0001181431-12-059109.txt : 20121116
0001181431-12-059109.hdr.sgml : 20121116
20121116164247
ACCESSION NUMBER: 0001181431-12-059109
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: Manovich Dave
CENTRAL INDEX KEY: 0001539712
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 121212117
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 9815 SOUTH MONROE ST., SUITE 100
CITY: SANDY
STATE: UT
ZIP: 84070
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
rrd359159.xml
FORM 4 DAVE MANOVICH
X0306
4
2012-11-14
0
0000849146
Lifevantage Corp
LFVN
0001539712
Manovich Dave
9815 S. MONROE STREET
SUITE 100
SANDY
UT
84070
1
0
0
0
Common Stock
2012-11-14
4
A
0
25000
0
A
35000
D
Common Stock
305537
D
Common Stock
240000
I
By Spouse
Common Stock
40000
I
Beneficiary of 401(k) Account
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.
Joint with spouse.
/s/ Rob Cutler, Attorney-in-Fact
2012-11-16