-----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, PzDJvuQQSSZQe5Q0ZzdqsBU8vtUqmzfTSed+4n6cJ9PetXjEBPqG8SD78QvN6GfD uDpwYHQZIh84lMomxsI2nQ== 0000021212-04-000137.txt : 20041001 0000021212-04-000137.hdr.sgml : 20041001 20041001185624 ACCESSION NUMBER: 0000021212-04-000137 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040930 FILED AS OF DATE: 20041001 DATE AS OF CHANGE: 20041001 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: 041059974 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 tom554.xml X0202 4 2004-09-30 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 2004-09-30 4 A 0 97.6941 0 A 20172.9669 D Common Stock 171.0000 I By 401(k) Stock Units 0.000 2004-09-30 4 A 0 304.2236 0 A 1988-08-08 1988-08-08 Common Stock 304.2236 4097.1843 I By Deferred Compensation Plan Stock Option (Right to Buy) 12.000 2002-08-06 2011-08-06 Common Stock 36000.0000 36000.0000 D Stock Option (Right to Buy) 16.500 2003-02-19 2012-02-19 Common Stock 5500.0000 5500.0000 D Stock Option (Right to Buy) 11.180 2004-03-28 2013-03-28 Common Stock 1600.0000 1600.0000 D Shares acquired under the Coachmen Employee Stock Purchase Plan as of September 30, 2004 quarterly purchase Based on shares reported as of October 1, 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 are payable in cash. Stock units representing amounts deferred by the reporting person are payable upon termination of employment. Direct holdings in Table I, column 5 include .257 shares acquired on Setpember 16, 2004 under the Coachmen Industries, Inc. DRIP. 401(k) holdings based on June 30, 2004 statement By: By: Melanie A. DeMorrow as Attorney-in-fact for: 2004-10-01 -----END PRIVACY-ENHANCED MESSAGE-----