0001104659-22-100763.txt : 20220916
0001104659-22-100763.hdr.sgml : 20220916
20220916142650
ACCESSION NUMBER: 0001104659-22-100763
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220914
FILED AS OF DATE: 20220916
DATE AS OF CHANGE: 20220916
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: POLINSKY DOUGLAS MICHAEL
CENTRAL INDEX KEY: 0001394819
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41472
FILM NUMBER: 221247827
MAIL ADDRESS:
STREET 1: 130 LAKE ST. WEST
CITY: WAYZATA
STATE: MN
ZIP: 55391
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
tm2226063-1_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2022-09-14
0
0001425355
Mill City Ventures III, Ltd
MCVT
0001394819
POLINSKY DOUGLAS MICHAEL
130 LAKE ST. WEST
WAYZATA
MN
55391
1
1
0
0
Chief Executive Officer
Common Stock
30850
I
By Great North Capital Corp.
Common Stock
128915
I
By Lantern Advisers LLC
Common Stock
246165
D
Common Stock
2022-09-14
4
P
0
1181
2.80
A
247346
D
Common Stock
2022-09-14
4
P
0
8819
2.85
A
256165
D
Common Stock
2022-09-15
4
P
0
529
2.73
A
256694
D
Common Stock
2022-09-15
4
P
0
200
2.75
A
256894
D
Common Stock
2022-09-15
4
P
0
85
2.78
A
256979
D
A Minnesota corporation of which the reporting person is the Chief Executive Officer.
A Minnesota limited liability company of which the reporting person is a member and manager. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest.
Of the reported amount, 10,000 common shares are held subject to forfeiture pursuant to a restricted stock agreement with the issuer under which all such shares are to vest, and forfeiture restrictions lapse, on January 24, 2023.
/s/ Douglas M. Polinsky
2022-09-16