0000849146-17-000097.txt : 20170912 0000849146-17-000097.hdr.sgml : 20170912 20170912161011 ACCESSION NUMBER: 0000849146-17-000097 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170912 FILED AS OF DATE: 20170912 DATE AS OF CHANGE: 20170912 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: 171081202 MAIL ADDRESS: STREET 1: C/O LIFEVANTAGE CORPORATION STREET 2: 9785 SOUTH MONROE ST. SUITE 300 CITY: SANDY STATE: UT ZIP: 84070 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 4 1 wf-form4_150524699667030.xml FORM 4 X0306 4 2017-09-12 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 2017-09-12 4 P 0 2300 4.22 A 149258 D Common Stock 2017-09-12 4 P 0 100 4.20 A 149358 D /s/ Darren Jay Jensen 2017-09-12