-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DJ3uYE/+NTBaAilNO55+7dUvaYkkl3+xGjZOaINogLtiSWbtcYlVbwVxTITag//+ AvvcmLnorC3AHQdk5HQh6g== 0001209191-09-050118.txt : 20091029 0001209191-09-050118.hdr.sgml : 20091029 20091029154801 ACCESSION NUMBER: 0001209191-09-050118 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091001 FILED AS OF DATE: 20091029 DATE AS OF CHANGE: 20091029 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Thompson Jack R. CENTRAL INDEX KEY: 0001422155 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-30489 FILM NUMBER: 091144614 MAIL ADDRESS: STREET 1: 6400 FIDDLERS GREEN CIRCLE STREET 2: SUITE 1970 CITY: GREENWOOD VILLAGE STATE: CO 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: 11545 WEST BERNARDO COURT STREET 2: SUITE 301 CITY: SAN DIEGO STATE: CA ZIP: 92127 BUSINESS PHONE: 858-312-8000 MAIL ADDRESS: STREET 1: 11545 WEST BERNARDO COURT STREET 2: SUITE 301 CITY: SAN DIEGO STATE: CA ZIP: 92127 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 doc4.xml FORM 4 SUBMISSION X0303 4 2009-10-01 0 0000849146 Lifevantage Corp LFVN 0001422155 Thompson Jack R. 1449 W. LITTLETON BLVD. SUITE 200 LITTLETON CO 80120 1 0 0 0 Common Stock 2009-10-01 4 M 0 150000 0.20 A 1176784 D Common Stock 2009-10-27 4 M 0 35000 0.21 A 1211784 D Stock Option (right to buy) 0.21 2009-10-27 4 M 0 35000 0.21 A 2008-10-31 2017-11-13 Common Stock 35000 140000 D Shares acquired via a conversion of a $30,000 convertible note into common stock at a conversion price of $0.20 per share. /s/Bradford K. Amman as Attorney in fact for Jack R. Thompson 2009-10-29 -----END PRIVACY-ENHANCED MESSAGE-----