0001179110-17-014687.txt : 20171129 0001179110-17-014687.hdr.sgml : 20171129 20171129135851 ACCESSION NUMBER: 0001179110-17-014687 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171127 FILED AS OF DATE: 20171129 DATE AS OF CHANGE: 20171129 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: 814-00991 FILM NUMBER: 171227821 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: UNKNOWN SIC - 0000 [0000] IRS NUMBER: 204709758 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 328 BARRY AVENUE STREET 2: SUITE 210 CITY: WAYZATA STATE: MN ZIP: 55391 BUSINESS PHONE: 952 473 3442 MAIL ADDRESS: STREET 1: 328 BARRY AVENUE STREET 2: SUITE 210 CITY: WAYZATA STATE: MN ZIP: 55391 FORMER COMPANY: FORMER CONFORMED NAME: POKER MAGIC INC DATE OF NAME CHANGE: 20080129 4 1 edgar.xml FORM 4 - X0306 4 2017-11-27 0 0001425355 Mill City Ventures III, Ltd MCVT 0001394819 POLINSKY DOUGLAS MICHAEL 328 BARRY AVE, SUITE 210 WAYZATA MN 55391 1 1 0 0 Chairman and CEO Common Stock 69411 I By Great North Capital Corp. Common Stock 12728 I By Minor children Common Stock 290055 I By Lantern Advisers LLC Common Stock 2017-11-27 4 P 0 16000 .70 A 203364 D A Minnesota corporation, of which the Reporting Person is founder and Chief Executive Officer. The Reporting Person has no pecuniary interest in these shares and disclaims beneficial ownership. A limited liability company, of which the Reporting Person is a member and a manager. /s/ Douglas M. Polinsky 2017-11-29