0000849146-17-000076.txt : 20170329
0000849146-17-000076.hdr.sgml : 20170329
20170329163446
ACCESSION NUMBER: 0000849146-17-000076
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170328
FILED AS OF DATE: 20170329
DATE AS OF CHANGE: 20170329
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: Washington Beatryx
CENTRAL INDEX KEY: 0001698608
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 17722644
MAIL ADDRESS:
STREET 1: 9785 S. MONROE STREET, SUITE 300
CITY: SANDY
STATE: UT
ZIP: 84070
4
1
wf-form4_149081967192569.xml
FORM 4
X0306
4
2017-03-28
0
0000849146
Lifevantage Corp
LFVN
0001698608
Washington Beatryx
9785 S. MONROE STREET, SUITE 300
SANDY
UT
84070
0
1
0
0
Senior VP and General Counsel
Performance Stock Units
2017-03-28
4
A
0
46700
0
A
2019-12-31
Common Stock
46700.0
46700
D
The Performance Stock Units ("PSUs") are subject to a three-year performance period of 1/1/2017 through 12/31/2019, subject to earlier expiration upon a change in control of the issuer ("Performance Period"). Subject generally to the reporting person's continued service with the issuer, each PSU represents a contingent right for such person to receive, within 30 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 PSUs. The actual number of shares distributed will be based on the issuer's total stockholder return (TSR) performance during the Performance Period. Vesting for 50% of the target PSUs 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 PSUs is based upon a relative comparison of the issuer's TSR to the Vanguard Russell 2000 exchange traded fund TSR for such period.
/s/ Beatryx Washington
2017-03-29