UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
|
| ||||||||||||||||||||||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
GOLDMAN SACHS GROUP INC/ 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GOLDMAN SACHS & CO 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GS CAPITAL PARTNERS V FUND LP 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GSCP V ADVISORS, LLC 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GS CAPITAL PARTNERS V OFFSHORE FUND LP 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GSCP V OFFSHORE ADVISORS LLC 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GS Capital Partners V Institutional L P 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GS ADVISORS V LLC 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
GS CAPITAL PARTNERS V GmbH & CO KG 85 BROAD ST NEW YORK, NY 10004 |
 |  X |  |  |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date | |
/s/ Yvette Kosic, Attorney-in-fact | 10/22/2007 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | This statement is being filed by The Goldman Sachs Group, Inc. ("GS Group"), Goldman, Sachs & Co. ("Goldman Sachs"), GSCP V Advisors, L.L.C. ("GSCP Advisors"), GSCP V Offshore Advisors, L.L.C. ("GSCP Offshore Advisors"), GS Advisors V, L.L.C. ("GS Advisors"), Goldman, Sachs Management GP GmbH ("GS GmbH"), GS Capital Partners V Fund, L.P. ("GS Capital"), GS Capital Partners V Offshore Fund, L.P. ("GS Offshore"), GS Capital Partners V GmbH & Co. KG ("GS Germany"), GS Capital Partners V Institutional, L.P. ("GS Institutional" and, together with GS Capital, GS Offshore and GS Germany, the "Funds") and Coffeyville Acquisition II LLC ("CA II") (GS Group, Goldman Sachs, GSCP Advisors, GSCP Offshore Advisors, GS Advisors, GS GmbH, the Funds and CA II, collectively, the "Reporting Persons"). |
(2) | Due to the electronic system's limitation of 10 Reporting Persons per joint filing, this statement is being filed in duplicate. |
(3) | The 31,433,360 shares of CVR Energy, Inc. (the "Company") common stock, par value $0.01 per share ("Common Stock") reported herein are beneficially owned directly by CA II. The Funds are members of CA II and own common units of CA II. At this time, the Funds' common units correspond to 31,125,918 shares of Common Stock. The common units of CA II that correspond to the balance of the Common Stock owned by CA II are held by certain officers and directors of the Company. |
(4) | Goldman Sachs and GS Group may be deemed to beneficially own indirectly, in the aggregate, all of the Common Stock owned directly by CA II through the Funds because (i) affiliates of Goldman Sachs and GS Group are the general partner, managing general partner, managing partner, managing member or member of the Funds and (ii) the Funds control CA II and have the power to vote or dispose of the Common Stock owned by CA II. Goldman Sachs is a direct and indirect wholly-owned subsidiary of GS Group. Goldman Sachs is the investment manager of certain of the Funds. |
(5) | GS Capital and its general partner, GSCP Advisors, may be deemed to beneficially own indirectly 16,389,665 shares of Common Stock. GSCP Offshore and its general partner, GSCP Offshore Advisors, may be deemed to beneficially own indirectly 8,466,218 shares of Common Stock. GS Institutional and its general partner, GS Advisors, may be deemed to beneficially own indirectly 5,620,242 shares of Common Stock. GS Germany and its general partner, GS GmbH, may be deemed to beneficially own indirectly 649,793 shares of Common Stock. |
(6) | The Reporting Persons disclaim beneficial ownership of all shares of Common Stock in excess of their pecuniary interest, if any, and this report shall not be deemed an admission that any such person or entity is the beneficial owner of, or has any pecuniary interest in, such securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. |