Actionable news
0
All posts from Actionable news
Actionable news in MPB: Mid Penn Bancorp,

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

The Securities and Exchange Commission has not necessarily reviewed the information in this filing and has not determined if it is accurate and complete.
The reader should not assume that the information is accurate and complete.

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM D

Notice of Exempt Offering of Securities

OMB APPROVAL
OMB Number: 3235-0076
Estimated average burden
hours per response: 4.00

1. Issuer's Identity

CIK (Filer ID Number) Previous Names
X None
Entity Type
0000879635
X Corporation
Limited Partnership
Limited Liability Company
General Partnership
Business Trust
Other (Specify)

Name of Issuer
MID PENN BANCORP INC
Jurisdiction of Incorporation/Organization
PENNSYLVANIA
Year of Incorporation/Organization
X Over Five Years Ago
Within Last Five Years (Specify Year)
Yet to Be Formed

2. Principal Place of Business and Contact Information

Name of Issuer
MID PENN BANCORP INC
Street Address 1 Street Address 2
349 UNION STREET
City State/Province/Country ZIP/PostalCode Phone Number of Issuer
MILLERSBURG PENNSYLVANIA 17061 8666427736

3. Related Persons

Last Name First Name Middle Name
Ritrievi Rory G
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

President and Chief Executive Officer

Last Name First Name Middle Name
Grubic Robert C
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Chairman

Last Name First Name Middle Name
Abel Robert A
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Boyer Steven T
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
DeSoto Matthew G
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Kerwin Gregory M
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Klinger Robert E
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Mowery Theodore W
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Noone John E
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Specht, III William A
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Vice Chairman

Last Name First Name Middle Name
Moisey Robert J
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Quandel, Jr. Noble C
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Last Name First Name Middle Name
Peduzzi Michael D
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Clarification of Response (if Necessary):

Executive Vice President and Chief Financial Officer

Last Name First Name Middle Name
Micklewright Scott W
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Executive Vice President and Chief Lending Officer

Last Name First Name Middle Name
Webb Justin T
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Executive Vice President and Chief Risk Officer

Last Name First Name Middle Name
Neiderer Kelly K
Street Address 1 Street Address 2
c/o Mid Penn Bancorp, Inc. 349 Union Street
City State/Province/Country ZIP/PostalCode
Millersburg PENNSYLVANIA 17061

Executive Vice President and Chief Retail Officer

4. Industry Group

Agriculture
Banking & Financial Services
X Commercial Banking
Insurance
Investing
Investment Banking
Pooled Investment Fund
Is the issuer registered as
an investment company under
the Investment Company
Act of 1940?
Yes No
Other Banking & Financial Services
Business Services
Energy
Coal Mining
Electric Utilities
Energy Conservation
Environmental Services
Oil & Gas
Other Energy
Health Care
Biotechnology
Health Insurance
Hospitals & Physicians
Pharmaceuticals
Other Health Care
Manufacturing
Real Estate
Commercial
Construction
REITS & Finance
Residential
Other Real Estate
Retailing
Restaurants
Technology
Computers
Telecommunications
Other Technology
Travel
Airlines & Airports
Lodging & Conventions
Tourism & Travel Services
Other Travel
Other

5. Issuer Size

Revenue Range OR Aggregate Net Asset Value Range
No Revenues No Aggregate Net Asset Value
$1 - $1,000,000 $1 - $5,000,000
$1,000,001 - $5,000,000 $5,000,001 - $25,000,000
$5,000,001 - $25,000,000 $25,000,001 - $50,000,000
X $25,000,001 - $100,000,000 $50,000,001 - $100,000,000
Over $100,000,000 Over $100,000,000
Decline to Disclose Decline to Disclose
Not Applicable Not Applicable

6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)

