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