0001181431-12-059107.txt : 20121116 0001181431-12-059107.hdr.sgml : 20121116 20121116164140 ACCESSION NUMBER: 0001181431-12-059107 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121114 FILED AS OF DATE: 20121116 DATE AS OF CHANGE: 20121116 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: 001-35647 FILM NUMBER: 121212109 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: 9815 S. MONROE STREET STREET 2: SUITE 100 CITY: SANDY STATE: UT ZIP: 84070 BUSINESS PHONE: 858-312-8000 MAIL ADDRESS: STREET 1: 9815 S. MONROE STREET STREET 2: SUITE 100 CITY: SANDY STATE: UT ZIP: 84070 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 rrd359096.xml FORM 4 GARRY MAURO X0306 4 2012-11-14 0 0000849146 Lifevantage Corp LFVN 0001436020 Mauro Garry Paul 9815 S. MONROE STREET SUITE 100 SANDY UT 84070 1 0 0 0 Common Stock 2012-11-14 4 A 0 25000 0 A 288689 D Common Stock 170 I By Son Common Stock 374 I By Son Common Stock 177 I By Son Common Stock 374 I By Daughter Common Stock 170 I By Son These shares were acquired pursuant to a restricted stock award granted November 14, 2012, which vests in full in a single vesting increment on the date of the Company's next annual meeting of shareholders, subject to continued service with the Company. /s/ Rob Cutler, Attorney-in-Fact 2012-11-16