SEC FORM
3
SEC Form 3
| 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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O GOLDMAN, SACHS & CO., 200 WEST ST. |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
04/07/2011
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3. Issuer Name and Ticker or Trading Symbol
CVR PARTNERS, LP
[ UAN ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
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| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
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| No securities are beneficially owned. |
|
Yvette Kosic, Attorney-in-fact |
04/07/2011 |
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** 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. |
Power of Attorney
POWER OF ATTORNEY
The undersigned
does hereby appoint Roger S. Begelman, Felicia Rector, Andrea DeMar, Yvette
Kosic and Kevin Treanor (and any other employee of The Goldman Sachs Group,
Inc. or one of its affiliates designated in writing by one of the
attorneys-in-fact), his true and lawful attorneys, and each of them his true
and lawful attorney, with power to act without the other, and with full power
of substitution and resubstitution, to execute for him and in his name any
Initial Statement of Beneficial Ownership of Securities on Form 3, any
Statement of Changes in Beneficial Ownership on Form 4 and any Annual
Statement of Changes in Beneficial Ownership on Form 5, or any similar or
successor form, which may be required to be filed by him with the Securities
and Exchange Commission and any and all instruments necessary or incidental
therewith, hereby granting unto said attorneys and each of them full power and
authority to do and perform in the name and on behalf of the undersigned, and
in any and all capacities, every act and thing whatsoever required or necessary
to be done in and about the premises, as fully and to all
intents and purposes as the undersigned might or could do in person, hereby
ratifying and approving the act of said attorneys and each of them.
This power of
attorney shall not be affected by the subsequent disability or incompetence of
the principal. This power of attorney shall remain in full force and effect
until either revoked in writing by the undersigned or until such time as the
person or persons to whom power of attorney has been hereby granted cease(s) to
be an employee of The Goldman Sachs Group, Inc. or one of its affiliates.
In witness thereof
the undersigned hereunto signed his name this 1st day of June 2007.
/s/ Scott L.
Lebovitz
