0001104659-24-000614.txt : 20240103 0001104659-24-000614.hdr.sgml : 20240103 20240103093847 ACCESSION NUMBER: 0001104659-24-000614 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240102 FILED AS OF DATE: 20240103 DATE AS OF CHANGE: 20240103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: UAW GM RETIREES MEDICAL BENEFITS PLAN CENTRAL INDEX KEY: 0001795050 ORGANIZATION NAME: FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 814-01563 FILM NUMBER: 24504583 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 ORGANIZATION NAME: FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 814-01563 FILM NUMBER: 24504584 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 ORGANIZATION NAME: FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 814-01563 FILM NUMBER: 24504585 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: Brightwood Capital Corp I CENTRAL INDEX KEY: 0001895316 ORGANIZATION NAME: 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 tm241543-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2024-01-02 0 0001895316 Brightwood Capital Corp I 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 2024-01-02 4 P 0 947619 10.50 A 7179263 D Common Stock 2024-01-02 4 P 0 1466667 10.50 A 11111623 D Common Stock 2024-01-02 4 P 0 2347619 10.50 A 17785812 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 2024-01-03 UAW FORD RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Chief Financial Officer 2024-01-03 UAW GM RETIREES MEDICAL BENEFITS PLAN By: /s/ Garon Meikle Name: Garon Meikle Title: Chief Financial Officer 2024-01-03