0001667731-16-000034.txt : 20160726 0001667731-16-000034.hdr.sgml : 20160726 20160726163309 ACCESSION NUMBER: 0001667731-16-000034 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160725 FILED AS OF DATE: 20160726 DATE AS OF CHANGE: 20160726 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 ST CITY: MILLERSBURG STATE: PA ZIP: 17061 BUSINESS PHONE: 7176922133 MAIL ADDRESS: STREET 1: 349 UNION STREET STREET 2: 349 UNION STREET CITY: MILLERSBURG STATE: PA ZIP: 17061 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Webb Justin T. CENTRAL INDEX KEY: 0001555503 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 161784670 MAIL ADDRESS: STREET 1: 147 BURROUGHS DRIVE CITY: AMHERST STATE: NY ZIP: 14226 4 1 form4webb.xml OWNERSHIP DOCUMENT X0306 4 2016-07-25 0 0000879635 MID PENN BANCORP INC MPB 0001555503 Webb Justin T. 734 LINDEN ROAD HERSHEY PA 17033 0 1 0 0 EVP and Chief Risk Officer Mid Penn Bancorp, Inc. Common Stock 2016-07-25 4 A 0 500 0 A 1698.0617 D Mid Penn Bancorp, Inc. Common Stock 1250 I IRA Shares granted in the form of restricted stock, which vests, subject to acceleration upon certain occurrences, 25% on each anniversary of the date of grant (each, a "vesting tranche"), but only if such reporting person (i) remains continuously employed through the applicable anniversary date and (ii) during each vesting tranche, purchases and holds an equal number of shares. Balance includes shares acquired through Employee Stock Purchase Plan and Dividend Reinvestment Plan and shares granted in the form of restricted stock. /s/ Justin T. Webb 2016-07-26