREET 1: 98 FAIRWAY BLVD CITY: MONROE TOWNSHIP STATE: NJ ZIP: 08831 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 X0407 4 2023-05-19 0 0000879635 MID PENN BANCORP INC MPB 0001256425 GUMINA FRANK JR 2407 PARK DRIVE HARRISBURG PA 17110 1 0 0 0 0 Mid Penn Bancorp, Inc. Common Stock 2023-05-19 4 A 0 17299 0 A 17799 D Mid Penn Bancorp, Inc. Common Stock 2023-05-19 4 A 0 4001 0 A 4001 I Company-owned Mid Penn Bancorp, Inc. Common Stock 2023-05-19 4 A 0 1242 0 A 1242 I By spouse Acquired pursuant to the Agreement and Plan of Merger, dated as of December 20, 2022 (the Merger Agreement), by and between Mid Penn Bancorp, Inc. (MPB) and Brunswick Bancorp (Brunswick), pursuant to which Brunswick merged with and into MPB, with MPB continuing as the surviving corporation (Merger), on May 19, 2023. Pursuant to the Merger Agreement, at the effective time of the Merger (the Effective Time), each share of common stock of Brunswick held by Mr. Gumina immediately prior to the Effective Time that was not converted into cash was converted into the right to receive 0.598 shares of MPB common stock. Shares held in the name of Franina Associates, LLC. /s/ Frank Gumina, Jr. 2023-05-23