Rule 504(b)(1) (not (i), (ii) or (iii))
Rule 504 (b)(1)(i)
Rule 504 (b)(1)(ii)
Rule 504 (b)(1)(iii)
X Rule 506(b)
Rule 506(c)
Securities Act Section 4(a)(5)
Investment Company Act Section 3(c)
Section 3(c)(1) Section 3(c)(9)
Section 3(c)(2) Section 3(c)(10)
Section 3(c)(3) Section 3(c)(11)
Section 3(c)(4) Section 3(c)(12)
Section 3(c)(5) Section 3(c)(13)
Section 3(c)(6) Section 3(c)(14)
Section 3(c)(7)

7. Type of Filing

8. Duration of Offering

9. Type(s) of Securities Offered (select all that apply)

Equity Pooled Investment Fund Interests
X Debt Tenant-in-Common Securities
Option, Warrant or Other Right to Acquire Another Security Mineral Property Securities
Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security Other (describe)

10. Business Combination Transaction

Clarification of Response (if Necessary):

11. Minimum Investment

Recipient
Recipient CRD Number None
Ambassador Financial Group, Inc. 143093
(Associated) Broker or Dealer X None
(Associated) Broker or Dealer CRD Number X None
None None
Street Address 1 Street Address 2
1605 North Cedar Crest Boulevard Suite 508
City State/Province/Country ZIP/Postal Code
Allentown PENNSYLVANIA 18104
State(s) of Solicitation (select all that apply)
Check “All States” or check individual States
All States
Foreign/non-US
FLORIDA
INDIANA
NEW JERSEY
NEW YORK
PENNSYLVANIA

13. Offering and Sales Amounts

Total Offering Amount $10,000,000 USD
or Indefinite
Total Amount Sold $10,000,000 USD
Total Remaining to be Sold $0 USD
or Indefinite

Clarification of Response (if Necessary):

14. Investors

15. Sales Commissions & Finder's Fees Expenses

Provide separately the amounts of sales commissions and finders fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.

Clarification of Response (if Necessary):

16. Use of Proceeds

Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.

Clarification of Response (if Necessary):

Signature and Submission

Please verify the information you have entered and review the Terms of Submission below before signing and clicking SUBMIT below to file this notice.

In submitting this notice, each issuer named above is:
  • Notifying the SEC and/or each State in which this notice is filed of the offering of securities described and undertaking to furnish them, upon written request, in the accordance with applicable law, the information furnished to offerees.*
  • Irrevocably appointing each of the Secretary of the SEC and, the Securities Administrator or other legally designated officer of the State in which the issuer maintains its principal place of business and any State in which this notice is filed, as its agents for service of process, and agreeing that these persons may accept service on its behalf, of any notice, process or pleading, and further agreeing that such service may be made by registered or certified mail, in any Federal or state action, administrative proceeding, or arbitration brought against the issuer in any place subject to the jurisdiction of the United States, if the action, proceeding or arbitration (a) arises out of any activity in connection with the offering of securities that is the subject of this notice, and (b) is founded, directly or indirectly, upon the provisions of: (i) the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, or the Investment Advisers Act of 1940, or any rule or regulation under any of these statutes, or (ii) the laws of the State in which the issuer maintains its principal place of business or any State in which this notice is filed.
  • Certifying that, if the issuer is claiming a Regulation D exemption for the offering, the issuer is not disqualified from relying on Rule 504 or Rule 506 for one of the reasons stated in Rule 504(b)(3) or Rule 506(d).

Each Issuer identified above has read this notice, knows the contents to be true, and has duly caused this notice to be signed on its behalf by the undersigned duly authorized person.

For signature, type in the signer's name or other letters or characters adopted or authorized as the signer's signature.

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.

* This undertaking does not affect any limits Section 102(a) of the National Securities Markets Improvement Act of 1996 ("NSMIA") [Pub. L. No. 104-290, 110 Stat. 3416 (Oct. 11, 1996)] imposes on the ability of States to require information. As a result, if the securities that are the subject of this Form D are "covered securities" for purposes of NSMIA, whether in all instances or due to the nature of the offering that is the subject of this Form D, States cannot routinely require offering materials under this undertaking or otherwise and can require offering materials only to the extent NSMIA permits them to do so under NSMIA's preservation of their anti-fraud authority.


More