0001667731-16-000036.txt : 20160726 0001667731-16-000036.hdr.sgml : 20160726 20160726165117 ACCESSION NUMBER: 0001667731-16-000036 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: Paese Joseph L CENTRAL INDEX KEY: 0001672207 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13677 FILM NUMBER: 161784795 MAIL ADDRESS: STREET 1: 1416 FARMHOUSE LANE CITY: MIDDLETOWN STATE: PA ZIP: 17057 4 1 joepaese061716.xml OWNERSHIP DOCUMENT X0306 4 2016-07-25 0 0000879635 MID PENN BANCORP INC MPB 0001672207 Paese Joseph L 1416 FARMHOUSE LANE MIDDLETOWN PA 17057 0 1 0 0 EVP, Dir of Trust, Wealth Mgmt Mid Penn Bancorp, Inc. Common Stock 2000 I IRA Mid Penn Bancorp, Inc. Common Stock 2016-07-25 4 A 0 1500 0 A 1500 D 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. /s/ Joseph L. Paese 2016-07-26