0000849146-19-000004.txt : 20190103
0000849146-19-000004.hdr.sgml : 20190103
20190103144535
ACCESSION NUMBER: 0000849146-19-000004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181231
FILED AS OF DATE: 20190103
DATE AS OF CHANGE: 20190103
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: 19504929
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 9785 SOUTH 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: DE
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_154654471951362.xml
FORM 4
X0306
4
2018-12-31
0
0000849146
Lifevantage Corp
LFVN
0001642848
Jensen Darren Jay
9785 SOUTH MONROE STREET, SUITE 400
SANDY
UT
84070
1
1
0
0
Chief Executive Officer
Common Stock
2018-12-31
4
M
0
178571
0
A
288071
D
Common Stock
2018-12-31
4
F
0
88036
13.19
D
200035
D
Performance Stock Units
2018-12-31
4
M
0
178571
0
D
2018-12-31
Common Stock
178571.0
0
D
On March 28, 2016, the reporting person was granted Performance Stock Units ("PSUs"), subject to a three-year performance period of 1/1/2016 through 12/31/2018, 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 116.7% of the previously reported target number of PSUs. Based on the issuer's total stockholder return performance during the Performance Period, the actual number of shares distributed was 116.7% of the target number of PSUs.
PSUs convert into common stock on a one-for-one basis.
These shares were withheld to satisfy tax withholding obligations in connection with the vesting of a PSU award granted on March 28, 2016.
/s/ Darren Jay Jensen
2019-01-03