0000849146-15-000045.txt : 20150305
0000849146-15-000045.hdr.sgml : 20150305
20150305135349
ACCESSION NUMBER: 0000849146-15-000045
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150303
FILED AS OF DATE: 20150305
DATE AS OF CHANGE: 20150305
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Lifevantage Corp
CENTRAL INDEX KEY: 0000849146
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 841097796
STATE OF INCORPORATION: CO
FISCAL YEAR END: 0630
BUSINESS ADDRESS:
STREET 1: 9815 S. MONROE STREET
STREET 2: SUITE 100
CITY: SANDY
STATE: UT
ZIP: 84070
BUSINESS PHONE: 801-432-9000
MAIL ADDRESS:
STREET 1: 9815 S. MONROE STREET
STREET 2: SUITE 100
CITY: SANDY
STATE: UT
ZIP: 84070
FORMER COMPANY:
FORMER CONFORMED NAME: LIFELINE THERAPEUTICS, INC.
DATE OF NAME CHANGE: 20041019
FORMER COMPANY:
FORMER CONFORMED NAME: YAAK RIVER RESOURCES INC
DATE OF NAME CHANGE: 19920703
FORMER COMPANY:
FORMER CONFORMED NAME: ANDRAPLEX CORP
DATE OF NAME CHANGE: 19920406
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Manovich Dave
CENTRAL INDEX KEY: 0001539712
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 15676821
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 9815 SOUTH MONROE ST., SUITE 100
CITY: SANDY
STATE: UT
ZIP: 84070
4
1
wf-form4_142558161969510.xml
FORM 4
X0306
4
2015-03-03
0
0000849146
Lifevantage Corp
LFVN
0001539712
Manovich Dave
9785 SOUTH MONROE STREET, SUITE 300
SANDY
UT
84070
1
1
0
0
Executive Vice Chairman
Common Stock
2015-03-03
4
D
0
25000
0
D
110000
D
Common Stock
305537
D
Common Stock
240000
I
By Spouse
Common Stock
40000
I
Beneficiary of 401(k) Account
These shares were acquired pursuant to a restricted stock award granted on November 19, 2014, which was cancelled in its entirety prior to vesting of the shares with the Reporting Person's consent on March 3, 2015. No consideration was paid to the Reporting Person for such cancellation.
Joint with spouse
/s/ Rob Cutler, Attorney-in-Fact
2015-03-05