0001181431-12-037999.txt : 20120626
0001181431-12-037999.hdr.sgml : 20120626
20120626163831
ACCESSION NUMBER: 0001181431-12-037999
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120626
FILED AS OF DATE: 20120626
DATE AS OF CHANGE: 20120626
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lu C. Mike
CENTRAL INDEX KEY: 0001481765
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-30489
FILM NUMBER: 12927561
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 11545 W. BERNARDO CT., SUITE 301
CITY: SAN DIEGO
STATE: CA
ZIP: 92127
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
rrd348706.xml
LU FORM 4 6-14-12
X0305
4
2012-06-26
0
0000849146
Lifevantage Corp
LFVN
0001481765
Lu C. Mike
9815 S. MONROE STREET
SUITE 100
SANDY
UT
84070
1
0
0
0
Common Stock
2012-06-26
4
X
0
57000
0.50
A
3104500
D
Warrant (Right to Buy)
0.50
2012-06-26
4
X
0
57000
0
D
2009-06-30
2012-06-30
Common Stock
57000
0
D
/s/ Rob Cutler Attorney-In-Fact for Mike Lu
2012-06-26