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