0001104659-21-152011.txt : 20211221
0001104659-21-152011.hdr.sgml : 20211221
20211221101927
ACCESSION NUMBER: 0001104659-21-152011
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211220
FILED AS OF DATE: 20211221
DATE AS OF CHANGE: 20211221
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: 814-01393
FILM NUMBER: 211507311
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: 814-01393
FILM NUMBER: 211507312
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: 814-01393
FILM NUMBER: 211507313
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: Kayne DL 2021, Inc.
CENTRAL INDEX KEY: 0001850787
IRS NUMBER: 862440860
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 811 MAIN STREET, 14TH FLOOR
CITY: HOUSTON
STATE: TX
ZIP: 77002
BUSINESS PHONE: 713-493-2020
MAIL ADDRESS:
STREET 1: 811 MAIN STREET, 14TH FLOOR
CITY: HOUSTON
STATE: TX
ZIP: 77002
4
1
tm2135791-1_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-12-20
0
0001850787
Kayne DL 2021, 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
2021-12-20
4
P
0
1544.400
5000
A
1660.23
D
Common Stock
2021-12-20
4
P
0
2407.680
5000
A
2588.256
D
Common Stock
2021-12-20
4
P
0
3967.920
5000
A
4265.514
D
These shares of common stock (the "Shares") of Kayne DL 2021, 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.
UAW CHRYSLER RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Controller
2021-12-20
UAW FORD RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Controller
2021-12-20
UAW GM RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Controller
2021-12-20