-----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, BPS4VdqfJlv1yYfxKdvmLehyvvNV8nzDHGL53YiyMsfmnYXK7CsVgRvKaKY3Y5Oi HIM+kEWLsrpKPs3Ikhemeg== 0001209191-09-057026.txt : 20091215 0001209191-09-057026.hdr.sgml : 20091215 20091215120715 ACCESSION NUMBER: 0001209191-09-057026 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091211 FILED AS OF DATE: 20091215 DATE AS OF CHANGE: 20091215 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CRAPO JAMES D CENTRAL INDEX KEY: 0001120570 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-30489 FILM NUMBER: 091240918 MAIL ADDRESS: STREET 1: AEOLUS PHARMACEUTICALS, INC. STREET 2: PO BOX 14287 CITY: RTP STATE: NC ZIP: 27709-4287 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2009-12-11 0 0000849146 Lifevantage Corp LFVN 0001120570 CRAPO JAMES D 1449 W. LITTLETON BLVD. SUITE 200 LITTLETON CO 80120 1 0 0 0 Stock Warrant (right to buy) 0.50 2009-12-11 4 P 0 62500 0.0004 A 2009-12-11 2014-12-11 Common Stock 62500 62500 D Convertible debenture 0.20 2009-12-11 4 P 0 124875 0.20 A 2009-12-11 2011-12-11 Common Stock 124875 124875 D On December 11, 2009 Dr. Crapo purchased a warrant to purchase 62,500 shares of common stock exercisable for five (5) years. On December 11, 2009 Dr. Crapo purchased a note convertible into 124,875 shares of common stock. /s/ James D. Crapo 2009-12-15 -----END PRIVACY-ENHANCED MESSAGE-----