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 |
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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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
JERNIGAN WYATT E 2277 PLAZA DRIVE SUITE 500 SUGAR LAND, TX 77479 |
 |  |  EVP, Crude Oil Acq. & Pet. Mkt |  |
/s/ Susan M. Ball, 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). |
 Remarks: Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC each own shares of CVR Energy, Inc. (the "Company") common stock, par value $0.01 per share ("Common Stock"). Mr. Jernigan owns common units equal to 0.039% of the total common units of each of Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC. Mr. Jernigan also owns (i) 215,896 override units in Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC and (ii) 594,284 phantom points pursuant to the Coffeyville Resources, LLC Phantom Unit Appreciation Plan (Plan I) and Coffeyville Resources, LLC Phantom Unit Appreciation Plan (Plan II). Override units and phantom points constitute rights to a portion of the profits generated by Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC.  The phantom unit appreciation plans are filed as exhibits 10.3 and 10.32 to the Company's Registration Statement on Form S-1, File No. 333-137588 (the "Registration Statement"). The limited liability company agreements of Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC are filed as exhibits 10.34 and 10.35, respectively, to the Registration Statement. Mr. Jernigan does not have the power to vote or dispose of the shares of Common Stock that correspond to his ownership of common units in Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC and thus does not have beneficial ownership of such shares.  In addition, Mr. Jernigan does not have any pecuniary interest in the shares of Common Stock held by Coffeyville Acquisition LLC and Coffeyville Acquisition II LLC (or override units or phantom points) because he does not control either Coffeyville Acquisition LLC or Coffeyville Acquisition II LLC and does not have or share investment control over either entity's securities. Exhibit List: Exhibit 24: Power of Attorney |