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