0000849146-21-000087.txt : 20210908 0000849146-21-000087.hdr.sgml : 20210908 20210908160742 ACCESSION NUMBER: 0000849146-21-000087 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210903 FILED AS OF DATE: 20210908 DATE AS OF CHANGE: 20210908 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: 211242222 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: 3300 TRIUMPH BLVD STREET 2: SUITE 700 CITY: LEHI STATE: UT ZIP: 84043 BUSINESS PHONE: 801-432-9000 MAIL ADDRESS: STREET 1: 3300 TRIUMPH BLVD STREET 2: SUITE 700 CITY: LEHI STATE: UT ZIP: 84043 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_163113163313739.xml FORM 4 X0306 4 2021-09-03 0 0000849146 Lifevantage Corp LFVN 0001649432 Rose Justin 3300 NORTH TRIUMPH BLVD #700 LEHI UT 84043 0 1 0 0 Chief Sales &Marketing Officer Common Stock 2021-09-03 4 F 0 2550 7.70 D 176050 D These shares were withheld to satisfy tax withholding obligations in connection with the partial vesting of a restricted stock award granted on September 3, 2020. Includes 1,716 shares purchased under the Employee Stock Purchase Plan. /s/ Justin Rose 2021-09-08