-----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, KyyTmf8rbvqjJFlKYbfROzu7YZLGSG3UfS+4OfwRT5OSDko4l38cBgCJtmerWDKI bLoHZ2XEfVkBLhbaC4Pm+Q== 0000021212-05-000006.txt : 20050104 0000021212-05-000006.hdr.sgml : 20050104 20050104155129 ACCESSION NUMBER: 0000021212-05-000006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041231 FILED AS OF DATE: 20050104 DATE AS OF CHANGE: 20050104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LAVERS RICHARD M CENTRAL INDEX KEY: 0001215511 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07160 FILM NUMBER: 05507213 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 lav560.xml X0202 4 2004-12-31 0 0000021212 COACHMEN INDUSTRIES INC COA 0001215511 LAVERS RICHARD M P O BOX 3300 ELKHART IN 46515 0 1 0 0 EVP, Sec'y & General Counsel Common Stock 18603.5350 D Common Stock 284.0000 I By 401(k) Stock Units 2004-12-31 4 A 0 148.6603 0 A 1988-08-08 1988-08-08 Common Stock 148.6603 2663.1749 I By Deferred Compensation Plan Stock Option (Right to Buy) 10.000 2001-10-06 2010-10-06 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 Based on shares reported as of current quarter end. 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 11.492 shares acquired on December 16, 2004 under the Coachmen Industries, Inc. DRIP. 401(k) holdings based on September 30, 2004 statement. By: By: Melanie A. DeMorrow as Attorney-in-fact for: 2005-01-04 -----END PRIVACY-ENHANCED MESSAGE-----