0001376139-12-000044.txt : 20120925 0001376139-12-000044.hdr.sgml : 20120925 20120925174554 ACCESSION NUMBER: 0001376139-12-000044 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120613 FILED AS OF DATE: 20120925 DATE AS OF CHANGE: 20120925 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HAUGEN ROBERT W CENTRAL INDEX KEY: 0001403554 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33492 FILM NUMBER: 121109776 MAIL ADDRESS: STREET 1: C/O CVR ENERGY, INC. STREET 2: 2277 PLAZA DRIVE, SUITE 500 CITY: SUGAR LAND STATE: TX ZIP: 77479 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CVR ENERGY INC CENTRAL INDEX KEY: 0001376139 STANDARD INDUSTRIAL CLASSIFICATION: PETROLEUM REFINING [2911] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2277 PLAZA DRIVE STREET 2: SUITE 500 CITY: SUGAR LAND STATE: TX ZIP: 77479 BUSINESS PHONE: (281) 207-7711 MAIL ADDRESS: STREET 1: 2277 PLAZA DRIVE STREET 2: SUITE 500 CITY: SUGAR LAND STATE: TX ZIP: 77479 5 1 primary_doc.xml PRIMARY DOCUMENT X0306 5 2012-06-13 0 0 0 0001376139 CVR ENERGY INC CVI 0001403554 HAUGEN ROBERT W C/O CVR ENERGY, INC. 2277 PLAZA DRIVE, SUITE 500 SUGAR LAND TX 77479 0 1 0 0 EVP, Refining Operations Common Stock 2012-06-13 5 P 0 1 24.54 A 43095 D /s/ Edmund S. Gross, Attorney-in-fact 2012-09-25