0001104659-22-119190.txt : 20221115 0001104659-22-119190.hdr.sgml : 20221115 20221115171449 ACCESSION NUMBER: 0001104659-22-119190 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221110 FILED AS OF DATE: 20221115 DATE AS OF CHANGE: 20221115 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: 814-01563 FILM NUMBER: 221392062 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: 814-01563 FILM NUMBER: 221392063 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: 814-01563 FILM NUMBER: 221392064 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: Brightwood Capital Corp I CENTRAL INDEX KEY: 0001895316 IRS NUMBER: 000000000 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 810 SEVENTH AVENUE, 26TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 646-957-9525 MAIL ADDRESS: STREET 1: 810 SEVENTH AVENUE, 26TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019 4 1 tm2230606-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-11-10 0 0001895316 Brightwood Capital Corp I 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 2022-11-10 4 P 0 995000 10.00 A 2985000 D Common Stock 2022-11-10 4 P 0 1540000 10.00 A 4620000 D Common Stock 2022-11-10 4 P 0 2465000 10.00 A 7395000 D These shares of common stock (the "Shares") of Brightwood Capital Corporation I (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: Chief Financial Officer 2022-11-15 UAW FORD RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Chief Financial Officer 2022-11-15 UAW GM RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Chief Financial Officer 2022-11-15