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