0001104659-23-074270.txt : 20230623 0001104659-23-074270.hdr.sgml : 20230623 20230623162426 ACCESSION NUMBER: 0001104659-23-074270 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230621 FILED AS OF DATE: 20230623 DATE AS OF CHANGE: 20230623 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: 231038033 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: 814-01387 FILM NUMBER: 231038034 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: 814-01387 FILM NUMBER: 231038035 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: 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: 360 S. ROSEMARY, SUITE 1700 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: 360 S. ROSEMARY, SUITE 1700 CITY: WEST PALM BEACH STATE: FL ZIP: 33401 4 1 tm2319556-2_4seq1.xml OWNERSHIP DOCUMENT X0407 4 2023-06-21 0 0001841514 Commonwealth Credit Partners BDC I, 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 0 Common Stock 2023-06-21 4 P 0 5945.32 974.12 A 96991.25 D Common Stock 2023-06-21 4 P 0 9268.60 974.12 A 151206.87 D Common Stock 2023-06-21 4 P 0 15274.90 974.12 A 249192.90 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. UAW CHRYSLER RETIREES MEDICAL BENEFITS PLAN, By: /s/ Garon Meikle, Chief Financial Officer 2023-06-23 UAW FORD RETIREES MEDICAL BENEFITS PLAN, By: /s/ Garon Meikle, Chief Financial Officer 2023-06-23 UAW GM RETIREES MEDICAL BENEFITS PLAN, By: /s/ Garon Meikle, Chief Financial Officer 2023-06-23