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