0000849146-17-000029.txt : 20170214
0000849146-17-000029.hdr.sgml : 20170214
20170214191932
ACCESSION NUMBER: 0000849146-17-000029
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170213
FILED AS OF DATE: 20170214
DATE AS OF CHANGE: 20170214
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: Mauro Garry Paul
CENTRAL INDEX KEY: 0001436020
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 17612271
MAIL ADDRESS:
STREET 1: 6400 S. FIDDLER'S GREEN CIRCLE
STREET 2: SUITE 1970
CITY: GREENWOOD VILLAGE
STATE: X1
ZIP: 80111
4
1
wf-form4_148711795830636.xml
FORM 4
X0306
4
2017-02-13
0
0000849146
Lifevantage Corp
LFVN
0001436020
Mauro Garry Paul
9785 SOUTH MONROE STREET, SUITE 300
SANDY
UT
84070
1
0
0
0
Common Stock
2017-02-13
4
P
0
1700
6.71
A
46513
D
Common Stock
2017-02-13
4
P
0
225
6.75
A
225
I
By Spouse
Common Stock
2017-02-13
4
P
0
170
6.75
A
196
I
By Son (F.M.)
Common Stock
2017-02-13
4
P
0
170
6.75
A
195
I
By Son (D.M.)
Common Stock
2017-02-13
4
P
0
170
6.75
A
195
I
By Son (A.M.)
Common Stock
54
I
By Son (D.W.M.)
Common Stock
54
I
By Daughter (A.P.M.)
Garry P. Mauro
2017-02-14