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