0000849146-19-000103.txt : 20191209 0000849146-19-000103.hdr.sgml : 20191209 20191209170543 ACCESSION NUMBER: 0000849146-19-000103 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191205 FILED AS OF DATE: 20191209 DATE AS OF CHANGE: 20191209 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brockovich Erin CENTRAL INDEX KEY: 0001324073 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35647 FILM NUMBER: 191275889 MAIL ADDRESS: STREET 1: 5125 LANKERSHIM BOULEVARD CITY: NORTH HOLLYWOOD STATE: CA ZIP: 91601 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_157592912645176.xml FORM 4 X0306 4 2019-12-05 0 0000849146 Lifevantage Corp LFVN 0001324073 Brockovich Erin 9785 SOUTH MONROE STREET SUITE 400 SANDY UT 84070 1 0 0 0 Common Stock 2019-12-05 4 A 0 5051 15.20 A 8553 D These shares were granted to the reporting person pursuant to the issuer's outside director compensation program and will vest in a single installment on December 5, 2020, subject to continued service through such date. /s/ Erin Brockovich 2019-12-09