0001104659-21-120683.txt : 20210929
0001104659-21-120683.hdr.sgml : 20210929
20210929140610
ACCESSION NUMBER: 0001104659-21-120683
CONFORMED SUBMISSION TYPE: 3/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210817
FILED AS OF DATE: 20210929
DATE AS OF CHANGE: 20210929
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: UAW Retiree Medical Benefits Trust
CENTRAL INDEX KEY: 0001480561
STATE OF INCORPORATION: XX
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290905
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: HARPER HERSHEL
CENTRAL INDEX KEY: 0001794997
FILING VALUES:
FORM TYPE: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290901
MAIL ADDRESS:
STREET 1: C/O UAW RETIREE MEDICAL BENEFITS TRUST
STREET 2: 200 WALKER STREET
CITY: DETROIT
STATE: MI
ZIP: 48207
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: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290902
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: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290903
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: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 814-01387
FILM NUMBER: 211290904
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: 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: 525 OKEECHOBEE BOULEVARD, SUITE 1050
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: 525 OKEECHOBEE BOULEVARD, SUITE 1050
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
3/A
1
tm2128761d1_3a.xml
FORM 3/A
X0206
3/A
2021-08-17
2021-08-17
0
0001841514
Commonwealth Credit Partners BDC I, Inc.
NONE
0001480561
UAW Retiree Medical Benefits Trust
1155 BREWERY PARK BLVD., SUITE 400
DETROIT
MI
48207
0
0
1
0
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
0001794997
HARPER HERSHEL
C/O UAW RETIREE MEDICAL BENEFITS TRUST
1155 BREWERY PARK BLVD., SUITE 400
DETROIT
MI
48207
0
0
1
0
Common Stock
5791.455
D
Common Stock
9028.731
D
Common Stock
14879.586
D
This Form 3 amendment is being filed to correct the original Form 3 filed on August 17, 2021. The amount of securities beneficially owned for each Reporting Person was incorrectly stated on the original Form 3.
These Shares are owned directly by the UAW Chrysler Retirees Medical Benefits Plan. The UAW Chrysler Retirees Medical Benefits Plan is an employee welfare benefit plan established under the UAW RMBT. Hershel Harper is the Chief Investment Officer of the UAW RMBT. The UAW RMBT is deemed to be the indirect beneficial owner of these Shares by reason of its ability to direct the vote and/or disposition of such Shares. The UAW RMBT does not have a pecuniary interest in such Shares (within the meaning of Rule 16a-1(a)(2) under the Securities Exchange Act of 1934, as amended (the "Exchange Act")). Hershel Harper is deemed to be the indirect beneficial owner of these Shares by reason of his ability to direct the vote and/or disposition of such Shares. Hershel Harper does not have a pecuniary interest in such Shares (within the meaning of Rule 16a-1(a)(2) under the Exchange Act).
These Shares are owned directly by the UAW Ford Retirees Medical Benefits Plan. The UAW Ford Retirees Medical Benefits Plan is an employee welfare benefit plan established under the UAW RMBT. Hershel Harper is the Chief Investment Officer of the UAW RMBT. The UAW RMBT is deemed to be the indirect beneficial owner of these Shares by reason of its ability to direct the vote and/or disposition of such Shares. The UAW RMBT does not have a pecuniary interest in such Shares (within the meaning of Rule 16a-1(a)(2) under the Exchange Act). Hershel Harper is deemed to be the indirect beneficial owner of these Shares by reason of his ability to direct the vote and/or disposition of such Shares. Hershel Harper does not have a pecuniary interest in such Shares (within the meaning of Rule 16a-1(a)(2) under the Exchange Act).
These Shares are owned directly by the UAW GM Retirees Medical Benefits Plan. The UAW GM Retirees Medical Benefits Plan is an employee welfare benefit plan established under the UAW RMBT. Hershel Harper is the Chief Investment Officer of the UAW RMBT. The UAW RMBT is deemed to be the indirect beneficial owner of these Shares by reason of its ability to direct the vote and/or disposition of such Shares. The UAW RMBT does not have a pecuniary interest in such Shares (within the meaning of Rule 16a-1(a)(2) under the Exchange Act). Hershel Harper is deemed to be the indirect beneficial owner of these Shares by reason of his ability to direct the vote and/or disposition of such Shares. Hershel Harper does not have a pecuniary interest in such Shares (within the meaning of Rule 16a-1(a)(2) under the Exchange Act).
This Form 3 is being filed by (i) UAW Retiree Medical Benefits Trust, organized as a 501(c)(9) Voluntary Employee Beneficiary Association (the "UAW RMBT"); (ii) 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 RMBT (the "UAW Chrysler Retirees Medical Benefits Plan"); (iii) 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 (the "UAW Ford Retirees Medical Benefits Plan"); (iv) 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 (the "UAW GM Retirees Medical Benefits Plan"); and (v) Hershel Harper, a United States citizen and the Chief Investment Officer of the Trust (collectively, the "Reporting Persons"). The Reporting Persons are members of a group that owns more than 10% of the common stock (the "Shares") of Commonwealth Credit Partners BDC I, Inc. (the "Issuer").
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29
By: /s/ Garon Meikle, Name: Garon Meikle, Title: Controller
2021-09-29
/s/ Hershel Harper
2021-09-29