0000849146-17-000086.txt : 20170728 0000849146-17-000086.hdr.sgml : 20170728 20170728120626 ACCESSION NUMBER: 0000849146-17-000086 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170727 FILED AS OF DATE: 20170728 DATE AS OF CHANGE: 20170728 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rose Justin CENTRAL INDEX KEY: 0001649432 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35647 FILM NUMBER: 17988751 MAIL ADDRESS: STREET 1: C/O LIFEVANTAGE CORPORATION STREET 2: 9785 S. MONROE ST. SUITE 300 CITY: SANDY STATE: UT ZIP: 84070 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 4 1 wf-form4_150125797292347.xml FORM 4 X0306 4 2017-07-27 0 0000849146 Lifevantage Corp LFVN 0001649432 Rose Justin 9785 SOUTH MONROE STREET, SUITE 300 SANDY UT 84070 0 1 0 0 Chief Sales Officer Common Stock 2017-07-27 4 F 0 2478 3.86 D 14316 D These shares were withheld to satisfy tax withholding obligations in connection with the partial vesting of a restricted stock award granted on July 27, 2015. /s/ Justin Rose 2017-07-28