0001104659-21-120684.txt : 20210929
0001104659-21-120684.hdr.sgml : 20210929
20210929140700
ACCESSION NUMBER: 0001104659-21-120684
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210928
FILED AS OF DATE: 20210929
DATE AS OF CHANGE: 20210929
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: UAW GM RETIREES MEDICAL BENEFITS PLAN
CENTRAL INDEX KEY: 0001795050
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290908
BUSINESS ADDRESS:
STREET 1: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
BUSINESS PHONE: 313-324-5928
MAIL ADDRESS:
STREET 1: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: UAW Ford Retireees Medical Benefits Plan
CENTRAL INDEX KEY: 0001795052
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290909
BUSINESS ADDRESS:
STREET 1: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
BUSINESS PHONE: 313-324-5928
MAIL ADDRESS:
STREET 1: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: UAW Chrysler Retireees Medical Benefits Plan
CENTRAL INDEX KEY: 0001795057
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290910
BUSINESS ADDRESS:
STREET 1: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
BUSINESS PHONE: 313-324-5928
MAIL ADDRESS:
STREET 1: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Commonwealth Credit Partners BDC I, Inc.
CENTRAL INDEX KEY: 0001841514
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: C/O COMVEST CAPITAL ADVISORS, LLC
STREET 2: 525 OKEECHOBEE BOULEVARD, SUITE 1050
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
BUSINESS PHONE: 561.727.2100
MAIL ADDRESS:
STREET 1: C/O COMVEST CAPITAL ADVISORS, LLC
STREET 2: 525 OKEECHOBEE BOULEVARD, SUITE 1050
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
4
1
tm2128761d2_4.xml
FORM 4
X0306
4
2021-09-28
0
0001841514
Commonwealth Credit Partners BDC I, Inc.
NONE
0001795057
UAW Chrysler Retireees Medical Benefits Plan
C/O UAW RETIREE MEDICAL BENEFITS TRUST
1155 BREWERY PARK BLVD., SUITE 400
DETROIT
MI
48207
0
0
1
0
0001795052
UAW Ford Retireees Medical Benefits Plan
C/O UAW RETIREE MEDICAL BENEFITS TRUST
1155 BREWERY PARK BLVD., SUITE 400
DETROIT
MI
48207
0
0
1
0
0001795050
UAW GM RETIREES MEDICAL BENEFITS PLAN
C/O UAW RETIREE MEDICAL BENEFITS TRUST
1155 BREWERY PARK BLVD., SUITE 400
DETROIT
MI
48207
0
0
1
0
Common Stock
2021-09-28
4
P
0
3860.97
1000
A
9652.43
D
Common Stock
2021-09-28
4
P
0
6019.15
1000
A
15047.88
D
Common Stock
2021-09-28
4
P
0
9919.72
1000
A
24799.31
D
These shares of common stock (the "Shares") of Commonwealth Credit Partners BDC I, Inc. (the "Issuer") are owned directly by the UAW Chrysler Retirees Medical Benefits Plan, as established and maintained by the UAW Chrysler Retirees Employees' Beneficiary Association, an employee organization within the meaning of Section 3(4) of the Employee Retirement Income Security Act of 1974, as amended ("ERISA") under the UAW Retiree Medical Benefits Trust, organized as a 501(c)(9) Voluntary Employee Beneficiary Association (the "UAW RMBT").
These Shares of the Issuer are owned directly by the UAW Ford Retirees Medical Benefits Plan, as established and maintained by the UAW Ford Retirees Employees' Beneficiary Association, an employee organization within the meaning of Section 3(4) of ERISA under the UAW RMBT.
These Shares of the Issuer are owned directly by the UAW GM Retirees Medical Benefits Plan, as established and maintained by the UAW GM Retirees Employees' Beneficiary Association, an employee organization within the meaning of Section 3(4) of ERISA under the UAW RMBT.
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29