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