-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PaVTYZ/cUsq0+T6UsKNcVvMOMkLK4J1HXRqolzJXjDqKsrka7zjE3O6TALPjvrm/ FDAvQtbrPL+5Z78/xe2GjA== 0000021212-04-000014.txt : 20040102 0000021212-04-000014.hdr.sgml : 20040101 20040102174836 ACCESSION NUMBER: 0000021212-04-000014 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TOMCZAK JOSEPH P CENTRAL INDEX KEY: 0001215513 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07160 FILM NUMBER: 04501740 BUSINESS ADDRESS: STREET 1: P O BOX 3300 CITY: ELKHART STATE: IN ZIP: 465153300 MAIL ADDRESS: STREET 1: P O BOX 3300 CITY: ELKHART STATE: IN ZIP: 465153300 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: COACHMEN INDUSTRIES INC CENTRAL INDEX KEY: 0000021212 STANDARD INDUSTRIAL CLASSIFICATION: MOTOR HOMES [3716] IRS NUMBER: 351101097 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2831 DEXTER DRIVE CITY: ELKHART STATE: IN ZIP: 46514 BUSINESS PHONE: 5742620123 MAIL ADDRESS: STREET 1: PO BOX 3300 STREET 2: 2831 DEXTER DRIVE CITY: ELKHART STATE: IN ZIP: 46515 4 1 tom481.xml X0201 4 2003-12-31 0 0000021212 COACHMEN INDUSTRIES INC COA 0001215513 TOMCZAK JOSEPH P P O BOX 3300 ELKHART IN 46515 0 1 0 0 Exec. VP & CFO Common Stock 2003-12-31 4 A 0 121.766 0 A 11167.8683 D Common Stock 131.0000 I By 401(k) Stock Units 0.00 2003-12-31 4 A 0 364.5218 0 A 1988-08-08 1988-08-08 Common Stock 364.5218 3217.5681 I By Deferred Compensation Plan Restricted Stock Grant 0.00 2002-07-02 2004-07-02 Common Stock 1500.0000 1500.0000 D Stock Option (Right to Buy) 12.00 2002-08-06 2011-08-06 Common Stock 36000.0000 36000.0000 D Stock Option (Right to Buy) 16.50 2003-02-19 2012-02-19 Common Stock 5500.0000 5500.0000 D Stock Option (Right to Buy) 11.18 2004-03-28 2013-03-28 Common Stock 1600.0000 1600.0000 D Shares acquired under the Coachmen Employee Stock Purchase Plan as of December 31, 2003 quarterly purchase Based on shares reported as of January 2, 2004. The stock units represent amounts deferred and employer matching contributions accrued under the Coachmen Industries, Inc. Deferred Compensation Plan. Stock units representing employer matching contributions vest in 5 years (subject to acceleration upon certain events) and are payable following the termination of employment or a change in control, subject to forfetiture if certain post-employment covenants are breached. Stock units representing 50% of the employer matching contributions are payable in common stock (subject to certain diversification rights) and the remainder of stock units are payable in common stock or cash at the reporting person's election. Stock units representing amounts deferred by the reporting person are payable upon termination of employment. 401(k) shares based on December 31, 2003 statement. Shares decreased due to increase in stock price. Direct holdings in Table I, column 5 include 10.3640 shares acquired on December 23, 2003 under the Coachmen Indusries, Inc. DRIP By: Melanie A. DeMorrow as Attorney-in-fact 2004-01-02 -----END PRIVACY-ENHANCED MESSAGE-----