0000849146-16-000139.txt : 20160104
0000849146-16-000139.hdr.sgml : 20160104
20160104162856
ACCESSION NUMBER: 0000849146-16-000139
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160104
FILED AS OF DATE: 20160104
DATE AS OF CHANGE: 20160104
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: 9785 S. MONROE STREET
STREET 2: SUITE 300
CITY: SANDY
STATE: UT
ZIP: 84070
BUSINESS PHONE: 801-432-9000
MAIL ADDRESS:
STREET 1: 9785 S. MONROE STREET
STREET 2: SUITE 300
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: Jensen Darren Jay
CENTRAL INDEX KEY: 0001642848
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 161318432
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 9785 SOUTH MONROE ST. SUITE 300
CITY: SANDY
STATE: UT
ZIP: 84070
4
1
wf-form4_145194292220472.xml
FORM 4
X0306
4
2016-01-04
0
0000849146
Lifevantage Corp
LFVN
0001642848
Jensen Darren Jay
9785 SOUTH MONROE STREET, SUITE 300
SANDY
UT
84070
0
1
0
0
Chief Executive Officer
Performance Stock Units
2016-01-04
4
A
0
51000
0
A
2016-12-31
Common Stock
51000.0
51000
D
Performance Stock Units
2016-01-04
4
A
0
51000
0
A
2017-12-31
Common Stock
51000.0
51000
D
Performance Stock Units
2016-01-04
4
A
0
51000
0
A
2018-12-31
Common Stock
51000.0
51000
D
Subject generally to the reporting person's continued service with the issuer, each Performance Stock Unit represents a contingent right for the reporting person to receive, within thirty days after the end of the Performance Period, a distribution of common shares of the issuer equal to 0% to 200% of the reported target number of Performance Stock Units. The actual number of shares distributed will be based on the issuer's total stockholder return (TSR) performance during the performance period of 1/1/2016 through the earlier of 12/31/2016 or a change in control of the issuer ("Performance Period"). The vesting for 50% of the target Performance Stock Units is based upon the issuer's absolute TSR for the Performance Period as compared to a matrix of fixed numeric values and the vesting for the other 50% of the target Performance Stock Units is based upon a relative comparison of the issuer's TSR to the Vanguard Russell 2000 exchange traded fund TSR for the Performance Period.
The vesting and distribution conditions for the reported target Performance Stock Units are the same as described under footnote (1), except that the Performance Period is 1/1/2017 through the earlier of 12/31/2017 or a change in control of the issuer.
The vesting and distribution conditions for the reported target Performance Stock Units are the same as described under footnote (1), except that the Performance Period is 1/1/2018 through the earlier of 12/31/2018 or a change in control of the issuer.
/s/ Darren Jay Jensen
2016-01-04