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| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/24/2008 |
3. Issuer Name and Ticker or Trading Symbol
CVR ENERGY INC [ CVI ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| No securities are beneficially owned. | 0 | D | |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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: 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 | ||||
| Explanation of Responses: |
| Remarks: |
| Exhibit List: Exhibit 24: Power of Attorney |
| /s/ Edmund S. Gross, Attorney-in-fact | 09/26/2008 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * 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). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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 Number. | ||
LIMITED POWER OF ATTORNEY
The undersigned, being a person or entity who will be subject to the reporting obligations of
Section 16 of the Securities Exchange Act of 1934, as amended (the “Act”), with respect to
securities of CVR Energy, Inc. (the “Corporation”), hereby constitutes and appoints each of Edmund
S. Gross, James T. Rens and Susan M. Ball as the undersigned’s true and lawful attorney-in-fact and
agent solely so as to permit the undersigned to file Forms 3, 4 and 5 with the Securities and
Exchange Commission on the undersigned’s behalf pursuant to Section 16 of the Act, and the rules
and regulations promulgated thereunder, or any successor laws and regulations, as a consequence of
the undersigned’s ownership, acquisition or disposition of equity securities of the Corporation,
and to perform all acts necessary in order to file such forms as she shall deem appropriate. The
undersigned hereby ratifies and confirms all that said attorneys-in-fact and agent shall do or
cause to be done by virtue hereof.
This Limited Power of Attorney shall remain in full force and effect unless earlier revoked by
the undersigned in a writing delivered to the foregoing attorneys-in-fact.
This Limited Power of Attorney is executed as of the date set forth below.
| C. Scott Hobbs | ||||||||
| By: | /s/ C. Scott Hobbs | |||||||
| Dated: | 09/16/08 | |||||||