0001104659-23-027835.txt : 20230302 0001104659-23-027835.hdr.sgml : 20230302 20230302141342 ACCESSION NUMBER: 0001104659-23-027835 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230228 FILED AS OF DATE: 20230302 DATE AS OF CHANGE: 20230302 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: 23698018 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 Retirees 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: 23698019 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 FORMER NAME: FORMER CONFORMED NAME: UAW Ford Retireees Medical Benefits Plan DATE OF NAME CHANGE: 20191125 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: UAW Chrysler Retirees 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: 23698020 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 FORMER NAME: FORMER CONFORMED NAME: UAW Chrysler Retireees Medical Benefits Plan DATE OF NAME CHANGE: 20191125 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 tm238377-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2023-02-28 0 0001850787 Kayne DL 2021, Inc. NONE 0001795057 UAW Chrysler Retirees 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 Retirees 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 2023-02-28 4 P 0 921.744 5236.00 A 4956.295 D Common Stock 2023-02-28 4 P 0 1436.975 5236.00 A 7726.736 D Common Stock 2023-02-28 4 P 0 2368.172 5236.00 A 12733.865 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, Chief Financial Officer 2023-03-02 UAW FORD RETIREES MEDICAL BENEFITS PLAN, By: /s/ Garon Meikle, Chief Financial Officer 2023-03-02 UAW GM RETIREES MEDICAL BENEFITS PLAN, By: /s/ Garon Meikle, Chief Financial Officer 2023-03-02