0001181431-12-006599.txt : 20120207
0001181431-12-006599.hdr.sgml : 20120207
20120207191208
ACCESSION NUMBER: 0001181431-12-006599
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120207
FILED AS OF DATE: 20120207
DATE AS OF CHANGE: 20120207
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: McQueen Carrie E
CENTRAL INDEX KEY: 0001469779
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-30489
FILM NUMBER: 12579373
MAIL ADDRESS:
STREET 1: 11545 W. BERNARDO COURT
STREET 2: SUITE 301
CITY: SAN DIEGO
STATE: CA
ZIP: 92127
FORMER NAME:
FORMER CONFORMED NAME: Carlander Carrie E
DATE OF NAME CHANGE: 20090806
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
rrd333042.xml
FORM 4- MCQUEEN 2-3-12
X0304
4
2012-02-07
0
0000849146
Lifevantage Corp
LFVN
0001469779
McQueen Carrie E
9815 S. MONROE STREET
SANDY
UT
84070
0
1
0
0
Chief Financial Officer
Stock Option (Right to Buy)
1.50
2012-02-03
4
A
0
150000
0
A
2022-02-02
Common Stock
150000
150000
D
) This stock option will vest as follows: (i) 1/4 of the option vests on February 3, 2013 and (ii) an additional 1/48 of the option vests per month for each of the 36 months following February 3, 2013, subject to continued service with the company.
/s/ Carrie E. McQueen
2012-02-07