0001104659-22-090311.txt : 20220812 0001104659-22-090311.hdr.sgml : 20220812 20220812215950 ACCESSION NUMBER: 0001104659-22-090311 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220811 FILED AS OF DATE: 20220812 DATE AS OF CHANGE: 20220812 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ZIPKIN LAURENCE S CENTRAL INDEX KEY: 0001166727 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41472 FILM NUMBER: 221162037 MAIL ADDRESS: STREET 1: 701 XENIA AVE S. STREET 2: SUITE 130 CITY: MINNEAPOLIS STATE: MN ZIP: 55416 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Mill City Ventures III, Ltd CENTRAL INDEX KEY: 0001425355 STANDARD INDUSTRIAL CLASSIFICATION: SHORT-TERM BUSINESS CREDIT INSTITUTIONS [6153] IRS NUMBER: 900316651 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1907 WAYZATA BOULEVARD STREET 2: SUITE 205 CITY: WAYZATA STATE: MN ZIP: 55391 BUSINESS PHONE: (952) 479-1923 MAIL ADDRESS: STREET 1: 1907 WAYZATA BOULEVARD STREET 2: SUITE 205 CITY: WAYZATA STATE: MN ZIP: 55391 FORMER COMPANY: FORMER CONFORMED NAME: POKER MAGIC INC DATE OF NAME CHANGE: 20080129 4 1 tm2223424d1_4.xml OWNERSHIP DOCUMENT X0306 4 2022-08-11 0 0001425355 Mill City Ventures III, Ltd MCVT 0001166727 ZIPKIN LAURENCE S 10275 WAYZATA BOULEVARD, SUITE 100 MINNETONKA MN 55305 1 0 0 0 Common Stock 36859 D Common Stock 2022-08-11 4 A 0 15000 4.00 A 51859 D All shares reported on this Form reflect a reverse stock split effected on August 9, 2022, pursuant to which every 2.25 shares issued and outstanding at that time were combined into one whole share, with any resulting fraction of a share rounded up to the nearest whole share. Of the reported amount, 6,667 common shares are subject to forfeiture pursuant to a restricted stock agreement with the issuer. Forfeiture restrictions on those 6,667 common shares lapse on January 24, 2023. /s/ Laurence S. Zipkin 2022-08-12