0001209191-11-035556.txt : 20110620
0001209191-11-035556.hdr.sgml : 20110620
20110620165438
ACCESSION NUMBER: 0001209191-11-035556
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20110526
FILED AS OF DATE: 20110620
DATE AS OF CHANGE: 20110620
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lu C. Mike
CENTRAL INDEX KEY: 0001481765
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-30489
FILM NUMBER: 11921378
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 11545 W. BERNARDO CT., SUITE 301
CITY: SAN DIEGO
STATE: CA
ZIP: 92127
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
c19000_4x0.xml
MAIN DOCUMENT DESCRIPTION
X0303
4
2011-05-26
0000849146
Lifevantage Corp
LFVN
0001481765
Lu C. Mike
11545 W. BERNARDO CT.
SUITE 301
SAN DIEGO
CA
92127
1
0
0
0
Common Stock
2011-05-26
4
C
0
2497500
0.20
A
3047500
D
8% Convertible Debenture
0.20
2011-05-26
4
C
0
499500
0
D
2010-02-04
2012-02-04
Common Stock
2497500
0
D
/s/ C. Mike Lu
2011-06-20