0000849146-17-000041.txt : 20170221
0000849146-17-000041.hdr.sgml : 20170220
20170221171443
ACCESSION NUMBER: 0000849146-17-000041
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170216
FILED AS OF DATE: 20170221
DATE AS OF CHANGE: 20170221
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: Manovich Dave
CENTRAL INDEX KEY: 0001539712
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 17625987
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_148771526969839.xml
FORM 4
X0306
4
2017-02-16
1
0000849146
Lifevantage Corp
LFVN
0001539712
Manovich Dave
9785 SOUTH MONROE STREET, SUITE 300
SANDY
UT
84070
0
0
0
1
Former Director
Common Stock
2017-02-16
4
A
0
7708
0
A
23423
D
Common Stock
43649
D
Common Stock
34286
I
By Spouse
Common Stock
5715
I
Beneficiary of 401(k) Account
These shares were granted to the reporting person pursuant to the issuer's outside director compensation program. The award compensates the reporting person for his service on the Board of Directors from the date of his re-election as a director at the annual meeting of shareholders held on October 15, 2015, through the following annual meeting of shareholders, which was held on February 16, 2017, and as such was fully vested at grant.
Joint with spouse
/s/ Dave Manovich
2017-02-21