0001181431-11-060816.txt : 20111216 0001181431-11-060816.hdr.sgml : 20111216 20111216152510 ACCESSION NUMBER: 0001181431-11-060816 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111214 FILED AS OF DATE: 20111216 DATE AS OF CHANGE: 20111216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mauro Garry Paul CENTRAL INDEX KEY: 0001436020 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-30489 FILM NUMBER: 111266198 MAIL ADDRESS: STREET 1: 6400 S. FIDDLER'S GREEN CIRCLE STREET 2: SUITE 1970 CITY: GREENWOOD VILLAGE STATE: X1 ZIP: 80111 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Lifevantage Corp CENTRAL INDEX KEY: 0000849146 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 841097796 STATE OF INCORPORATION: CO FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 10813 S. RIVER FRONT PARKWAY STREET 2: STE. 500 CITY: SOUTH JORDAN STATE: UT ZIP: 84095 BUSINESS PHONE: 858-312-8000 MAIL ADDRESS: STREET 1: 10813 S. RIVER FRONT PARKWAY STREET 2: STE. 500 CITY: SOUTH JORDAN STATE: UT ZIP: 84095 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 rrd328375.xml X0304 4 2011-12-14 0 0000849146 Lifevantage Corp LFVN 0001436020 Mauro Garry Paul 11545 W. BERNARDO COURT, SUITE 301 SAN DIEGO CA 92127 1 0 0 0 Common Stock 2011-12-14 4 P 0 3796 1.37 A 153796 D Common Stock 2011-12-14 4 P 0 170 1.37 A 170 I By Son Common Stock 2011-12-14 4 P 0 374 1.37 A 374 I By Son Common Stock 2011-12-14 4 P 0 177 1.37 A 177 I By Son Common Stock 2011-12-14 4 P 0 374 1.36 A 374 I By Daughter Common Stock 2011-12-14 4 P 0 170 1.37 A 170 I By Son Garry P. Mauro 2011-12-16