0000849146-20-000006.txt : 20200103 0000849146-20-000006.hdr.sgml : 20200103 20200103112908 ACCESSION NUMBER: 0000849146-20-000006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191231 FILED AS OF DATE: 20200103 DATE AS OF CHANGE: 20200103 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: 20503869 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: 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_157806892850805.xml FORM 4 X0306 4 2019-12-31 0 0000849146 Lifevantage Corp LFVN 0001649432 Rose Justin 9785 SOUTH MONROE STREET, SUITE 400 SANDY UT 84070 0 1 0 0 Chief Sales Officer Common Stock 2019-12-31 4 M 0 93400 0 A 188594 D Common Stock 2019-12-31 4 F 0 42311 15.61 D 146283 D Performance Stock Units 2019-12-31 4 M 0 93400 0 D 2019-12-31 Common Stock 93400.0 0 D On March 28, 2017, the reporting person was granted Performance Stock Units, 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 (the "Performance Period"). Subject generally to the reporting person's continued service with the issuer, each PSU represented a contingent right 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 is based on the issuer's total stockholder return (TSR) performance during the Performance Period. The actual number of shares distributed was 200% 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, 2017. /s/ Justin Rose 2020-01-03