-----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, AMO/qH71UREFtTgEQo99hQRYz2TXe7G1d+l6AVQDV0pHwWd6bq4Rglw9de9y2SX8 Xu1DCsiCnHL1uS1+UynauQ== 0000021212-06-000015.txt : 20060103 0000021212-06-000015.hdr.sgml : 20060102 20060103175828 ACCESSION NUMBER: 0000021212-06-000015 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051230 FILED AS OF DATE: 20060103 DATE AS OF CHANGE: 20060103 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: 06503771 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 tom642.xml X0202 4 2005-12-30 1 0000021212 COACHMEN INDUSTRIES INC COA 0001215513 TOMCZAK JOSEPH P P O BOX 3300 ELKHART IN 46515 0 0 0 1 Former Exec VP & CFO Common Stock 2005-12-30 4 A 0 144.4232 10.3320 A 6379.7232 D Common Stock 225.0000 I By 401(k) Stock Option (Right to Buy) 11.1800 2004-03-28 2013-03-28 Common Stock 800.0000 800.0000 D Stock Units 2005-12-30 4 D 0 2877.7214 0 D 1988-08-08 1988-08-08 Common Stock 2877.7214 1991.7358 I By Deferred Compensation Plan Stock Option (Right to Buy) 12.0000 2002-08-06 2011-08-06 Common Stock 36000.0000 36000.0000 D Stock Option (Right to Buy) 16.5000 2003-02-19 2012-02-19 Common Stock 4125.0000 4125.0000 D Shares acquired under the Coachmen Employee Stock Purchase Plan as of current quarterly purchase 1-for-1 Based on shares reported as of current quarter end. Represents forfeiture of unvested portion of stock units under the Coachmen Industries, Inc. Deferred Compensation Plan. Holdings in Table l, column 5 includes .0372 shares acquired on 10/05/05 and .0372 shares acquired on 12/15/05 under the Coachmen Industries, Inc. DRIP. 401(k) Holdings based on September 30, 2005 statement By: By: Melanie A. DeMorrow as Attorney-in-fact for: 2006-01-03 -----END PRIVACY-ENHANCED MESSAGE-----