0000849146-17-000017.txt : 20170214
0000849146-17-000017.hdr.sgml : 20170214
20170214161733
ACCESSION NUMBER: 0000849146-17-000017
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170213
FILED AS OF DATE: 20170214
DATE AS OF CHANGE: 20170214
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: 9785 S. MONROE STREET
STREET 2: SUITE 300
CITY: SANDY
STATE: UT
ZIP: 84070
BUSINESS PHONE: 801-432-9000
MAIL ADDRESS:
STREET 1: 9785 S. MONROE STREET
STREET 2: SUITE 300
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jensen Darren Jay
CENTRAL INDEX KEY: 0001642848
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35647
FILM NUMBER: 17609041
MAIL ADDRESS:
STREET 1: C/O LIFEVANTAGE CORPORATION
STREET 2: 9785 SOUTH MONROE ST. SUITE 300
CITY: SANDY
STATE: UT
ZIP: 84070
4
1
wf-form4_148710691839530.xml
FORM 4
X0306
4
2017-02-13
0
0000849146
Lifevantage Corp
LFVN
0001642848
Jensen Darren Jay
9785 SOUTH MONROE STREET, SUITE 300
SANDY
UT
84070
1
1
0
0
Chief Executive Officer
Common Stock
2017-02-13
4
P
0
1500
6.75
A
144958
D
/s/ Darren Jay Jensen
2017-02-14